Cigarette smoking and semen quality in men of reproductive age

From sperm to offspring: Assessing the heritable genetic consequences of paternal smoking and potential public health impacts

Individuals who smoke generally do so with the knowledge of potential consequences to their own health. What is rarely considered are the effects of smoking on their future children. The objective of this work was to review the scientific literature on the effects of paternal smoking on sperm and assess the consequences to offspring. A literature search identified over 200 studies with relevant data in humans and animal models. The available data were reviewed to assess the weight of evidence that tobacco smoke is a human germ cell mutagen and estimate effect sizes. These results were used to model the potential increase in genetic disease burden in offspring caused by paternal smoking, with specific focus on aneuploid syndromes and intellectual disability, and the socioeconomic impacts of such an effect. The review revealed strong evidence that tobacco smoking is associated with impaired male fertility, and increases in DNA damage, aneuploidies, and mutations in sperm. Studies support that these effects are heritable and adversely impact the offspring. Our model estimates that, with even a modest 25% increase in sperm mutation frequency caused by smoke-exposure, for each generation across the global population there will be millions of smoking-induced de novo mutations transmitted from fathers to offspring. Furthermore, paternal smoking is estimated to contribute to 1.3 million extra cases of aneuploid pregnancies per generation. Thus, the available evidence makes a compelling case that tobacco smoke is a human germ cell mutagen with serious public health and socio-economic implications. Increased public education should be encouraged to promote abstinence from smoking, well in advance of reproduction, to minimize the transmission of harmful mutations to the next-generation.

Decline in sperm count in European men during the past 50 years

Purpose:

To investigate whether the sperm concentration of European men is deteriorating over the past 50 years of time.

Materials and Methods:

We analysed the data published in English language articles in the past 50 years in altering sperm concentration in European men.

Results:

A time-dependent decline of sperm concentration ( r = −0.307, p = 0.02) in the last 50 years and an overall 32.5% decrease in mean sperm concentration was noted.

Conclusion:

This comprehensive, evidence-based meta-analysis concisely presents the evidence of decreased sperm concentration in European male over the past 50 years to serve the scientific research zone related to male reproductive health.

The Disappearing Sperms: Analysis of Reports Published Between 1980 and 2015

Reports regarding the changes in sperm concentration in different counties of the world are inconsistent. Furthermore, the reports that sprung up from specific epidemiological and experimental examinations did not include data of prior studies or geographical variations. The current study, following a previous report of massive fall in semen volume over the past 33 years, attempts to delineate the trend of altering sperm concentrations and factors responsible for this by reviewing article published from 1980 to July 2015 with geographic differences. The current study identified an overall 57% diminution in mean sperm concentration over the past 35 years ( r = -.313, p = .0002), which, when analyzed for each geographical region, identified a significant decline in North America, Europe, Asia, and Africa. An increasing trend of sperm concentration was identified only in Australia. The association of male age with such a trend ( R² = .979) is reported. The authors also correlated male fertility with sperm concentration. Thus, this comprehensive, evidence-based literature review aims to concisely and systematically present the available data on sperm concentration from 1980 to 2015, as well as to statistically analyze the same and correlate male health with the declining pattern of sperm count in a single scientific review to serve the scientific research zone related to reproductive health. It points to the threat of male infertility in times ahead.

The effects of cigarette smoking on male fertility

Cigarette smoking, one of the main causes of preventable morbidity and mortality, has a multitude of well-known side effects. The relationship between cigarette smoking and infertility has been studied for decades; however, large-scale, population-wide prospective studies are lacking. The majority of the current literature is in the form of retrospective studies focused on the effects of smoking on semen analyses. This article discusses the results of these studies and reviews the postulated mechanisms. The effects of smoking on assisted reproduction and in vitro fertilization outcomes are noted. The consequences of smoking while pregnant on future fertility as well as the outcomes of second-hand smoke are analyzed. The current evidence suggests that men should be advised to abstain from smoking in order to improve reproductive outcomes.

The Low Prevalence of Y Chromosomal Microdeletions is Observed in the Oligozoospermic Men in the Area of Mato Grosso State and Amazonian Region of Brazilian Patients

OBJECTIVE

To determine the prevalence of chromosomal abnormalities and microdeletions on Y chromosome in infertile patients with oligozoospermia or azoospermia in Mato Grosso state, Brazil.

METHODS

This cross-sectional study enrolled 94 men from infertile couples. Karyotype analysis was performed by lymphocyte culture technique. DNA from each sample was extracted using non-enzymatic method. Microdeletions were investigated by polymerase chain reaction (PCR).

RESULTS

With the use of cytogenetic analysis, five patients (5.3%) had abnormal karyotype, one azoospermic patient (1.1%) had karyotype 46,XY,t(7;1) (qter-p35), one (1.1%) with mild oligozoospermia had karyotype 46,XY,delY(q), and two other azoospermic patients had karyotype 47,XXY, consistent with Klinefelter syndrome (KS). One of them (1.1%) with severe oligozoospermia had karyotype 46,XY,8p+. Microdeletion on Y chromosome was found in the azoospermia factor c (AZFc) region in only one azoospermic patient (1.1%).

CONCLUSIONS

The prevalence of genetic abnormalities in oligo/azoospermic Brazilian men from infertile couple was 5.3%, and microdeletion on Y chromosome was not a common finding in this population (1.1%).

In vitro effects of nicotine on human spermatozoa

Washed human spermatozoa from 12 normozoospermic donors were treated with different concentrations of nicotine 0.1, 1.0, 5.0 and 10.0 mm and were compared to spermatozoa suspended in nutrient medium only (control). Computer-aided sperm analysis was used to assess sperm kinematic properties after 30, 60, 120 and 180 min of incubation. Viability was assessed by means of a dye exclusion staining technique (eosin/nigrosin), while acrosome-reacted cells were identified under a fluorescent microscope using fluorescein isothiocyanate-Pisum sativum agglutinin as a probe. Nicotine significantly reduced total motility, progressive motility, curvilinear velocity, amplitude of lateral head displacement, beat cross-frequency, viability and caused spontaneous acrosome reaction at concentrations of ≥5.0 mm after 2 and 3 h of exposure. Nicotine concentrations of 0.1 and 1.0 mm had no significant effect (P < 0.05) on spermatozoa except that 1.0 mm significantly decreased (P < 0.05) sperm progressive motility at 2 and 3 h of incubation as well as viability after 3 h of incubation. This study concludes that the occurrence of high levels of nicotine in the body and seminal fluid might adversely affect fertilisation capacity of human spermatozoa through a mechanism that involves decreased motility, viability and premature induction of the acrosome reaction.

EFFECT OF LIFESTYLE FACTORS ONINFERTILITY IN MEN

Environmental factors, changes in lifestyle and occupational exposures are responsible for declining human semen quality. We investigated the effects of history of surgery and lifestyle choices on infertility of 271 infertile men and 251 healthy volunteers. The frequency of varicocelectomy was significantly higher in infertile men (2.9%) than in controls (0.4%; P < 0.05). Alcohol use was significantly more common in infertile men (92%) than in controls (80%; P < 0.01). Satisfaction with sexual life was greater in controls (85%) than in infertile men (77%; P < 0.05). Other factors had no effect.

Cigarette smoking as a cause of delay in conception

Epidemiological studies relating cigarette smoking to the ability to conceive and maintain a pregnancy provide information on the clinical significance of smoking on reproductive health. Cigarette smoking by females has significantly increased in the decades after World War II, and now has an average initiation at ages 18–20 years. Maternal smoking is a hazard to the general health, the reproductive health and the life of both mother and child. Gestational smoking renders the fetus a passive smoker. This can result in fetal and neonatal death and in reduced fecundity of adult daughters.

Environmental contaminants and human infertility: hypothesis or cause for concern?

Throughout the 1980s and 1990s the crude human birth rate (live births per 1000 population) declined, indicating reduced fertility and suggesting a potential decline in fecundity (the potential to conceive). Detection of environmental contaminants in human tissues, together with reports of a global decline in semen quality, further fueled speculation that human infertility rates are increasing and environmental toxicants are potentially important causal agents associated with this change. However, there is little compelling evidence to suggest that infertility rates amongst the general population have changed over time. Moreover, recent studies suggest a rise in the fertility rates. While several studies documented increased time to pregnancy (TTP) in exposed study populations, other investigators were not able to replicate these findings. Nevertheless, studies involving occupational exposure together with results from animal experiments lend support to the conclusion that environmental contaminants potentially adversely affect fertility. Consequently, the impact of exposure to environmental contaminants on human fertility remains controversial. To test the hypothesis that environmental contaminant exposure was associated with enhanced risk of infertility, data concerning trends in fertility and infertility rates were examined to assess the impact of exposure of developing gametes to environmental contaminants. The relationship between exposure and reproductive outcomes was then examined to illustrate the range of adverse effects for reproductive toxicants with data sets of divergent depth and reliability. Data showed that only a weak association between exposure to environmental contaminants and adverse effects on human fertility exists. However, it is postulated that evidence of chemical exposure and potential health consequences of these exposures highlight the need for further research in this area.

Association between tobacco exposure and reproductive parameters in adolescent males

Cigarette smoking is quite prevalent in the general population but our knowledge of its effect on male reproductive function is still very limited. Therefore, we investigated the impact of tobacco exposure on reproductive characteristics in young males. Military conscripts, 217 non-smokers and 85 smokers, with a median age of 18 years were enrolled. Physical examination and semen analysis, including measurement of accessory sex gland markers and reproductive hormone levels, were performed. Lifestyle-associated factors, including maternal smoking during pregnancy and snuffing, were recorded. Non-smokers had 49% higher total sperm number than smokers (95% CI 4.5-112%, p = 0.01). In addition, sperm concentration was 37% higher among non-smokers (95% CI -4% to 95%, p = 0.08). Serum levels of follicle-stimulating hormone (FSH) were 17% higher among non-smokers (95% CI 3-33%, p = 0.02), whereas no significant differences between smokers and non-smokers were found for inhibin B, testosterone, sex hormone binding globulin, luteinizing hormone and oestradiol. Those who smoked >10 cigarettes per day exhibited 37% lower (95% CI 10-69%, p = 0.005) FSH levels than those who smoked less. Maternal smoking during pregnancy had a negative impact on epididymal and seminal vesicle marker secretion. Smoking seems to impair sperm production and epididymal as well as accessory sex gland function and could be one of the factors contributing to regional differences in sperm parameters.

Is smoking a risk factor for decreased semen quality? A cross-sectional analysis

BACKGROUND

Previous studies suggest a deleterious effect of cigarette smoking on semen quality, but their results have not been consistent. We studied the association between current smoking and semen characteristics and hormonal levels in a large group of healthy men.

METHODS

From 1987 to 2004, seven separate occupational or environmental semen quality studies were co-ordinated by our department. A total of 2562 men participated, each providing semen and blood sample and answering a questionnaire about lifestyle and factors related to health. Appropriate semen and smoking data were available for 2542 men.

RESULTS

Adjusting for study, age and other covariates, we observed an inverse dose-response relation between smoking and semen volume, total sperm count and percentage motile sperm. Heavy smokers had a 19% lower sperm concentration than non-smokers. We found a positive dose-response relationship between smoking and testosterone, LH and the LH/free testosterone ratios.

CONCLUSION

Current smoking in adult life moderately impairs the semen quality. It is well known that semen quality is associated to fecundity. Therefore, it would be sensible to advise men to abstain from smoking to avoid decreased fecundity.

Smoking habits of parents and male: female ratio in spermatozoa and preimplantation embryos

BACKGROUND

Previous observations have addressed a decreased male:female ratio associated with smoking. Our aim was to assess whether this effect is observed at the spermatozoa or at the early embryo development.

METHODS

We retrospectively assessed smoking intake habits of 56 couples included in our preimplantation genetic diagnosis (PGD) program. Three groups were established according to male or female cigarette consumption per day: non-smokers, smokers (1-19 cigarettes per day) and heavy smokers (> or =20 cigarettes per day). Fluorescence in-situ hybridization (FISH) was performed on ejaculated sperm samples to analyse chromosomes X and Y. On day 3, embryos were also analysed. Additionally, sperm samples from four heavy smoking and four non-smoking donors were prospectively analysed before and after capacitation.

RESULTS

FISH on spermatozoa revealed no statistical differences in the Y:X ratio between the three groups. However, in the PGD study, in male heavy smokers, the XY:XX embryo ratio was decreased compared with non-smokers (22:47 versus 80:71; P = 0.0057). The smoking condition of the female partner had no significant effect on embryo XY:XX ratio, but for non-smoking females with a heavy smoking partner, the ratio was decreased (P = 0.0018) compared with non-smoking males. In heavy smoking donors a decreased of Y:X ratio was observed after swim-up with a statistically significant difference of ratios (P = 0.021).

CONCLUSIONS

Smoking habits of males do not have an effect on the percentage of X- and Y-bearing spermatozoa on ejaculated samples. However, male heavy smokers produce an increased incidence of female embryos that could be related to an enrichment of X spermatozoa after swim-up in patients with high tobacco consumption.

Semen quality of smoking and non-smoking men in infertile couples in a Turkish population

OBJECTIVE

This retrospective study was designed to reveal the effect of smoking on semen parameters in an infertile Turkish population.

PATIENTS

Two hundred and ninety-six infertile males were triaged as nonsmokers, light smokers and heavy smokers. Semen volume; sperm density, motility and morphology were the main outcome measures.

RESULTS

Rapidly progressing sperm ratio of the heavy smokers group was greater than that of the light smokers group (p<0.05). Morphologic evaluation results revealed better results for the nonsmokers than the heavy smokers in terms of tail anomalies and percent of coiled tails (p<0.05)

CONCLUSIONS

In infertile Turkish men, heavy smoking was found to have detrimental effects on tail of the spermatozoon. Interestingly, heavy smokers have a higher percent of rapidly progressive sperm with respect to light smokers. Prospective studies will help determining the definite effect of smoking on semen quality.

Common medications and drugs: how they affect male fertility

Numerous drugs and medications have been shown to have adverse effects on male fertility, acting through diverse mechanisms. These drugs are summarized in Table 2. Mechanisms of impaired fertility include direct effects on germ cells or their supporting cells, effects on the delicately balanced HPG axis, effects on erectile or ejaculatory function, and effects on libido. In a thorough fertility evaluation of the male partner, the physician should determine what medication the patient is taking and his social habits involving alcohol consumption, tobacco, and recreational drug use. Most adverse effects from drugs and medications can be reversed by simply discontinuing the offending agents; however, in some instances, such as chemotherapeutic regimens, the medications cannot be discontinued, and pretreatment sperm cryopreservation remains critical. It is essential for urologists treating infertile men to be familiar with the more commonly encountered drugs and medications that may affect the potential for fertility.

An electron microscope study of the axonemal ultrastructure in human spermatozoa from male smokers and nonsmokers

OBJECTIVE

To investigate possible abnormalities or deterioration of the sperm axonemal ultrastructure in men who have smoked a large quantity of cigarettes (> 20 per day) for a prolonged period.

DESIGN

Semen specimens were collected by patients via masturbation; qualitative characteristics of the sperm were assessed and ultrastructural analysis of the sperm axoneme was performed using standard operating procedures for electron transmission microscopy.

SETTING

The Andrology Institute of Lexington, Lexington, Kentucky, and the Department of Histology and Embryology, University of Salonika, Greece (collaborative effort).

PATIENT(S)

Twenty-nine men (mean age +/- SD, 30.7 +/- 2.1 years) who smoked a mean (+/- SD) of 30.7 +/- 2.1 cigarettes per day for 10.7 +/- 0.7 years and 15 men who never smoked (mean age +/- SD, 30.4 +/- 2.2 years) participated in this study.

MAIN OUTCOME MEASURE(S)

Ultrastructural organization of the sperm axoneme in male smokers and nonsmokers.

RESULT(S)

Changes in the number and the arrangement of axonemal microtubules were noted in the smoker group when compared to the nonsmoker group. The incidence of axonemal abnormalities was higher in spermatozoa from smokers compared with that in spermatozoa from nonsmokers.

CONCLUSION(S)

Smoking a large quantity of cigarettes per day, under the conditions of the current study, severely affected the ultrastructure of the flagellum and, more specifically, it affected the axoneme of the human spermatozoon.

Effects of seminal plasma from cigarette smokers on sperm viability and longevity

OBJECTIVE

To evaluate the effects of cigarette smoking on the ability of seminal plasma (SP) to maintain sperm viability.

DESIGN

Clinical randomized study. Spermatozoa from cigarette smoking or nonsmoking subjects were reconstituted in SP from smokers and nonsmokers and in modified Ham's F-10 medium, followed by sperm quality assessment during a 48-hour incubation period.

SETTING

Andrology Institute of Lexington, Lexington, Kentucky.

PATIENT(S)

Twenty men who had been smoking cigarettes for longer than 3 years (30 cigarettes per day or more) and 20 nonsmokers participated in this study.

MAIN OUTCOME MEASURE(S)

Improvement in sperm viability by removal of SP--and associated detrimental factors present in the SP--from smoker subjects.

RESULT(S)

The results obtained indicate that the quality of spermatozoa obtained from nonsmokers was superior to that of smokers. The SP from the two patient groups had a definite effect on their respective sperm quality, i.e., beneficial effects for the nonsmokers, detrimental effects for the smokers. Exposure of spermatozoa from the nonsmokers to SP from the smokers resulted in a significant reduction in sperm viability. However, exposure of spermatozoa from the smokers to SP from the nonsmokers or to Ham's F-10 medium yielded significant improvements in sperm viability.

CONCLUSION(S)

The detrimental effects of smokers' SP on nonsmokers' spermatozoa was prominent and a rather unique phenomenon. The results generated in this study could be of clinical significance since removal of smokers' SP and subsequent reconstitution and incubation in physiological media seems to enhance the viability, longevity, and possibly the fertilizing ability of these spermatozoa for use in various assisted reproductive technologies.

Smoking and male reproduction: a review

Because of the large number of men worldwide who smoke and the fact that cigarette smoke contains known mutagens and carcinogens, there has been concern that smoking may have adverse effects on male reproduction. A review of the epidemiological literature indicates that cigarette smoking is associated with modest reductions in semen quality including sperm concentration, motility and morphology. The associations between male smoking and sperm concentration and motility are stronger among studies of 'healthy' men (e.g. volunteers and sperm donors) than among men from infertility clinic populations. Smoking has also been associated with alterations in hormone levels in males, for example increases in the levels of oestrone and oestradiol. Despite modest reductions in semen quality and altered hormone levels among smokers compared to non-smokers, studies have not shown a reduction in male fertility in association with paternal smoking. There is some evidence to suggest that paternal smoking is associated with congenital anomalies and childhood cancer (with ORs in positive studies generally < 2.0). Smoking has not been shown to be mutagenic to human spermatozoa, although studies have been small and have had methodological shortcomings. It is concluded that, although smokers as a group may not experience reduced fertility, men with marginal semen quality who wish to have children may benefit from quitting smoking, since several small studies indicate the potential for improved semen quality after quitting smoking. More research on the benefits of quitting smoking among men with marginal semen quality is needed. Methodological improvements in studies aimed at clarifying the association between paternal smoking and reproductive and developmental outcomes in offspring should include obtaining accurate paternal smoking dose information, evaluating smoking exposure information in relation to various time windows (e.g. prior to conception, during gestation), and controlling for potential confounders and modifying factors such as age and maternal smoking habits. More sensitive and specific laboratory assays and increased sample sizes are required to establish whether smoking induces mutations in human spermatozoa.

Does cigarette smoking impair natural or assisted fecundity?

OBJECTIVES

To assess the effects of female and male smoking on natural and assisted fecundity.

DESIGN

A systematic review of published studies was conducted, identifying reports using on-line and hand search techniques.

INCLUDED STUDIES

Potentially relevant articles were screened for inclusion based on the following criteria: comparative study (cohort or case control) with clinical pregnancy or live birth reported among smokers and nonsmokers.

EXPOSURE

Cigarette smoking.

MAIN OUTCOME MEASURES

Time to conceive; conceptions per subject or per cycle; spontaneous abortion rate.

RESULTS

Thirteen relevant studies of natural conception were identified. All but one demonstrated a negative association between smoking and fecundity (odds ratio [OR] for conception or live birth 0.33 to 1.0). Seven studies of IVF-GIFT yielded a common odds ratio for conception of 0.57 (95% confidence interval 0.42 to 0.78). Seven studies evaluating spontaneous abortion suggested a small increased risk among female smokers (OR 0.83 to 1.8). Twenty-one studies assessing smoking in men demonstrated no consistent effect on sperm quality. None of the four studies evaluating fertility in male smokers demonstrated significant impairment.

CONCLUSION

This body of literature suggests a small but clinically significant detrimental effect of female smoking on both time to conception and spontaneous abortion risk. Variability between studies, particularly in terms of adjustment for confounding factors, undermines the strength of these conclusions. However, the consistent dose-response effect in both the spontaneous conception and abortion literature and a return to normal fecundity among exsmokers suggest a causal association. The effect of male smoking on fecundity is probably far less significant.

Effects of nicotine on sperm attachment and penetration of zona-free hamster eggs

A previous study from this laboratory showed that nicotine in vitro has deleterious effects on sperm motion characteristics. This study was conducted to evaluate the effects of nicotine on the ability of human spermatozoa to attach and penetrate zona-free hamster eggs. Spermatozoa from fertile donors, washed free of seminal plasma, were incubated with medium (control) and 0.1, 1, 5, and 10 mM concentrations of nicotine (concentrations estimated to approximate residual concentrations of nicotine in the testes of heavy smokers) for 18 h at 37 degrees C in a humid 5% carbon dioxide incubator. The sperm preparations were then mixed with enzymatically denuded hamster eggs and incubated for 3 h at 37 degrees C. The oocytes were examined by phase-contrast microscopy to enumerate the rates of sperm attachment and penetration. The data were analyzed by a paired t test and repeated measures analysis of variance using the arcsine transformation of the percentages. The percentages of eggs with attached spermatozoa significantly declined in a dose-dependent manner, the highest inhibition being at 10 mM (F = 24). The rate of sperm penetration was even more significantly decreased with the increase in nicotine concentrations in the following order: 10 mM (F = 56) > 5 mM (F = 30) > 1 mM (F = 44) > 0.1 mM (F = 12). Nicotine concentrations of 0.1 mM and above negatively affected sperm penetration of zona-free hamster eggs.

The effect of nicotine on in vitro sperm motion characteristics

PURPOSE AND STUDY PLAN: Men who are habitual smokers tend to have poor semen quality. We studied the effect of nicotine on sperm motility in vitro. Spermatozoa from 13 normal fertile nonsmoking donors, washed free of seminal plasma, were treated with medium alone (control); and, 10 mM, 5 mM, 1 mM and 0.1 mM nicotine (concentrations estimated to approximate residual concentrations of nicotine in the testes of heavy smokers). Computerized sperm motion analysis (CASA) was done at 2, 4, 6 and 24 h after incubation.

RESULTS

Sperm motility, beat/cross frequency, linearity and maximum anterior lateral head displacement (ALH max.) were significantly decreased across nominal dosages (P < 0.001 by repeated measures analysis of variance). Of the concentrations tested, 0.1 mM had no effect; 1 mM significantly decreased sperm motility (P = 0.003) and linearity (P = 0.02); 5 mM decreased the beat frequency (P = 0.001) and linearity (0.02); and 10 mM markedly decreased motility (P = 0.0001), beat frequency (P = 0.0002), linearity (P = 0.02) and ALH max. (P = 0.02). The interactions between dose and time were insignificant.

CONCLUSION

Nicotine at concentrations of > or = 1 mM significantly decreased sperm motion characteristics after different periods of incubation, whereas 0.1 mM concentration had the least effect.

Does early exposure to maternal smoking affect future fertility in adult males?

Animal data suggest that prenatal exposure to certain tobacco smoke components such as nicotine may affect the development of the male gonadal axis, which may in turn affect future adult fertility. There are no previous epidemiologic studies on the potential effects of early (prenatal and childhood) exposure to maternal smoking on the reproductive system in adult male offspring. To investigate this question, we used data from a follow-up study of reproductive function and fertility among young adult sons of mothers who had participated in a randomized clinical trial of diethylstilbestrol use during pregnancy. We observed no significant effects of early exposure to maternal smoking on conventional semen characteristics, hormone levels (follicle stimulating hormone [FSH], luteinizing hormone [LH] and testosterone), urogenital abnormalities and diseases, or perceived infertility problems. Current active smoking by the men was, however, associated with a significant decrease in the percentage of sperm with normal morphology.

Cigarette smoking and sperm quality

The effect of cigarette smoking on conventional semen parameters (volume, total sperm count, sperm count/ml, total motility, progressive motility, morphology) was studied retrospectively in 90 healthy patients (50 non-smokers, 40 smokers) of our infertility clinic. Both groups, comparable in age, height and weight, were subdivided into two age groups (less than 28 years, greater than or equal to 28 years). Smokers were found to have sperm volumes significantly smaller than non-smokers of the same age. No additional effects on sperm parameters were found. Cigarette smoking revealed no detrimental effect on spermatogenesis.