Premature ovarian insufficiency: A review on the role of tobacco smoke, its clinical harm, and treatment

Background: Premature ovarian insufficiency (POI) is the cessation of normal ovarian function before the age of 40 and is associated with infertility, hypoestrogenism, and increased risk of chronic disease. In environmental and lifestyle factors, cigarette smoking is a modifiable risk factor accelerate ovarian aging. Objective: This systematic review evaluate the association between tobacco smoke exposure and POI in women of reproductive age by reviewing findings from original studies assessing ovarian reserve markers, reproductive hormone profiles, and fertility outcomes. Methods: A literature search was conducted in (PubMed, Scopus, and Web of Science) for studies published between 2010 and 2025. Eligible studies included human participants aged 18 to 45, with exposure to active or passive cigarette smoking through self-report or biochemical markers. Included outcomes were anti-Müllerian hormone (AMH), follicle-stimulating hormone (FSH), in vitro fertilization (IVF) parameters, and natural fecundability. Studies were selected through a two phase screening process and analyzed qualitatively due to methodological heterogeneity. Results: Six original studies were included. Smoking was associated with lower AMH levels, higher FSH levels, and diminished ovarian reserve. Active smoking was linked to fewer oocytes retrieved, poorer embryo quality, and reduced pregnancy rates during IVF. Long-term or high-dose smokers show reduced fecundability in natural cycles. One study found no significant difference in IVF outcomes in smokers with normal ovarian reserve. Conclusion: Cigarette smoking negatively affects ovarian reserve and fertility. Smoking cessation should be advised to preserve reproductive health and prevent POI.