Impact of Cigarette, Hookah, and E‐Cigarette Use on Seminal Fluid Parameters in Men Attending Infertility Clinics

Background Smoking remains a leading modifiable risk factor for male infertility, impairing semen quality through oxidative stress from reactive oxygen species (ROS) in tobacco smoke, alongside toxins like nicotine and heavy metals that damage sperm membranes and DNA. While cigarettes are well‐studied, emerging data on water pipe (shisha/hookah) and vaping highlight regional gaps, especially in high‐prevalence areas like Jordan, where a 2025 national survey reported 51.6% adult tobacco use (71.2% males), exceeding WHO projections. Infertility affects 15% of couples globally, with male factors in 20%–50% of cases; in Jordan, cultural stigma often overlooks male contributions despite semen analysis as the cornerstone diagnostic tool. Methods This cross‐sectional study enrolled 299 men aged 20–50 years undergoing infertility evaluation at four Jordanian fertility centers (King Abdullah University Hospital, Istiqlal Hospital, Islamic Hospital, and Finlandi Hospital) from January to December 2025, using convenience sampling. Participants self‐reported smoking type/intensity: cigarettes (light: <10/day; moderate: 10–20/day; and heavy: >20/day), water pipe (sessions/week, duration), and vaping (nicotine strength). Exclusions encompassed chronic illnesses (e.g., diabetes, varicocele), substance use, medications affecting fertility, and hormonal therapy. Data via supervised questionnaires included demographics and smoking history; semen analysis followed WHO 6th edition protocols (volume ≥1.4 mL, concentration ≥16 × 10 6 /mL, total motility ≥42%, progressive ≥30%, and morphology ≥4%). Analysis used Jamovi: descriptive stats, one‐way ANOVA (continuous parameters), chi‐square (categorical vs. WHO thresholds), and p < 0.05 significant. Ethical approval from Yarmouk University ensured informed consent and confidentiality. Results Participants comprised non‐smokers (NOs) ( n = 76), light ( n = 72), moderate ( n = 87), and heavy smokers ( n = 64; primarily cigarettes, with subsets for shisha/vaping). Means showed no significant ANOVA differences: volume (3.0 ± 1.6 mL overall, F = 0.25, p = 0.858), concentration (34.5 ± 33.3 × 10 6 /mL, F = 1.56, p = 0.202), total motility (38.9 ± 18.0%, F = 0.04, p = 0.990), progressive motility (25.4 ± 18.2%, F = 1.88, p = 0.136), and morphology (6.9 ± 15.0%, F = 0.30, p = 0.822). Chi‐square revealed one significant link: motility categories (progressive >32%, immotile <32%; χ 2 = 14.5, df = 6, p = 0.0246), with NOs favoring >32% and smokers more <32%/immotile. No differences in volume ( χ 2 = 2.58, p = 0.461), concentration ( χ 2 = 5.10, p = 0.165), total count ( χ 2 = 4.39, p = 0.222), pH ( χ 2 = 2.56, p = 0.862), or morphology. Conclusion Smoking shows selective motility associations without broad semen impacts, urging expanded studies for mechanistic insights and public health interventions in high‐burden settings like Jordan.