CIGARETTE-SMOKING ACCELERATES THE DEVELOPMENT OF DIMINISHED OVARIAN RESERVE AS EVIDENCED BY THE CLOMIPHENE CITRATE CHALLENGE TEST

Objective: To test whether the reduced fecundity in women who smoke cigarettes may be attributed to the accelerated development of diminished ovarian reserve. Design: Retrospective evaluation of clomiphene citrate (CC) challenge tests in women from a general infertility population who did and did not smoke cigarettes (part 1) and retrospective evaluation of the impact of smoking on pregnancy rates (PRs) in IVF among women with normal ovarian reserve (part 2). Setting: Large military tertiary care center. Patients: Sixty-five women who smoked cigarettes and 145 women who did not smoke cigarettes in the general infertility population (part 1) and women undergoing IVF for strict tubal factor infertility with normal ovarian reserve who did (n = 29) and did not (n = 73) smoke (part 2). Interventions: Clomiphene citrate challenge tests, composed of FSH levels on cycle days 3 and 10 with 100 mg of CC administered on cycle days 5 through 9. Main Outcome Measures: Comparison of the incidence of abnormal CC challenge test results between women who did and did not smoke, and comparison of peak E(2) levels, number of mature follicles, number of mature oocytes retrieved, fertilization rates, and total and ongoing PRs. Results: The incidence of diminished ovarian reserve was increased in women who smoked (8 of 65 [12.31%]) when compared with age-matched controls who did not smoke (7 of 145 [4.83%]). Among women with normal CC challenge tests who were undergoing IVF, there were no differences in peak E(2) levels, the number of mature follicles, the number of mature oocytes retrieved, fertilization rates, or total and ongoing PRs. Conclusion: Women who smoke have an accelerated development of clinically detectable diminished ovarian reserve. Additionally, the fact that women who smoke cigarettes with normal ovarian reserve have ovarian responses and PRs that are equivalent to age-matched nonsmoking controls suggests that diminished ovarian reserve may be a principal mechanism reducing fecundity among women who smoke cigarettes.