A significant portion of Indian adults, approximately 29%, use tobacco, with smokeless varieties being most common, and this widespread issue poses a major public health threat with substantial economic costs, extending beyond known risks like cancer and heart disease to silently impact reproductive health. Experts, including Dr. Kalyani Shrimali, highlight that smoking accelerates ovarian ageing, diminishes egg quality, disrupts hormone production, and can lead to earlier menopause by increasing oxidative stress and inflammation, damaging delicate egg cells and reducing blood supply to the ovaries, ultimately decreasing fertility and increasing pregnancy complications, though quitting smoking can still positively influence reproductive outcomes by improving circulation and reducing damage to remaining eggs.

A significant portion of Indian adults, approximately 29%, use tobacco, with smokeless varieties being most common, and this widespread issue poses a major public health threat with substantial economic costs, extending beyond known risks like cancer and heart disease to silently impact reproductive health. Experts, including Dr. Kalyani Shrimali, highlight that smoking accelerates ovarian ageing, diminishes egg quality, disrupts hormone production, and can lead to earlier menopause by increasing oxidative stress and inflammation, damaging delicate egg cells and reducing blood supply to the ovaries, ultimately decreasing fertility and increasing pregnancy complications, though quitting smoking can still positively influence reproductive outcomes by improving circulation and reducing damage to remaining eggs.

A significant portion of Indian adults, approximately 29%, use tobacco, with smokeless varieties being most common, and this widespread issue poses a major public health threat with substantial economic costs, extending beyond known risks like cancer and heart disease to silently impact reproductive health. Experts, including Dr. Kalyani Shrimali, highlight that smoking accelerates ovarian ageing, diminishes egg quality, disrupts hormone production, and can lead to earlier menopause by increasing oxidative stress and inflammation, damaging delicate egg cells and reducing blood supply to the ovaries, ultimately decreasing fertility and increasing pregnancy complications, though quitting smoking can still positively influence reproductive outcomes by improving circulation and reducing damage to remaining eggs.

According to the World Health Organization (WHO), nearly 267 million adults aged 15 years and above in India - around 29 per cent of all adults - were tobacco users as per the Global Adult Tobacco Survey India 2016–17. While smokeless tobacco products such as khaini, gutkha, zarda, and betel quid with tobacco remain the most commonly used forms in the country, smoking products like cigarettes, bidis, and hookah also continue to be widely consumed. 

Globally, tobacco use remains one of the biggest public health threats, contributing not only to loss of life but also to severe social and economic consequences. WHO estimates that the total economic costs attributed to tobacco-related diseases in India among people aged 35 years and above amounted to INR 1,77,341 crore (USD 27.5 billion) in 2017–18. 

While smoking is often associated with lung disease, cancer, and heart-related illnesses, many people still remain unaware that tobacco can also quietly impact fertility and reproductive health. Experts warn that smoking may accelerate ovarian ageing, reduce egg quality, affect hormone production, and even increase the risk of early menopause over time. 

Amid growing concerns around reproductive health and fertility challenges, we spoke to Dr Kalyani Shrimali, Clinical Director and Fertility Specialist at Nova IVF Fertility, Indore, to understand how smoking impacts ovarian ageing, why it affects fertility, and what women should know about protecting their reproductive health. 

Smoking doesn’t just affect the lungs

While smoking is commonly associated with lung disease, cancer, and cardiovascular problems, Dr Kalyani Shrimali, Clinical Director and Fertility Specialist at Nova IVF Fertility, said its impact on women’s reproductive health often goes unnoticed. 

According to her, growing evidence suggests that smoking can accelerate ovarian ageing, reduce fertility potential, and even lead to earlier menopause. She explained that women who smoke are often found to have lower Anti-Müllerian Hormone (AMH) levels compared to non-smokers. Since AMH is considered an important marker of ovarian reserve, reduced levels may indicate diminished reproductive potential and faster ovarian ageing. 

“The ovaries naturally lose eggs over time as part of the ageing process. However, smoking can significantly accelerate this decline by affecting both the quantity and quality of eggs,” Dr Shrimali said. “In some women, these effects may begin much earlier than expected, even during their 20s or 30s.” 

How smoking damages ovarian health

Dr Shrimali explained that cigarette smoke contains thousands of harmful chemicals, including nicotine, carbon monoxide, cadmium, and other toxic substances that increase oxidative stress and inflammation in the body. 

She noted that eggs are highly sensitive cells, making them particularly vulnerable to toxin exposure. According to her, smoking may damage the DNA within eggs, interfere with follicle development, and speed up the loss of ovarian follicles over time. 

“Women are born with a fixed number of eggs. When smoking accelerates follicle loss, it can shorten the reproductive lifespan significantly,” she said. 

She further added that smoking may also affect blood circulation to the ovaries, reducing oxygen and nutrient supply required for healthy egg development. 

The link between smoking and early menopause

One of the most well-established reproductive effects of smoking is its association with early menopause, Dr Shrimali said. 

According to her, studies have shown that women who smoke may experience menopause one to four years earlier compared to non-smokers. She explained that this does not only affect fertility but may also increase long-term health risks linked to declining estrogen levels. 

“Early menopause can raise the risk of conditions such as osteoporosis, cardiovascular disease, and certain metabolic disorders,” she said. “The risk tends to increase with both the duration and intensity of smoking.” 

Reduced fertility and pregnancy-related risks

Dr Shrimali noted that smoking can interfere with multiple stages of reproduction, including ovulation, egg quality, fertilisation, and implantation. 

“Women who smoke are often more likely to experience delayed conception compared to non-smokers,” she explained. “Smoking may also reduce the success rates of assisted reproductive techniques such as IVF.” 

She added that even second-hand smoke exposure may negatively affect fertility, particularly among women already facing reproductive challenges. 

According to Dr Shrimali, the impact of smoking may continue during pregnancy as well. Smoking during pregnancy has been linked to higher risks of miscarriage, ectopic pregnancy, placental complications, premature birth, and low birth weight. 

“Toxins present in cigarette smoke can interfere with placental blood flow and oxygen delivery to the fetus, which may affect fetal growth and development,” she said. 

Can fertility improve after quitting smoking?

Despite the risks, Dr Shrimali emphasised that quitting smoking can still positively influence reproductive health outcomes. 

“While lost eggs cannot be restored, stopping smoking may help improve blood circulation, reduce oxidative stress, and support the health of the remaining eggs over time,” she said. 

According to her, women planning pregnancy are often advised to quit smoking several months before trying to conceive, allowing the body time to recover from nicotine-related damage. 

She also pointed out that smoking affects male fertility and sperm quality as well, making smoking cessation important for both partners. 

Dr Shrimali stressed that many women remain unaware of how strongly smoking can affect fertility until they begin facing difficulties conceiving. “Ovarian ageing often progresses silently,” she said. “That is why awareness around the reproductive effects of smoking is extremely important, especially among younger women.” 

This story is done in collaboration with First Check, which is the health journalism vertical of DataLEADS

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