• Karilynn Rockhill, Van T Tong, Sheree L Boulet, Yujia Zhang, Denise J Jamieson, and Dmitry M Kissin.
• 1 Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Reproductive Health, Atlanta, Georgia.
• J Womens Health (Larchmt). 2019 Mar 1; 28 (3): 314-322.

BackgroundSmoking near conception has adverse effects on pregnancy outcomes. We estimated the proportion of assisted reproductive technology (ART) cycles with smoking reported and associated clinical outcomes.MethodsWe used a retrospective cohort study (2009-2013) using national data of ART cycles in the United States. We compared patient characteristics, infertility diagnoses, and treatment procedures by self-reported smoking in the 3 months before treatment. Using multivariable logistic regression accounting for clustering by state, clinic, and patient, we assessed adjusted odds ratios (aOR) and 95% confidence intervals (CI) between smoking and clinical outcomes: cycle cancellations among all cycles (cycle stopped before retrieval of eggs or transfer of embryos), treatment outcomes (implantation, ectopic pregnancy, intrauterine pregnancy, and live birth) among cycles with ≥1 fresh embryo transferred, and pregnancy outcomes (miscarriage, stillbirth, and live birth) among intrauterine pregnancies.ResultsSmoking was reported in 1.9% of cycles. Higher proportions of cycles among smokers versus nonsmokers were younger, non-Hispanic White, multigravida women and had tubal factor and male factor infertility diagnoses; lower proportions had diagnoses of diminished ovarian reserve and unexplained infertility, and used donor eggs. Smoking was associated with higher adjusted odds of cycle cancellation with no embryo transfer (aOR: 1.10; 95% CI: 1.00-1.21) and cancellations before fresh oocyte retrieval or frozen embryo transfer (1.11; 1.02-1.21). Associations between other clinical outcomes were nonsignificant.ConclusionsOver 12,000 ART cycles in the United States were exposed to smoking during 2009-2013; smoking increased the odds of cycle cancellation. Providers should encourage women to quit smoking before ART treatments.

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