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