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Tobacco as a significant predictor of infertility: A public health perspective in an Indian scenario

Introduction: Infertility is a major public health problem worldwide, including India. Tobacco consumption (smoking/chewing) is a significant predictor of metabolic perturbations in reproductive physiology, including infertility. The early identification of risk factors associated with infertility susceptibility in ethnically disparate population subsets is an attractive cost-effective strategy in infertility control, prevention, and management. Materials and Methods: A comprehensive literature search using PubMed and Medline scientific database(s) (last accessed November 4, 2017) was performed by the authors for the inclusion of most relevant articles in this review. Public health research studies for developing cost-effective infertility risk-assessment protocols in low-resource settings targeting couples who are infertile in India are ongoing for reducing the increasing burden of reproductive disorders and addressing the psychological/financial distress associated with the exorbitant cost of infertility treatment procedures, namely in-vitro fertilization. Results: With our clinical research experience in reproductive medicine/infertility, we strongly advocate the implementation of cost-effective community-based tobacco-cessation infertility management guidelines with robust public health research models in the specific population subsets of varying genetic landscapes and socioeconomic strata. Anti-tobacco public awareness campaigns should be organized for efficiently addressing health risks associated with tobacco consumption/cigarette smoking. Conclusion: The authors speculate that oxidative stress caused by tobacco in the physiological milieu may be diminished by therapeutically targeting specific metabolic/biochemical signaling pathways associated with cellular stress/death, immunomodulation, and inflammation. Biomarker development/validation for the stringent management of tobacco-mediated infertility will certainly provide spectacular gains in our current understanding of the pathophysiological basis of tobacco-related reproductive aberrations/disorders, primarily infertility, in the 21st century.