Smoking among French infertility specialists: habits, opinions and patients’ management Thomas Freour *, Lionel Dessolle, Miguel Jean, Paul Barriere Service de Me ´decine de la Reproduction et Biologie du De ´veloppement, Hoˆpital Me `re et Enfant, CHU de Nantes, 38 Boulevard Jean Monnet, 44093 Nantes Cedex, France 1. Introduction Smoking affects millions of people worldwide, creating a major public health problem in most countries, industrialised or not. Although tobacco is still responsible for more than 66,000 deaths per year in France, the number of young smokers in western European countries recently showed a stabilization or a slight decrease [1–3]. This is probably due to aggressive health politics, mainly through banning advertising, developing smoke-free policies and raising taxes on tobacco, with a rise by an average annual rate of 6.8% above inflation in Europe since 2001 [2,3]. Hopefully, this epidemiological tendency should help to improve public health and reduce the considerable tobacco-related health care costs. Although smoking related cancers have decreased in men in most European countries, however, the proportion of smokers in women of reproductive age has largely increased in the past 30 years [2–4]. Moreover, most women are unaware of the link between smoking and infertility [5] and the proportion of smokers among couples seeking infertility treatment remains high [6]. Thus, even if the risks of smoking during pregnancy are now generally admitted in the population, medical information on the risk of smoking-related infertility seems to be inadequate or inefficient, despite the large scientific literature available on this topic. Indeed, the association between smoking and infertility has been discussed in many studies, and cigarette smoke contains numerous toxicants that are known to be associated with subfertility, endocrine disorders, earlier onset of menopause, premature ovarian failure and diminished implantation rate [7– 13]. Thus, cigarette smoking leads to poor prognosis in assisted reproductive techniques (ART) [14–16]. In parallel, the proportion of smokers among physicians has largely decreased over the past 20 years [17–19]. Obviously, medical staffs play a key role in smoking cessation [20–22]. Nevertheless, some studies reported that only a small proportion of smokers quit thanks to the motivation given by their physicians [23,24]. This raises the question of medical intervention in smoking cessation in the general population, but also in infertile couples, who are generally in frequent contact with ART clinics and infertility specialists, at European Journal of Obstetrics & Gynecology and Reproductive Biology 155 (2011) 44–48 ARTICLE INFO Article history: Received 15 April 2010 Received in revised form 9 August 2010 Accepted 30 October 2010 Keywords: Smoking Infertility Physicians Patients’ management ABSTRACT Objective: The deleterious effects of tobacco on fertility are now largely demonstrated. Little is known, however, about how infertility doctors communicate on smoking and about their own smoking habits. In this study, we examined smoking habits among French infertility specialists and their attitudes towards infertile couples’ exposure to tobacco. Study design: A postal survey was sent in 2009 to the 803 French certified physicians (gynaecologists, urologists, endocrinologists and embryologists) specializing in infertility. Demographical data, smoking habits and attitude towards patients’ smoking were recorded. Statistical analysis and multiple correspondence analysis were performed in order to identify differences among physicians according to age, gender, occupation or smoking status. Results: Response rate was 42.3%. Half of the respondents were male, 41% were under 45 years, 37% were embryologists and 53.3% were gynaecologists. Thirteen percent reported current smoking. More than 80% always asked their patients about smoking status and cannabis consumption. Most physicians specifically informed infertile couples on tobacco, advised them to quit and proposed smoking cessation therapies. Only 24% refused care unless smoking cessation occurred. Statistical analysis showed some differences among subgroups according to gender, occupation or age. Surprisingly, results were comparable according to smoking status. Conclusion: Most infertility specialists are aware of the deleterious effects of tobacco on fertility and ask their patients to quit. The heterogeneity in infertile patients’ management, however, underlines the need for better professional and patients’ information on smoking. ß 2010 Elsevier Ireland Ltd. All rights reserved. * Corresponding author. Tel.: +33 240084370/3234; fax: +33 240083228. E-mail address: thomas.freour@chu-nantes.fr (T. Freour). Contents lists available at ScienceDirect European Journal of Obstetrics & Gynecology and Reproductive Biology journal homepage: www.elsevier.com/locate/ejogrb 0301-2115/$ – see front matter ß 2010 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ejogrb.2010.10.024