Yourfertility.org.au

Pre-conception Health Special Interest Group
Effects of caffeine, alcohol and
smoking on fertility
There is an increasing body of evidence that lifestyle factors affect fertility. As most lifestyle factors can be modified, providing advice and support in making healthy lifestyle changes can promote fertility. The evidence relating to the effects on fertility of caffeine, alcohol consumption and smoking are discussed here. Your Fertility is a national public education campaign funded by the Australian Government Department of Health and Ageing under the Family Planning Grants Program.
Pre-conception Health Special Interest Group
Effects of caffeine, alcohol and smoking
on fertility
Evidence review
Caffeine
Caffeine and alcohol consumption adversely affect fertility, most likely in Caffeine is commonly found in coffee, tea, some soft drinks and chocolate. a dose-dependent way. Both active and passive smoking reduce male and Some evidence suggests that the consumption of caffeine, with a possible female fertility and are harmful for the growing baby. In ART populations dose-response effect, may prolong the time to pregnancy and affect the male and female smoking significantly reduce conception and live birth health of a developing foetus, although the mechanism for this is unclear. rates and increase the risk of miscarriage. Caffeine may affect ovulation and corpus luteum functioning through alterations to hormone levels [1] and has been shown to be associated with Recommendations
higher early follicular E2 levels in females [2]. Although some studies have found a positive relationship between caffeine consumption and time to Based on existing evidence, it is recommended that women trying to conception [3-6], study results are inconsistent and should be interpreted conceive limit their caffeine intake to the equivalent of 1-2 cups of coffee per day [7-8, 23]. It is also recommended that women trying to conceive and pregnant women avoid drinking alcohol [7-8, 23-24]. It is recommended Most studies have focused on general rather than infertile populations and that men and women who smoke and wish to conceive stop smoking. For have relied on the collection of retrospective data, leaving them open to couples where one or both partners smoke, factual information about the recall bias. However, Willcox et al [3] conducted a prospective study of risks of smoking and active support to stop smoking should be offered by 104 women attempting pregnancy. Caffeine consumption was recorded at health professionals, as pregnancy is a time when smoking cessation advice regular intervals as well as daily information regarding menstrual bleeding has been found to be most effective [25].
and intercourse until pregnancy occurred. Women who consumed less than one cup of coffee were twice as likely to become pregnant, per cycle, as moderate coffee drinkers and the risk of not becoming pregnant increased with higher consumption. Other studies have also suggested an association between caffeine intake and increased time to conception that may be There are few studies on the effect of caffeine consumption in infertile populations. Klonoff-Cohen et al [1] conducted a prospective study over five years on couples undertaking assisted reproductive technology (ART) treatment. Increased caffeine consumption was found to be a risk factor for not achieving a live birth (either by not becoming pregnant or by having a Alcohol
Alcohol has been shown to affect male and female fertility, but the level of
consumption associated with risk is unclear. Although an adverse effect on fertility of any amount of alcohol consumption is highly plausible, studies are limited, as they must generally rely on recall of levels and timing of alcohol consumption [7]. High levels of maternal alcohol consumption are known to be dangerous to the unborn child [10-12], but the effects at lower levels are less certain. The mechanisms by which alcohol could impair fertility are unclear, but in men it can cause impotence, reduce libido and While most studies have focused on general populations, one prospective study of couples undergoing ART [1] reviewed male and female alcohol consumption in the year prior to treatment as well as during treatment. Both male and female alcohol consumption decreased the chance of a live birth and increased the risk of miscarriage.
In contrast, another study of women undergoing donor insemination found no association between their alcohol consumption and fecundity [15].
Smoking
There is strong evidence that smoking adversely affects male and female
fertility. Smokers are more likely to be infertile [7, 16-17] and women who are exposed to smoking take longer to conceive [18]. Furthermore, maternal smoking increases the risk of low birth weight and birth defects [19] and women who smoke reach menopause earlier than non-smokers [20]. Smoking can also damage sperm DNA. Heavy smoking (≥20 cigarettes per day) by fathers at the time of conception increases the child’s risk of childhood leukaemia and shortens the reproductive life span of daughters [21-22]. Pre-conception Health Special Interest Group
Effects of caffeine, alcohol and smoking
on fertility
References
1. Klonoff-Cohen, H., Bleha,J. et al. (2002). “A prospective study of the effects of female and male caffeine consumption on the reproductive endpoints of IVF and
gamete intra-Fallopian transfer.” Human Reproduction 17(7): 1746-1754.
2. Lucero, J., Harlow, B. L. et al. (2001). “Early follicular phase hormone levels in relation to patterns of alcohol, tobacco, and coffee use.” Fertility and Sterility
3. Wilcox, A., Weinberg, C. et al. (1988). “Caffeinated beverages and decreased fertility.” Lancet 2(8626-8627): 1453-1456.
4. Hatch, E. E. and Bracken M. B. (1993). “Association of delayed conception with caffeine consumption.” American Journal of Epidemiology 138(12): 1082-1092.
5. Stanton, C. K. and Gray, R. H. (1995). “Effects of caffeine consumption on delayed conception.” American Journal of Epidemiology 142(12): 1322-1329.
6. Bolumar, F., Olsen, J. et al. (1997). “Caffeine intake and delayed conception: a European multicenter study on infertility and subfecundity.” European Study Group
on Infertility Subfecundity. American Journal of Epidemiology 145(4): 324-334.
7. Homan, G. F., Davies, M. et al. (2007). “The impact of lifestyle factors on reproductive performance in the general population and those undergoing infertility
treatment: a review.” Human Reproduction Update 13(3): 209-223.
8. Anderson, K., Nisenblat, V. et al. (2010). “Lifestyle factors in people seeking infertility treatment - A review.” The Australian & New Zealand journal of Obstetrics
9. Anderson, K., Norman, R. J. et al. (2010). “Preconception lifestyle advice for people with subfertility.” Cochrane database of systematic reviews (4): CD008189.
10. Astley S.J., Bailey D., et al.(2000). “Fetal alcohol syndrome (FAS) primary prevention through FAS diagnosis: A comprehensive profile of 80 birth mothers of
children with FAS.” Alcohol Alcoholism 35: 509–512.
11. Goransson, M., Magnusson, A., et al. (2003). “Fetus at risk: prevalence of alcohol consumption during pregnancy estimated with a simple screening method in
Swedish antenatal clinics.” Addiction 98(11): 1513–1520.
12. Krulewitch C, (2005). “Alcohol during pregnancy.” Annual Review of Nursing Research, 23, (1), 101-134.
13. Donnelly, G. P., N. McClure, et al. (1999). “Direct effect of alcohol on the motility and morphology of human spermatozoa.” Andrologia 31(1): 43-47.
14. Muthusami, K. R. and Chinnaswamy, P. (2005). “Effect of chronic alcoholism on male fertility hormones and semen quality.” Fertility and Sterility 84(4): 919-924.
15. Zaadstra, B.M., Looman, C.W., et al. (1994). “Moderate drinking: no impact on female fecundity.” Fertility and Sterility, 62, 948–954.
16. Hassan M.A., Killick S.R. (2004). “Negative lifestyle is associated with significant reduction in fecundity.” Fertility and Sterility 81: 384-92.
17. Augood C., Duckitt K., et al. (1998). “Smoking and female infertility: a systematic review and meta-analysis.” Human Reproduction 13: 1532-39.
18. Hull M.G., North K, et al. (2000). “Delayed conception and active and passive smoking.” Fertility and Sterility 74: 725-33.
19. Hackshaw A, Rodeck C, et al. (2011). “Maternal smoking in pregnancy and birth defects: a systematic review based on 173 687 malformed cases and 11.7
million controls.” Human Reproduction Update 17: 589-604.
20. ESHRE Task Force on Ethics and Law. (2010). “Lifestyle-related factors and access to medically assisted reproduction.” Human Reproduction 25: 578-83.
21. Milne E, Greenop KR, et al. (2012). “Parental prenatal smoking and risk of childhood acute lymphoblastic leukemia.” American Journal of Epidemiology
22. Fakuda M, Fakuda K, et al. (2011). “Paternal smoking habits affect the reproductive life span of daughters.” Fertility and Sterility 95: 2542-44.
23. Government of South Australia (2008). “Government of South Australia Department of Health. South Australian Perinatal Practice Guidelines - Chapter 1
24. NHMRC. (2009). “Australian Guidelines to Reduce Health Risks from Drinking Alcohol.” Canberra, Australia: National Health and Medical Research Council
25. NHMRC. “Advising on smoking cessation in pregnancy.ccessed

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