Research Finds E-Cigarette Use and Smoking Associated With Reduced Ovarian Reserve

Could today’s vaping habits be quietly eroding tomorrow’s fertility? As e-cigarette use skyrockets among young women—in some regions now outpacing traditional smoking—an urgent question emerges: what does vaping do to reproductive health? A new study in BMC Women's Health delivers the largest dataset yet, shedding light on how both vaping and cigarette smoking relate to ovarian reserve markers.

Study Design: Unprecedented Scale and Rigorous Controls

Researchers analyzed data from 16,087 women, ages 18–45, who accessed a private reproductive hormone testing service in the UK. All participants were free of major reproductive disorders or hormonal contraception use, ensuring a “healthy” cohort. Each woman self-reported her vaping and smoking status and provided a capillary blood sample for measurement of anti-Müllerian hormone (AMH, a primary marker of ovarian reserve) and follicle-stimulating hormone (FSH, another indicator of ovarian function). The analysis controlled for age, BMI, and ethnicity, and adjusted for overlap between vaping and smoking.

Key Findings: Both Vaping and Smoking Linked to Lower AMH

Current vaping was associated with a 5.6% reduction in AMH compared to never-vapers, even after accounting for smoking status and confounders.

Current cigarette smoking was linked to a 9.4% reduction in AMH and a 7.7% increase in FSH—both statistically significant changes that align with established data connecting smoking to ovarian aging.

Occasional or former use (vaping or smoking) did not significantly impact AMH or FSH markers.

Sensitivity analyses, including exclusion of dual users, confirmed the robustness of these associations.

Clinical Implications: A Subtle but Concerning Signal

While the absolute difference in AMH for vapers was small at the individual level, these findings suggest a population-level effect that could become clinically relevant over time, especially as vaping becomes more common in younger cohorts. Smoking’s impact on ovarian reserve is well-documented, but this is the first large-scale human study to connect e-cigarette use to reduced AMH. The biological mechanisms may include nicotine exposure, as well as other chemicals commonly found in both cigarettes and vape liquids.

Limitations and Context

The study’s cross-sectional design cannot prove causality, and reliance on self-reported vaping/smoking habits means that exposure might be underestimated. No data were collected on duration, frequency, or specific product use. Still, the size and rigor of this dataset make it a significant advance in understanding lifestyle risk factors for female reproductive health.

Conclusion

This study provides the strongest evidence to date that both vaping and smoking are associated with lower markers of ovarian reserve in reproductive-aged women. As e-cigarette use becomes more widespread, these findings should inform both clinical counseling and public health messaging.

KEY POINTS

Both current vaping and cigarette smoking were linked to lower AMH levels, a marker of ovarian reserve.

Smoking was also associated with higher FSH levels, indicating reduced ovarian function.

The study included over 16,000 women and controlled for age, BMI, and ethnicity.

Occasional or former use of e-cigarettes or cigarettes was not significantly associated with ovarian reserve markers.

Findings highlight the need for further research and for clinicians to discuss vaping as a potential reproductive risk.

Citation: Getreu N, Wainwright E, Crawford L, Nedelcu S, Ní Dhonnabháin B, Rodrigues Vaz S, Vasavan T, O’Neill HC. E-cigarette use (vaping) and cigarette smoking are associated with reduced markers of ovarian reserve: a cross-sectional study of 16,087 women. BMC Women's Health. 2026;[Epub ahead of print]. DOI: https://doi.org/10.1186/s12905-026-04620-x