Does vaping affect fertility? New research links vaping to lower AMH

A new Hertility study of more than 16,000 women has found that current vaping is associated with lower levels of anti-Müllerian hormone (AMH), a commonly used marker of ovarian reserve.

Vaping is often positioned as a less harmful alternative to cigarette smoking. And when it comes to overall health, evidence suggests vaping exposes people to fewer harmful substances than smoking.

But less harmful does not mean risk-free.

Until now, we have known surprisingly little about how vaping could affect female reproductive health. Most previous research has come from animal studies, small fertility-clinic populations or studies looking at pregnancy rather than ovarian function.

New research from Hertility, published in the peer-reviewed journal BMC Women’s Health, looked at vaping, cigarette smoking and ovarian reserve markers in 16,087 women aged 18-45.

The main finding? Women who currently vaped had 5.6% lower AMH levels, on average, than women who had never vaped, even after accounting for cigarette smoking and other factors such as age, BMI and ethnicity.

That does not mean vaping has been proven to reduce fertility or that someone who vapes will struggle to get pregnant. But it is an important novel signal that deserves further investigation.

Does vaping affect fertility?

We don’t yet know whether vaping directly reduces female fertility. However, Hertility’s new study found that current vaping was associated with lower AMH, a hormone used as a marker of ovarian reserve.

The study did not measure whether women became pregnant, how long it took them to conceive, egg quality, IVF success or live birth rates. Because it was cross-sectional, it also cannot prove that vaping itself caused the difference in AMH.

Instead, the findings suggest there may be an association between current vaping and one aspect of ovarian biology.

This distinction matters.

Fertility is influenced by many different factors, including age, egg quality, ovulation, sperm health, the fallopian tubes and uterus. AMH is one piece of that puzzle.

What did the study find?

Researchers analysed reproductive health and hormone data from 16,087 women aged 18-45 across the UK.

The main findings were:

• Current vaping was associated with 5.6% lower AMH compared with never vaping.
• Current cigarette smoking was associated with 9.4% lower AMH compared with never smoking.
• Current cigarette smoking was also associated with 7.7% higher FSH.
• Vaping was not significantly associated with FSH.
• Former and occasional vaping were not significantly associated with either AMH or FSH in the main analysis.
• Only 64 women were current users of both cigarettes and vapes. Removing these dual users produced very similar results, suggesting the vaping finding was not simply being driven by cigarette smoking.

The association between vaping and AMH was relatively small. It represented an estimated absolute difference of around 0.71 pmol/L, which the researchers emphasise should not be interpreted as a clinically meaningful reduction in ovarian reserve for an individual woman.

Instead, it is better thought of as a population-level signal that now needs to be investigated in studies that follow women over time.

About the research

The study used anonymised data collected through Hertility’s reproductive health service between November 2022 and February 2025.

Women with reproductive health conditions that could independently influence ovarian reserve or hormone levels – including PMOS, previously known as PCOS, endometriosis, primary ovarian insufficiency and hypothalamic amenorrhoea — were excluded. Women using hormonal contraception were also excluded.

Participants reported whether they had never, previously, occasionally or currently vaped and smoked.

AMH and follicle-stimulating hormone (FSH) were measured from at-home capillary blood samples. Where applicable, samples were collected on day three of the menstrual cycle, and the researchers accounted statistically for age, BMI, ethnicity and cigarette-smoking behaviour.

Importantly, vaping and cigarette smoking were included in the same statistical model. This allowed the researchers to examine the association with vaping independently of smoking, rather than assuming everyone who vapes has never smoked cigarettes.

What is AMH and what does it have to do with fertility?

Anti-Müllerian hormone, or AMH, is produced by cells within developing follicles in the ovaries. It is commonly used as a marker of ovarian reserve – broadly, the pool of eggs remaining in the ovaries.

In general, AMH tends to decline as ovarian reserve decreases with age.

AMH testing can therefore be useful when assessing ovarian reserve and estimating how the ovaries might respond to stimulation during fertility treatment.

But there is an important caveat.

AMH does not measure egg quality and it cannot tell you whether you can or cannot get pregnant naturally.

Someone can have low AMH and conceive naturally, while someone with a high AMH can still experience fertility difficulties for completely unrelated reasons.

So, when this study reports lower AMH among current vapers, it does not mean that current vapers were 5.6% less fertile or had a 5.6% lower chance of pregnancy.

Those are different outcomes.

Does vaping reduce your egg count?

This study cannot tell us that vaping reduces someone’s egg count.

AMH is associated with the number of developing follicles in the ovaries, but it does not directly count how many eggs someone has.

The researchers also did not perform antral follicle counts (AFCs) using ultrasound, which would provide another measure of ovarian reserve.

For that reason, the finding should be described as an association between vaping and lower AMH, rather than evidence that vaping directly destroys eggs or causes diminished ovarian reserve.

Future studies combining repeated AMH measurements with AFC, detailed vaping exposure and long-term reproductive outcomes will be needed to answer this properly.

How could vaping affect the ovaries?

At the moment, we don’t know.

There are several biologically plausible explanations, but most of the evidence comes from cigarette smoking, laboratory studies or animal research rather than large human vaping studies.

Nicotine is one possibility. Experimental research suggests nicotine can influence follicular development, cell death and the normal production of reproductive hormones.

Nicotine’s major metabolite, cotinine, has also been detected in follicular fluid — the fluid surrounding a developing egg — in people who smoke and vape.

But nicotine may not be the whole story.

E-cigarette aerosol can contain a complex mixture of substances depending on the device and liquid used, including metals, aldehydes and flavouring chemicals. Some laboratory and animal studies have suggested that certain components may affect ovarian follicles or endocrine function.

That does not mean these substances have been shown to damage human fertility at the levels produced by normal vaping.

It does mean there is enough biological uncertainty to justify much better research – particularly as vaping becomes more common among younger people.

Is vaping worse for fertility than smoking?

This study does not show that vaping is more harmful than smoking.

In fact, cigarette smoking showed a stronger and more consistent association with ovarian reserve markers.

Current smokers had 9.4% lower AMH and 7.7% higher FSH, whereas current vapers had 5.6% lower AMH and no significant difference in FSH.

Smoking is already well established as harmful to reproductive and wider health.

Current UK public-health guidance also continues to recognise that vaping is substantially less harmful overall than cigarette smoking and can be useful for adults using it to stop smoking. It is therefore important not to interpret this research as a reason for someone who smokes cigarettes to continue smoking rather than switching.

The more useful distinction is:

If you don’t smoke, there is no health benefit to starting vaping. If you currently smoke, switching completely to vaping is generally considered less harmful than continuing to smoke – although stopping both is ultimately the lowest-risk option.

What about vaping when trying to conceive?

There is still very limited human evidence specifically looking at vaping and the chance of getting pregnant.

A previous prospective study of women trying to conceive found a small reduction in fecundability – the probability of conceiving during a menstrual cycle – among current e-cigarette users. However, research in this area remains sparse. Hertility’s study adds a different piece of evidence by examining ovarian reserve markers in a much larger group of women, many of whom were not experiencing infertility or actively trying to conceive.

Crucially, the new Hertility study did not measure time to pregnancy.

So we cannot currently say that the 5.6% difference in AMH translates into a meaningful difference in someone’s likelihood of conceiving.

If you are planning a pregnancy, stopping vaping where possible is a reasonable way to reduce an exposure whose long-term reproductive effects remain uncertain. If you currently use vaping to avoid smoking cigarettes, speak to your GP, pharmacist or stop-smoking service before making changes that could increase your risk of returning to smoking.

Does stopping vaping increase AMH?

We don’t know.

Interestingly, women who reported having quit vaping did not have significantly different AMH levels from women who had never vaped in the main analysis.

However, the study was not designed to test whether stopping vaping causes AMH to increase.

Researchers did not know how heavily participants had previously vaped, how many years they had used e-cigarettes, when they stopped or how their AMH changed before and after quitting.

That means it would be inappropriate to conclude that AMH definitely “recovers” after stopping vaping.

Longitudinal studies that repeatedly measure hormones before and after vaping cessation would be needed to answer this question.

What if I vape and have low AMH?

First: don’t panic because of this study.

The average AMH difference associated with vaping was small, and there is huge variation in AMH between individuals.

Age remains one of the most important influences on ovarian reserve, and AMH also varies because of biological factors, health conditions and testing methods.

A low AMH result also does not mean that vaping caused it.

If your AMH is lower than expected for your age, it can be helpful to look at the result alongside your age, menstrual history, symptoms, family history and — where appropriate — an antral follicle count.

At Hertility, hormone results are interpreted in the context of your wider reproductive health rather than as isolated numbers.

What are the study’s limitations?

This was, to the researchers’ knowledge, the largest study so far investigating vaping and hormonal markers of ovarian reserve in reproductively healthy women – but there are important limitations.

Most importantly, it was cross-sectional. Researchers measured vaping behaviour and hormones at one point in time rather than following people before and after they started vaping. This means the research can identify an association, but it cannot establish cause and effect.

Vaping and smoking were also self-reported. The researchers did not have information on how often people vaped, how long they had been vaping, the type of device used, nicotine concentration or the chemicals contained within individual products.

Other lifestyle factors that could potentially influence reproductive health, such as alcohol, cannabis use, chronic stress or environmental exposures, were not available for adjustment.

And although removing current dual users produced a very similar vaping-AMH association, another sensitivity analysis excluding all former users made the association smaller and no longer statistically significant. The direction of the effect remained the same, but this is another reason the result should be replicated before firm conclusions are drawn.

Finally, the study looked at AMH and FSH – not fertility outcomes. It cannot tell us whether vaping affects egg quality, ovulation, natural conception, miscarriage, IVF success or the chance of having a baby.

Why this research matters

Vaping has changed rapidly.

E-cigarettes have only been widely used for a relatively short period, and uptake has increased particularly quickly among younger people. That means the reproductive effects of years – or decades – of exposure may not yet be visible.

Historically, reproductive-health research has often had to catch up with changing behaviours rather than anticipating them.

Large real-world datasets give us an opportunity to spot potential signals earlier.

This study does not give us the final answer on vaping and fertility. But it does provide one of the strongest human datasets so far suggesting that the relationship deserves closer attention.

The next step is prospective research that can measure vaping exposure more accurately, follow people over time and determine whether differences in ovarian reserve markers translate into actual differences in reproductive outcomes.

Read the peer-reviewed research

Getreu N, Wainwright E, Crawford L, et al. (2026). 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 26, 437.

Want to understand your ovarian reserve?

Your hormone results mean more when they’re interpreted in context.

Hertility’s At-Home Hormone & Fertility Test can measure AMH alongside other reproductive and thyroid hormones, with personalised clinical interpretation to help you understand what your results mean for your reproductive health and fertility goals.

Frequently asked questions

Does vaping affect AMH?

A Hertility study of 16,087 women found that current vaping was associated with 5.6% lower AMH compared with never vaping after accounting for factors including age, BMI, ethnicity and cigarette smoking. The study cannot prove that vaping caused the difference.

Does vaping affect female fertility?

We do not yet have enough evidence to say whether vaping directly reduces female fertility. Hertility’s study found an association with lower AMH, a marker of ovarian reserve, but did not measure natural conception, egg quality, IVF success or live birth.

Does vaping reduce egg quality?

This study did not measure egg quality, so it cannot answer this question. Human evidence examining vaping and egg quality remains limited.

Does vaping lower your egg count?

Not necessarily. AMH provides information about ovarian reserve but does not directly count the number of eggs in the ovaries. The study also did not measure antral follicle count by ultrasound.

Is nicotine-free vaping safe for fertility?

There is currently not enough evidence to say that nicotine-free vaping is harmless to reproductive health. E-cigarette aerosols can contain substances other than nicotine, and this study did not record whether participants used nicotine-containing or nicotine-free products.

Is vaping better than smoking for fertility?

Smoking has much stronger evidence of reproductive harm. In Hertility’s study, current cigarette smoking was associated with a larger reduction in AMH and higher FSH, while vaping was associated only with lower AMH. Current UK guidance considers vaping substantially less harmful overall than smoking, but not risk-free.

Does AMH tell you if you’re fertile?

No. AMH is a marker of ovarian reserve and can provide information about egg quantity and expected response to ovarian stimulation. It does not measure egg quality and cannot predict whether someone will conceive naturally.

References

Getreu N, Wainwright E, Crawford L, et al. (2026). 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 26, 437. https://link.springer.com/article/10.1186/s12905-026-04620-x 

Harlow AF, Hatch EE, Wesselink AK, Rothman KJ, Wise LA. (2021). Electronic cigarettes and fecundability: results from a prospective preconception cohort study. American Journal of Epidemiology 190(3):353–361. https://pmc.ncbi.nlm.nih.gov/articles/PMC8086241/ 

Jackson SE, Brown J, Notley C, Shahab L, Cox S. (2024). Characterising smoking and nicotine use behaviours among women of reproductive age: a 10-year population study in England. BMC Medicine 22, 99. https://link.springer.com/article/10.1186/s12916-024-03311-4 

Montjean D, Godin Pagé MH, Bélanger MC, Benkhalifa M, Miron P. (2023). An overview of e-cigarette impact on reproductive health. Life 13(3):827. https://www.mdpi.com/2075-1729/13/3/827 

Cedars MI. (2022). Evaluation of female fertility — AMH and ovarian reserve testing. Journal of Clinical Endocrinology & Metabolism 107(6):1510–1519. https://academic.oup.com/jcem/article/107/6/1510/6518212