E-cigarette use (vaping) and cigarette smoking are associated with reduced markers of ovarian reserve: a cross-sectional study of 16,087 women

Background E-cigarette use (vaping) is rapidly increasing among women of reproductive age, with an estimated one in five women aged 15–45 now using e-cigarettes in England. Despite being promoted as a safer alternative to cigarettes, the reproductive health consequences of e-cigarettes remain poorly understood, despite products being on the market for 2 decades. This study aimed to investigate the association between e-cigarette use, cigarette smoking, and two hormonal markers of ovarian reserve in women of reproductive age.

A cross-sectional analysis was conducted using data from 16,087 women aged 18-45 who accessed a private reproductive hormone testing service between 11/2022 and 02/2025. Women with pre-existing reproductive health conditions (including PMOS, endometriosis, POI, and hypothalamic amenorrhoea) and those using hormonal contraception were excluded, ensuring a reproductively healthy population for analysis. Self-reported vaping and smoking were primary exposures, captured as never, former, occasional, or current use. Serum AMH and FSH were measured via standardised immunoassay from capillary blood samples. Multiple linear regression with log-transformed outcomes was performed, adjusting for age, BMI, and ethnicity. Vaping and smoking were modelled simultaneously to account for overlap between the two behaviours.

Current vaping was associated with 5.6% lower serum AMH compared to never-vapers (p=0.023), with no significant association observed for FSH. Current cigarette smoking was associated with a 9.4% reduction in AMH (p=0.005) and a 7.7% increase in FSH (p<0.001). Neither occasional nor former vaping or smoking was significantly associated with either marker. Sensitivity analyses excluding dual users of tobacco and e-cigarettes (n=64, 0.4% of sample) and excluding all former users produced consistent results. No significant interaction between smoking and vaping status was detected (p=0.271 for AMH; p=0.244 for FSH).

In this large study of reproductively healthy women, current vape use was independently associated with lower AMH, a commonly used marker of ovarian reserve, after adjustment for smoking status and relevant confounders. These findings warrant further investigation, particularly given the widespread and growing use of e-cigarettes among women of reproductive age. Similar content being viewed by others Abbreviations - AMH: - Anti-Müllerian hormone - FSH: - Follicle-stimulating hormone - BMI: - Body mass index - CI: - Confidence interval - GVIF: - Generalised variance inflation factor - OHA: - Online health assessment - CV: - Coefficient of variation - AFC: - Antral follicle count - IVF: - In vitro fertilization - PMOS: - Polyendocrine metabolic ovarian syndrome - POI: - Primary ovarian insufficiency - UK: - United Kingdom - TSH: - Thyroid-stimulating hormone - VIF: - Variance inflation factor

The authors thank all participants who consented to the use of their anonymised data for research purposes, and the team at Inuvi Diagnostics Ltd for laboratory analysis. Attestation statements Data regarding any of the subjects in the study has not been previously published unless specified. Data will be made available to the editors of the journal pre and/or post publication for review or query upon request. The STROBE checklist for this study design was followed. Capsule Vaping and smoking are associated with reduced ovarian reserve, with vaping linked to lower AMH levels and smoking linked to both lower AMH and higher FSH levels. Funding This work was supported by Hertility Health Ltd. Author information Authors and Affiliations Corresponding author Ethics declarations Ethics approval and consent to participate This study involved the retrospective analysis of anonymised data. All participants provided informed consent electronically at the time of completing the OHA, with clear information provided regarding data usage, privacy, and confidentiality. All data were fully anonymised prior to access by the research team. The research protocol was reviewed and approved by the London-Surrey Research Ethics Committee, part of the NHS Health Research Authority (REC reference: 20/LO/0265). All procedures were conducted in accordance with the 1964 Helsinki Declaration and its later amendments. Consent for publication Not applicable. Competing interests All authors are employees of Hertility Health Ltd., which provided funding and operational support for this study. Additional information Publisher’s Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Supplementary Information Rights and permissions Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. About this article Cite this article Getreu, N., Wainwright, E., Crawford, L. et al. 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). https://doi.org/10.1186/s12905-026-04620-x Received: Accepted: Published: DOI: https://doi.org/10.1186/s12905-026-04620-x