Introduction:
Infertility currently affects about 10 to 14 percent of the Indian population, with higher rates in urban areas where one out of six couples is impacted (Indian Society of Assisted Reproduction). Male fertility is affected by a variety of lifestyle habits that include tobacco use as one of the main causes of preventable morbidity and mortality.

Objectives:
The objective of the current study was to assess the relationship between tobacco use and its effect on sperm characteristics and infertility.

Methods:
The study used an exploratory analytical design and was conducted on patients who reported to the Infertility OPD of a Multispeciality Hospital in Delhi, India from January 2019 to September 2019. Male infertile patients who were current tobacco users were grouped and evaluated according to the frequency of their tobacco habit: mild (< 3 times/day), moderate (3-6 times/day) and severe (> 6 times/day). Clinical parameters including sperm characteristics of count, motility, morphology, and viability were evaluated. Tobacco cessation counseling was provided for current tobacco users. Data was analyzed using SPSS 21 version. Descriptive and inferential statistics were applied.

Results:
A total of 713 infertile couples were evaluated. Male infertility was found in 221(31%) patients. 22.3% (N=159) of the male infertile group were current tobacco users (both smoked and smokeless forms of tobacco). 28.3% (N=45), 41% (N=65) and 30.7% (N=49) patients respectively belonged to the mild, moderate and severe tobacco habit groups. Sperm characteristics were significantly lower in the severe group (p<0.05). Comprehensive tobacco cessation counseling along with supportive treatment for male infertility was provided. After one month of intervention the sperm characteristics improved with reported cessation.

Conclusion(s):
The effect of tobacco use on male infertility was significant when assessed among male infertile patients. Infertile men should be counseled about the adverse effects of tobacco on sperm quality along with co-morbidities due to tobacco at mass level, employing the common risk factor approach.