Tehran University of Medical Sciences Journal of Family and Reproductive Health 1735-8949 20 2 2026 09 13 120 125 Ashraf Moini Department of Obstetrics and Gynecology, Arash Women’s Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran AND Department of Endocrinology and Female Infertility, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran Sonia Eskandarion Department of Obstetrics and Gynecology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran Atiye Heidaridalfard Department of Obstetrics and Gynecology, Arash Women’s Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran Siamand Mazhar Department of Psychiatry, Roozbeh Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran Rana Karimi Department of Obstetrics and Gynecology, Arash Women’s Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran 2025 08 31 2026 08 05 Objective: The global prevalence of smoking among women of reproductive age is significant, and the impact of tobacco on assisted reproductive technologies requires evaluation. This study aimed to determine the association between cigarette or hookah smoking with in vitro fertilization (IVF) outcomes. Materials and methods: In this cross-sectional study, we enrolled 200 women undergoing their first IVF cycle at Arash Infertility Center (Tehran, Iran). Ovarian response, oocyte maturity (Metaphase I (MI) and II (MII), embryo quality, and pregnancy outcomes were compared between cigarette smokers and non-smokers, as well as between hookah users and non-users. Results: Among the 200 participants, cigarette smokers (n=100) had significantly fewer mature (MII) oocytes than non-smokers (6.72±2.90 vs. 8.63±6.20; P = 0.036).  Hookah users (n=100) did not show a significant decrease in the number of MII oocytes compared to non-smokers (8.06±5.81 vs. 8.73±6.12; P = 0.512). There were no significant differences in MI oocytes, embryos obtained, embryo quality, or chemical and clinical pregnancy rates between cigarette smokers and non-smokers. Hookah users had more MI oocytes compared to non-users (7.88±5.63 vs. 6.05±4.44; P = 0.010). The chemical pregnancy rate was higher in the hookah-user group than in non-users (P = 0.036). Logistic regression analysis showed no link between cigarette smoking, hookah smoking, age, or BMI and pregnancy rates. Conclusion: Cigarette smoking may impair oocyte maturation, while hookah use showed inconsistent associations with IVF outcomes. These findings should be interpreted cautiously due to the limited sample size and cross-sectional design. https://jfrh.tums.ac.ir/index.php/jfrh/article/view/3446 https://jfrh.tums.ac.ir/index.php/jfrh/article/download/3446/762