The impact of hookah smoking on AMH levels in women: a pilot study

Hookah (water pipe) smoking, an ancient tobacco smoking method, is gaining widespread popularity worldwide. Although research in this field is still lacking, its harmful effect on human health through the increased risk of cardiovascular disease, infection, and cancer has been proven. Cigarette smoking has been found to have a detrimental effect on reproductive function. However, no data about the effect of hookah smoking on human fertility or reproductive outcomes are available. In this study, we aimed to determine if smoking hookah has a harmful effect on the human ovarian reserve test, anti-Mullerian hormone levels, and cycle regularity. A total of 100 healthy non-cigarette smoking women in the 25-35 age range undergoing laboratory investigations were randomly chosen to participate. After obtaining consent, they completed a questionnaire about smoking habits and menstrual data. Blood samples were withdrawn for anti-Mullerian hormone testing. The anti-Mullerian hormone levels of 50 women hookah-only smokers were compared to 50 non-smoking women. There were no significant differences in mean anti-Mullerian hormone levels and cycle regularity between hookah smokers and non-smokers. However, period pain was significantly associated with hookah smokers relative to non-smokers (p=0.036). According to the generalized linear model of Log10 AMH response, the Log10 smoking index had no significant effect (p-value=0.094). Moreover, binary logistic regression for cycle regularity showed that hookah smoking was associated with an increase in the likelihood of having an irregular cycle, but the effect was not significant (p=0.514) for hookah smoking . Under the conditions of this study, no significant association between hookah smoking and neither AMH levels nor cycle regularity could be observed.