Tobacco smoking is a widely recognized health hazard and a major cause of preventable morbidity and mortality, but smoking remains prevalent in our society. Approximately 30% of women and 35% of men of reproductive age smoke. But more importantly, the incidence of smoking is increasing among adolescents and specifically teenage girls. Recently, substantial harmful effects of cigarette smoke on the ability to become pregnant have become apparent. Women who smoke take longer to achieve a natural pregnancy, require more hormonal stimulation during IVF treatment with reduced success, and reach menopause earlier than their non-smoking counterparts. Cigarette smoke constituents have been isolated at higher levels in the serum and follicular fluid of women exposed to mainstream (MS) and passive or sidestream (SS) smoke compared to non-smokers implying that cigarette smoke may act as an ovarian toxicant as one mechanism to disrupt female fertility. Cigarette smoke exposure may induce toxic effects and compromise fertility through several direct or indirect mechanisms.