Introduction Physical activity and energy state balance have fundamentally been related to reproductive system and health. This study explored the relationship between different types, intensities and frequencies of physical activity with primary infertility among women in Gaza Strip, Palestine. Methods A case-control study was conducted in Gaza Strip with the participation of 320 married couples. 160 infertile couples were chosen from five fertility centers registries from 2016 to 2018 and matched residentially with 160 fertile couples. Cases were selected through systematic stratified sampling of five lists categorized according to residency and the determined percentage selected from each list was proportional. Data were collected through a self-administered questionnaire extended by the short form of international physical activity questionnaire and analyzed through SPSS program version 22 by using descriptive analysis, independent T-test, cross-tabulation, and binary logistic regression. Results Low frequency, intensity and duration of physical activity were associated with 3.1 risk of primary infertility (95% CI, 1.60–5.99, P < 0.001). Adjustment for age, marital age, age of menarche, refugee status and monthly income provided 3.2 risk (95% CI, 1.55–6.60, P = 0.002). Women spending more than 300 minutes a day sedentarily were 2.3 times more likely to have fertility problems than physically active females. Measuring energy expenditure in MET-min/w (Metabolic Equivalent) showed vigorous MET-min/w as negatively associated with the infertility status of females (Interquartile range IQR: 480 for cases and 720 for controls, P = 0.010). On the basis of energy expended in kilocalories in relation to weight, results showed the same association (IQR: 564 for case and 864 for controls, P = 0.011). No associations were found between moderate activity levels and primary infertility. Conclusion Low levels of physical activity and sedentary lifestyle endanger the fertility status of females in Gaza Strip. This may offer the need for endorsing and formalizing adequate physical activity education and awareness protocols in the national reproductive health guidelines and empowering environmental capacity building to alter physical activity-related cultural norms.

<b><i>Introduction:</i></b> Tobacco smoking is constantly increasing mainly in developing countries and accounts for many morbidities and mortalities. Several studies have addressed the effect of smoking on male reproductive mechanism, particularly semen quality, but the effect of smoking behavior remained inconclusive. The aim of this study was to explore the relationship of tobacco smoking status, intensity, and duration between infertile and fertile men and other accompanying genitourinary conditions. <b><i>Methods:</i></b> Through a case-control study, 160 infertile couples were recruited from in vitro fertilization centers in Gaza Strip. Correspondingly, another 160 fertile couples were selected from governmental clinics and residentially matched with cases. The probable stratified random technique for 2017/2018 patient’s registries was performed. Both cases and controls were interviewed with a self-constructed questionnaire. Descriptive analysis, logistic regression, and the Cochran-Mantel-Haenszel test were deployed statistically with a significant level set on <i>p</i> = 0.05. <b><i>Results:</i></b> The mean age of cases and controls was 35.7 ± 10 and 34.9 ± 5 years, respectively, where 70 and 59%, respectively, were refugees; 52 and 43%, respectively, had university education; and 10.6% compared to 5.6%, respectively, earn &#x3e;USD 720/month. Active smoking was detected among 38% of infertile men and 42.5% of fertile men. Nevertheless, passive smoking (52.5% infertile and 37.5% fertile) and smoking duration &#x3e;2 years (85.2% infertile and 69.1% fertile) showed a positive significant relationship (<i>p</i> = 0.007 and <i>p</i> = 0.030, respectively). Furthermore, 34 and 49% of all infertile smokers showed a dose-dependent effect (odds ratio [OR]: 2.98, <i>p</i> = 0.023 for 6–10 cig/day and OR: 3.68, <i>p</i> = 0.004 for &#x3e;10 cig/day), mainly in nonobstructive causes (OR: 4.26, <i>p</i> = 0.040 for 6–10 cig/day and OR: 5.52, <i>p</i> = 0.004 for &#x3e;10 cig/day). Varicocele was more likely to occur among passive smokers (<i>p</i> = 0.024), smoking &#x3e;10 cig/day (<i>p</i> = 0.038), and for &#x3e;2 years (<i>p</i> = 0.024). Recurrent genitourinary tract infection was 3 times more among infertile passive smokers (OR: 2.96, 95% confidence interval: 1.38–6.32, and <i>p</i> = 0.005). Adjustment for age and refugee status showed 3.5 times risk for passive smoking, more than 9 times risk for former smokers, and 2.8 risk when smoking &#x3e;5 cig/day. <b><i>Conclusion:</i></b> Smoking more than 5 cigarettes/day and for &#x3e;2 years duration or exposure to passive smoking hold an increased risk on the fertility status of men. More global and national efforts need to be directed to controlling and eliminating tobacco smoking.