Infertility prevalence and the methods of estimation from 1990 to 2021: a systematic review and meta-analysis

Abstract

STUDY QUESTIONS What is the contemporary prevalence of infertility in world populations and how do they differ by methodological and study characteristics? SUMMARY ANSWER Pooled estimates of lifetime and period prevalence of 12-month infertility were 17.5% and 12.6%, respectively, but this varied by study population and methodological approach. WHAT IS KNOWN ALREADY Infertility affects millions of individuals worldwide. Accurate measures of its magnitude are needed to effectively address and manage the condition. There are distinct challenges and variation in how infertility is defined and measured, limiting comparability of estimates across studies. Further research is needed to understand whether and how differences in methodological approaches and study characteristics account for heterogeneity in estimates. STUDY DESIGN, SIZE, DURATION We conducted a systematic review and meta-analysis. Six electronic databases, websites of relevant organizations, and conference proceedings were systematically searched. Searches were limited to those published between January 1, 1990 and March 11, 2021, with no language restrictions. PARTICIPANTS/MATERIALS, SETTING, METHODS Descriptive and random-effects meta-analysis models were used to examine range of estimates and generate estimates of pooled lifetime and period prevalence of 12-month infertility, respectively, among representative populations. Meta-regression using restricted maximum likelihood was applied to account for definitional and study characteristics and to obtain adjusted estimates. Risk of bias was assessed with a validated tool. MAIN RESULTS AND THE ROLE OF CHANCE The search yielded 12,241 unique records of which 133 studies met the criteria for the systematic review. There were 65 and 69 studies that provided data for lifetime and period prevalence of 12-month infertility, respectively. Five methodological approaches were identified: prospective time-to-pregnancy design (TTP), current duration design, retrospective TTP design, self-reported infertility measure, and constructed infertility measure. Ranges for lifetime (3.3 - 39.7%) and period estimates (1.6 - 34.0%) were similar and wide even after accounting for methodological and study characteristics. Pooled estimates of lifetime and period prevalence were 17.5% (95% CI: 15.0, 20.3, n = 37 studies, I2 = 99.5%) and 12.6% (95% CI: 10.7, 14.6, n = 43 studies, I2 = 99.8%), respectively, with some variation in magnitude by region and methodological approach, but with most confidence intervals overlapping. LIMITATIONS, REASONS FOR CAUTION Pooled estimates generated from meta-analysis were derived from 12-month infertility prevalence estimates that were heterogeneous across different domains, even after adjusting for definitional and study characteristics. The number of studies was small for certain strata from which pooled estimates were derived (e.g., there were only two studies for lifetime prevalence in Africa). WIDER IMPLICATIONS OF THE FINDINGS While findings show a high prevalence of infertility globally and regionally, it also reveals variation in measures to ascertain and compare infertility prevalence. More systematic and comprehensive collection of data using a consistent definition is needed to improve infertility prevalence estimates at global, regional and country-levels. STUDY FUNDING/COMPETING INTEREST(S) This work was supported by the World Health Organization. The authors have no conflicts of interest. REGISTRATION NUMBER PROSPERO CRD42020211704

Financial costs of assisted reproductive technology for patients in low- and middle-income countries: a systematic review

“…The provision of infertility treatment is a complex issue that is compounded by a lack of political will to prioritize infertility, particularly in the context of other health problems such as high rates of maternal morbidity and mortality, unmet needs in contraception, vaccine preventable diseases, and emerging infectious diseases, which are deemed more important. However, infertility is itself a widely prevalent cause of significant health burden for millions of people ( Makuch et al , 2010 ; Mascarenhas et al , 2012 ; Cox et al , 2022 ) that should be the addressed alongside other health needs to achieve universal health coverage ( Starrs et al , 2018 ). The results of this review add to the calls for governments in LMICs to increase investments in the provision of fertility treatment, by better integrating infertility in the national health policy and financing ( WHO, 2020 ; Connolly et al , 2021 ).…”

“…While reported prevalence estimates vary widely due to different methodologies, global estimates show that between 48.5 and 72.4 million couples have infertility ( Boivin et al , 2007 ; Mascarenhas et al , 2012 ). The prevalence of infertility among reproductive-aged couples ranges between 12.6% and 17.5% worldwide, with relatively higher prevalence rates in some regions such as the Americas, Western Pacific, African, and European regions ( Cox et al, 2022 ). Regional disparities in prevalence reflect differences in sexual and reproductive health and rights and differences in access to and quality of health care, which, in turn, are further influenced by environmental, cultural, and societal factors ( Ombelet, 2011 ).…”

“If I use family planning, I may have trouble getting pregnant next time I want to”: A multicountry survey-based exploration of perceived contraceptive-induced fertility impairment and its relationship to contraceptive behaviors

“…These nationally and regionally representative results underscore the importance of efforts to address beliefs about contraception, while also recognizing women’s legitimate concerns about potential delayed conception following use of certain methods. The repercussions of these beliefs on contraceptive behaviors are perhaps not surprising in contexts where pressure to bear children is significant and where infertility is common and often goes untreated given a dearth of services [13] , [24] , [25] , [26] . Approaches to fully support women in achieving their reproductive goals need to expand beyond pregnancy prevention and consider women’s fertility concerns, accounting for the local representations of health, fertility, and pregnancy that inform contraceptive decisions [27] .…”

Ethical issues surrounding the use of assisted reproductive technologies in Ghana: An analysis of the experiences of clients and service providers

“…It is estimated that 8%–12% of couples in their reproductive years are infertile [ 1 ], which corresponds to 50–80 million people worldwide. Also, lifetime and period prevalence estimates of 12-month infertility were 17.5% and 12.6%, respectively, according to Cox et al [ 2 ]; however, this varied by study population and methodological approach. Prior to 2010, the World Health Organization projected that 48.5 million individuals worldwide experienced infertility, but it is now believed that as many as 186 million people worldwide suffer from infertility [ 3 ].…”