Liang Yuanhao, Huang Jing, Zhao Qiang, Mo Haixin, Su Zhaohong, Feng Suihua, Li Shuzhen, Ruan Xiaohong
Clinical Experimental Center, Jiangmen Engineering Technology Research Center of Clinical Biobank and Translational Research, Jiangmen Central Hospital, Jiangmen, China.
Department of Obstetrics and Gynecology, Clinical Transformation and Application Key Lab for Obstetrics and Gynecology, Pediatrics, and Reproductive Medicine of Jiangmen, Jiangmen Central Hospital, Jiangmen, China.
Hum Reprod. 2025 Mar 1;40(3):529-544. doi: 10.1093/humrep/deae292.
What is the prevalence and trend of infertility among individuals of childbearing age at global, regional, and national levels by sex and socio-demographic index (SDI) across 21 regions and 204 countries and territories?
Our findings reveal a growing prevalence of infertility among individuals aged 15-49 years worldwide from 1990 to 2021, with an expected continued increase through 2040.
Infertility is a persistent global reproductive health issue, leading to significant societal and health consequences. No study has specifically described the current prevalence of infertility, its secular trend, or the variations between regions or countries with different SDI levels.
STUDY DESIGN, SIZE, DURATION: A sex- and SDI-stratified systematic analysis of the prevalence of infertility across 21 regions and 204 countries and territories from 1990 to 2021 has been performed.
PARTICIPANTS/MATERIALS, SETTING, METHODS: We retrieved data from the Global Burden of Disease Study (GBD) 2021 on the count and crude rate of infertility prevalence for individuals aged 15-49 years across 204 countries and territories from 1990 to 2021. In the GBD 2021 framework, infertility is defined as the absence of a live birth in a couple who have been in a union for at least 5 years and are actively trying to conceive, or in a couple who have been in a union for at least 5 years since their last live birth, with no use of contraceptives during this period. Estimated annual percent change was calculated to quantify the temporal trend in age-standardized prevalence rates (ASPRs) for infertility by sex, age, and SDI. The Bayesian age-period-cohort model was used to project the ASPRs from 2022 to 2040.
In 2021, an estimated 55 000 818 men and 110 089 459 women were living with infertility worldwide, corresponding to approximately 1820.6 cases per 100 000 population (1.8%) for males and 3713.2 cases per 100 000 population (3.7%) for females. Regionally, the highest infertility prevalence was observed in middle SDI regions, such as East and South Asia and Eastern Europe. Infertility primarily affected the age group of 35-39 years and females in most regions, with some notable exceptions. Between 1990 and 2021, the global ASPRs of infertility increased by an average of 0.49% (95% CI 0.34-0.63) for males and 0.68% (0.51-0.86) for females. Additionally, the fastest increase in female infertility occurred in high SDI regions, while the most significant rise in male infertility was seen in low-middle SDI areas. Furthermore, the global ASPR of male infertility is projected to rise more rapidly than that of female infertility from 2022 to 2040.
LIMITATIONS, REASONS FOR CAUTION: The primary data sources for the infertility burden in the GBD 2021 are population-based surveys; however, less-developed regions often lack complete population-based statistics, leading to potential reporting bias of the infertility burden in these areas due to data sparsity and incompleteness. Additionally, this study could not separately assess the prevalence and trends of primary and secondary infertility. Furthermore, the GBD 2021 does not provide the attributable proportion of each cause of infertility; hence, we cannot compare the contribution of these causes to infertility by sex, age, and location.
Sexual and reproductive health are crucial for individuals' health, economic development, and overall human wellbeing. It is essential for governments and the public to recognize the severity of infertility and prioritize the implementation of targeted interventions to enhance reproductive health.
STUDY FUNDING/COMPETING INTEREST(S): This study was supported by the grants from the Science and Technology Project of Jiangmen (2020030103110009027). The authors have declared no conflict of interest.
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在全球、区域和国家层面，按性别和社会人口指数（SDI）划分，21个地区以及204个国家和地区中育龄人群的不孕不育患病率及趋势如何？
我们的研究结果显示，1990年至2021年期间，全球15至49岁人群的不孕不育患病率呈上升趋势，预计到2040年还会持续增加。
不孕不育是一个长期存在的全球性生殖健康问题，会导致重大的社会和健康后果。此前尚无研究专门描述不孕不育的当前患病率、长期趋势，或不同SDI水平的地区或国家之间的差异。
研究设计、规模、持续时间：对1990年至2021年期间21个地区以及204个国家和地区的不孕不育患病率进行了按性别和SDI分层的系统分析。
研究对象/材料、地点、方法：我们从《2021年全球疾病负担研究》（GBD 2021）中获取了1990年至2021年期间204个国家和地区15至49岁人群不孕不育的病例数和粗患病率数据。在GBD 2021框架中，不孕不育被定义为：夫妻双方在一起至少5年且积极尝试受孕但未生育活产婴儿；或夫妻双方自上次生育活产婴儿后在一起至少5年，在此期间未使用避孕措施。计算了估计的年度百分比变化，以量化按性别、年龄和SDI划分的不孕不育年龄标准化患病率（ASPR）的时间趋势。使用贝叶斯年龄-时期-队列模型预测了2022年至2040年的ASPR。
2021年，全球估计有55000818名男性和110089459名女性患有不孕不育症，男性患病率约为每10万人1820.6例（1.8%），女性患病率约为每10万人3713.2例（3.7%）。在区域层面，中等SDI地区（如东亚、南亚和东欧）的不孕不育患病率最高。在大多数地区，不孕不育主要影响35至39岁年龄组及女性，但也有一些明显例外。1990年至2021年期间，全球男性不孕不育的ASPR平均每年增加0.49%（95%置信区间0.34 - 0.63），女性为0.68%（0.51 - 0.86）。此外，高SDI地区女性不孕不育患病率增长最快，而低-中等SDI地区男性不孕不育患病率上升最为显著。此外，预计2022年至2040年全球男性不孕不育的ASPR增长速度将快于女性。
局限性、谨慎原因：GBD 2021中不孕不育负担的主要数据来源是基于人群的调查；然而，欠发达地区往往缺乏完整的基于人群的统计数据，由于数据稀少和不完整，这些地区的不孕不育负担可能存在报告偏差。此外，本研究无法分别评估原发性和继发性不孕不育的患病率及趋势。此外，GBD 2021未提供不孕不育各病因的归因比例；因此，我们无法比较这些病因按性别、年龄和地点对不孕不育的贡献。
性与生殖健康对个人健康、经济发展和人类整体福祉至关重要。政府和公众必须认识到不孕不育问题的严重性，并优先实施有针对性的干预措施，以促进生殖健康。
研究资金/利益冲突：本研究得到江门市科技项目（2020030103110009027）的资助。作者声明无利益冲突。
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