Feng Jiale, Wu Qingguo, Liang Yangbing, Liang Yiwen, Bin Qin
Urology Department, Gui Gang People's Hospital, Eighth Affiliated Hospital of Guangxi Medical University, Guigang, 537100, Guangxi Zhuang Autonomous Region, China.
Reprod Health. 2025 Feb 19;22(1):26. doi: 10.1186/s12978-025-01966-7.
Infertility, defined as the inability to achieve pregnancy after 1 year of regular unprotected intercourse, affects approximately 186 million people globally, with consistent prevalence across different income levels. Globally, the rising infertility rates are impacting population growth and individual quality of life. Infertility is not just a personal issue but also a public health concern, with social and economic implications, including stigmatization, marital discord, and mental strain. The COVID-19 pandemic has further exacerbated mental health issues among individuals with infertility, underscoring the need for research into the mental health impacts and access to fertility services. Economically, infertility poses a significant financial burden, especially in regions where Assisted Reproductive Technology (ART) costs can be up to 200% of the GDP per capita. Understanding the complexities and spread of infertility is essential for guiding policy decisions and program rollouts, with studies analyzing infertility issues based on the Global Burden of Disease (GBD) database.
The study leverages data from the GBD 2021, encompassing 371 conditions or injuries and 88 risk factors across 204 nations. It examines prevalence, disability-adjusted life years (DALYs), age-standardized prevalence rate (ASPR), and age-standardized DALYs rate (ASDR) for infertility, categorized by sex, age, regions, and nations. The Social and Demographic Index (SDI), reflecting socio-economic levels, is used to analyze its correlation with infertility burden. The study employs decomposition analysis and frontier analysis methods to assess changes in infertility prevalence and DALYs, and Spearman's rank correlation coefficient to confirm relationships between age-standardized rates (ASRs) and SDI. The estimated annual percentage change (EAPC) of rates, with 95% confidence intervals (CIs), was calculated.
In 2021, it was calculated that the global ASPR for male infertility stood at 1354.76 cases per 100,000 individuals, with a 95% Uncertainty Interval ranging from 802.12 to 2174.77 cases per 100,000 individuals. For female infertility, the ASPR was recorded at 2764.62 per 100,000 individuals (95% UI: 1476.33-4862.57 per 100,000 individuals). Between 1990 and 2021, the EAPC in ASPR was observed to be 0.5% (95% CI 0.36-0.64) for males and 0.7% (95% CI 0.53-0.87) for females. In that same year, the global ASDR attributed to male infertility was 7.84 per 100,000 individuals (95% UI: 2.85-18.56 per 100,000 individuals), while for female infertility, it amounted to 15.12 per 100,000 individuals (95% UI: 5.35-36.88 per 100,000 individuals). The EAPC for ASDR linked to male and female infertility from 1990 to 2021 was assessed at 0.51% (95% CI 0.38-0.65) and 0.71% (95% CI 0.54-0.88), respectively. Among the 204 countries and territories in 2021, India ranked first in both the prevalence of cases and DALYs associated with male and female infertility, followed by China and Indonesia. Additionally, the investigation revealed a slight negative correlation between the ASPR and ASDR of infertility and the SDI. Decomposition analysis indicated that approximately 65% of the rise in the global burden of infertility could be attributed to population growth. Frontier analysis suggested that the variations in efficiency frontiers across specific SDI levels diminish as the SDI increases. Looking forward, the study projects a global rise in ASPR and ASDR for infertility between 2022 and 2036.
The worldwide prevalence of infertility has substantially increased between 1990 and 2021, largely as a result of population growth. This trend highlights the pressing necessity for better strategies concerning prevention, diagnosis, and treatment, particularly in low and middle-income nations. Strengthening healthcare infrastructures, enhancing access to high-quality medical services, and raising awareness about infertility are vital measures to tackle this issue. The results of the study offer essential information to help policymakers and health officials formulate targeted strategies for the prevention and management of infertility.
不孕症定义为在规律无保护性交1年后仍无法怀孕，全球约有1.86亿人受其影响，不同收入水平的患病率较为一致。在全球范围内，不断上升的不孕率正在影响人口增长和个人生活质量。不孕症不仅是个人问题，也是一个公共卫生问题，具有社会和经济影响，包括污名化、婚姻不和以及精神压力。新冠疫情进一步加剧了不孕症患者的心理健康问题，凸显了对心理健康影响和获得生育服务进行研究的必要性。在经济方面，不孕症带来了巨大的经济负担，特别是在辅助生殖技术（ART）成本可能高达人均国内生产总值200%的地区。了解不孕症的复杂性和传播情况对于指导政策决策和项目推广至关重要，已有研究基于全球疾病负担（GBD）数据库分析不孕症问题。
该研究利用了GBD 2021的数据，涵盖204个国家的371种疾病或损伤以及88种风险因素。它按性别、年龄、地区和国家对不孕症的患病率、伤残调整生命年（DALYs）、年龄标准化患病率（ASPR）和年龄标准化DALYs率（ASDR）进行了研究。反映社会经济水平的社会人口指数（SDI）用于分析其与不孕症负担的相关性。该研究采用分解分析和前沿分析方法来评估不孕症患病率和DALYs的变化，并使用斯皮尔曼等级相关系数来确认年龄标准化率（ASRs）与SDI之间的关系。计算了比率的估计年度百分比变化（EAPC）及其95%置信区间（CIs）。
2021年，计算得出全球男性不孕症的年龄标准化患病率为每10万人1354.76例，95%不确定区间为每10万人802.12至2174.77例。女性不孕症的年龄标准化患病率为每10万人2764.62例（95%不确定区间：每10万人1476.33至4862.57例）。1990年至2021年期间，男性年龄标准化患病率的EAPC为0.5%（95% CI 0.36 - 0.64），女性为0.7%（95% CI 0.53 - 0.87）。同年，全球男性不孕症归因的年龄标准化DALYs率为每10万人7.84（95%不确定区间：每10万人2.85至18.56），女性为每10万人15.12（95%不确定区间：每10万人5.35至36.88）。1990年至2021年与男性和女性不孕症相关的年龄标准化DALYs率的EAPC分别评估为0.51%（95% CI 0.38 - 0.65）和0.71%（95% CI 0.54 - 0.88）。在2021年的204个国家和地区中，印度在与男性和女性不孕症相关的病例患病率和DALYs方面均排名第一，其次是中国和印度尼西亚。此外，调查显示不孕症的年龄标准化患病率和年龄标准化DALYs率与社会人口指数之间存在轻微负相关。分解分析表明，全球不孕症负担增加的约65%可归因于人口增长。前沿分析表明，随着社会人口指数的增加，特定社会人口指数水平上效率前沿的差异会减小。展望未来，该研究预测2022年至2036年全球不孕症的年龄标准化患病率和年龄标准化DALYs率将上升。
1990年至2021年期间，全球不孕症患病率大幅上升，主要是由于人口增长。这一趋势凸显了制定更好的预防、诊断和治疗策略的迫切必要性，特别是在低收入和中等收入国家。加强医疗基础设施、增加获得高质量医疗服务的机会以及提高对不孕症的认识是解决这一问题的关键措施。该研究结果为政策制定者和卫生官员制定不孕症预防和管理的针对性策略提供了重要信息。
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