National, regional, and global trends in infertility prevalence since 1990: a systematic analysis of 277 health surveys

Abstract

Background: Global, regional, and national estimates of prevalence of and tends in infertility are needed to target prevention and treatment efforts. By applying a consistent algorithm to demographic and reproductive surveys available from developed and developing countries, we estimate infertility prevalence and trends, 1990 to 2010, by country and region.

Methods and findings: We accessed and analyzed household survey data from 277 demographic and reproductive health surveys using a consistent algorithm to calculate infertility. We used a demographic infertility measure with live birth as the outcome and a 5-y exposure period based on union status, contraceptive use, and desire for a child. We corrected for biases arising from the use of incomplete information on past union status and contraceptive use. We used a Bayesian hierarchical model to estimate prevalence of and trends in infertility in 190 countries and territories. In 2010, among women 20-44 y of age who were exposed to the risk of pregnancy, 1.9% (95% uncertainty interval 1.7%, 2.2%) were unable to attain a live birth (primary infertility). Out of women who had had at least one live birth and were exposed to the risk of pregnancy, 10.5% (9.5%, 11.7%) were unable to have another child (secondary infertility). Infertility prevalence was highest in South Asia, Sub-Saharan Africa, North Africa/Middle East, and Central/Eastern Europe and Central Asia. Levels of infertility in 2010 were similar to those in 1990 in most world regions, apart from declines in primary and secondary infertility in Sub-Saharan Africa and primary infertility in South Asia (posterior probability [pp] ≥0.99). Although there were no statistically significant changes in the prevalence of infertility in most regions amongst women who were exposed to the risk of pregnancy, reduced child-seeking behavior resulted in a reduction of primary infertility among all women from 1.6% to 1.5% (pp=0.90) and a reduction of secondary infertility among all women from 3.9% to 3.0% (pp>0.99) from 1990 to 2010. Due to population growth, however, the absolute number of couples affected by infertility increased from 42.0 million (39.6 million, 44.8 million) in 1990 to 48.5 million (45.0 million, 52.6 million) in 2010. Limitations of the study include gaps in survey data for some countries and the use of proxies to determine exposure to pregnancy.

Conclusions: We analyzed demographic and reproductive household survey data to reveal global patterns and trends in infertility. Independent from population growth and worldwide declines in the preferred number of children, we found little evidence of changes in infertility over two decades, apart from in the regions of Sub-Saharan Africa and South Asia. Further research is needed to identify the etiological causes of these patterns and trends.

Figure 1. Global prevalence of primary and secondary infertility in 2010, by the female partner's age.

Infertility is calculated as the percent of women who seek a child and as the percent of all women of reproductive age. The solid line represents the posterior mean, and the shaded area the 95% uncertainty interval.

Figure 2. Prevalence of primary infertility and secondary infertility, presented as the percent of women who seek a child, and as the percent of all women of reproductive age, in 1990 and 2010.

Infertility prevalence is indexed on the female partner; age-standardized prevalence among women aged 20–44 y is shown here. Horizontal lines indicate the 95% uncertainty interval.

Figure 3. Prevalence of primary infertility among women who seek a child, in 2010.

Infertility prevalence is indexed on the female partner; age-standardized prevalence among women aged 20–44 y is shown here.

Figure 4. Prevalence of secondary infertility among women who have had a live birth and seek another, in 2010.

Infertility prevalence is indexed on the female partner; age-standardized prevalence among women aged 20–44 y is shown here.

Figure 5. Absolute change in prevalence of primary and secondary infertility, measured as the percent of women who seek a child and as the percent of all women of reproductive age, between 1990 and 2010.

Infertility prevalence is indexed on the female partner; change in age-standardized prevalence among women aged 20–44 y is shown here. Horizontal lines indicate the 95% uncertainty interval.