The prevalence of couple infertility in the United States from a male perspective: evidence from a nationally representative sample

Abstract

Infertility is a couple-based fecundity impairment, although population level research is largely based upon information reported by female partners. Of the few studies focusing on male partners, most focus on the utilization of infertility services rather than efforts to estimate the prevalence and determinants of infertility as reported by male partners. Data from a nationally representative sample of men aged 15-44 years who participated in the 2002 National Survey of Family Growth (NSFG) were used to estimate the prevalence of infertility and determinants of longer time-to-pregnancy (TTP) using the novel current duration (CD) approach. Using backward recurrence time parametric survival methods, we estimated infertility prevalence (TTP > 12 months) and time ratios (TR) associated with TTP as derived from males' reported CD of their pregnancy attempt. The estimated prevalence of infertility was 12.0% (95% CI: 7.0, 23.2). Longer TTP was associated with older male age (35-45 vs. 17-24 years) (TR: 2.49; 95% CI: 1.03, 6.03), biological childlessness (TR: 1.53; 95% CI: 1.07, 2.19) and lack of health insurance (TR: 1.73; 95% CI: 1.02, 2.94) after controlling for the differences in couples' age and other socioeconomic factors. The prevalence of infertility based on male reporting is consistent with estimates of infertility in the US found in prospective cohort studies and CD studies based on female reporting. Our findings suggest that male partners can reliably inform about couple infertility. Interventions and services aimed at reducing couple infertility should include attention to male factors associated with longer TTP identified in this study.

FIGURE 1

Flow chart of men surveyed in the National Survey of Family Growth based on their eligibility for the current duration analysis. Footnotes ¹ n₁ pertains to men who reported they were married or living with a partner of the opposite sex; n₂ pertains to men with a recent (past 12 months) sexual partner who were not married or cohabiting, or who’s last partner was not the respondents wife who had died; n pertains to the total number of men with a current partner from each respective category (n = n₁+n₂). ² Includes n₁ = 13 and n₂ = 2 responding “Don’t Know” to the respective category. ³ Includes n₂ = 18 responding “Don’t Know” to the respective category; n₂ = 3 men reporting vasectomy as method of contraception at last sex. ⁴ Includes n₁ = 8 and n₂ = 3 responding “Don’t Know” or “Refuse” to the respective category. ⁵ Includes n₁ = 3 and n₂ = 1 responding “Don’t Know” or “Refuse” to the respective category.

FIGURE 2

Estimation of the proportion of couples not yet pregnant as a function of the number of months trying for pregnancy as reported by males (n = 157) in the National Survey of Family Growth. The solid curve is the weighted survival function censored at 30 months for the time until pregnancy or end of attempt and the dashed curves indicate 95% confidence intervals (CI).