Global, Regional, and National Prevalence and Disability-Adjusted Life-Years for Female Infertility: Results from a Global Burden of Disease Study, 1990-2019

Abstract

Objectives: We aimed to determine the prevalence of female infertility in 204 countries and territories from 1990 to 2019.

Design: We evaluated the female infertility global burden between 1990 and 2019 in this systematic study.

Materials: The Global Health Data Exchange query tool (http://ghdx.healthdata.org/gbd-results-tool) and sociodemographic index (SDI) (http://ghdx.healthdata.org/data-type/estimate) provided data on the annual prevalence numbers, age-standardized prevalence rates (ASR), and disability-adjusted life-years (DALYs) of female infertility in 204 countries and territories from 1990 to 2019 for various age groups.

Setting: Female infertility has a devastating impact on the physical and mental health of individuals and national fertility. However, most of the previous studies on this subject were conducted on rather small sample sizes and have certain limitations.

Methods: We examined female infertility in terms of prevalence, ASR, and DALYs across different age groups in 204 countries and territories from 1990 to 2019 using data from the Global Health Data Exchange query tool.

Results: From 1990 to 2019, ASR and DALYs for female infertility increased globally. At the SDI quintile level, middle-SDI and high-middle-SDI countries exhibited a faster increase in the ASR of female infertility. In 2019, with the highest female infertility rate recorded among those between the ages of 30-34 years and the lowest among those between the ages of 45-49 years. In 2019, high-income North America recorded the highest proportion of primary infertility, while East Asia recorded the lowest proportion.

Limitations: First, the global burden of disease (GBD) database lacks data for some countries and regions. Second, data access and quality differ across locations. Third, the causes of infertility are not comprehensive, and data on Klinefelter in GBD 2019 in relation to primary infertility were absent.

Conclusion: Globally, the prevalence of DALYs and age-standardized female infertility rates increased from 1990 to 2019.

Keywords: Disability-adjusted life-years; Female infertility; Global burden of disease study; Prevalence; Sociodemographic index.

Fig. 1.

Trends in global disease burden of female infertility prevalence from 1990 to 2019. a Trends in global disease burden of female infertility prevalence by SDI from 1990 to 2019. b Trends in global disease burden of female infertility prevalence by region from 1990 to 2019.

Fig. 2.

Trends in global disease burden of female infertility DALYs from 1990 to 2019. a Trends in global disease burden of female infertility DALYs by sociodemographic index from 1990 to 2019. b Trends in global disease burden of female infertility DALYs by region from 1990 to 2019.

Fig. 3.

Trends in global disease burden of female infertility prevalence and DALYs in age groups from 20 to 49 years old from 1990 to 2019. a Prevalence. b DALYs.

Fig. 4.

Global disease burden of female infertility prevalence in 204 countries and territories. a The percentage change in age-standardized prevalence of female infertility between 1990 and 2019. b The estimated annual percentage change (EAPC) of female infertility age-standardized prevalence from 1990 to 2019.

Fig. 5.

Female infertility age-standardized prevalence rate and its proportion by etiologies. a Primary infertility age-standardized prevalence rate and its proportion in different SDI regions and countries by etiologies in 1990 and 2019. b Secondary infertility age-standardized prevalence rate and its proportion in different countries and SDI regions by etiologies in 1990 and 2019. c The proportion of primary infertility and secondary infertility for female infertility in different SDI regions and geographical regions in 1990 and 2019.

Fig. 6.

Coevolution of age-standardized burden estimates with SDI and for GBD regions for female infertility from 1990 to 2019. a Prevalence. b DALYs. Colored lines show region values for age-standardized burden estimate rates. Each point in a line represents 1 year, starting in 1990 and ending in 2019. The black line represents the average expected relationship between SDI and burden estimate rates for female infertility based on values from each region in the 1990–2019 estimation period.