Assessing and projecting the global impacts of female infertility: a 1990–2040 analysis from the Global Burden of Disease study
Hanjin Wang A # and Bengui Jiang
A
# These authors contributed equally to this paper
Handling Editor: Ian Simms
Abstract
This study aims to assess the global burden of female infertility from 1990 to 2040.
Data on disability-adjusted life years associated with female infertility were sourced from the Global Burden of Disease 2021 study. Generalized additive models were utilized to predict trends for the period spanning from 2022 to 2040.
The global burden of female infertility is expected to increase significantly, with the age-standardized disability-adjusted life year rate projected to reach 19.92 (95% uncertainty interval (UI): 18.52, 21.33) by 2040. The projected estimated annual percentage change (EAPC) for the age-standardized disability-adjusted life year rate from 2022 to 2040 is expected to be 1.42, with a 95% confidence interval (CI) of 1.3951–1.4418. This is in contrast to the EAPC of 0.71 (95% CI: 0.5391–0.8789) observed from 1990 to 2021. Central sub-Saharan Africa is projected to have the highest age-standardized rate at 29.37 (95% UI: 24.58–34.16), whereas Australasia is expected to have the lowest at 0.78 (95% UI: 0.72–0.84). Age-specific projections show a consistent decline in infertility rates across all age groups. Countries such as Kenya, Chad and Peru exhibit EAPCs exceeding 9.00, whereas Mali and South Africa show significant negative EAPCs. Correlation analysis indicates that regions with a higher sociodemographic index generally have lower female infertility burdens, with notable trends observed in Europe and Asia.
The projected global burden of female infertility is expected to increase significantly from 2021 to 2040, with notable regional disparities. Central sub-Saharan Africa and south Asia are anticipated to experience higher burdens, whereas overall rates are projected to decrease across different age groups.
Keywords: age-standardized rates, disability-adjusted life years, estimated annual percentage change, female infertility, global burden of disease, prediction, reproductive health, sociodemographic index (SDI).
References
1 Collaborators. Infertility. East Afr Med J 1989; 66(7): 425-6.
| Google Scholar |
2 The Practice Committee of the American Society for Reproductive Medicine. Aging and infertility in women. Fertil Steril 2006; 86(5 Suppl 1): S248-52.
| Crossref | Google Scholar |
3 WHO. Infertility; 2024. Available at https://www.who.int/news-room/fact-sheets/detail/infertility [cited 23 January 2025]
4 Borumandnia N, Majd HA, Khadembashi N, et al. Assessing the trend of infertility rate in 198 countries and territories in last decades. Iran J Publ Health 2021; 50(8): 1735-7.
| Crossref | Google Scholar | PubMed |
5 Nik Hazlina NH, Norhayati MN, Shaiful Bahari I, et al. Worldwide prevalence, risk factors and psychological impact of infertility among women: a systematic review and meta-analysis. BMJ Open 2022; 12(3): e057132.
| Crossref | Google Scholar | PubMed |
6 Farquhar CM, Bhattacharya S, Repping S, et al. Female subfertility. Nat Rev Dis Primers 2019; 5(1): 7.
| Crossref | Google Scholar | PubMed |
7 GBD 2021 Fertility and Forecasting Collaborators. Global fertility in 204 countries and territories, 1950–2021, with forecasts to 2100: a comprehensive demographic analysis for the Global Burden of Disease Study 2021. Lancet 2024; 403(10440): 2057-99.
| Crossref | Google Scholar |
8 Adachi T. [Female infertility]. Nihon Rinsho 2002; 60(Suppl 4): 591-4.
| Google Scholar |
9 Boivin J, Bunting L, Collins JA, Nygren KG. International estimates of infertility prevalence and treatment-seeking: potential need and demand for infertility medical care. Hum Reprod 2007; 22(6): 1506-12.
| Crossref | Google Scholar |
10 GBD 2021 Risk Factors Collaborators. Global burden and strength of evidence for 88 risk factors in 204 countries and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021. Lancet 2024; 403(10440): 2162-203.
| Crossref | Google Scholar |
11 Chakravarty BN, Dastidar SG. Unexplained infertility. J Indian Med Assoc 2001; 99(8): 414-5, 417.
| Google Scholar | PubMed |
12 Cheung AP. Clinical approach to female reproductive problems. Occup Med 1994; 9(3): 415-22.
| Google Scholar | PubMed |
13 Yu J, Fu Y, Zeng L, et al. Burden of female infertility in China from 1990 to 2019: a temporal trend analysis and forecasting, and comparison with the global level. Sex Health 2023; 20(6): 577-84.
| Crossref | Google Scholar | PubMed |
14 Wang Y, Wang W, Li H, et al. Trends in the burden of female infertility among adults aged 20–49 years during 1990–2019: an analysis of data from the Global Burden of Disease Study 2019. BMJ Open 2024; 14(7): e084755.
| Crossref | Google Scholar | PubMed |
15 GBD 2015 Eastern Mediterranean Region Diabetes and Chronic Kidney Disease Collaborators. Diabetes mellitus and chronic kidney disease in the Eastern Mediterranean Region: findings from the Global Burden of Disease 2015 study. Int J Public Health 2018; 63(Suppl 1): 177-86.
| Crossref | Google Scholar |
16 GBD 2017 Causes of Death Collaborators. Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 2018; 392(10159): 1736-88.
| Crossref | Google Scholar | PubMed |
17 Yao Y, Qin M, Chen Y, Huang R, Yang Y, Lu N, Wang H. Analysis of risk factors related to female infertility and countermeasures. J Kunm Med Univ 2024; 45(9): 103-09.
| Crossref | Google Scholar |
18 Braverman AM, Davoudian T, Levin IK, et al. Depression, anxiety, quality of life, and infertility: a global lens on the last decade of research. Fertil Steril 2024; 121(3): 379-83.
| Crossref | Google Scholar | PubMed |
19 Njagi P, Groot W, Arsenijevic J, et al. Financial costs of assisted reproductive technology for patients in low- and middle-income countries: a systematic review. Hum Reprod Open 2023; 2023(2): hoad007.
| Crossref | Google Scholar |
20 Klein Meuleman SJM, Post B, Vissers J, et al. Uterine niches and infertility: challenge for the future. Fertil Steril 2023; 119(5): 893.
| Crossref | Google Scholar | PubMed |
21 Sun H, Gong TT, Jiang YT, et al. Global, regional, and national prevalence and disability-adjusted life-years for infertility in 195 countries and territories, 1990–2017: results from a global burden of disease study, 2017. Aging 2019; 11(23): 10952–91. 10.18632/aging.102497
22 Carson SA, Kallen AN. Diagnosis and management of infertility: a review. JAMA 2021; 326(1): 65-76.
| Crossref | Google Scholar | PubMed |
23 Malíčková K, Ambrusová Z, Belvončíková S, et al. Current possibilities of diagnostics and treatment of immunological causes of female infertility. Cas Lek Cesk 2021; 160(1): 5-13.
| Google Scholar | PubMed |
24 Fidler AT, Bernstein J. Infertility: from a personal to a public health problem. Public Health Rep 1999; 114(6): 494-511.
| Crossref | Google Scholar | PubMed |
25 Shi YW, Wang Q, Qi D. Frontier research hotspot and progress in assisted reproductive technology. J Shandong Univ 2021; 59(9): 97-102.
| Google Scholar |