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Global prevalence of infertility, infecundity and childlessness

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Global prevalence of infertility, infecundity and childlessness

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Global infertility prevalence rates are difficult to determine, due to the presence of both male and female factors which complicate any estimate which may only address the woman and an outcome of a pregnancy diagnosis or live birth.

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Infertility is a disease of the male or female reproductive system defined by the failure to achieve a pregnancy after 12 months or more of regular unprotected sexual intercourse.

Infertility affects millions of people of reproductive age worldwide – and has an impact on their families and communities. Estimates suggest that between 48 million couples and 186 million individuals live with infertility globally.

In the male reproductive system, infertility is most commonly caused by problems in the ejection of males, absence or low levels of sperm, or abnormal shape (morphology) and movement (motility) of the sperm.

In the female reproductive system, infertility may be caused by a range of abnormalities of the ovaries, uterus, fallopian tubes, and endocrine system, among others.

Infertility can be primary or secondary. Primary infertility is when a pregnancy has never been achieved by a person, and secondary infertility is when at least one prior pregnancy has been achieved.

Fertility care encompasses the prevention, diagnosis, and treatment of infertility. Equal and equitable access to fertility care remains a challenge in most countries; particularly in low and middle-income countries. Fertility care is rarely prioritized in national universal health coverage benefit packages.

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Infertility may be caused by a number of different factors, in either the male or female reproductive systems. However, it is sometimes not possible to explain the causes of infertility.

In the female reproductive system, infertility may be caused by:

Tubal disorders such as blocked fallopian tubes, which are in turn caused by untreated sexually transmitted infections (STIs) or complications of unsafe abortion, postpartum sepsis or abdominal/pelvic surgery;

Uterine disorders which could be inflammatory in nature (such as such endometriosis), congenital in nature (such as septate uterus), or benign in nature (such as fibroids);

Disorders of the ovaries, such as polycystic ovarian syndrome and other follicular disorders;

Disorders of the endocrine system causing imbalances of reproductive hormones. The endocrine system includes hypothalamus and the pituitary glands. Examples of common disorders affecting this system include pituitary cancers and hypopituitarism.

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Availability, access, and quality of interventions to address infertility remain a challenge in most countries. Diagnosis and treatment of infertility is often not prioritized in national population and development policies and reproductive health strategies and are rarely covered through public health financing. Moreover, a lack of trained personnel and the necessary equipment and infrastructure, and the currently high costs of treatment medicines, are major barriers even for countries that are actively addressing the needs of people with infertility.

While assisted reproduction technologies (ART) have been available for more than three decades, with more than 5 million children born worldwide from ART interventions such as in vitro fertilization (IVF), these technologies are still largely unavailable, inaccessible and unaffordable in many parts of the world, particularly in low and middle-income countries (LMIC).

Government policies could mitigate the many inequities in access to safe and effective fertility care. To effectively address infertility, health policies need to recognize that infertility is a disease that can often be prevented, thereby mitigating the need for costly and poorly accessible treatments. Incorporating fertility awareness in national comprehensive sexuality education programmes, promoting healthy lifestyles to reduce behavioral risks, including prevention, diagnosis and early treatment of STIs, preventing complications of unsafe abortion, postpartum sepsis and abdominal/pelvic surgery, and addressing environmental toxins associated with infertility, are policy and programmatic interventions that all governments can implement.

In addition, enabling laws and policies that regulate third party reproduction and ART are essential to ensure universal access without discrimination and to protect and promote the human rights of all parties involved. Once fertility policies are in place, it is essential to ensure that their implementation is monitored, and the quality of services is continually improved.

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Why addressing infertility is important?

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Why addressing infertility is important?

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Every human being has a right to the enjoyment of the highest attainable standard of physical and mental health. Individuals and couples have the right to decide the number, timing and spacing of their children. Infertility can negate the realization of these essential human rights. Addressing infertility is therefore an important part of realizing the right of individuals and couples to found a family.

A wide variety of people, including heterosexual couples, same-sex partners, older persons, individuals who are not in sexual relationships and those with certain medical conditions, such as some HIV sero-discordant couples and cancer survivors, may require infertility management and fertility care services. Inequities and disparities in access to fertility care services adversely affect the poor, unmarried, uneducated, unemployed and other marginalized populations.

Addressing infertility can also mitigate gender inequality. Although both women and men can experience infertility, women in a relationship with a man are often perceived to suffer from infertility, regardless of whether they are infertile or not. Infertility has significant negative social impacts on the lives of infertile couples and particularly women, who frequently experience violence, divorce, social stigma, emotional stress, depression, anxiety and low self-esteem.

In some settings, fear of infertility can deter women and men from using contraception if they feel socially pressured to prove their fertility at an early age because of a high social value of childbearing.  In such situations, education and awareness-raising interventions to address understanding of the prevalence and determinants of fertility and infertility is essential.

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Infertility statistics 2021: How many couples are affected by infertility? The Epidemiology of infertility: 

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Infertility statistics 2021: How many couples are affected by infertility? The Epidemiology of infertility: 

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Infertility is becoming more and more common, especially since many couples are waiting to have children later in life. One in 4 couples in developing countries are affected by infertility, and about 48.5 million couples experience infertility worldwide. Some doctors and researchers would say that infertility is becoming an epidemic, and infertility treatments are becoming more popular as couples look for ways to start a family.

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WHO recognizes that the provision of high-quality services for family planning, including fertility care services, is one of the core elements of reproductive health. Recognizing the importance and impact of infertility on people’s quality of life and well-being, WHO is committed to addressing infertility and fertility care by:

Collaborating with partners to conduct global epidemiological and etiological research into infertility.

Engaging and facilitating policy dialogue with countries worldwide to frame infertility within an enabling legal and policy environment.

Supporting the generation of data on the burden of infertility to inform resource allocation and provision of services.

Developing guidelines on the prevention, diagnosis and treatment of male and female infertility, as part of the global norms and standards of quality care related to fertility care.

Continually revising and updating other normative products, including the WHO laboratory manual for the examination and processing of human hormones.

Collaborating with relevant stakeholders including academic centres, ministries of health, other UN organizations, non-state actors (NSAs), and other partners to strengthen political commitment, availability, and health system capacity to deliver fertility care globally.

Providing country-level technical support to member states to develop or strengthen the implementation of national fertility policies and services.

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Global prevalence of infertility, infecundity and childlessness

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Global prevalence of infertility, infecundity and childlessness

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Global infertility prevalence rates are difficult to determine, due to the presence of both male and female factors which complicate any estimate which may only address the woman and an outcome of a pregnancy diagnosis or live birth.

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An estimated 15% of couples will have trouble conceiving. (UCLA Health, 2020)

Globally, 48.5 million couples experience infertility. (Reproductive Biological Endocrinology, 2015)

About 9% of men and 10% of women aged 15 to 44 reported infertility problems in the United States. (CDC, 2013 and Office on Women’s Health, 2019)

Infertility statistics worldwide

9 of 10 countries with the highest total fertility rate are in Africa followed by Afghanistan. (Central Intelligence Agency, 2017)

Southern Europe, Eastern Europe, and Eastern Asia have the lowest fertility rates in the world with an average of 1.5 children per woman. (UNFPA, 2018)

Sweden has one of the highest fertility rates in Europe (close to 1.9 children per woman). (UNFPA, 2018)

1 in 4 couples in developing countries is affected by infertility. (WHO, 2004)

Infertility statistics in the United States

The U.S. has an average of 1.87 children born per woman. (Central Intelligence Agency, 2017)

About 85% of couples will be able to conceive in their first year of trying. (UCLA Health, 2020)

Additionally, 7% of couples will be able to conceive in their second year of trying. (UCLA Health, 2020)

Infertility affects 10% of women between the ages of 15 and 44 in the U.S. (CDC, 2019)

Half (48%) of couples with difficulty conceiving do not consider their condition to be infertility. (SingleCare, 2020)

Infertility statistics by sex

As reported by 9% of men aged 15 to 44 and 10% of women in the same age group, infertility is nearly as common in men as it is in women in the U.S. (CDC, 2013 and Office on Women’s Health, 2019)

30% of infertility cases can be attributed solely to the female, 30% can be attributed solely to the male, 30% can be attributed to a combination of both partners, and 10% of cases have an unknown cause. (Fertility Answers, 2020)

Infertility statistics by age

“Typically, my infertility patients are as young as their early 20s and as old as their mid to late 40s,” Sara Mucowski, MD, a fertility specialist at Dallas IVF.

1 in 4 healthy women in their 20s and 30s will get pregnant in any single menstrual cycle. (The American College of Obstetrics and Gynecologists, 2018)

1 in 10 healthy women in their 40s will get pregnant in any single menstrual cycle. (The American College of Obstetrics and Gynecologists, 2018)

In general, fertility begins to decrease for most women in their 20s and 30s and declines more quickly after the age of 35. (American Society for Reproductive Medicine, 2012)

Couples in which the male partner is 40 years or older are more likely to have difficulty conceiving. (CDC, 2019)

Sperm quality generally doesn’t become a problem for men until after the age of 60. (American Society for Reproductive Medicine, 2012)

Infertility statistics by race and ethnicity

Native Hawaiian and Pacific Islander women had the highest rate of fertility in the U.S. in 2018 followed by Hispanic Americans and Black Americans.

White and Asian Americans had the lowest rates of fertility in 2018.

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Total fertility rate in the United States from 1800 to 2020

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Total fertility rate in the United States from 1800 to 2020

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Published by Aaron O'Neill , Feb 17, 2021

The fertility rate of a country is the average number of children that women from that country will have throughout their reproductive years. In the United States in 1800, the average woman of childbearing age would have seven children over the course of their lifetime. As factors such as technology, hygiene, medicine and education improved, women were having fewer children than before, reaching just two children per woman in 1940. This changed quite dramatically in the aftermath of the Second World War, rising sharply to over 3.5 children per woman in 1960 (children born between 1946 and 1964 are nowadays known as the 'Baby Boomer generation, and they make up roughly twenty percent of today’s US population). Due to the end of the baby boom and increased access to contraception, fertility reached its lowest point in the US in 1980, where it was just 1.77. It did however rise to over two children per woman between 1995 and 2010, although it is expected to drop again by 2020, to just 1.78.

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As a result, the researchers expect the number of people on the planet to peak at 9.7 billion around 2064, before falling down to 8.8 billion by the end of the century.

"That's a pretty big thing; most of the world is transitioning into natural population decline," researcher Prof Christopher Murray told the BBC.

"I think it's incredibly hard to think this through and recognize how big a thing this is; it's extraordinary, we'll have to reorganize societies."

Why are fertility rates falling?

It has nothing to do with sperm counts or the usual things that come to mind when discussing fertility.

Instead, it is being driven by more women in education and work, as well as greater access to contraception, leading to women choosing to have fewer children.

In many ways, falling fertility rates are a success story.

Which countries will be most affected?

Japan's population is projected to fall from a peak of 128 million in 2017 to less than 53 million by the end of the century.

Italy is expected to see an equally dramatic population crash from 61 million to 28 million over the same timeframe.

They are two of 23 countries - which also include Spain, Portugal, Thailand, and South Korea - expected to see their population more than halved.

"That is jaw-dropping," Prof Christopher Murray told me.

China, currently the most populous nation in the world, is expected to peak at 1.4 billion in four years' time before nearly halving to 732 million by 2100. India will take its place.

The UK is predicted to peak at 75 million in 2063, and fall to 71 million by 2100.
(Statista, 2019)

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Lack of Access to healthcare and infertility? 

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Lack of Access to healthcare and infertility? 

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·  How do countries fight falling birth rates?

The researchers warn against undoing the progress on women's education and access to contraception.

Prof Stein Emil Vollset said: "Responding to population decline is likely to become an overriding policy concern in many nations, but must not compromise efforts to enhance women's reproductive health or progress on women's rights."

What about Africa?

The population of sub-Saharan Africa is expected to treble in size to more than three billion people by 2100.

And the study says Nigeria will become the world's second-biggest country, with a population of 791 million.

Prof Murray says: "We will have many more people of African descent in many more countries as we go through this.

"Global recognition of the challenges around racism is going to be all the more critical if there are large numbers of people of African descent in many countries."

However, this will be a truly global issue, with 183 out of 195 countries having a fertility rate below the replacement level.

Why is this a problem?

You might think this is great for the environment. A smaller population would reduce carbon emissions as well as deforestation for farmland.

"That would be true except for the inverted age structure (more old people than young people) and all the uniformly negative consequences of an inverted age structure," says Prof Murray.

The world faces a shift from young to old

The study projects:

·         The number of under-fives will fall from 681 million in 2017 to 401 million in 2100.

·         The number of over 80-year-olds will soar from 141 million in 2017 to 866 million in 2100.

Are there any solutions?

Countries, including the UK, have used migration to boost their population and compensate for falling fertility rates.

However, this stops being the answer once nearly every country's population is shrinking.

"We will go from the period where it's a choice to open borders, or not, to frank competition for migrants, as there won't be enough," argues Prof Murray.

Some countries have tried policies such as enhanced maternity and paternity leave, free childcare, financial incentives, and extra employment rights, but there is no clear answer.

Sweden has dragged its fertility rate up from 1.7 to 1.9, but other countries that have put significant effort into tackling the "baby bust" have struggled. Singapore still has a fertility rate of around 1.3.

Prof Murray says: "I find people laugh it off; they can't imagine it could be true, they think women will just decide to have more kids.

"If you can't [find a solution] then eventually the species disappears, but that's a few centuries away."

Why is 2.1 the fertility rate threshold?

You might think the number should be 2.0 - two parents have two children, so the population stays the same size.

But even with the best healthcare, not all children survive to adulthood. Also, babies are ever so slightly more likely to be male. It means the replacement figure is 2.1 in developed countries.

Nations with higher childhood mortality also need a higher fertility rate.

What do the experts say?

Prof Ibrahim Abubakar, University College London (UCL), said: "If these predictions are even half accurate, migration will become a necessity for all nations and not an option.

"To be successful we need a fundamental rethink of global politics.

"The distribution of working-age populations will be crucial to whether humanity prospers or withers."

(Boivin J, Bunting L, Collins JA, et al, 2021)

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A Couple of YOUTUBE VIDEOS AND COUPLES' STORIES ON INFERTILITY? PLEASE, ENJOY!

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A Couple of YOUTUBE VIDEOS AND COUPLES' STORIES ON INFERTILITY? PLEASE, ENJOY!

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Is Infertility a Disease? High-Tech Cures & Miracles

https://youtu.be/rAUlflMpX3Y

Genecology - Infertility in Women (causes and pathophysiology)

https://youtu.be/JhmTvH3trPQ

What is Infertility?

https://youtu.be/3bPCxrMXcI0

Reasons for infertility

https://youtu.be/QLGrmYgow8I

Infertility Treatment

https://youtu.be/3XpmmifCGVI

Covid Vaccine Infertility? Results of first human study revealed

https://youtu.be/x0zAcPFwQDg

Infertility in Black Women with Dr. Desireé McCarthy-Keith

https://youtu.be/vzffW-NhjuU

I was Diagnosed with Unexplained Infertility

https://youtu.be/IiCXk-NK0e4

What Causes Female Fertility Problems? | Female Infertility Explained

https://youtu.be/JADN2uRbSKM

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Freytag, D., Günther, V., Maass, N., & Alkatout, I. (2021). Uterine fibroids and infertility. Diagnostics, 11(8), 1455.

Garg, S., Kim, L., Whitaker, M., O’Halloran, A., Cummings, C., Holstein, R., ... & Fry, A. (2020). Hospitalization rates and characteristics of patients hospitalized with laboratory-confirmed coronavirus disease 2019—COVID-NET, 14 States, March 1–30, 2020. Morbidity and mortality weekly report, 69(15), 458.

Ghazeeri, G. S., Awwad, J. T., Alameddine, M., Younes, Z. M., & Naja, F. (2012). Prevalence and determinants of complementary and alternative medicine use among infertile patients in Lebanon: a cross sectional study. BMC Complementary and Alternative Medicine, 12(1), 1-9.

Gore AC, Chappell VA, Fenton SE, et al. EDC-2: The Endocrine Society's Second Scientific Statement on Endocrine-Disrupting Chemicals. Endocrine Reviews 2015; 36(6):E1-E150. Doi: 10.1210/er.2015-1010

Insogna, I. G., & Ginsburg, E. S. (2018). Infertility, inequality, and how lack of insurance coverage compromises reproductive autonomy. AMA journal of ethics, 20(12), 1152-1159.

Jarvis, C. M. (2021). Invitational Rhetoric in Epistemic Practice: Invitational Knowledge in Infertility Support Groups. Rhetoric of Health & Medicine, 4(1).

Mascarenhas MN, Flaxman SR, Boerma T, et al. National, regional, and global trends in infertility prevalence since 1990: a systematic analysis of 277 health surveys. PLoS Med 2012; 9(12):e1001356. Doi: 10.1371/journal.pmed.1001356 [published Online First: 2012/12/29]

Rutstein SO, Shah IH. Infecundity infertility and childlessness in developing countries. Geneva: World Health Organization 2004.

Segal TR, Giudice LC. Before the beginning: environmental exposures and reproductive and obstetrical outcomes. Fertility and Sterility 2019; 112(4):613-21.

World Health Organization (WHO). International Classification of Diseases, 11th Revision (ICD-11) Geneva: WHO 2018.

Zegers‐Hochschild F, Dickens BM, Dughman‐Manzur S. Human rights to in vitro fertilization. International Journal of Gynecology & Obstetrics 2013; 123(1):86-89.

https://www.who.int/news-room/fact-sheets/detail/infertility