Worldwide trend analysis of primary and secondary infertility rates over past decades: A cross-sectional study

Background: Infertility is a global health issue and is reported differently worldwide. Objective: To assess the longitudinal trends of primary and secondary infertility prevalence rate (PSIPR) per 100,000 across all countries during past decades. Materials and Methods: The PSIPR was extracted from the Global Burden of Disease database for 195 countries during 1993-2017. The longitudinal trends of PSIPR were explored across the seven epidemiological regions designated by the Global Burden of Disease. Results: Globally, the PSIPR was lower among men than women. Over time, the prevalence of primary infertility in men and women had a decreasing trend of - 9.3 and -11.6 in high-income countries. Other regions have seen an increase, the highest being in South Asian women, and men of the Middle East and North Africa, with rates of change of 40.9 and 19.0, respectively. Over time, the secondary infertility prevalence in women of Central Asia, Central Europe and Eastern Europe, as well as of high-income countries, has been declining (rates of change of -16.9 and -11.7, respectively). Other regions have been on the rise, with the highest increase among women of the Middle East, North Africa, and South Asia (trend of 119.9 and 83.4, respectively), and in South Asian men (trend of 48.4). Conclusion: The overall trend of infertility prevalence shows a downward trajectory in high-income and developed countries and an upward trend in others. These findings might be explained by missed cases of infertility due to a low tendency for reproduction and the presence of more infertility treatment facilities in these regions.