One in six people across the globe face infertility at some point in their lifetime, according to the first new estimates from the World Health Organization in a decade.
The prevalence is “staggering,” Pascale Allotey, director of sexual and reproductive health and research at WHO, said at a press conference Monday. The report estimates that 17.8% of adults in high-income countries and 16.5% in low- and middle-income countries experience infertility.
Infertility can be “physically, emotionally, and sometimes financially exhausting,” Gitau Mburu, a WHO fertility researcher, said at the press conference. In a call to action, the WHO recommended that countries offer universal health coverage of fertility treatments, pointing to many European countries as well as Morocco (which has made fertility treatment available in the public sector) and Indonesia (which includes it in primary care services) as leading the way.
The report analyzed 133 studies from 1990 to 2021, defining infertility as a disease wherein a person fails to conceive a pregnancy after one year or more of regular, unprotected sexual intercourse. But the studies that researchers analyzed used varying definitions of infertility and data that was disaggregated differently, or not at all.
That means more research is needed to understand the full scope of the problem and potential disparities — particularly large, nationally-representative clinical studies. WHO researchers did not break down the new report’s results by sex, age, or other categories. The analysis did not find that infertility rates changed over time, but it was not technically organized to answer that question.
“The jury is out on that question,” said James Kiarie, the head of contraception and fertility care at WHO.
The difference in infertility rates in high-income versus low-income countries is not statistically significant, Mburu said, due to overlapping confidence intervals and data gaps from certain global regions. There are, however, major disparities when it comes to accessing treatment such as in vitro fertilization.
“The costs of fertility care are an immense challenge for many people,” Allotey said, especially in low-income countries. Around the world, most people pay out-of-pocket for fertility treatment; in the U.S., a single round of IVF typically costs $15,000 to $20,000. Patients in low-income countries without public financing options often pay significantly more than their entire annual income for one round of assisted reproductive technology. Such high costs create “a medical poverty trap for those affected,” Allotey said.
The report focuses on infertility between male and female couples, but even more people are in need of accessible fertility treatment when same-sex couples and those pursuing single parenthood by choice are taken into account, Asima Ahmad, chief medical officer and co-founder of the fertility benefits company Carrot Fertility, noted in a comment on the report.
Infertility affects people of all genders, but in many places, women face strong societal pressure to bear children. Previous studies have found that infertile women are at an increased risk for intimate partner violence, WHO researchers said during the press conference.
WHO expects to release more guidelines on the prevention, diagnosis, and treatment for infertility in the coming year.
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