Materiały źródłowe

• #1 Fertility and infertility: Definition and epidemiology – PubMed

  https://pubmed.ncbi.nlm.nih.gov/29555319/

  Infertility is a disease characterized by the failure to establish a clinical pregnancy after 12 months of regular and unprotected sexual intercourse. It is estimated to affect between 8 and 12% of reproductive-aged couples worldwide. […] Males are found to be solely responsible for 20-30% of infertility cases but contribute to 50% of cases overall. […] Secondary infertility is the most common form of female infertility around the globe, often due to reproductive tract infections. […] The three major factors influencing the spontaneous probability of conception are the time of unwanted non-conception, the age of the female partner and the disease-related infertility. […] The chance of becoming spontaneously pregnant declines with the duration before conception. […] The fertility decline in female already starts around 25-30 years of age and the median age at last birth is 40-41 years in most studied populations experiencing natural fertility.

• #2

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

  Infertility affects millions of people and has an impact on their families and communities. Estimates suggest that approximately one in every six people of reproductive age worldwide experience infertility in their lifetime. […] 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. […] 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. […] 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 peoples 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.

• #3 Infertility: Frequently Asked Questions | Reproductive Health | CDC

  https://www.cdc.gov/reproductive-health/infertility-faq/index.html

  For public health data collection, infertility is defined as not being able to get pregnant (conceive) after 1 year (or longer) of unprotected sex. […] In the United States, 1 in 5 (19%) of married women aged 15 to 49 with no prior births are unable to get pregnant after 1 year of trying. About 1 in 4 (26%) of women in this group have difficulty getting pregnant or carrying a pregnancy to term. […] CDC publishes ART success rates for all fertility clinics in the United States. In addition, CDC created an IVF Success Estimator to help estimate the chance of having a live birth using IVF based on the experiences of women and couples with similar characteristics. […] CDC’s National Assisted Reproductive Technology Surveillance System.

• #4 Epidemiology of infertility and characteristics of infertile couples requesting assisted reproduction in a low-resource setting in Africa, Sudan | Fertility Research and Practice | Full Text

  https://fertilityresearchandpractice.biomedcentral.com/articles/10.1186/s40738-019-0060-1

  Infertility is a big health problem worldwide. Few data exist on infertility in Sudan. A descriptive study was conducted to assess the pattern and the causes of infertility among couples (800) attending the University of Khartoum Fertility Centre, Saad Abualila Teaching Hospital in Khartoum, Sudan. The mean (SD) age of the females was 32.4 (7.4) years while that of the males was 37.5 (7.2) years. The mean (SD) duration of infertility was 4.9(3.9) years. Five hundred and fifty one (68.9%) couples had primary infertility, while the remainder 249(31.1%) had secondary infertility. Two hundred and eighty four (35.5%) couples had male infertility, 342(42.8%) couples had female infertility. One hundred and forty seven (18.4%) couples had combined male and female infertility and in 27 (3.4%) couples the cause of infertility was not identified. Female factors of infertility were observed more frequently among couples with secondary infertility compared with primary infertility (143/551(57.4) vs. 199/249(36.1), P0.001. The current study showed a high rate of primary infertility and female factor predominates compared with male factors. Future research direction should focus on the reasons why majority of clients seek this service very late. Infertility is a big health problem worldwide as it has been estimated that in 2010 there are 48.5 million (45.0 million, 52.6 million) infertile couples worldwide. World Health Organization (WHO) defines infertility as a disease of the reproductive system defined by the failure to achieve a clinical pregnancy after 12months or more of regular unprotected sexual intercourse. Meanwhile the WHOs epidemiologic definition of infertility as women of reproductive age at risk of becoming pregnant who report unsuccessfully trying for a pregnancy for more than two years. Among the various regions in the world, South East Asia and Sub-Saharan Africa countries have the highest prevalence of infertility. Investigating the types and causes of infertility is highly needed to generate data important for planning and interventions. While there is much data of infertility in high-income countries as well as in other African countries, few data exist on infertility in Sudan. Sudan is the third largest country in Africa with a population of 36,787,000. There is a lack of proper infertility statistic in Sudan. However, infertility rate of 11.5% has been reported in 10 out of 18 Sudanese states. The current study was conducted to investigate the types and causes of infertility in University of Khartoum Fertility Centre, Saad Abualila Teaching Hospital in Khartoum, Sudan. The main findings of the current study were the high rate of primary infertility (68.9%) and high rate of female factors among infertile couples. The high rate of primary infertility in this study was similar to our previous results in Khartoum where 443 (62.4%) couples had primary infertility and 267 (37.6%) couples had secondary infertility. However, this is contrary to what have been reported in Nigeria and in Tanzania where the secondary infertility (62.9%) predominated. In middle income countries e.g. Brazil in which over half (56.3%) of couples referred for in-vitro fertilization centre have secondary infertility. Previous studies from developed countries have shown lower rates of secondary infertility. The plausible explanation for the high rate of secondary infertility is high rate (85%) of tubal factor in Sub-Sahara Africa compared to lower rate (33%) in infertile women worldwide. In the current study 284(35.5%) couples had male infertility, 342(42.8%) couples had female infertility, 18.4% of the couples had combined male and female infertility and in 3.4% couples the cause of infertility was not identified. This goes with the findings of Ugwu et al., who reported that the combined male/female factors were observed in 20.4% of cases in Nigeria. A previous study in Benin documented that 32.2% of the couples have combined male and female factors. However, other studies have reported that the causes of infertility may be associated with male factors (40%), female factors (40%) or the combination (20%) of both. Previous report have shown that tubal damage, male factor, anovulation and uterine factors as the main causes of infertility in Ghana. Interestingly in Rwanda Dhont et al., who investigated 312 infertile women and their partners- have observed a low rate (3%) of unexplained infertility while half (50%) of the couples have combination of male and female causes. Likewise in Tanzania, Larsen et al., have shown that female only factor was the cause of infertility in 65.9% of the couples, male only factor was identified in 6.8% of the couple and 15.2 and 12.1% of the couples had combined and unexplained infertility, respectively. A similar to low rate of unexplained infertility in our study (3.4%), a low rate of unexplained infertility was also reported in Rwanda (3%) and in Nigeria (1.2%). It is worth mentioning that recent evidence-based meta-analysis and systematic review results have shown a decreased sperm concentration in the African male over past 50years. Multiple factors such as infectious, environmental, genetic, and dietary factors might have a role in causation of infertility. Our results have shown that mean (SD) age of the female was 32.4 (7.4) years while that of the male was 37.5 (7.2) years. This is lower than the mean age of the women [34.1(4.9) year) which was previously reported in Nigeria. Moreover, previous studies from Nigeria and India have reported the average age of the females and their husbands as 36.7/43.7 and 35/40years, respectively. Perhaps couples have spent too much time treating infertility using conventional methods before presented to specialised centre. It is worth to be mentioned that in study in non-specialized centre in Benin Teaching Hospital, Nigeria, the mean age of women was 25 (3) years, however women presented at much higher (36.7years) to IVF unit. On the other hand the other reasons for presenting at advanced age include delayed marriage due to education and/or economic factors. Our results documented the predominance of anovulation, while in most of the African countries tubal factor was the main of the cause of the female infertility. The tubal factor could be due to infectious diseases such as Neisseria gonorrhoeae and Chlamydia trachomatis. The current study showed a high rate of primary infertility and female factor predominate. Future research direction should focus on the reasons why majority of clients seek this service very late.

• #5

  https://www.who.int/news/item/04-04-2023-1-in-6-people-globally-affected-by-infertility

  Large numbers of people are affected by infertility in their lifetime, according to a new report published today by WHO. Around 17.5% of the adult population roughly 1 in 6 worldwide experience infertility, showing the urgent need to increase access to affordable, high-quality fertility care for those in need. […] The new estimates show limited variation in the prevalence of infertility between regions. The rates are comparable for high-, middle- and low-income countries, indicating that this is a major health challenge globally. Lifetime prevalence was 17.8% in high-income countries and 16.5% in low- and middle-income countries. […] While the new report shows convincing evidence of the high global prevalence of infertility, it highlights a persistent lack of data in many countries and some regions. It calls for greater availability of national data on infertility disaggregated by age and by cause to help with quantifying infertility, as well as knowing who needs fertility care and how risks can be reduced.

• #6 Prevalence, regional distribution, and determinants of infertility in Uganda between 2006 and 2016: analysis of three Demographic and Health Surveys | Published in Journal of Global Health Reports

  https://www.joghr.org/article/94212-prevalence-regional-distribution-and-determinants-of-infertility-in-uganda-between-2006-and-2016-analysis-of-three-demographic-and-health-surveys

  According to WHO, at least 50 million couples worldwide experienced infertility in 2017. A systematic review of 277 health surveys concluded that one in every four couples in low- and middle-income countries (LMICs) had been found to be affected by infertility. […] The African region had the highest period prevalence of infertility at 16.4% in 2019, followed by the western Pacific (13%) and European (12.4%) regions. […] Infertility has negative consequences on the social, economic, and psychological well-being of affected individuals, families, and communities. […] In LMICs, infertility care has been perceived as suboptimal, as services to prevent and treat infertility are often inaccessible, unaffordable, or non-existent. […] Recently, there has been growing interest in closely monitoring how health indicators can highlight the needs of vulnerable populations, including individuals and couples with infertility and track how their needs can be addressed through policies and programs.

• #7 FastStats – Infertility

  https://www.cdc.gov/nchs/fastats/infertility.htm

  Percent of women ages 1549 who have impaired fecundity: 13.4% […] Percent of married women ages 1549 who are infertile: 8.5% […] Percent of women ages 1549 who have ever used infertility services: 12.2% […] Source: Key Statistics from the National Survey of Family Growth (data are for 2015-2019) […] CDC-National ART Surveillance

• #8 Epidemiology and Etiology of Infertility in Iran, Systematic Review and Meta-Analysis

  https://www.scitechnol.com/peer-review/epidemiology-and-etiology-of-infertility-in-iran-systematic-review-and-metaanalysis-JVqd.php?article_id=1622

  This meta-analysis showed that 78.4% of the couples in Iran suffered from primary infertility compared to 21.6% for the secondary infertility. The etiologic cause of infertility for 43.5% of the couples was a female factor. Among the female causes of infertility ovulatory dysfunction was the most frequent etiologic factor reported by all of the centers followed by tubal factor. […] The prevalence rate of life time infertility was 10.9% and current infertility was 3.3% in Iran. Male factor was responsible for 34.0%, female factor for 43.5%, both factors for 17.1% and 8.1% were unexplained. These data may provide useful information for the health policy makers to help these couples and decrease the burden of the condition and its related pressures on this relatively large fraction of the population.

• #8 Epidemiology and Etiology of Infertility in Iran, Systematic Review and Meta-Analysis

  https://www.scitechnol.com/peer-review/epidemiology-and-etiology-of-infertility-in-iran-systematic-review-and-metaanalysis-JVqd.php?article_id=1622

  Meta-analysis that was performed by using data of these studies showed heterogeneity among the studies and concluded that the total average rate of infertility in Iran is 10.9% (95% CI 7.4-14.4), primary infertility is 10.6% ( 95% CI 5.3-16.0), secondary infertility is 2.7% (95% CI 1.9-3.5) and current infertility is 3.3% (95% CI 2.7-3.8). […] The present metaanalysis showed that the average prevalence rate of life time infertility is 10.9% in Iran and 3.3% of the population have current infertility. […] Meta-analysis of the etiology of infertility among the referees to the different infertility clinics of Iran showed that 78.4% of the couples suffer from primary and 21.6% from secondary fertility problems. 34% of them have male factor, 43.5% female factor and 17% both male and female factors and 8.1% have no determined cause for their infertility.

• #9 Epidemiological characteristics of infertility, 1990–2021, and 15-year forecasts: an analysis based on the global burden of disease study 2021 | Reproductive Health | Full Text

  https://reproductive-health-journal.biomedcentral.com/articles/10.1186/s12978-025-01966-7

  Infertility, defined as the inability to achieve pregnancy after 1 year of regular unprotected intercourse, affects approximately 186 million people globally, with consistent prevalence across different income levels. […] The COVID-19 pandemic has further exacerbated mental health issues among individuals with infertility, underscoring the need for research into the mental health impacts and access to fertility services. […] Understanding the complexities and spread of infertility is essential for guiding policy decisions and program rollouts, with studies analyzing infertility issues based on the Global Burden of Disease (GBD) database. […] In 2021, it was calculated that the global ASPR for male infertility stood at 1354.76 cases per 100,000 individuals, with a 95% Uncertainty Interval ranging from 802.12 to 2174.77 cases per 100,000 individuals. For female infertility, the ASPR was recorded at 2764.62 per 100,000 individuals.

• #10 Epidemiology of infertility and characteristics of infertile couples requesting assisted reproduction in a low-resource setting in Africa, Sudan

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6637545/

  Infertility is a big health problem worldwide. Few data exist on infertility in Sudan. A descriptive study was conducted to assess the pattern and the causes of infertility among couples (800) attending the University of Khartoum Fertility Centre, Saad Abualila Teaching Hospital in Khartoum, Sudan. The mean (SD) age of the females was 32.4 (7.4) years while that of the males was 37.5 (7.2) years. The mean (SD) duration of infertility was 4.9(3.9) years. Five hundred and fifty one (68.9%) couples had primary infertility, while the remainder 249(31.1%) had secondary infertility. Two hundred and eighty four (35.5%) couples had male infertility, 342(42.8%) couples had female infertility. One hundred and forty seven (18.4%) couples had combined male and female infertility and in 27 (3.4%) couples the cause of infertility was not identified. The current study showed a high rate of primary infertility and female factor predominates compared with male factors. Future research direction should focus on the reasons why majority of clients seek this service very late. Among the various regions in the world, South East Asia and Sub-Saharan Africa countries have the highest prevalence of infertility. Investigating the types and causes of infertility is highly needed to generate data important for planning and interventions. While there is much data of infertility in high-income countries as well as in other African countries, few data exist on infertility in Sudan. Sudan is the third largest country in Africa with a population of 36,787,000. There is a lack of proper infertility statistic in Sudan. However, infertility rate of 11.5% has been reported in 10 out of 18 Sudanese states. The current study was conducted to investigate the types and causes of infertility in University of Khartoum Fertility Centre, Saad Abualila Teaching Hospital in Khartoum, Sudan. The main findings of the current study were the high rate of primary infertility (68.9%) and high rate of female factors among infertile couples.

• #11 Prevalence, regional distribution, and determinants of infertility in Uganda between 2006 and 2016: analysis of three Demographic and Health Surveys | Published in Journal of Global Health Reports

  https://www.joghr.org/article/94212-prevalence-regional-distribution-and-determinants-of-infertility-in-uganda-between-2006-and-2016-analysis-of-three-demographic-and-health-surveys

  Given the high level of individual and local heterogeneity within geographic or administrative units, effective infertility policy designs require a detailed knowledge of the distribution of infertility and its various determinants. […] The prevalence of primary infertility dropped from 1.4% (95% Confidence Interval (CI)= 1.0-1.8) in 2006 to 0.7%(95% CI= 0.5-1.0) and 0.8% (95% CI= 0.6-1.0)in 2011 and 2016, respectively. The prevalence of secondary infertility remained almost the same over the three surveys at 7.4% (95% CI= 6.5-8.4), 6.9% (95% CI= 5.9-8.0) and 7.1% (95% CI= 6.4-7.9) in 2006, 2011 and 2016, respectively. […] Secondary infertility was highest in the Central zone at 6.2% (95% CI= 4.6-8.1), 9.2% (95% CI= 6.9-12.1) and 7.9% (95% CI= 6.1-10.3) and in the Northern region at 8.7% (95% CI= 7.0-10.8), 8.1% (95% CI= 6.5-10.1), 7.4% (95% CI= 6.1-8.9) in 2006, 2011 and 2016 respectively.

• #12 Prevalence and Correlates of Primary Infertility in Mysore, India

  https://digitalcommons.fiu.edu/epidemiology/6/

  There are sparse data on the prevalence of primary infertility in India and almost none from Southern India. This study describes the correlates and prevalence of primary infertility among young women in Mysore, India. […] The prevalence of primary infertility was 12.6 per cent [95% Confidence Interval (CI): 10.5-15.0%]. […] The estimated prevalence of primary infertility among women in the study was within the range reported by the WHO and similar to other estimates from India.

• #13 Chapter 2 – Epidemiology of Infertility | Obgyn Key

  https://obgynkey.com/chapter-2-epidemiology-of-infertility/

  Infertility is defined by WHO-ICMART as a disease of the reproductive system defined as the failure to achieve a clinical pregnancy after 12 of more months of regular unprotected sexual intercourse. […] According to a Scottish study, nearly 20% of couples within their reproductive lifespan failed to conceive within 12 months and 12% failed to conceive within 24 months. […] Couples can most likely be considered infertile when failing to conceive within five years. A worldwide systematic review and meta-analysis concluded that within a period of five years, 1.9% of women aged 2044 years who wanted to have children were unable to have their first live birth (primary infertility), and 10.5% of women with a previous live birth were unable to have an additional live birth (secondary infertility). […] This study found that levels of infertility did not change significantly between 1990 and 2010.

• #14 Epidemiological characteristics of infertility, 1990–2021, and 15-year forecasts: an analysis based on the global burden of disease study 2021 | Reproductive Health | Full Text

  https://reproductive-health-journal.biomedcentral.com/articles/10.1186/s12978-025-01966-7

  The worldwide prevalence of infertility has substantially increased between 1990 and 2021, largely as a result of population growth. […] Strengthening healthcare infrastructures, enhancing access to high-quality medical services, and raising awareness about infertility are vital measures to tackle this issue. […] A deep understanding of the complexities and spread of infertility is essential for gauging progress in combating this health issue and guiding policy decisions and program rollouts. […] The study anticipates the ASRs for infertility gender in both males and females from 2022 to 2036. It highlights that the ASPR and ASDR associated with infertility for both genders are expected to show an increase on a global scale. […] This research provides essential data to assist policymakers and health authorities in developing focused approaches for preventing and managing infertility.

• #15 Female Infertility: Epidemiology Forecast to 2033

  https://www.researchandmarkets.com/reports/4829188/female-infertility-epidemiology-forecast-to-2033?srsltid=AfmBOopibHDhde3u-_fdDNhzh9Z6rzMoeuz–B75KOt9k4zwInqchOh-

  In the 7MM, the diagnosed incident cases of female infertility are expected to decrease from 420,793 cases in 2023 to 408,771 cases in 2033, at a negative annual growth rate (AGR) of 0.29%. In 2033, the US will have the highest number of diagnosed incident cases of female infertility in the 7MM, with 139,027 diagnosed incident cases, whereas Spain will have the fewest diagnosed incident cases with 26,859 cases. […] In the 7MM, the total prevalent cases of female infertility are expected to decrease from 16,732,165 cases in 2023 to 16,053,363 cases in 2033, at a negative AGR of 0.41%. In 2033, the US will have the highest number of total prevalent cases of female infertility in the 7MM, with 5,492,669 cases, whereas Spain will have the fewest cases with 1,009,964 total prevalent cases. The analyst epidemiologists attribute the changes in the diagnosed incident cases and total prevalent cases to the underlying demographic changes in the respective markets.

• #16 Female infertility: Causes – UpToDate

  https://www.uptodate.com/contents/female-infertility-causes

  Infertility is a complex disorder with significant medical, psychosocial, and economic aspects. […] In a World Health Organization (WHO) study of 8500 infertile couples, female factor infertility was reported in 37 percent of infertile couples in developed countries, male factor infertility in 8 percent, and both male and female factor infertility in 35 percent. […] The most common identifiable female factors, which accounted for 81 percent of female infertility, were: Ovulatory disorders (25 percent).

• #17 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Male-Infertility-Epidemiology.aspx

  Infertility issues plague nearly 15% of couples in the world. This means that close to 48 million couples worldwide have trouble conceiving a baby despite trying to for a year or more. Of these cases nearly 30% are due to male infertility issues. […] According to the CDC, infertility affects close to 12% of the population of the United States in the sexually active demographic. Since a number of infertility cases do not get reported in various other countries across the globe, the actual number of cases may be much higher. […] The estimated number of infertile men in the world ranges between 30,625,864 and 30,641,262. The highest concentration of male infertility was found in Europe. […] The study concluded that nearly 50% of infertility cases rest with women while 30% are caused due to male infertility issues. The remaining have a combination of both male and female infertility problems.

• #18 Epidemiology – GPnotebook

  https://gpnotebook.com/en-GB/pages/gynaecology/infertility/epidemiology

  Estimated that infertility affects 1 in 7 heterosexual couples in the UK […] since 2004 there has been a small increase in the prevalence of fertility problems, and a greater proportion of people now seeking help for such problems […] a male factor is responsible for a couple’s infertility in about 30% of cases […] main causes of infertility in the UK are (percent figures indicate approximate prevalence) (1): unexplained infertility (no identified male or female cause) (25%), ovulatory disorders (25%), tubal damage (20%), factors in the male causing infertility (30%), uterine or peritoneal disorders (10%) […] in about 40% of cases disorders are found in both the man and the woman. Uterine or endometrial factors, gamete or embryo defects, and pelvic conditions such as endometriosis may also play a role

• #19 Fertility and infertility: Definition and epidemiology – PubMed

  https://pubmed.ncbi.nlm.nih.gov/29555319/

  The disease-related infertility may affect both genders or be specific to one gender. […] The factors affecting both genders’ fertility are hypogonadotrophic hypogonadism, hyperprolactinemia, disorders of ciliary function, cystic fibrosis, infections, systemic diseases and lifestyle related factors/diseases. […] Premature ovarian insufficiency, polycystic ovary syndrome, endometriosis, uterine fibroids and endometrial polyps may play a role in female infertility. […] Male infertility may be due to testicular and post-testicular deficiencies. […] Semen decline that has been observed over the years, endocrine disrupting chemicals and consanguinity are other factors that may be involved.

• #20 Epidemiology and etiology of Male Infertility | Stony Brook Medicine

  https://www.stonybrookmedicine.edu/patientcare/urology/Epidemiology_info

  Idiopathic male infertility remains the most common single diagnostic entity, although this classification may be changed with recent advances in the genetics of male infertility. The common causes of male infertility are varicocele, accessory gland infection, immunological factor, congenital abnormalities; obstructive azoospermia; iatrogenic systemic and endocrine causes.

• #20 Epidemiology and etiology of Male Infertility | Stony Brook Medicine

  https://www.stonybrookmedicine.edu/patientcare/urology/Epidemiology_info

  Infertility is defined as a couple’s inability to achieve pregnancy following one year of unprotected intercourse. It has been estimated that 15-20% of couples attempting to achieve pregnancy are unable to do so. A male factor is contributory in more than 50% of couples presenting for fertility evaluation. In many studies male factor infertility is the most common single diagnostic category. […] Therefore, a thorough evaluation of the male partner should be pursued as strongly as a female evaluation at the same time. It has been shown that the longer couples remain infertile, the worse their chance for an effective treatment. […] Most studies have determined male factor infertility based on conventional criteria of sperm quality. Nevertheless, these criteria are not absolute. Significant proportion of men with normal semen quality will be infertile because of defective sperm function, while men with abnormal sperm quality will have normal sperm function.

• #21 Male Infertility: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/436829-overview

  Debate has occurred in the literature regarding a poorer semen quality, decreased sperm counts (113 million/mL in 1940 compared with 66 million/mL in the 1990s), and decreased fertility in men today compared with fertility 50 years ago. […] Isolated conditions of the female are responsible for infertility in 35% of cases, isolated conditions of the male in 30%, conditions of both the male and female in 20%, and unexplained causes in 15%. Even if one partner has an obvious cause for the infertility, a thorough evaluation of both partners for completeness is prudent. In addition, both partners may be aided by evaluation of their sexual practices. […] The effect of aging on fertility is unclear. As men age, their testosterone levels decrease, while estradiol and estrone levels increase. Studies have shown that, as men age, their sperm density decreases. Young men have spermatids present in 90% of seminiferous tubules, which decreases to 50% by age 50-70 years and to 10% by age 80 years. Additionally, 50% of Sertoli cells are lost by age 50 years, and 50% of Leydig cells are lost by age 60 years. Despite this, aging men may achieve fertility rates similar to those in younger men, although conception often takes longer.

• #22

  https://www.ijrcog.org/index.php/ijrcog/article/view/12456

  Approximately 10% to 15% of couples in developing countries are infertile. Male infertility is responsible for 20-43% of infertility cases and contributes to another 12-20% of cases. […] Aims and objectives of current study was to analyze the epidemiology and clinical factors of male infertility in Central India and identify its risk factors. […] Couples should be educated about infertility causes and the contribution of male infertility to it. Multifactorial analysis along with clinicopathological analysis should contribute to accurate diagnosis of the cause of male infertility and proposal of adequate measures.

• #23

  https://journals.lww.com/obgynsurvey/fulltext/2014/02000/definition_and_epidemiology_of_unexplained.17.aspx

  The diagnosis of unexplained infertility can be made only after excluding common causes of infertility using standard fertility investigations, which include semen analysis, assessment of ovulation, and tubal patency test. […] It is estimated that a standard fertility evaluation will fail to identify an abnormality in approximately 15% to 30% of infertile couples. […] The reported incidence of such unexplained infertility varies according to the age and selection criteria in the study population. […] After completing this CME activity, physicians should be better able to identify the epidemiology of unexplained infertility and standard investigations for infertile couples and to consider other possible causes of infertility before making a diagnosis of unexplained infertility.

• #24

  https://journals.lww.com/epidem/abstract/1994/03000/body_mass_index_and_ovulatory_infertility.16.aspx

  Several studies have examined the association between body mass index and infertility. We compared body mass index in 597 women diagnosed with ovulatory infertility at seven infertility clinics in the United States and Canada with 1,695 primiparous controls who recently gave birth. The obese women (body mass index 27) had a relative risk of ovulatory infertility of 3.1 (95% confidence interval (CI) = 2.24.4], compared with women of lower body weight (body mass index 2024.9). We found a small effect in women with a body mass index of 2526.9 or less than 17 [relative risk (RR) = 1.2, 95% CI = 0.81.9; and RR = 1.6, 95% CI = 0.73.9, respectively). We conclude that the risk of ovulatory infertility is highest in obese women but is also slightly increased in moderately overweight and underweight women.

• #25

  https://www.ijcmph.com/index.php/ijcmph/article/view/11577

  Infertility is a global reproductive health problem and the prevalence rate increased by 0.37% per year for females. […] The purpose of the study is to identify and quantify the burden of infertility and associated risk factors for infertility. […] Out of 444 study population majority of women were fertile (88.7%), while 6.3% of women were secondary infertile and 5% women were primary infertile. […] The difference of occurrence of infertility in relation to time since marriage, male age at marriage, number of family members, thyroid, PCOD, tuberculosis and height were statistically significant. […] Almost all the factors came out to be responsible for infertility were modifiable. Awareness generation and provision of infertility care services at primary health care facilities will be of use in addressing infertility in Haryana.

• #26 Infertility and incident endometrial cancer risk: a pooled analysis from the epidemiology of endometrial cancer consortium (E2C2) | British Journal of Cancer

  https://www.nature.com/articles/bjc201524

  Nulliparity is an endometrial cancer risk factor, but whether or not this association is due to infertility is unclear. […] Nulliparous women had an elevated endometrial cancer risk compared with parous women, even after adjusting for infertility (OR=1.76; 95% CI: 1.591.94). […] Women who reported infertility had an increased risk compared with those without infertility concerns, even after adjusting for nulliparity (OR=1.22; 95% CI: 1.131.33). […] Based on mainly self-reported infertility data that used study-specific definitions of infertility, nulliparity and infertility appeared to independently contribute to endometrial cancer risk. […] Understanding residual endometrial cancer risk related to infertility, its causes and its treatments may benefit from large studies involving detailed data on various infertility parameters.

• #27 Follow-up Studies of Women Evaluated and Treated for Infertility – NCI

  https://dceg.cancer.gov/research/who-we-study/cohorts/infertility-treated-women-follow-up-study

  Infertility has long been recognized as a risk factor for various cancers, including breast and gynecologic cancers. […] Investigators in DCEG have been involved with a number of investigations to clarify effects of fertility drug exposures on risk of various cancers. […] The latest follow-up, which assessed cancer incidence through 2010, revealed 749 breast, 118 endometrial and 85 ovarian cancer cases, and allowed a detailed assessment of risk in relation to both clomiphene and gonadotropins. […] Results regarding effects of ovulation-stimulating drugs on endometrial and ovarian cancers were largely reassuring. […] For medically validated invasive breast cancers, however, there was a significantly elevated risk observed for women who received 12 or more clomiphene cyclesa dosage much higher than would be prescribed in current practice.

• #28 Biological and Social Aspects of Human Infertility: A Global Perspective | Oxford Research Encyclopedia of Global Public Health

  https://oxfordre.com/publichealth/display/10.1093/acrefore/9780190632366.001.0001/acrefore-9780190632366-e-184

  Infertility remains a neglected area in sexual and reproductive health, yet its consequences are staggering. Infertility is estimated to impact about 10-25% (estimates range from 48 to 180 million) of couples of reproductive age worldwide. […] Despite these consequences, disparities in access to infertility treatment between low- and high-income populations persist given the high cost and limited geographic availability of diagnostic services and assisted reproductive technologies. […] A renewed global focus on infertility epidemiology, risk factors, and access to and receipt of quality of care will support individuals in trying to reach their desired number and spacing of children and improve overall health and well-being. […] The tracking and measurement of infertility are highly complex, resulting in considerable ambiguity about its prevalence and stratification in reproduction globally.

• #29 UCSF Infertility Trial → Genetic Epidemiology of Ovarian Aging

  https://clinicaltrials.ucsf.edu/trial/NCT00501800

  The purpose of this study is to identify clinical and genetic markers of ovarian aging. […] Improving our understanding of reproductive aging has profound economic, and social, implications given the complex choices women face regarding the timing of childbearing and the growing burden of infertility. […] The primary goal of this study is to demonstrate the relationship between antral follicle count and common genetic polymorphisms and the effect of modification of environmental factors. […] This study will provide evidence to support ultrasound evaluation as a non-invasive marker of ovarian aging. […] The ethnic diversity of this population will allow multiple comparisons to identify true „risk factors” for early, and/or accelerated, ovarian aging and their correlation with ethnicity.

• #30 Biological and Social Aspects of Human Infertility: A Global Perspective | Oxford Research Encyclopedia of Global Public Health

  https://oxfordre.com/publichealth/display/10.1093/acrefore/9780190632366.001.0001/acrefore-9780190632366-e-184

  A focus on infertility as a global health concern, however, predates the ICPD with the inception of the Expanded (later Special) Programme of Research, Development and Research Training in Human Reproduction, or Human Reproduction Programme (HRP) in 1972, but efforts were hindered by shifting prioritization to prevention of unintended pregnancies, resulting in the dissolution of the Infertility Task Force in 1998. […] A renewed global focus on infertility measurement, prevention, and treatment will support individuals in trying to reach their desired number and spacing of children and improve overall health and well-being. […] Infertility is considered a disease, but its public health implications extend far beyond a diagnosis. Improved data systems and further research are needed to better understand the magnitude, disparities, and potential risk and protective factors of infertility.

• #31 The Epidemiology of Infertility | SpringerLink

  https://link.springer.com/chapter/10.1007/978-1-4471-1962-3_2

  Few countries collect information relevant to the study of the epidemiology of infertility. National data available in the UK are either indirect or incomplete. Furthermore, most published studies have methodological problems which mean they must be carefully interpreted. In particular there are difficulties studying the rates of resolved infertility and secondary infertility. Similarly, there are few data or studies in any European countries which provide information on secular trends in infertility, although such information may be available in the US. […] It is, however, clear that infertility is a common problem affecting a large proportion of otherwise healthy individuals, usually in their 20s and 30s. Infertility diminishes their sense of wellbeing and fulfilment and sometimes causes great personal distress. This chapter reviews the available information on the epidemiology of infertility and, even though all the current surveys are deficient in one way or another, conclusions are drawn where possible. It is hoped that the need for a robust system of national data collection will become apparent.

• #32 Infertility and ART (Chapter 1) – Assisted Reproductive Technology Surveillance

  https://www.cambridge.org/core/books/assisted-reproductive-technology-surveillance/infertility-and-art/3BDE0F4322848C983682EDD71534D708

  Infertility is generally defined as the inability to establish a clinical pregnancy after 12 months of regular, unprotected sexual intercourse. Estimates of the prevalence of infertility are variable due to differing methodological approaches. […] ART techniques have improved over time and use of ART has increased substantially, although use of ART varies across regions, countries, and jurisdictions. Availability of ART services may be affected by legal restrictions and guidelines. Insurance coverage for ART differs across countries; lack of reimbursement for fertility treatment costs is often barrier to accessing to ART.

• #33 Epidemiology and management of Infertility: A population based-study in UK primary care

  https://durham-repository.worktribe.com/output/1546318/epidemiology-and-management-of-infertility-a-population-based-study-in-uk-primary-care

  Background. Our current knowledge of the epidemiology of infertility is limited and outdated. […] Objective. To describe the incidence, prevalence, referral patterns and outcomes of infertile couples, presenting in general practice in UK. […] The incidence of infertility was 0.9 couples per 1000 general population. […] Half of the couples required treatment with IVF or ICSI. […] Adopting the British Fertility Society recommendation of allowing couples, where one or both partners has a child in a previous relationship, will result in an additional 26% of infertile couples becoming eligible for NHS fertility treatment.

• #34

  https://cuestionesdefisioterapia.com/index.php/es/article/view/1448

  Infertility is a condition of the male or female reproductive system that is defined by the inability to become pregnant following more than 12 months of unprotected, common, or sexual behaviour. […] Numerous studies have shown that around thirty per cent of occurrences of infertility are due to males alone. […] The main goal of infertility in male evaluation is the identification of contributing causes, treatment that are reversible and assisted reproductive procedures (ART) and counselling for all the issues that are irreversible as well as untreatable. […] Additionally, Male infertility occasionally may be a sign of a more serious ailment that further causes life threatening problems or disorders.

• #35 Fertility evaluation of infertile women: a committee opinion (2021) | American Society for Reproductive Medicine | ASRM

  https://www.asrm.org/practice-guidance/practice-committee-documents/fertility-evaluation-of-infertile-women-a-committee-opinion-2021/

  Fertility evaluation of infertile women: a committee opinion (2021) […] Infertility is a disease historically defined as the failure to achieve a successful pregnancy after 12 months of regular, unprotected sexual intercourse or because of impairment of the capacity to reproduce either as an individual or with a partner. […] Infertility evaluation should be initiated immediately if there is a known medical history that is associated with infertility. […] Infertility evaluation, and indicated treatment, should be initiated at 12 months in women 35 years of age and at 6 months in women aged 35 years. In women 40 years, a more immediate evaluation and treatment may be warranted. […] The infertility evaluation should include an evaluation of ovulatory status, the structure and patency of the female reproductive tract, and semen evaluation of the male partner.

• #36

  https://openarchive.ki.se/articles/thesis/Female_and_male_infertility_in_Nigeria_studies_on_the_epidemiology_of_infertility_in_Nigeria_with_special_reference_to_the_role_of_genital_tract_infections_and_sexual_and_reproductive_risk_factors/26916802

  Infertility is a major public health problem in Nigeria, contributing to inappropriate contraceptive behavior and poor sexual and reproductive health of women. […] The objectives of this thesis are: (1) to provide substantive scientific data on the epidemiological and reproductive health risk factors predisposing to male and female infertility in Nigeria, and (2) to make recommendations on the design of interventions for reducing the prevalence of infertility in the country. […] These results show that past episodes of RTIs, correlates of sexual activity and antibodies against NG and CT are the most significant predictors of infertility in this population. The results demonstrate the important role of RTIs and STIs in the epidemiology of male and female infertility in Nigeria. We believe that a public health approach that integrates the prevention of STIs and RTIs within existing services for women and men would reduce the burden of infertility and its consequences in Nigeria.

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