The World Health Organization is now calling for better access to fertility treatments.
For millions of couples around the world, conceiving a child can be agonisingly difficult, when hopes of starting a family are quashed by one negative pregnancy test after another.
Around one in six people worldwide face infertility at some point in their lives, according to a new report by the World Health Organization (WHO) which shows no continent is better off.
“This is a global issue affecting people in all countries and in all walks of life,” Dr Gitau Mburu, a fertility scientist at WHO, told reporters.
The health agency defines infertility as “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”.
Previous estimates suggest that between 48 million couples and 186 million people live with infertility globally. WHO did not update these estimates in its report, and said the data it had analysed, covering 1990 to 2021, did not allow it to determine a trend.
“Based on the data we have, we cannot say that infertility is increasing or constant. The jury is still out on that question,” said Dr James Kiarie, WHO’s Head of Contraception and Fertility Care.
The report also found the prevalence of infertility varies little from one geographical region to another. The lifetime prevalence of infertility - the share of a population who ever experienced it in their life - was 17.8 per cent in high-income countries and 16.5 per cent in low and middle-income countries.
The report shows “infertility does not discriminate,” WHO Director-General Dr Tedros Adhanom Ghebreyesus said in the report’s foreword.
Struggling to conceive can also have wide-reaching repercussions on the lives of people affected, from anxiety and depression to social stigma and domestic violence.
At any point in time, about 12.6 per cent of the global population struggle with infertility. This share was highest in the WHO African region, at 16.4 per cent, and lowest in the Eastern Mediterranean Region, at 10 per cent.
However, the report highlights that a lack of available data in many countries made it difficult to compare in greater detail the burden of infertility around the world.
It calls for improvements in the way research on infertility is conducted, so future data can be more consistent and easier to compare.
What causes infertility?
The WHO report did not provide a breakdown of male and female infertility. Infertility may be caused by a number of different factors, in either the male or female reproductive systems, or both. In some cases, the causes of infertility remain unexplained.
In the female reproductive system, infertility may be caused by a wide range of factors including sexually transmitted infections, blocked fallopian tubes, uterine disorders such as endometriosis, disorders of the ovaries such as polycystic ovarian syndrome (PCOS), or imbalances of reproductive hormones.
In the male reproductive system, infertility may be caused by genital infections, hormonal imbalance, or abnormal sperm production and quality.
Environmental and lifestyle factors such as smoking, excessive alcohol consumption and obesity are all known to affect fertility, but scientists also suspect exposure to environmental pollutants can disrupt reproductive hormones and damage eggs and sperm.
While assisted reproduction techniques such as in vitro fertilisation (IVF) have been available for more than three decades, WHO said these technologies are inaccessible and unaffordable in many parts of the world, particularly in low and middle-income countries, where their high cost can “catapult” a couple into poverty.
In most countries, fertility treatments are largely funded out of pocket. WHO is now calling on governments to improve infertility prevention, diagnosis and care, and ensure more equitable access to treatments such as IVF.
"Millions of people face catastrophic healthcare costs after seeking treatment for infertility, making this a major equity issue and all too often, a medical poverty trap for those affected,” said Dr Pascale Allotey, WHO Director of Sexual and Reproductive Health and Research.