One in six people worldwide are affected by infertility, according to a report that lays bare the scale of the problem.
About 17.5% of the global adult population – roughly one in six – will experience infertility at some point in their lifetime, the 98-page report published by the World Health Organization (WHO) says. The figures are its first estimates of infertility prevalence in more than a decade.
Dr Tedros Adhanom Ghebreyesus, the WHO director general, said the report underlined the magnitude of infertility as a public health issue globally, and showed there was an urgent need to expand access to prevention, diagnosis and treatments.
“The report reveals an important truth – infertility does not discriminate,” said Tedros. “The sheer proportion of people affected shows the need to widen access to fertility care and ensure this issue is no longer sidelined in health research and policy, so that safe, effective and affordable ways to attain parenthood are available for those who seek it.”
The WHO said there was insufficient evidence to be able to know whether prevalence was rising or not.
Strikingly, the new estimates, based on more than 100 studies conducted between 1990 and 2021, show limited variation in prevalence between regions.
The rates are also comparable for high-, middle- and low-income countries, suggesting infertility is a serious health challenge in every community, country and region of the world. Lifetime prevalence was recorded as 17.8% in high-income countries and 16.5% in low- and middle-income countries.
“For millions around the world, the path to parenthood can be difficult to access, if not impossible,” said Tedros. “Globally, an estimated one out of every six people are affected by the inability to have a child at some point in their life. This is regardless of where they live and what resources they have.”
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, the report says. It can cause significant distress, stigma and financial hardship, affecting people’s mental and psychosocial wellbeing.
“The causes of infertility are varied and often complex, and it is something that both men and women experience,” said Tedros. “Indeed, a wide variety of people, in all regions, may require fertility care.
“Access to sexual and reproductive health services is the primary way for people to have the best chance of having the number of children they desire. However, in most countries, these services are inadequate.”
Despite the scale of the issue, solutions for the prevention, diagnosis and treatment of infertility – including assisted reproductive technology such as IVF – remain underfunded and inaccessible to many due to high costs, social stigma and limited availability, the report said.
In most countries fertility treatments are largely funded privately – often resulting in huge financial costs.
People in the poorest countries spend a greater proportion of their income on fertility care compared with people in wealthier countries, the report says. High costs prevent people from accessing infertility treatments or can catapult them into poverty as a consequence of seeking care, it adds.
“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, the director of sexual and reproductive health and research at the WHO.
“Better policies and public financing can significantly improve access to treatment and protect poorer households from falling into poverty as a result.”
While the new report highlights convincing evidence of the high global prevalence of infertility, it also shows 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.
“It is my hope that governments use this report to develop evidence-based policies and adopt proven solutions, as part of their efforts to strengthen health systems to help people fulfil their fertility intentions and live healthier lives,” said Tedros.
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