Introduction
Infertility is a disease of the reproductive system defined by the failure to achieve a pregnancy after a period of regular unprotected sexual intercourse1. It is estimated that 48 million couples and 186 million people worldwide suffer from infertility2-4. These infertility patients always suffer from various psychological stress and are more prone to anxiety and depression, which in turn affects the quality of life, leading to disharmonious relationships among family members, and even domestic violence5, 6. Moreover, infertility places a huge financial burden on patients , with the cost of assisted reproductive treatment for infertile couples to obtain a live birth ranging from approximately $17,100 to $24,200 7. In many parts of the world, especially in low- and middle-income countries, having children is highly valued and expected8. For couples, involuntary infertility can lead to public stigmatization, economic deprivation, social isolation and even loss of status9, 10. In addition, on a societal level, it increases the burden on society’s health care system, economy and disease11. The existence of a large number of infertile people will not only lead to a lower birth rate, but will even affect the demographic structure of a country and national security12. With the steady increase in infertility rates in recent years and the harm it causes to individuals, societies and nations, it has become a global public health problem.
Estimating the prevalence of infertility is crucial for gaining insights into its current status and to aid governments and societies in determining appropriate resource allocation for addressing this issue. However, there are still difficulties in assessing infertility rates. One important reason for this is that the definition of infertility varies around the world due to differences in countries and populations. For example, sociology defines it by the childless13, while not elsewhere as a duration of two years, etc14-16. WHO believes that it should be defined in terms of 12 months (one year)17, and that such a definition may be timely to help doctors and patients better understand when to seek professional help and begin treatment18. Another reason is the difference between the hospital population and the community population. The hospital population is limited to a specific hospital or medical institution, without considering other individuals who haven’t sought treatment at that medical facility. This can lead to selection bias, making the research results non-representative of the entire community or population. Currently, most reviews do not screen the population but directly combine infertility prevalence, which can lead to an overestimation of infertility rates19.
Globally, the prevalence of infertility varies widely due to different definitions of infertility and population differences1, 4, 20. Though several previous studies tried to estimate the prevalence of infertility, the definition of infertility and the population were not clearly definite, which may remarkedly influence the estimating of infertility prevalence. Therefore, a system review and meta-analysis was conduct to estimate global infertility rates, based on community-based populations. The definition of infertility has been critically defined to ensure accurate understanding in order to provide a comprehensive assessment of the global prevalence of infertility.