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.