2. Burden of disease: Globally an estimated 9% of women of reproductive age suffer from infertility. This equates to approximately 80 million women.
The prevalence of infertility can only be estimated. Estimates vary considerably depending on the criteria used to define infertility and the population sampled. One review, using data from published population surveys on infertility, reported that globally an estimated 9% of women of reproductive age suffered from infertility, amounting to 72.4 million women worldwide (Boivin et al, 2007). Experts anticipate that this prevalence will rise further if women increasingly postpone childbearing until later in life. Another report, evaluating data from demographic health surveys, concluded that in developing countries alone more than 186 million ever-married women age 15-49 suffered from primary or secondary infertility (Rutstein and Shah, 2004). In contrast, a more conservative estimate of 48.5 million infertile women and men worldwide was provided by researchers who applied more stringent definitions and statistical analysis to demographic and reproductive health survey data (Mascarenhas et al, 2012). These wide variations highlight the difficulties of accurately determining the extent of infertility. While it is desirable to get more precise and consistent estimates in the future based on consensus regarding definitions and sampling methods (Gurunath et al, 2011), discrepancies in estimates should not deter from a simple truth, namely that infertility is a common reproductive health problem affecting tens of millions of women and men worldwide.
Paradoxically, high infertility rates are often observed in countries which also have high total fertility rates. This paradox can be explained by sexual behaviour which is orientated towards having (many) children (such as early age at marriage, universal marriage, low use of contraception) in settings where there are also many risk factors for infertility (such as high prevalence of sexually transmitted diseases, formal and informal polygamy, poor pregnancy care with high rates of pregnancy-related sepsis). Thus, many developing countries have a problem of both overpopulation and infertility. Infertile people living in these countries suffer particularly as they are often ostracized in the family and community, as well as in health systems which do not allocate resources to infertility. Prevalence is one of two factors determining the burden of disease. The other factor is quality of life. Conditions which have a high prevalence and which impact very negatively on quality of life give rise to a high burden of disease. The burden of disease associated with infertility has not been accurately estimated. But because infertility is a very frequent condition and can seriously impact on people’s lives, the disease burden of infertility is likely to be significant.