WHO: Infertility ‘global health issue’ that affects one in six people

The health organization says the findings show the ‘urgent need to increase access to affordable, high-quality fertility care for those in need’

Pablo Linde
Laboratorios del Institut Marquès
A fertility clinic in Barcelona.

One in six people worldwide are affected by infertility in their lifetime. That’s according to the largest study to date on the topic, which was published Tuesday by the World Health Organization (WHO). In the press release to announce the findings, the WHO said infertility was a “global health issue” that affected all regions of the world, “showing the urgent need to increase access to affordable, high-quality fertility care for those in need.”

The report — a compendium of the main meta-analyses (research that in turn compiles many other publications) of the last 30 years — quantified the problem, but did not analyze its causes or trends.

“We have no evidence that infertility rates have increased,” Dr Gitau Mburu, a WHO expert on sexual and reproductive health, said at a virtual press conference on Monday. According to Mburu, there is no major difference between the data from 1990 and the data from 2010. The expert, however, pointed out that the way the figures were compiled was not designed to show changes over time, or whether there was a higher prevalence of infertility among men and women.

The goal of the WHO report, said Mburu, was to quantify the impact of infertility, which is defined by the failure to achieve a pregnancy after 12 months or more of regular unprotected sexual intercourse. The definition applies to the 15-49 age group, although some of the studies in the review collected information from people aged between 20 and 44.

“Given the global magnitude of infertility, and its negative impact on people’s lives and wellbeing, there is a clear need to make fertility care services widely available, accessible and affordable,” said Mburu.

One negative impact of infertility is social stigma. “This is especially pronounced for women in some countries, who are often blamed for the couple’s lack of fertility, and this has an impact on the increase in gender violence,” Pascale Allotey, director of sexual and reproductive health and research at WHO, said at the press conference.

Infertility also takes a toll financially, as couples typically cover the “devastating financial costs” themselves, according to the WHO. “People in the poorest countries spend a greater proportion of their income on fertility care compared to people in wealthier countries. High costs frequently prevent people from accessing infertility treatments or alternatively, can catapult them into poverty as a consequence of seeking care,” the press release explained.

“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,” added Allotey. “Better policies and public financing can significantly improve access to treatment and protect poorer households from falling into poverty as a result.”

The WHO data showed some variation between different parts of the world, but given the gaps in data collection and the differing scopes of each investigation, it’s not possible to draw conclusions. Keeping that in mind, the study found that the Pacific region had the highest rates of infertility (23.3%), followed by the Americas (20.0%), Europe (16.5%) and Africa (13.1%). The Eastern Mediterranean region reported the lowest rate (10.7%). There were no major differences between countries of different income levels: the infertility rate in high-income countries was 17.8%, compared to 16.5% for low- and middle-income countries.

“The report reveals an important truth: infertility does not discriminate,” said Dr Tedros Adhanom Ghebreyesus, Director-General at WHO in a statement. “The sheer proportion of people affected show 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.”

Causes unclear

Infertility has various causes, but further investigation is needed to determine the impact of each one. A study published last year showed that the quality of human sperm has dropped by half in the last half century. But it is also not clear why this has happened. Jaime Mendiola, the co-author of that paper, told EL PAÍS that they were considering the effect of exposure to chemicals and environmental pollutants, which could cause hormonal disruption of the hypothalamic-pituitary-gonadal axis, and in turn affect sperm production.

However, Rocío Núñez Calonge, the scientific director of the International Reproduction Unit, argues that it is not even clear that this “supposed” decrease in sperm quality is the cause of fertility problems, since it is not known if it has really decreased in the last decades. According to the expert, there are two reasons why it appears that more and more people are having trouble conceiving. “Firstly, the stigma of not being able to conceive has decreased, meaning it is more common for couples to go to fertility clinics,” she said. “Secondly, in countries such as Spain, women are trying to have children at an older age. We know that from the age of 35 there is a sharp drop in fertility and more and more women are above this age, or even close to 40.″

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