A large number of people are affected by infertility during their lifetime, according to a new report published this Monday (3) by the World Health Organization (WHO). Around 17.5% of the adult population – around 1 in 6 people worldwide – suffer from infertility, showing the urgent need to increase access to affordable, high-quality healthcare.
The new estimates show limited variation in the prevalence of infertility across regions. Rates are comparable for high-, middle-, and low-income countries, indicating that this is a major health challenge globally. Lifetime prevalence was 17.8% in high-income countries and 16.5% in low- and middle-income countries.
Infertility is a condition of the male or female reproductive system, defined by the inability to achieve pregnancy after 12 months or more of regular intercourse without condoms. The problem can cause significant suffering, stigma and financial hardship, affecting people’s mental and psychosocial well-being.
WHO warns that despite the magnitude of the problem, solutions for the prevention, diagnosis and treatment of infertility – including assisted reproductive technology such as fertilization in vitro – remain underfunded and inaccessible to many due to high costs, social stigma and limited availability.
“The report reveals an important truth – infertility does not discriminate,” said Tedros Adhanom, WHO Director-General. “The large proportion of people affected shows the need to expand access to fertility care and ensure that this issue is no longer overlooked in health research and policy, so that safe, effective and affordable ways to achieve parenthood are in place. available to those who seek it”, he adds.
Currently, in most countries, fertility treatments are largely out-of-pocket – often resulting in financial costs for families.
According to the new WHO report, people in the poorest countries spend a greater proportion of their income on fertility care compared to people in the richest countries. Furthermore, high costs often prevent people from accessing treatment or, alternatively, can catapult them into poverty as a result of seeking care in the area.
“Millions of people face catastrophic healthcare costs after seeking treatment for infertility, making this a major equity issue and often a medical poverty trap for those affected,” said Pascale Allotey, Director of Health and Research Sexual and Reproductive Care of the WHO, including the United Nations Special Program for Research, Development and Training in Human Reproductive Research. “Better policies and public funding can significantly improve access to treatment and protect the poorest families from falling into poverty as a result.”
While the new report provides compelling evidence for the high global prevalence of infertility, it highlights a persistent lack of data in many countries and some regions. The document calls for greater availability of national data on infertility disaggregated by age and cause to help quantify the problem, as well as distinguish who needs fertility care and how risks can be reduced.
“Unfortunately, in Brazil, assisted reproduction treatments are expensive and are not part of the ANS list. [Agência Nacional de Saúde Suplementar]. Therefore, they are not covered by most health plans. Infertility is a disease that is even part of the international classification of diseases, the famous ICD, but it is still not treated as such in Brazil”, says gynecologist Natália Ramos Seixas, from the women’s health clinic Oya Care.
What explains the increase in infertility in the world
Infertility is related to factors associated with the woman, the man or a combination of the two. Hormonal and genetic characteristics, in addition to issues associated with behavior, such as smoking, alcohol or drug abuse and anabolic steroids contribute to the development of the problem.
In the case of women, different factors can influence the ability to become pregnant, such as issues associated with the ovulation process, the uterus and sequelae caused by infections.
Hormonal, genetic and infectious factors are some of the causes of male infertility. In the case of men, the main alterations in the body that can make reproduction difficult can be seen in a test called a spermogram, capable of detecting the quantity and concentration of sperm, in addition to characteristics such as mobility and shape of the gametes.
“The high rates of infertility in the world can be explained by several factors. One of them is advanced maternal age, the main cause of infertility in the world. Currently, from a reproductive point of view, above 35 years old we already consider an advanced maternal age, since we have a significant decrease in the quantity and quality of eggs that are not replaced during the life of the woman or the person with an ovary”, explains the gynecologist.
“Next, we also have the male factor, which corresponds to approximately 40% of cases of marital infertility. In relation to the worldwide trend of increasing the problem, in fact, we can say that infertility is a problem that tends to increase more and more”, completes the specialist.
Regular visits to a gynecologist are recommended as part of monitoring a woman’s health from early adolescence. In addition to hormonal assessment and female health as a whole, guidance on prevention of sexually transmitted infections and contraceptive methods are common.
“Life habits such as a sedentary lifestyle, smoking, alcohol and drug use, increased rates of overweight and obesity, all contribute to the increase in infertility numbers not only in Brazil, but throughout the world”, highlights Natália.
The best way to prevent infertility is through individual medical advice, says the doctor.
“During counseling on reproductive life, the person will be guided on their individual risks based on their ovarian reserve in the case of women, previous illnesses and lifestyle habits. In addition, today we have several complementary tests that can help us in the early diagnosis of risk factors for infertility. Here, I highlight the tests for evaluating the ovarian reserve, the ‘egg stock’ of women, such as the dosage of anti-Müllerian hormone and the transvaginal ultrasound with the count of antral follicles”, she explains.
Advances help to help you get pregnant
People who have difficulty conceiving can benefit from advanced methods of medicine in the field of reproduction.
One of them is programmed intercourse, which consists of controlling the woman’s ovulation and guiding her to have sexual intercourse during the period of greatest probability of pregnancy.
“Programmed intercourse can be done in a natural cycle, in which the woman does not use any medication, or in a cycle with medication to increase ovulation. The advantage of having programmed intercourse with ovulation induction is that the chances of getting pregnant increase, but the risks of multiple pregnancies also increase”, says gynecologist Silvana Chedid Grieco, from Hospital Sírio-Libanês, in São Paulo.
In vitro fertilization, created 45 years ago, is still a tool available for those who have a greater difficulty in natural pregnancy.
“The sperm sample is prepared in the laboratory and the doctor, with a small probe, places the sperm inside the woman’s uterus, through the cervix. Sperm ‘swim’ inside the uterus and travel to the fallopian tubes, where they will find the eggs that have been produced and will be fertilized, ”she explains.
The Oya Care gynecologist says that egg freezing is a safe and effective method and is no longer considered experimental.
“Studies bring scientific evidence that for ten years these eggs remain healthy but, in practice, they remain healthy ‘ad aeternum’. Freezing is an old technique, used in the beginning. Today, we call it egg vitrification, a quick freeze. Studies will come out over the next few decades, but with clinical practice we are realizing that these eggs do not age.
The specialist explains that the procedure allows the postponement of maternity and prevents to reduce the risks of genetic diseases.
“In the case of a woman who froze at 35 and intends to get pregnant at 45, her eggs will have the potential of when they were frozen, which reduces the risk of malformations and chromosomal diseases”, he says.
About the report
The WHO report provides information on the global and regional prevalence of infertility from the analysis of all relevant studies from 1990 to 2021, taking into account different estimation approaches.
The search identified 12,241 records of potentially relevant studies from around the world. Screening these records led to the selection of 133 studies that were included in the analysis of the report.
From these, relevant data points were used to generate pooled estimates for lifetime and period prevalence of infertility.
Source: CNN Brasil
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