Primary and secondary infertility in India: a systematic review and meta-analysis

Infertility emerges as a notable health concern worldwide, affecting approximately 17.5% of couples. There is a lack of comprehensive estimates regarding its prevalence. This meta-analysis aims to address this gap by examining the combined prevalence of infertility, both primary and secondary in India. Studies conducted in India (1997–2023) reporting overall, primary and secondary infertility prevalence, among females aged 15–49 years were included through a systematic search in PubMed, ScienceDirect, and Google Scholar databases. Newcastle Ottawa scale was used to assess the quality of included studies. The meta-analysis employed a random-effects model and presented the combined prevalence along with 95% confidence interval (CI). Heterogeneity was evaluated using the I2 index, which allowed assessment of variability in the results across the different included studies. Out of 3,216 total studies, 10 were eligible for inclusion, and eight among those were included in the meta-analysis. Two studies were excluded based on quality assessment scores falling below the threshold of 50%. The eight studies represented 25,778 women of reproductive age, across various states in India. Most studies were conducted in community setup. The pooled prevalence of overall infertility, primary infertility and secondary infertility was 8% (95% CI: 0.01–0.14), 5% (95% CI: 0.03–0.06) and 2% (95% CI: 0.01–0.04) respectively. Infertility urgently requires a comprehensive policy emphasising a strategic plan of action that addresses the public health concerns. Facilities that are accessible with equitable reproductive health care services within the overall RMNCH + A framework are needed for early identification and management of infertility. Infertility poses a significant global health concern that affects individuals and couples worldwide, impacting their emotional, psychological, and social well-being. Despite its profound implications, obtaining accurate estimates of infertility prevalence, particularly in regions like India, has been challenging. To address this gap, a systematic review was undertaken to report the comprehensive estimates of its prevalence by reviewing across multiple databases including PubMed, Science Direct and Google Scholar. Ten studies out of 3,216 were included in the review based on inclusion and exclusion criteria. Post quality assessment, eight studies were included. Focusing on Indian women aged 15–49 years, our analysis revealed that the pooled overall, primary, and secondary infertility was 8%, 5%, and 2%, respectively. Primary infertility was found to be more prevalent in India. While India as a country has made notable progress in enhancing Sexual and Reproductive health, infertility remains a critical but overlooked domain within the overarching reproductive health agenda. These observations highlight the need for equitable access to infertility services within the overall RMNCH + A framework and crucial for policy formulation.