Prevalence of Infertility in South Asia: A Systematic Review and Meta-Analysis

Background: Infertility affects about 16.5% of adults in low- and middle-income countries, according to the World Health Organization, and represents a major global public health concern. Despite this burden, population-level estimates from South Asia remain limited. Objective: To address this gap, we conducted a systematic review and meta-analysis to estimate the pooled prevalence of infertility in South Asia and to assess the quality of existing studies. Materials and Methods: We systematically searched PubMed, Scopus and Embase from inception to 12 April 2025 for studies reporting infertility prevalence in South Asia, excluding studies that did not report the total population from which the prevalence was calculated. Two reviewers independently screened studies, extracted data and assessed study quality using the Joanna Briggs Institute checklist. A random-effects meta-analysis of proportions was performed, and heterogeneity was assessed using I ² and Cochran’s Q statistics. Results: Of 4326 records screened, 16 studies met the inclusion criteria and were included in the systematic review, of which five were eligible for primary analysis. Except for one study from Nepal, the remaining studies were from India. The pooled prevalence of infertility was 8% (95% confidence interval [CI]: 5%–13%; I ² = 98.6%). Community and hospital-based studies showed a prevalence of 10% and 8%, respectively. Primary infertility prevalence was 7% (95% CI: 2%–14%), while secondary infertility was 3% (95% CI: 0%–12%). Interpretation: The review shows a pooled prevalence that is lower than recent global estimates, highlighting the need for robust region-specific data. Limitations: Considerable variation in infertility definitions contributed to substantial heterogeneity and reduced comparability across studies. About one-third of the included studies were clinic-based, which are not ideal for estimating population prevalence. PROSPERO Registration: CRD42024623937.