Trends in Burden of Female Infertility During 1990–2021: An Analysis of Data from the Global Burden of Disease Study 2021

Jingfang Zheng, Xiang Chen, Aijuan Yuan, Liying YingDepartment of Obstetrics and Gynaecology, The Affiliated People’s Hospital of Ningbo University, Ningbo, Zhejiang, 315040, People’s Republic of ChinaCorrespondence: Jingfang Zheng, Department of Obstetrics and Gynaecology, The Affiliated People’s Hospital of Ningbo University, 251 Baizhang East Road, Yinzhou District, Ningbo, Zhejiang, 315040, People’s Republic of China, Email [email protected]: This study aimed to analyze the global trends in the disease burden of Female Infertility (FI) from 1990 to 2021.Material and Methods: Data were sourced from the GBD2021 database, which aggregates information from disease registries, cause-of-death statistics, and medical records across numerous countries and regions worldwide. The primary metrics analyzed were the age-standardized Disability-Adjusted Life Years (DALYs) and DALY rates for FI. The estimated annual percentage change (EAPC) was calculated to quantify temporal trends. Regions were also categorized according to their socio-demographic index (SDI) to evaluate the association between development levels and the FI disease burden.Results: Globally, the age-standardized DALY rate for FI increased from 12.32 per 100,000 in 1990 to 15.12 per 100,000 in 2021, with an EAPC of 0.71, indicating a significant upward trend. Geographically, East Asia, Eastern Europe, and South Asia had the highest age-standardized DALY rates in 2021. The most notable increases in the burden of FI were observed in Andean Latin America (EAPC: 8.11), High-income North America (EAPC: 2.91), and South Asia (EAPC: 1.85). In contrast, regions such as Oceania and Eastern Sub-Saharan Africa experienced a decrease in the FI burden. When analyzed by SDI, regions with high-middle and middle SDI carried the highest overall disease burden. Meanwhile, high-SDI countries, despite having a relatively lower burden, showed the highest rate of increase. Age-specific analysis revealed that the DALY rate peaked among women aged 40– 44 years, followed by a sharp decline in the 45– 49 age group. Notably, contrary to the conventional developmental gradient expectation, SDI exhibited nearly no meaningful correlation with female infertility burden across all continents, with R2 values close to zero throughout the study period.Conclusion: The findings from the GBD Study indicate a rising global trend in the disease burden of female infertility from 1990 to 2021. The increasing burden, particularly in high-SDI regions and among women in their late reproductive years (40– 44), highlights a growing public health challenge that requires targeted interventions and resource allocation.Keywords: female infertility, DALY, EAPC, GBD, SDI