Prevalence of anxiety and depressive symptoms among men attending infertility services in Africa: a systematic review and meta-analysis

Abstract Background Anxiety and depression are common comorbidities in individuals with infertility, but their pooled prevalence and study-level sources of heterogeneity among men attending infertility services in Africa are not well defined. This systematic review and meta-analysis aimed to estimate the pooled prevalence of anxiety and depressive symptoms in men attending infertility services in Africa. Methods We followed PRISMA guidance and searched PubMed/MEDLINE, Embase, Cochrane Library, and African Journals Online (AJOL) from inception through August 31, 2026, supplemented by citation tracking and grey‑literature searches; two reviewers independently screened studies, extracted data, and appraised study quality using the JBI prevalence checklist. We pooled prevalence estimates using a logit-transformed random-effects meta-analysis and assessed heterogeneity using 𝐼 2 and Cochran’s 𝑄. Exploratory subgroup analyses and study-level meta-regression examined whether geographic region, publication year, and study sample size were associated with variation in prevalence estimates. These variables were treated as study characteristics and were not interpreted as individual-level determinants or risk factors. Results Nine studies involving 1,014 participants contributed to the depression analysis, while eight studies involving 764 participants contributed to the anxiety analysis. Most were cross‑sectional ( n = 8) and one was case-control ( n = 1). The pooled prevalence of anxiety symptoms was 28.0% (95% CI: 16.3% to 43.7%), and the pooled prevalence of depressive symptoms was 25.6% (95% CI: 9.6% to 52.9%). Heterogeneity was substantial for both outcomes. Subgroup analyses suggested higher prevalence estimates in smaller studies and variation by geographic region, although these differences were not statistically significant in meta-regression. Leave-one-out analyses showed variation in the pooled estimates, including a reduction in the depression estimate after exclusion of Gamel et al. Evidence regarding small-study effects was inconclusive, and publication-bias assessments were difficult to interpret because of the small number of studies and substantial heterogeneity. Conclusions Anxiety and depressive symptoms are common among men attending infertility services in Africa, indicating a substantial mental‑health burden in this population. Infertility services may consider context-appropriate psychological assessment and referral pathways to identify and manage psychological dysfunction among affected men.