Documented Fertility-Related Diagnoses and Care in German Gynecological Practices Between 2021 and 2025

Background/Objectives: Current data on documented fertility-related diagnoses in German outpatient gynecological care are scarce. This study described their frequency and trends between 2021 and 2025. Methods: This retrospective cross-sectional study used the IQVIA Disease Analyzer database and included women aged 18 to 45 years attending 154 gynecological practices between 2021 and 2025. Fertility-related diagnoses were defined by documented female infertility and/or procreative management. Annual case numbers were extrapolated nationally and related to the female population and to women attending gynecological practices. Practice-clustered confidence intervals (CIs) and trend tests were calculated, and restrictive case definitions were examined in sensitivity analyses. Results: Per year, 9996 to 10,918 women with a documented fertility-related diagnosis were identified. Among women attending gynecological practices, the proportion remained stable (4.53% to 4.81%; odds ratio per year 1.00, 95% CI 0.98–1.02). Related to the female population, it was 3.65% in 2021 and 3.06% in 2025, in parallel with fewer women attending gynecological practices and fewer office-based gynecologists. The cumulative 5-year proportion among these women was 7.98% (practice-clustered 95% CI: 5.96–9.99). Counseling on procreation dominated the case definition (82.2% to 84.0% of patients). Restricted to female infertility and/or assisted reproductive technology (ART) codes, the proportion was stable at 0.97% to 1.06%. Results were similar after exclusion of one practice with a reproductive medicine focus, whereas trends in individual ART codes depended on single practices. Conclusions: The proportion of women with documented fertility-related diagnoses among women attending gynecological practices remained stable, including under a restrictive case definition. The lower population-based proportion is consistent with a lower volume of care provided by office-based gynecologists, as the proportion among women attending gynecological practices remained stable. These figures describe documented care contacts, not the clinical prevalence of subfertility.