A unique view on male infertility around the globe
TL;DR: At least 30 million men worldwide are infertile with the highest rates in Africa and Eastern Europe, and a novel and unique way to calculate the distribution of male infertility around the world is demonstrated.
Abstract: Infertility affects an estimated 15% of couples globally, amounting to 485 million couples Males are found to be solely responsible for 20-30% of infertility cases and contribute to 50% of cases overall However, this number does not accurately represent all regions of the world Indeed, on a global level, there is a lack of accurate statistics on rates of male infertility Our report examines major regions of the world and reports rates of male infertility based on data on female infertility Our search consisted of systematic reviews, meta-analyses, and population-based studies by searching the terms “epidemiology, male infertility, and prevalence” We identified 16 articles for detailed study We typically used the assumption that 50% of all cases of infertility are due to female factors alone, 20-30% are due to male factors alone, and the remaining 20-30% are due to a combination of male and female factors Therefore, in regions of the world where male factor or rates of male infertility were not reported, we used this assumption to calculate general rates of male factor infertility Our calculated data showed that the distribution of infertility due to male factor ranged from 20% to 70% and that the percentage of infertile men ranged from 2·5% to 12% Infertility rates were highest in Africa and Central/Eastern Europe Additionally, according to a variety of sources, rates of male infertility in North America, Australia, and Central and Eastern Europe varied from 4 5-6%, 9%, and 8-12%, respectively This study demonstrates a novel and unique way to calculate the distribution of male infertility around the world According to our results, at least 30 million men worldwide are infertile with the highest rates in Africa and Eastern Europe Results indicate further research is needed regarding etiology and treatment, reduce stigma & cultural barriers, and establish a more precise calculation
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TL;DR: The chance of becoming spontaneously pregnant declines with the duration before conception, and the three major factors influencing the spontaneous probability of conception are the time of unwanted non-conception, the age of the female partner and the disease-related infertility.
914 citations
Additional excerpts
...5–6%, 9%, and 8–12%, respectively [6]....
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University of Dundee1, Karolinska University Hospital2, University of Minnesota3, Baylor College of Medicine4, Clínica Alemana5, Hudson Institute of Medical Research6, Boston University7, Population Council8, World Bank9, Brown University10, University of Southern California11, Vrije Universiteit Brussel12
TL;DR: The consensus guideline methodology is described, the evidence-based recommendations provided to the World Health Organization for their consideration in the development of global guidance are summarized and a narrative review of the diagnosis of male infertility as related to the eight prioritized PICO questions is presented.
Abstract: BACKGROUND
Herein, we describe the consensus guideline methodology, summarize the evidence-based recommendations we provided to the World Health Organization (WHO) for their consideration in the development of global guidance and present a narrative review of the diagnosis of male infertility as related to the eight prioritized (problem or population (P), intervention (I), comparison (C) and outcome(s) (O) (PICO)) questions. Additionally, we discuss the challenges and research gaps identified during the synthesis of this evidence.
272 citations
Cites result from "A unique view on male infertility a..."
...Agarwal et al. have attempted to pursue this type of review (Agarwal et al., 2015) but due to a paucity of high-quality comparable studies they were unable to make robust conclusions....
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...have attempted to pursue this type of review (Agarwal et al., 2015) but due to a paucity of high-quality comparable studies they were unable to make robust conclusions....
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TL;DR: Overall, despite some inconsistencies across phthalates in the specific outcomes associated with exposure, these results support that phthalate exposure at levels seen in human populations may have male reproductive effects, particularly DEHP and DBP.
263 citations
02 Dec 2019
TL;DR: DisMod-MR 2.1 is a Bayesian meta-regression method that estimates non-fatal outcomes using sparse and heterogeneous epidemiological data and found that high SDI countries had the lowest level of prevalence and DALYs in both genders, however, the largest increasing trend was observed in high-SDI countries for females.
Abstract: To provide comprehensive estimates of the global, regional, and national burden of infertility from 1990 to 2017, using findings from a 2017 study on the global burden of disease (GBD), we assessed the burden of infertility in 195 countries and territories from 1990 to 2017. DisMod-MR 2.1 is a Bayesian meta-regression method that estimates non-fatal outcomes using sparse and heterogeneous epidemiological data. Globally, the age-standardized prevalence rate of infertility increased by 0.370% per year for females and 0.291% per year for males from 1990 to 2017. Additionally, age-standardized disability-adjusted life-years (DALYs) of infertility increased by 0.396% per year for females and 0.293% per year for males during the observational period. An increasing trend to these burden estimates was observed throughout the all socio-demographic index (SDI) countries. Interestingly, we found that high SDI countries had the lowest level of prevalence and DALYs in both genders. However, the largest increasing trend was observed in high-SDI countries for females. By contrast, low-SDI countries had the largest increasing trend in males. Negative associations were observed between these burden estimates and the SDI level. The global disease burden of infertility has been increasing throughout the period from 1990 to 2017.
232 citations
Cites background from "A unique view on male infertility a..."
...Others exclusively examined males registered at infertility clinics [13, 14]....
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Cleveland Clinic1, University of the Western Cape2, Lilavati Hospital and Research Centre3, University of Kent4, University of Miami5, Loma Linda University6, Flinders University7, Aarhus University8, State University of Campinas9, Hamad Medical Corporation10, Harvard University11, University of Melbourne12, Imperial College London13, Hammersmith Hospital14, Union Hospital15, Sohag University16, University of Utah17, Cooper University Hospital18, Autonomous University of Madrid19, Pusan National University20, McGill University21, Department of Urology, University of Virginia22, Sapienza University of Rome23, University Hospital Bonn24, Southern Illinois University School of Medicine25, University of Birmingham26, University of Toronto27, First Affiliated Hospital of Wenzhou Medical University28, Tygerberg Hospital29, Icahn School of Medicine at Mount Sinai30, University of Hasselt31, University of Florence32, Yokohama City University Medical Center33, University of Catania34, University of Santo Tomas Hospital35, University of São Paulo36, ALFA37, Hadassah Medical Center38, Sheba Medical Center39, Tel Aviv University40, Ben-Gurion University of the Negev41, Meir Medical Center42, University of Central Florida43, All India Institute of Medical Sciences44, Manipal Hospitals45, Hacettepe University46, University of Belgrade47, Universiti Teknologi MARA48, University of Sousse49, New York University50, Ravenshaw University51, Ege University52
TL;DR: Oxidation-reduction potential (ORP) can be a useful clinical biomarker for the classification of MOSI, as it takes into account the levels of both oxidants and reductants (antioxidants) and may provide a more targeted, reliable approach for administering antioxidant therapy while minimizing the risk of antioxidant overdose.
Abstract: Despite advances in the field of male reproductive health, idiopathic male infertility, in which a man has altered semen characteristics without an identifiable cause and there is no female factor infertility, remains a challenging condition to diagnose and manage. Increasing evidence suggests that oxidative stress (OS) plays an independent role in the etiology of male infertility, with 30% to 80% of infertile men having elevated seminal reactive oxygen species levels. OS can negatively affect fertility via a number of pathways, including interference with capacitation and possible damage to sperm membrane and DNA, which may impair the sperm's potential to fertilize an egg and develop into a healthy embryo. Adequate evaluation of male reproductive potential should therefore include an assessment of sperm OS. We propose the term Male Oxidative Stress Infertility, or MOSI, as a novel descriptor for infertile men with abnormal semen characteristics and OS, including many patients who were previously classified as having idiopathic male infertility. Oxidation-reduction potential (ORP) can be a useful clinical biomarker for the classification of MOSI, as it takes into account the levels of both oxidants and reductants (antioxidants). Current treatment protocols for OS, including the use of antioxidants, are not evidence-based and have the potential for complications and increased healthcare-related expenditures. Utilizing an easy, reproducible, and cost-effective test to measure ORP may provide a more targeted, reliable approach for administering antioxidant therapy while minimizing the risk of antioxidant overdose. With the increasing awareness and understanding of MOSI as a distinct male infertility diagnosis, future research endeavors can facilitate the development of evidence-based treatments that target its underlying cause.
229 citations
Cites background or methods from "A unique view on male infertility a..."
...Male factor infertility (50%) 93 million Agarwal et al (Reprod Biol Endocrinol 2015;13:37) [10]...
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...Data from Agarwal et al (Reprod Biol Endocrinol 2015;13:37) [10]....
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References
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TL;DR: Semen quality of the reference population was superior to that of the men from the general population and normozoospermic men, and provide an appropriate tool in conjunction with clinical data to evaluate a patient's semen quality and prospects for fertility.
Abstract: BACKGROUND Semen quality is taken as a surrogate measure of male fecundity in clinical andrology, male fertility, reproductive toxicology, epidemiology and pregnancy risk assessments. Reference intervals for values of semen parameters from a fertile population could provide data from which prognosis of fertility or diagnosis of infertility can be extrapolated. METHODS Semen samples from over 4500 men in 14 countries on four continents were obtained from retrospective and prospective analyses on fertile men, men of unknown fertility status and men selected as normozoospermic. Men whose partners had a time-to-pregnancy (TTP) of < or =12 months were chosen as individuals to provide reference distributions for semen parameters. Distributions were also generated for a population assumed to represent the general population. RESULTS The following one-sided lower reference limits, the fifth centiles (with 95th percent confidence intervals), were generated from men whose partners had TTP < or = 12 months: semen volume, 1.5 ml (1.4-1.7); total sperm number, 39 million per ejaculate (33-46); sperm concentration, 15 million per ml (12-16); vitality, 58% live (55-63); progressive motility, 32% (31-34); total (progressive + non-progressive) motility, 40% (38-42); morphologically normal forms, 4.0% (3.0-4.0). Semen quality of the reference population was superior to that of the men from the general population and normozoospermic men. CONCLUSIONS The data represent sound reference distributions of semen characteristics of fertile men in a number of countries. They provide an appropriate tool in conjunction with clinical data to evaluate a patient's semen quality and prospects for fertility.
2,264 citations
"A unique view on male infertility a..." refers methods in this paper
...In 2010, the WHO changed their guidelines for semen analysis for the diagnosis of the infertile male [24]....
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TL;DR: This work uses information from demographic reproductive health surveys to estimate the global, regional, and country levels, patterns, and trends in infertility between 1990 and 2010.
Abstract: BACKGROUND: Global regional and national estimates of prevalence of and tends in infertility are needed to target prevention and treatment efforts. By applying a consistent algorithm to demographic and reproductive surveys available from developed and developing countries we estimate infertility prevalence and trends 1990 to 2010 by country and region. METHODS AND FINDINGS: We accessed and analyzed household survey data from 277 demographic and reproductive health surveys using a consistent algorithm to calculate infertility. We used a demographic infertility measure with live birth as the outcome and a 5-y exposure period based on union status contraceptive use and desire for a child. We corrected for biases arising from the use of incomplete information on past union status and contraceptive use. We used a Bayesian hierarchical model to estimate prevalence of and trends in infertility in 190 countries and territories. In 2010 among women 20-44 y of age who were exposed to the risk of pregnancy 1.9% (95% uncertainty interval 1.7% 2.2%) were unable to attain a live birth (primary infertility). Out of women who had had at least one live birth and were exposed to the risk of pregnancy 10.5% (9.5% 11.7%) were unable to have another child (secondary infertility). Infertility prevalence was highest in South Asia Sub-Saharan Africa North Africa/Middle East and Central/Eastern Europe and Central Asia. Levels of infertility in 2010 were similar to those in 1990 in most world regions apart from declines in primary and secondary infertility in Sub-Saharan Africa and primary infertility in South Asia (posterior probability [pp] >/=0.99). Although there were no statistically significant changes in the prevalence of infertility in most regions amongst women who were exposed to the risk of pregnancy reduced child-seeking behavior resulted in a reduction of primary infertility among all women from 1.6% to 1.5% (pp=0.90) and a reduction of secondary infertility among all women from 3.9% to 3.0% (pp>0.99) from 1990 to 2010. Due to population growth however the absolute number of couples affected by infertility increased from 42.0 million (39.6 million 44.8 million) in 1990 to 48.5 million (45.0 million 52.6 million) in 2010. Limitations of the study include gaps in survey data for some countries and the use of proxies to determine exposure to pregnancy. CONCLUSIONS: We analyzed demographic and reproductive household survey data to reveal global patterns and trends in infertility. Independent from population growth and worldwide declines in the preferred number of children we found little evidence of changes in infertility over two decades apart from in the regions of Sub-Saharan Africa and South Asia. Further research is needed to identify the etiological causes of these patterns and trends.
1,552 citations
"A unique view on male infertility a..." refers background or methods in this paper
...Data calculated from a different source than Sub-Saharan Africa calculations in Tab between 1990 and 2010, providing a 5-year projection of infertility [3]....
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...According to this data, the highest rates of infertility were concentrated through Africa and Central/ Eastern Europe [3]....
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...Demographic studies, on the other hand, look at infertility over a fiveyear projection [3]....
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...Mascarenhaas and colleagues used a 5-year demographic definition of male infertility in their study [3]....
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...While many clinical studies have examined infertility over the course of a year, several demographic studies examine infertility over a five-year projection [3]....
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TL;DR: These EAU guidelines are a short comprehensive overview of the updated guidelines of male infertility as recently published by the EAU and are also available in the National Guideline Clearinghouse ( www.guideline.gov/).
802 citations
"A unique view on male infertility a..." refers background or methods in this paper
...These numbers are based upon data from the National Health Statistics Report (NHSR) from the CDC National Health Interview Survey, the Australian Institute for Health and Welfare (AIHW), and the European Association of Urology (EAU) guidelines for male infertility [4,10,11]....
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...nalysis of 277 Health Surveys on Female infertility [11]...
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TL;DR: The prevalence rate of infertility in France was found to be 14.1%, indicating that one woman out of seven in France will consult a doctor for an infertility problem during her reproductive life, and the main causes of female infertility were ovulation disorders and tubal damage.
Abstract: To estimate the prevalence and main causes of infertility, a multicentre survey was conducted over 1 year (July 1988-June 1989) in three regions of France. All the 1686 couples in these regions, who consulted a practitioner for primary or secondary infertility during this period, were included in the investigation. The prevalence rate of infertility was found to be 14.1%, indicating that one woman out of seven in France will consult a doctor for an infertility problem during her reproductive life. The main causes of female infertility were ovulation disorders (32%) and tubal damage (26%), and of male infertility oligo-terato-asthenozoospermia (21%), asthenozoospermia (17%), teratozoospermia (10%) and azoospermia (9%). Infertility was also found to be caused by disorders in both the male and female partners together; thus in 39% of cases both the man and woman presented with disorders. The woman alone was responsible for infertility in one-third of cases and the man alone in one-fifth. Unexplained infertility was found in 8% of the couples surveyed.
764 citations
"A unique view on male infertility a..." refers background or methods in this paper
...In Inhorn and Buss, in 40/87 (46%) of cases, male factor was involved [13]....
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...In Inhorn and Buss, in 11/87 (13%) of evaluated cases, male factor infertility was the sole cause of infertility [13]....
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...Male data was calculated based on the various reported rates of male factor contr Male data for world was calculated based on the argument that while 50% of infe present in females 34% of the time, and in both males and females 38% of the time [13]....
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University of California, San Francisco1, Johns Hopkins University School of Medicine2, University of Louisville3, Baylor College of Medicine4, Brown University5, Cleveland Clinic6, NewYork–Presbyterian Hospital7, University of Virginia8, Mayo Clinic9, University of Pennsylvania10, University of California, Davis11, SUNY Downstate Medical Center12
TL;DR: This research aims to provide a more complete picture of the central nervous system and the role that emotion, disease and disease play in the development of chronic disease and its treatment.
661 citations
"A unique view on male infertility a..." refers background or methods in this paper
...In general, according to Sharlip, 50% of infertility cases are due to a solely female factor, pure male factor accounts for 20-30% of the problem, and the remaining 20-30% is due to a combination of both male and female factors [1]....
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...We applied Sharlip’s estimate that approximately 20-30% of the total infertile couple population could be attributed to male infertility [1]....
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...Background Infertility is a worldwide problem, and according to Sharlip et al, it affects 15% of couples that have unprotected intercourse [1]....
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