Infertility has been identified as a public health problem because it affects about 17.5% of the world’s adult population and has been ranked by the World Health Organization as the 5th most common disability globally.
It affects populations in all regions equally, regardless of the income of the affected population.
Globally, 48.5 million couples suffer from infertility.
According to the World Health Organization’s latest report, fertility treatments in most countries today are largely funded directly by patients and often involve exorbitant costs.
People in poorer countries spend a higher proportion of their income on fertility care than people in richer countries.
High costs often prevent people from accessing infertility treatments or can push them into poverty as a direct result of seeking care.
Defining birth rates and fertility
Fertility is the concrete capacity to reproduce. It is a condition of childbirth.
The fertility rate is the ratio of the number of live births per year to the entire female population of childbearing age (15-50 years).
The birth rate is the frequency of live births in a population, expressed as the ratio of the number of births in a year to the number of live births in the population.
The birth rate is defined as the number of births in a population. A country’s birth rate depends on female fertility and the number of women in the population.
WHO fertility report
According to the WHO, one in six people worldwide is affected by infertility.
Large numbers of people suffer from infertility during their lifetime, according to a new report published today by the World Health Organization (WHO).
The problem affects around 17.5% of the adult population – or about one in six people worldwide – so there is an urgent need to increase access to high-quality, affordable fertility care for those in need.
➔ The new estimates show that the prevalence of infertility varies little between regions.
➔ Similarly, the rates are comparable whether countries are high, middle or low income, indicating that it is a major health problem in all countries and regions of the world.
Despite the scale of the problem, solutions to prevent, diagnose and treat infertility – including assisted reproductive technologies such as in vitro fertilization (IVF) – remain underfunded and are often inaccessible to many due to high costs, social stigma and limited availability.
About this WHO report
This report provides an overview of the global and regional prevalence of infertility, analyzing all relevant studies from 1990 to 2021, taking into account the different approaches used in the estimates.
The search identified 12,241 files of potentially relevant studies from around the world. The review of these files led to the selection of 133 studies that were included in the analysis for the report. From these, relevant data were used to generate pooled estimates for lifetime and period prevalence of infertility.
New research on treatment costs
In addition, new research, funded by HRP with support from the WHO and published in the journal Human Reproduction Open, assesses the costs associated with infertility treatments in low- and middle-income countries.
Very contrasting situations between countries when comparing the reports submitted.
In 2000, female fertility peaked at 0.12 in France’s 30s, meaning that 12 children were born in 2016 for every 1000 women aged 30.
Age-specific fertility rates vary widely from country to country.
In the Netherlands, women have children later than in France (the curve is shifted to the right); in other countries, fertility is lower: it hardly exceeds 0.1, even at the ages with the highest fertility. In the UK, births to mothers aged 17 to 20 are more frequent than in other countries, while in Spain and Italy fertility is lower at younger ages.
These rates describe the age-specific time of fertility.
Age-specific rates range from 1.34 children per woman in Italy and Spain to 1.92 in France.
Sweden has one of the highest fertility rates in Europe (close to 1.9 children per woman) (UNFPA, 2018) (UNFPA, 2018).
1 in 4 couples in developing countries is affected by infertility.
Case study; France and USA
We look next at France, which leads the European Union (EU) countries for fertility, and the USA.
Birth rate in France
Presentation
In 2023, the rate falls from 2022 to 1.68 children per woman, the INSEE demographic report reveals.
The average age at childbearing is 31, the same as in 2022 (it was 29.5 20 years ago). Fertility rates vary by age group:
➔ declining among women under 30, with a downward trend since the 2000s;
➔ Also falling to a level not seen since 1999 among women aged 30-34 (11.5 children per 100 women in this age group in 2023), this rate has been falling slightly since the mid-2010s, except for a rebound in 2021;
➔ a decrease to 6.8 children per 100 women in 2023 among women aged 35-39;
➔ but increasing among women aged 40 and over (on the rise since the mid-1980s).
According to the latest demographic report by the National Institute of Statistics and Economic Studies (INSEE) published on January 16, 2024, 678,000 children were born in France in 2023, or 48,000 fewer than in 2022. The number of births reaches a new historic low after an increase in 2021 linked to the consequences of the health crisis. The decline in births accelerates: from 1.6% on average between 2014 and 2019, it rises to -2.2% in 2022 and -6.6% in 2023 .
In 2023, the rate falls from 2022 to 1.68 children per woman, the INSEE demographic report reveals.
The average age at childbearing is 31, the same as in 2022 (it was 29.5 20 years ago). Fertility rates vary by age group:
➔ falling among women under 30, with a downward trend since the 2000s;
➔ Also falling to a level not seen since 1999 among women aged 30-34 (11.5 children per 100 women in this age group in 2023), this rate has been falling slightly since the mid-2010s, except for a rebound in 2021;
➔ a decrease to 6.8 children per 100 women in 2023 among women aged 35-39;
➔ but increasing among women aged 40 and over (on the rise since the mid-1980s).
According to the latest demographic report by the National Institute for Statistics and Economic Studies (INSEE) published on January 16, 2024, 678,000 children will be born in France in 2023, or 48,000 fewer than in 2022.
The number of births hits a new all-time low after an increase in 2021 linked to the aftermath of the health crisis.
The decline in births is accelerating: from 1.6% on average between 2014 and 2019, it rises to -2.2% in 2022 and -6.6% in 2023 .
In 2019, 753,000 babies were born in France, or 6,000 fewer births than in 2018 (-0.7%). The number of births has fallen every year for the past five years, but at a rate that has slowed over the years. While the drop was 2.4% in 2015, it rose to 1.9% in 2016, then 1.8% in 2017, 1.4% in 2018 and finally 0.7% in 2019. In mainland France, the number of births remains higher than the low point since 1994 (711,000).
The number of births depends on both the number of women of childbearing age and their fertility.
The population of women in their 20s and 40s, the ages at which they are most fertile, has been declining since the mid-1990s and their fertility is falling and remains, in 2019, the main factor behind the decline in births.
In 2019, the total fertility rate (TCI) was 1.87 children per woman, after 1.88 in 2018. After four years of decline between 2015 and 2018, the TCI is therefore stabilizing. Between 2006 and 2014, it was around 2.0 children per woman.
The most fertile women are aged 25-34.
However, the fertility rate of women under 30 has been falling since the 2000s, and this decline has accelerated since 2015.
In 1999, 13.0 children per 100 women aged 25-29 gave birth to 13.0, then 12.2 in 2014 and only 10.9 in 2019. the fertility rate of women aged 30-34 has fallen more recently: from 13.1 children per 100 women in 2014 to 12.7 in 2019. the average age at motherhood reached 30.7 in 2019, compared to 29.3 twenty years earlier.
The decline in fertility observed since 2015 is not centered on a particular wealth group: it concerns both wealthy women and those belonging to the most modest households.
This reduction also affects both women who have not had children and those who have already had children. However, it does not concern immigrants, whose fertility remains stable.
In 2017, France remains the European Union (EU) country with the highest fertility (GCI of 1.90).
From 2000 to 2015, Ireland and France were the most fertile countries in the EU every year.
Since 2016, Sweden has been ahead of Ireland. Its total fertility rate was 1.78 in 2017, compared with 1.77 for Ireland.
In contrast, Mediterranean countries are less fertile. The five least fertile EU countries are Malta (TFR 1.26), Spain (TFR 1.31), Italy (TFR 1.32), Cyprus (TFR 1.32) and Greece (TFR 1.35). Germany, which 10 years ago was one of the least fertile countries in the EU, now averages 1.57 (TFR 1.57) compared to 1.59 for the EU as a whole.
Reduced fertility
In 2023 , 678,000 babies were born in France, or 48,000 fewer than in 2022. The number of births hit a new all-time low after an increase in 2021 linked to the consequences of the health crisis.
The decline in births is accelerating: from 1.6% on average between 2014 and 2019, it rises to -2.2% in 2022 and -6.6% in 2023 . Fertility falls compared to 2022 to 1.68 children per woman . The average age at childbearing is 31 years , the same as in 2022 (it was 29.5, 20 years ago).
Case study; USA
How common is infertility?
About 9% of men and about 11% of women of reproductive age in the United States have experienced fertility problems.
➔ In a third of infertile couples, the problem lies with the man.
➔ In a third of infertile couples, the problem is either not identifiable or is present in both men and women.
➔ In a third of infertile couples, the problem is with the woman.
Studies suggest that after 1 year of unprotected sex, 12% to 15% of couples are unable to get pregnant, and after 2 years, 10% of couples still have not had a live birth.2,3,4 (In couples). younger than 30 years of age, who are generally healthy, 40% to 60% are able to conceive within the first 3 months of trying.
Fertility declines with age in both men and women, but the effects of age are much greater in women.
By the age of 30, women are about half as fertile as they were in their early 20s, and women’s chances of conception drop significantly after the age of 35.6 Male fertility also declines with age, but more gradually.
An estimated 15% of couples will have trouble conceiving.
Globally, 48.5 million couples suffer from infertility.
About 9% of men and 10% of women aged 15-44 have reported infertility problems in the US.
Infertility statistics in the United States
The US has an average of 1.87 children born per woman.
➔ About 85% of couples will be able to conceive in the first year of trying.
➔ In addition, 7% of couples will be able to conceive in the second year of trying.
➔ Infertility affects 10% of women aged 15-44 in the US
➔ Half (48%) of couples with difficulties conceiving do not consider their condition to be infertility.
Infertility statistics by sex
As reported by 9% of men aged 15 to 44 and 10% of women in the same age group, infertility is almost as common in men as in women in the US
➔ 30% of infertility cases can be attributed exclusively to women,
➔ 30% can only be attributed to the man,
➔ 30% can be attributed to a combination of both partners and 10% of cases have an unknown cause.
Infertility statistics by age
➢ 1 in 4 healthy women in their 20s and 30s will get pregnant in any menstrual cycle.
➢ 1 in 10 healthy women in their 40s will get pregnant in any menstrual cycle.
In general, fertility starts to decline for most women in their 20s and 30s and declines more rapidly after the age of 35.
➢ Couples where the male partner is 40 or older are more likely to have difficulty conceiving.
➢ Sperm quality generally doesn’t become a problem for men until after the age of 60.
Infertility statistics by race and ethnicity
➢ Native Hawaiian and Pacific Islander women had the highest fertility rate in the US in 2018, followed by Hispanic Americans and Americans of color.
➢ White and Asian Americans had the lowest fertility rates in 2018.
Common complications of infertility
Infertility and complications of infertility, such as miscarriages, can negatively affect a person’s overall health and quality of life.
Many couples who want to start a family and are unable to get pregnant will experience psychological and interpersonal distress that could negatively affect their quality of life. Infertility is one of the main reasons couples divorce.
➢ Up to 60% of infertile people reported psychiatric symptoms with significantly higher levels of anxiety and depression than fertile people.
➢ Almost 41% of infertile women have depression.
➢ Nearly 87% of infertile women have anxiety.
➢ Women who get pregnant through IVF are more likely to give birth prematurely
IVF statistics
In the US, 12% of women of childbearing age have used an infertility service
Almost 2% of live births in the US are the result of assisted reproductive technology (ART).
Women aged 30-33 have the highest chance of success (58%) during their first IVF cycle compared to women in other age groups.
In a study of women seeking fertility treatment,
➢ 4% of women used only drugs,
➢ 21% used IUI,
➢ 53% have used IVF and 22% have not had cycle-based treatment.
The cost of infertility treatment
➢ All infertility treatment costs can range from $5,000 to $73,000
➢ The average patient goes through two IVF cycles, bringing the total cost of IVF (including procedures and drugs) to between $40,000 and $60,000.
➢ It is estimated that 85% of IVF costs are often paid out of pocket.
➢ IVF babies are hospitalized more frequently than non-IVF babies. The cost of post-neonatal hospital care for children with singleton IVF was almost twice that of children without singleton IVF.
Examples of specific treatment costs incurred by European countries
In Austria, the state has been paying 70% of infertility treatment costs since 2000.
In addition to the drugs, Austrians also benefit from 4 in vitro fertilization procedures, and if pregnancy occurs, the state subsidizes four more.
In Belgium, the state pays for 6 cycles of assisted human reproduction procedures. Couples choose whether they want artificial insemination or in vitro fertilization. In addition, embryotransfers are unlimited and free of charge.
In Spain and Portugal, assisted human reproduction procedures are 100% paid for by the state, with one condition – everything must take place in state hospitals.
In Romania, almost a quarter of pregnancies are achieved following specific treatment
In Romania, 4 out of 10 couples who fail to get pregnant have been trying for 1-5 years.
23% of pregnancies are achieved following specific treatment for at least one partner.
The Romanian Ministry of Family Affairs is currently offering in vitro fertilization to couples with fertility problems.
The National IVF Program 2024 is a government initiative to support couples and singles in their fight against infertility. This program provides financial support for in vitro fertilization, thus helping families achieve their dream of having children.
Bibliographical references
● https://www.who.int/fr/news/item/04-04-2023-1-in-6-people-globally-affected-by-infertility
● https://www.inserm.fr/dossier/infertilite/
● https://www.inserm.fr/actualite/infertilite-masculine-vers-test-predisant-succes-biopsie-testiculaire/
● https://www.inserm.fr/actualite/fertilite-masculine-y-a-t-il-peril-en-la-demeure/
● https://www.inserm.fr/actualite/proteines-multifonctions-dans-spermatozoides/
● https://www.nationalgeographic.fr/sciences/la-fertilite-des-femmes-baisse-t-elle-vraiment-a-partir-de-35-ans
● https://www.ined.fr/fr/tout-savoir-population/graphiques-cartes/graphiques-interpretes/fecondite-europe/
● https://www.vie-publique.fr/questions-reponses/292778-natalite-fecondite-infertilite-le-point-en-5-questions
● https://www.singlecare.com/blog/news/infertility-statistics/
● https://hotnews.ro/unul-din-sase-cupluri-din-romania-se-confrunta-cu-infertilitatea-propunerile-autoritatilor-de-la-facilitati-fiscale-pentru-parinti-la-crese-si-gradinite-in-blocurile-anl-1818997
● https://www.digi24.ro/special/campanii-digi24/romania-furata/romania-in-goana-pentru-copii-ce-face-statul-pentru-cuplurile-infertile-893041