Xin Dang, Lei Liu
The COVID-19 pandemic was not associated with a measurable change in global infertility burden beyond expected long-term trends. Despite substantial disruptions to reproductive healthcare services, no measurable deviation in GBD-estimated population-level infertility burden was detected during 2020-2023. These findings provide global evidence that no measurable deviation in infertility burden trends was observed during the study period, while highlighting the need for continued surveillance and equitable access to reproductive healthcare.
BACKGROUND: The COVID-19 pandemic caused widespread disruptions to reproductive healthcare services and raised concerns regarding potential adverse effects on fertility. However, no study has quantified whether these disruptions translated into measurable changes in the global burden of infertility. We evaluated the impact of the pandemic on population-level infertility burden worldwide.
METHODS: We conducted a population-based interrupted time-series analysis using data from the Global Burden of Disease Study 2023 for 204 countries and territories from 1990 to 2023. Age-standardized prevalence rates (ASPR) and age-standardized years lived with disability rates (ASYR) for male and female infertility were analyzed. Autoregressive integrated moving average models were fitted to pre-pandemic data (1990-2019) to generate counterfactual projections for 2020-2023 assuming no pandemic. Observed and expected estimates were compared globally and across sex, age, socio-demographic index (SDI), and selected countries. Sensitivity analyses evaluated alternative pandemic onset assumptions.
RESULTS: The global infertility burden increased steadily between 1990 and 2019. During 2020-2023, observed ASPR and ASYR remained closely aligned with counterfactual projections. Relative deviations between observed and expected estimates ranged from 1.34 % to 2.80 % for ASPR and from 1.45 % to 3.38 % for ASYR. Across sex-, age-, SDI-, and country-specific analyses, most observed estimates remained within model-derived prediction intervals. Sensitivity analyses produced consistent findings and identified no statistically significant pandemic-associated increase in infertility burden.
CONCLUSIONS: The COVID-19 pandemic was not associated with a measurable change in global infertility burden beyond expected long-term trends. Despite substantial disruptions to reproductive healthcare services, no measurable deviation in GBD-estimated population-level infertility burden was detected during 2020-2023. These findings provide global evidence that no measurable deviation in infertility burden trends was observed during the study period, while highlighting the need for continued surveillance and equitable access to reproductive healthcare.