Yiran Liu, Siyi Hua, Fang Wang, Caixia Zhou, Guiping Wan, Weiwei Tang
The recent rebound in EAI burden reveals a growing hidden threat to female reproductive health. Its upward trend is expected to continue to 2030. Early screening for primary infertility in women aged 20-29 years and targeted management of secondary infertility in those aged 35-39 years are warranted.
BACKGROUND: Endometriosis-associated infertility (EAI) has emerged as an increasingly pressing reproductive health problem. Nevertheless, existing epidemiological research on EAI remains inadequate.
METHODS: This study integrated the Global Burden of Disease (GBD) 2023 data and single-center clinical data. We analyzed time trends in prevalence and years lived with disability (YLDs) of EAI in China, Japan, and the Republic of Korea. For China, we conducted age-period-cohort analysis and adopted the Bayesian age-period-cohort model to forecast disease burden trends up to 2030. Clinical data from a single center were used to compare age, BMI, and surgical stage among EAI subgroups.
RESULTS: In 2023, the number of prevalent cases of EAI in China was 181587 (95% UI: 114233, 278960), with the age-standardized prevalence rate (ASPR) of 26.38 (95% UI: 16.45, 39.91) per 100,000 population. Although the overall ASPR of EAI in China showed a downward trend from 1990 to 2023, with an average annual percent change of -0.57% (95% CI: -0.80, -0.43), an increase was observed during the recent period from 2021 to 2023, with an annual percent change of 9.75% (95% CI: 4.06, 13.51). Trends in YLDs were consistent with prevalence patterns. ASPR and prevalent cases are projected to rise through 2030. Both GBD and real-world data identified a peak in secondary infertility at ages 35-39; for primary infertility, the peak age was 20-24 years based on GBD data and 25-29 years according to real-world data. Secondary infertility is the predominant type, and most patients were classified as the American Society for Reproductive Medicine (ASRM) stage III.
CONCLUSION: The recent rebound in EAI burden reveals a growing hidden threat to female reproductive health. Its upward trend is expected to continue to 2030. Early screening for primary infertility in women aged 20-29 years and targeted management of secondary infertility in those aged 35-39 years are warranted.