Global, Regional, and National Burden of Endometriosis, PCOS, and Unexplained Infertility and Their Attribution to Infertility, 1990-2021: Global Burden of Disease Study 2021.

AIM: Infertility is a growing global health issue affecting millions worldwide. While endometriosis, polycystic ovarian syndrome (PCOS) and unexplained infertility are recognized as the major contributors, their specific burden and impact on infertility among women of childbearing age (WCBA) remain inadequately quantified. This study aimed to evaluate the global burden of three diseases and infertility attributable to them.

METHODS

Using data from Global Burden of Disease Study 2021, we assessed the temporal trends of three diseases by average annual percentage change (AAPC) in age-standardized prevalence rate (ASPR) and DALYs rate (ASDR), and evaluated their correlation with socio-demographic index (SDI). We also calculated the age-standardized prevalence and years lived with disability (YLDs) rates of infertility attributable to three diseases.

RESULTS

In 2021, the global ASPRs of endometriosis, PCOS, and unexplained infertility were 1070.7 (AAPC: -1.02%, declining), 3364.5 (AAPC: 0.74%, increasing), and 5586.2 (AAPC: 0.70%, increasing), and infertility attributable to three diseases were 60.6, 638.2, and 5586.2 per 100,000 population, respectively. Regionally, Oceania had the highest ASPR for endometriosis, East Asia for unexplained infertility, and high-income Asia Pacific for PCOS. Infertility attributable to PCOS exhibited higher age-standardized prevalence and YLDs rates compared to endometriosis in most regions. Notably, ASPRs and ASDRs for endometriosis and unexplained infertility decreased with SDI, while PCOS rates increased with SDI.

CONCLUSIONS

The increasing global burden of endometriosis, PCOS, and unexplained infertility among WCBA has significantly contributed to rising infertility rates, with distinct regional and demographic disparities. Targeted public health strategies are needed to address these trends.