A unique view on male infertility around the globe.
BACKGROUND
Infertility affects an estimated 15% of couples globally, amounting to 48.5 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.


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
Center for Reproductive Medicine, Cleveland Clinic, Cleveland, Ohio, 44195, USA. agarwaa@ccf.org.
Ashok
A
Agarwal
Center for Reproductive Medicine, Cleveland Clinic, Cleveland, Ohio, 44195, USA. amulgund@neomed.edu.|Northeast Ohio Medical University, 4209 State Route 44, PO Box 95, Rootstown, OH, 44272, USA. amulgund@neomed.edu.
Aditi
A
Mulgund
Department of Urology, Jackson South Hospital, Miami University, Miami, FL, 33176, USA. alaa1977hh@gmail.com.
Alaa
A
Hamada
Northeast Ohio Medical University, 4209 State Route 44, PO Box 95, Rootstown, OH, 44272, USA. mchyatte@neomed.edu.
Michelle Renee
MR
Chyatte
D000349:Africa / Q000453:epidemiology; D017954:Africa South of the Sahara / Q000453:epidemiology; D001208:Asia / Q000453:epidemiology; D001315:Australia / Q000453:epidemiology; D005060:Europe / Q000453:epidemiology; D006801:Humans; D007248:Infertility, Male / Q000453:epidemiology* / Q000523:psychology; D007843:Latin America / Q000453:epidemiology; D008297:Male; D008877:Middle East / Q000453:epidemiology; D009656:North America / Q000453:epidemiology; D015995:Prevalence