Over the past few decades, the rate of infertility among women in the United States has remained largely the same, according to researchers at Johns Hopkins Medicine. Their new analysis of data collected from 1995 and 2019, and published on June 14 in the journal Fertility and sterilityfound that infertility is more common in older women, who are non-Hispanic black and have less income or education, and women who do not have access to sexual and reproductive health services.
These findings suggest that we must continue to invest in our public health services and push for equal access to reproductive and sexual health care if we are to achieve national goals for reducing infertility.
Morgan Snow, Study First Author, Medical Student, Johns Hopkins University School of Medicine
Infertility -; defined as the inability to achieve pregnancy after at least one year of unprotected intercourse -; affects millions of men and women of childbearing age. Studies conducted in the early 2000s found that infertility rates declined throughout the 1980s and 1990s, although the reasons for the decline were unclear.
More recently, experts suspect that rates of sexually transmitted infections, which have been steadily increasing year on year, are contributing to the rising rate of infertility. Additionally, they say, the number of women receiving preventive gynecological care has dropped and the average age of first-time mothers has increased.
“This is a unique time when sexually transmitted infections are on the rise and there are a number of emerging threats to access to health care,” says Maria Trent, MD, MPH, Bloomberg Professor of Health and American Pediatrics at Johns Hopkins University Schools. of public health and medicine, and lead author of the research report. “For healthcare providers who work with women, it’s important to understand how these factors might influence fertility.”
For the new study, Snow and Trent analyzed data from 53,764 women who participated in the federally funded National Survey of Family Growth (NSFG). Although the survey did not ask explicit questions about infertility, it did contain questions about sexual activity, contraception, and pregnancy that had not been used in previous studies to estimate infertility rates. It also collected information on socio-demographic factors and health care.
Based on the responses, the researchers concluded that the rate of infertility varied slightly from year to year, with a low from 2006 to 2010 of 5.8% and a high from 2017 to 2019 of 8.1. %. However, these fluctuations are not considered statistically significant and the team concluded that overall fertility rates did not change significantly over the study period.
In some populations, however, infertility rates were significantly higher than average, compared to the general population. Women aged 40 to 44 were about 11 times more likely to be infertile than younger women, women who had not completed high school were twice as likely to be infertile as those with a higher education, non-Hispanic black women were 44% more likely to be infertile than women of other races, and women who had not received recent sexual health care were 61% more likely to be sterile. Unlike previous studies, the new data did not show a higher rate of infertility in Hispanic women.
“These numbers tell us that fertility is still an issue, especially for certain vulnerable populations,” says Trent, who is also director of the division of adolescent/young adult medicine at Johns Hopkins Children’s Center.
Understanding who is most at risk of infertility can help shape public health guidelines and messaging, Trent notes. The association between access to preventive health care and infertility, for example, suggests that a focus on identifying and treating sexually transmitted infections can reduce infertility by reducing rates of pelvic inflammatory disease. , which is a major risk factor for infertility.
The researchers caution that their study was limited by its reliance on questions included in the NSFG, which were not designed to directly measure infertility rates or access to care. However, the study offers a valuable comparison with previous studies of infertility rates, Snow says. Further work is needed to understand the complex sociodemographic factors underlying the associations.
In addition to Snow and Trent, the authors of Fertility and sterility article are Jamie Perin, Ph.D., of Johns Hopkins University, and Tyler Vranich, MS, a former Johns Hopkins University student who is now a student at the Medical University of South Carolina. The research was supported by the National Institute of Nursing Research (NINR-R01NR013507-;Trent).
Snow, Mr. et al. (2022) Estimates of Infertility in the United States: 1995-2019. Fertility and sterility. doi.org/10.1016/j.fertnstert.2022.05.018.