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Arnold School of Public Health


EPID/BIOS’ Alexander McLain successfully estimates infertility prevalence in low-to-middle-income income countries

March 29, 2017 | Erin Bluvas, bluvase@sc.edu 

Infertility is frequently seen as a challenge affecting only high-income nations, such as the United States. However, this public health issue is also a problem in low-to-middle-income countries. The extent of infertility prevalence is difficult to assess due to under-measurement, and access to infertility care is limited.

Those who are affected by infertility in developing countries face negative social, economic, physical, and mental consequences. Misperceptions about infertility’s impact on members of low-to-middle-income countries are also fueled by more widespread concerns about high rates of unintended pregnancies and unsafe abortions as well as unmet needs for contraception in these same areas. 

In order to begin to help address infertility in low-to-middle-income countries, public health researchers and practitioners need accurate data regarding the prevalence of the issue. Yet, estimating rates of infertility in developing countries is especially challenging due to lack of resources, particularly in low-income settings.

Assistant Professor of Epidemiology and Biostatistics Alexander McLain and a team of researchers* have recently applied a statistical method (current duration approach) to successfully estimate infertility rates in low-to-middle-income countries using Demographic and Health Survey Data.

McLain and co-author Marie Thoma have worked on the current duration approach since they were  postdoctoral fellows at the Eunice Kennedy Shriver National Institute of Child Health and Human Development where they researched and applied the methodology to the United States to estimate infertility prevalence. They have since continued their collaborations, branching out to apply this method to other settings.

The current study, published in Human Reproduction, provides one such application and was the first published study to produce infertility prevalence estimates using current duration approach in a low-to-middle-income country setting. Through their analysis, the researchers were able to gain insight into numerous demographic and other trends for various countries they studied.

For example, they found that among Nigerian couples: 31.3 percent have difficulty conceiving within 12 months, 17.7 percent continue to have trouble by 24 months, and 11.5 percent still struggle to conceive at the 36-month mark. They also learned that infertility prevalence was higher among women over 35 years of age and women who had previously had children.

This data is routinely collected and available for analysis in over 90 countries, making the application of the current duration method to the data set a fast and cost-effective approach. “The current duration approach is a viable method for estimating the prevalence of infertility, and determining risk factors for prolonged time-to-pregnancy,” says McLain. “Due to the relatively small expense for current duration studies, this is great news for middle- to low-income nations that cannot afford expensive prospective pregnancy studies.”

The researchers hope that continued applications of this approach will be useful in monitoring infertility by using existing data. They also believe the availability of these prevalence rates can facilitate the ability of low-to-middle-income countries to better predict and address health system needs for infertility care.

 *Co-authors include: Chelsea B. Polis (Johns Hopkins University), Caris M. Cox (St. Catherine University), Özge Tuncalp (World Health Organization), and Marie Thoma (University of Maryland)