Analysis of the evolving disease burden of female infertility and its associated risk factors

The global burden of female infertility is increasing, yet the roles of metabolic syndrome (MetS) and circadian syndrome (CircS) remain poorly understood. This study aimed to describe the global disease burden of female infertility and examine the associations between MetS, CircS, and infertility.

Global Burden of Disease (GBD) 2023 data were used to assess trends in infertility prevalence. Cross-sectional data from the National Health and Nutrition Examination Survey (NHANES) were used to evaluate associations between metabolic status and infertility using weighted logistic regression.

The global number of women with infertility nearly doubled from 59.8 million in 1990 to 114.5 million in 2023 (ASR, + 25.27%), with the sharpest increase in Western Sub-Saharan Africa (247.6%). Both MetS (OR = 1.41, 95% CI 1.00-1.99) and CircS (OR = 1.46, 95% CI 1.04-2.07) were associated with an elevated risk of infertility. The combined presence of MetS and CircS was also positively associated with infertility (OR = 1.51, 95% CI 1.04-2.18). Among women under 35 years of age, CircS (OR = 1.69; 95% CI 1.00-2.87) and the combination of both syndromes (OR = 1.77; 95% CI 1.02-3.10) were associated with an elevated risk of infertility. Elevated blood pressure was the individual component most strongly associated with infertility.

The global burden of female infertility is substantial. Both MetS and CircS are significant risk factors for infertility, with a stronger association for CircS among younger women. Elevated blood pressure showed the strongest association among the individual metabolic components. These findings support integrating metabolic and circadian risk assessment into infertility prevention strategies.