A unique view on male infertility around the globe

Infertility is a worldwide problem, and according to Sharlip et al, it affects 15% of couples that have unprotected intercourse [1]. Although this statistic is commonly cited, it is an amalgamation of numbers taken from around the world and thus does not reflect rates in specific countries and regions. On a global scale, accurate information regarding rates of male infertility is acutely lacking, and has not been accurately reported. Calculating regionally based male infertility rates is challenging for a number of reasons. First, population surveys generally interview couples or female partners of a couple who have unprotected intercourse and wish to have children. This is a very specific population. As such, data from a significant number of infertile individuals is never included, which may bias the data. Second, unlike female infertility, male infertility is not well reported in general but especially in countries where cultural differences and patriarchal societies may prevent accurate statistics from being collected and compiled. For example, in Northern Africa and Middle East, the female partner is often blamed for infertility. Men, therefore, do not usually agree to undergo fertility evaluation, resulting in underreporting of male infertility. Furthermore, polygamy is a common practice in many cultures [2]. One of the reasons for polygamy is to overcome infertility and increase the probability of having children. Additionally, in some African countries, the tradition of “Chiramu” allows an infertile male to bring in a brother or a relative to impregnate his wife [2]. In this way, the man retains his masculine identity and status in his community’s eyes.

A third challenge stems from the fact that male infertility has never been defined as a disease, which has resulted in sparse statistics. Additionally, demographic and clinical studies vary in epidemiological definition of infertility. While many clinical studies have examined infertility over the course of a year, several demographic studies examine infertility over a five-year projection [3]. Finally, while some studies only examine females, others only examine the men presenting to infertility clinics, which are generally small groups who are not representative of the larger population of infertile men. Without accurate, region-specific data, it is not possible to identify and comprehensively treat infertile men. Therefore, to bridge this gap in knowledge, we have consolidated current data and, where recent information is lacking, estimated rates of male infertility using preexisting data on female infertility in areas around the world. We focused especially on North America, Latin America and the Caribbean, North Africa and the Middle East, Sub-Saharan Africa, Europe, Eastern Europe, Central Asia, Eastern Asia, the Pacific, and Australia. The developing world has much less data available, which is why the above regions were selected. Therefore, the goal of this commentary is to consolidate the large breadth of information available on male infertility and provide answers to the following two questions: How does the rate of male infertility vary in the different regions across the world? Can accurate estimates of male infertility be captured globally while identifying potential socio-economic and cultural reporting barriers that skew the results?

Click here to read more – Agarwal et al (2015) a unique view on male infertility ariund the globe

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`You are a man because you have children’: experiences, reproductive health knowledge and treatment-seeking behaviour among men suffering from couple infertility in South Africa