Epidemiology of infertility in China: a population-based study

Objective: To assess the current prevalence of and risk factors for infertility among couples of reproductive age in China. Design: Population-based cross-sectional study. Setting: We approached 25 270 couples in eight provinces/municipalities, of whom 18 571 (response rate 74%) were interviewed. Population: Couples living together and married for more than 1 year, of whom the female spouse was 20–49 years old. Methods: Women were approached via telephone and face-to-face conversation to complete the standardised and structured questionnaire by trained interviewers. Main outcome measures: Prevalence of and risk factors for infertility. Results: Among women ‘at risk’ of pregnancy, the prevalence of infertility was 15.5% (2680/17 275). Among 10 742 women attempting to become pregnant, the prevalence of infertility was 25.0% (2680/10 742), which increased with age in the second population. Among women who failed to achieve pregnancy in the last 12 months, 3470 finished our questionnaire about fertility care, and 55.2% (1915/3470) of them had sought medical help. Sociodemographic risk factors for infertility included lower educational level [adjusted odds ratio (aOR) 3.4, 95% CI 2.0–5.5] and employment (aOR 2.3, 95% CI 1.9–2.9). Clinical risk factors were irregular menstrual cycle (aOR 1.8, 95% CI 1.2–2.5), light menstrual blood volume (aOR 1.6, 95% CI 1.2–2.0), history of cervicitis (aOR 1.5, 95% CI 1.2–2.0) and endometriosis (aOR 3.1, 95% CI 1.1–9.3), previous stillbirth (aOR 2.1, 95% CI 1.3–3.3) and miscarriage (aOR 2.7, 95% CI 2.1–3.5). In addition, history of operation was a significant risk factor of infertility. Conclusions: Among couples of reproductive age in China, the prevalence of infertility was 25%, and almost half of the couples experiencing infertility had not sought medical help. Tweetable abstract: In China, 25% of couples actively attempting to become pregnant suffered infertility.