Global, Regional, and National Burden of Infertility Attributable to Sexually Transmitted Infections From 1990 to 2021, With Projections to 2050

Abstract Objective: To explore the specific impact of sexually transmitted infections (STIs) on infertility including differences in disease burden among different regions and populations and temporal trends. Methods: Data on STI-attributable infertility were extracted from the Global Burden of Diseases Study 2021. The study focused on two types of infertility (primary and secondary) and three STIs (chlamydia, gonococcal, and other STIs). The disease burden was measured using the age-standardized prevalence rate (ASPR) and the age-standardized years lived with disability (YLD) rate (ASYR). The estimated annual percent change (EAPC) was calculated to determine temporal variations. Temporal trends were modeled using joinpoint analysis and the age-period-cohort-Web tool. Finally, future trends were predicted using the Bayesian age-period-cohort model. Results: In 2021, there were 18,413,845 (95% uncertainty interval ( UI ): 15,765,620–21,547,032) prevalent cases and 102,961 (95% UI : 40,469–213,098) YLDs associated with STI-attributable infertility globally. The corresponding ASPR and ASYR per 100,000 population were 225.44 (95% UI : 193.19–262.80) and 1.26 (95% UI : 0.50–2.61), with EAPCs from 1990 to 2021 of 0 (95% confidence interval ( CI ): −0.05–0.06) and −0.01 (95% CI : −0.07–0.04), respectively. Chlamydia infection was identified as the primary contributor to this burden. Nationally, Guinea-Bissau had the highest burden, followed by Guinea and Mauritania. A significant inverse correlation was observed between the ASPR and socio-demographic index (SDI) levels. From 1990 to 2021, the disease burden exhibited an upward trend. Notably, the model predicted this increasing trend would continue across all age groups until 2050, with individuals aged 40 to 44 being the most affected. Conclusion: Infertility attributable to STIs remains a critical public health challenge, with a projected increasing trend through 2050. Global efforts to reduce the burden of infertility should focus on improving STI prevention, diagnosis, and treatment strategies, especially in regions with low and middle SDI levels.