Epidemiology and Etiology of Infertility in Iran, Systematic Review and Meta-Analysis

Background: Epidemiological study of infertility might let the related policy makers to make accurate decisions regarding the potential users’ requirements for infertility workup or management. The objective of this study was to find the incidence and etiologic factors for infertility in Iranian population. Methods: an internet based search through PubMed, Google Scholar, Iran Medex, magiran and SID with the search terms including: “Iran” and “infertility” and “epidemiology” or “etiology” or “cause” and university library archives was performed that was restricted to the publications in the recent 25 years (since 19872012) in English or Persian. This project included all of the studies that were designed by random cluster sampling with face to face interviews at home from the Iranian population. Life time infertility was defined as inability to conceive after 12 months of unprotected intercourse. For analyzing the causes of infertility we included the published articles that were designed by Iranian infertility clinics and evaluated the causes of infertility by appropriate diagnostic techniques. Independent data extraction was performed by two observers and meta-analysis was done. Random affects metaanalyses, forest plot and Sata graph, publication bias and sensitivity analyses were performed. Results: Twelve studies that were designed to evaluate the prevalence rate of infertility were identified and meta-analysis was performed to integrate the findings of the separate studies. The average rate of infertility was; 10.9% (95% CI 7.4-14.4), Primary infertility; 10.6% (95% CI 5.3-16.0), secondary infertility; 2.7% (95% CI 1.9-3.5) and current infertility; 3.3% (95% CI 2.7-3.8). Causes of infertility were picked up from seven qualified studies. Male factor was; 34.0% (95%CI 26.942.0), female factor; 43.5% (95% CI 35.551.7), both male and female factors; 17.1% (95% CI 11.421.9) and unexplained cause; 8.1% (95% CI 5.6-11.5), respectively. Conclusions: Prevalence rate of life time infertility was 10.9%. The most common cause was female factor.