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Guideline for the prevention, diagnosis and treatment of infertility [Internet]. Geneva: World Health Organization; 2025.

Cover of Guideline for the prevention, diagnosis and treatment of infertility

Guideline for the prevention, diagnosis and treatment of infertility [Internet].

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Annex 1Distribution of the causes of infertility

Table A1.1General categories of infertility (percentages of couples)a,b,c,d,e

High-income countriesRegions in LMICsAverage LMICsAverage across all countriesf
AfricaAsiaLatin AmericaEastern Mediterranean
Female cause only31.0037.0034.0025.0025.0030.25 30.62
Male cause only22.008.0013.0022.0019.0015.5 18.75
Causes found in both21.0035.0024.0030.0038.0031.75 26.37
No cause found in either14.005.0013.0010.003.007.75 10.87
Became pregnant during the course of the study12.0015.0016.0013.0015.0014.75 13.37
Total100.00100.00100.00100.00100.00100.00 99.98
a

Data adapted from Cates et al., 1985 (1); see also WHO, 1992 (2).

b

Study involved 8500 couples in 33 medical centres in 25 countries representing high-, middle- and low-income countries.

c

8500 couples were enrolled and just over 5800 (≈69%) completed the investigation to the point of a diagnosis being made for both partners.

d

Couples were admitted to the study if they had been infertile for at least 1 year (i.e. inclusion criteria).

e

Classifications of income categories of countries as at the time of the original study.

f

The average across all countries was derived by summing the prevalence in the “high-income countries” and “average LMICs” columns and dividing this by 2.

Fig. A1.1. Causes of infertility.

Fig. A1.1Causes of infertilitya

a

Data adapted from Cates et al., 1985 (1); see also WHO, 1992 (2).

Table A1.2Specific diagnoses of infertility (percentages of couples)a,b,c,d,e,f

High-income countriesLMICsAverage LMICsAverage across all countriesg
AfricaAsiaLatin AmericaEastern Mediterranean
Female diagnosis
No demonstrable cause40.0016.0031.0035.0026.0027.00 33.50
Bilateral tubal occlusion11.0049.0014.0015.0020.0024.50 17.75
Pelvic adhesions13.0024.0013.0017.0013.0016.75 14.87
Acquired tubal abnormality12.0012.0012.0012.009.0011.25 11.62
Anovulatory regular cyclesh10.0014.009.009.0015.0011.75 10.87
Anovulatory oligomenorrhoeah9.003.007.009.0011.007.50 8.25
Ovulatory oligomenorrhoeah7.004.0011.005.008.007.00 7.00
Hyperprolactinaemia7.005.007.008.006.006.50 6.75
Endometriosis6.001.0010.003.001.003.75 4.87
Male diagnosis
No demonstrable cause49.0046.0058.0041.0028.0043.25 46.12
Varicocele11.0020.0010.0019.0012.0015.25 13.12
Primary testicular failure10.007.0011.0013.0025.0014.00 12.00
Accessory gland infection7.0011.003.0012.003.007.25 7.12
Abnormal sperm morphologyi8.005.003.004.003.003.75 5.87
Low sperm motilityi3.001.005.008.005.004.75 3.87
a

Data adapted from Cates et al., 1985 (1); see also WHO, 1992 (2).

b

Study involved 8500 couples in 33 medical centres in 25 countries representing high-, middle- and low-income settings.

c

8500 couples were enrolled and just over 5800 (≈69%) completed the investigation to the point of a diagnosis being made for both partners.

d

Couples were admitted to the study if they had been infertile for at least 1 year (i.e. inclusion criteria).

e

Classifications of income categories of countries as at the time of the original study.

f

Not all diagnostic categories were listed in the original publication; some patients had more than one diagnosis or cause.

g

The average across all countries was derived by summing the prevalence in the “high-income countries” and “average LMICs” columns and dividing this by 2.

h

Categories merged and reported under anovulatory and oligo-ovulatory disorders in this guideline, with a total prevalence of 26.1% across all countries.

i

Categories merged and reported under abnormal semen parameters in this guideline, with a total of 9.7% across all countries.

Fig. A1.2. Specific diagnoses of infertility (male).

Fig. A1.2Specific diagnoses of infertility (male)a

a

Data adapted from Cates et al., 1985 (1); see also WHO, 1992 (2).

Fig. A1.3. Specific diagnoses of infertility (female).

Fig. A1.3Specific diagnoses of infertility (female)a

References

1.
Cates W, Farley TM, Rowe PJ. Worldwide patterns of infertility: is Africa different? Lancet. 1985;2(8455):596–8 (10.1016/s0140-6736(85)90594-x). [PubMed: 2863605] [CrossRef]
2.
Recent advances in medically assisted conception: report of a WHO Scientific Group. Geneva: World Health Organization; 1992 (https://iris​.who.int/handle/10665/38679). [PubMed: 1642014]
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