Infertility in the Middle East and North Africa Region: A systematic review with meta-Analysis of prevalence surveys

Abstract

Infertility is a worldwide health issue with high impact on individuals involved and society as a whole. Estimates of infertility are very important to inform social and economic policies. The aim of this systematic literature review is to estimate prevalence of primary and secondary infertility in Middle East and North Africa (MENA) region and produce overall estimate of different indicators of infertility in MENA region. A systematic search was conducted to identify publications providing data from MENA countries. All titles and abstracts retrieved using this search strategy were managed by Endnote software, duplicates were removed and studies on animals, systematic reviews, and from non-MENA region was removed from EndNote library. Seven electronic databases and websites were searched for relevant articles and surveys with no language or date restriction on July 2017. Data of prevalence, risk factors, and causes of infertility were extracted from included articles and meta-analyzed to produce overall effect sizes of infertility estimates. Eight cross-sectional studies and one World Health Organization report contained prevalence data from four MENA countries were included in this study. The clinical primary infertility defined as the failure to become pregnant after 12 months or more of continuous and unprotected sexual intercourse was estimated in 5 surveys as 3.8% (95% confidence interval (CI) = 1.7–8.4, effect size = −7.564, P = 0.0001), with total clinical infertility, both primary and secondary infertility, estimate was 17.2% (95% CI = 10.6–26.7, effect size = −5.5, P = 0.0001). Demographic primary infertility was 22.6% (95% CI = 13.4–35.5, effect size = −3.8, P = 0.0001) and demographic total infertility rate was 38.5% (95% CI = 28.8–49.2, effect size = −2.11, P = 0.035). The data extracted suggested, overall, that clinical primary infertility is low at 3.8% and demographic infertility in MENA region is high, at 22.6%.