شیوع و علل ناباروری اولیه در ایران: مطالعه مبتنی بر جمعیت  The Prevalence and Causes of Primary Infertility in Iran: A Population-Based Study

1. Introduction Infertility is a common problem affecting one couple out of every six couples (Brugo-Olmedo, Chillik, & Kopelman, 2001). It is defined as incapacity to become pregnant after mostly 12 months of sexual intercourse, without using any contraception. In this respect, primary infertility was defined as the “Inability to conceive within one year of exposure to pregnancy (i.e.-being sexually active, usingnon-contraception, and non-lactating) among women aged 15-49 years” (Nygren et al., 2011). The 12-month prevalence rate of infertility ranges from 3.5% to 16.7% in more developed countries and from 6.9% to 9.3% in the less-developed ones, with an estimated overall median prevalence of 9% (Boivin, Bunting, Collins, & Nygren, 2007). Differences between the developed and developing world are emerging due to variations of infertility care and different socio-cultural values surrounding procreation and childlessness (OMbelet, 2011). In recent years, the prevalence of infertility has been significantly increased (Brugo-Olmed et al., 2001). The increasing trend could be due to delayed childbearing of couples, alterations in semen quality due to habits such as cigarette smoking and alcohol, changes in sexual behavior and elimination of most taboos (Brugo-Olmed et al., 2001). Infertility has been recognized as a potentially serious, costly and burdensome problem for affected families (Mohammad & Ardalan, 2009). It is a medical circumstance that not only has health implications for those involved, but also is a condition linked to individual human rights (OMbelet, 2011; Naab, Brown, & Heidrich, 2013). The social stigma of childlessness still leads to isolation and abandonment in many developing countries (Gannon, Glover, & Abel, 2004).