مروری بر اپیدمولوژی ناباروری اولیه در ایران An Overview of the Epidemiology of Primary Infertility in Iran

Introduction nfertility has been recognized as a potentially serious, costly and burdensome problem on affected families. Infertility may have far-reaching consequences, including marital conflicts, violence, stigmatization, isolation and divorce (1). The consequences are more serious in societies where women are primarily stereotyped as mothers. Epidemiological study of infertility might assist public health policy-makers in making efficient decisions by estimating the potential users of health services for infertility work up or treatment. The terminology and definitions of infertility and its kinds have always been controversial and they could cause many differences in interpretations and estimations. In this article, we review the epidemiology of primary infertility based on the national surveys that have been conducted earlier in Iran. Materials and Methods We conducted an internet-based search through Google Scholar, PubMed and IranMedex to find about previous primary infertility studies in Iran. The key words included in the search were Iran, infertility, epidemiology and prevalence. A comprehensive search of the Deputy of Research and Technology of MOH & ME and relevant research centers was also carried out on previously undertaken national projects in Iran regarding the subject. We only included national studies regarding the epidemiology of infertility. The only exception was a research that had been conducted in Tehran, Iran because of its a) design quality and b) taking into account the variable of age at the first marriage. Eventually, the following three studies were considered for the review: 1- Research on Primary Infertility in Tehran (Tehran Study), which had been carried out on 1,992 women aging 15-49 years, who were married for at least one year, in Tehran and suburban areas during 1997. 2- The National Infertility Study (NIS) (2004- 2005), supported by the National Research Center for Medical Sciences of Iran (NRCMSI), had studied 10,783 women aging 19-49 years. 3- The National Health Survey (NHS) (2001), conducted by Iran Ministry of Health and Medical Education (MOH & ME). All the above studies had defined primary infertility as inability to conceive upon one year of unprotected intercourse. Regarding the definitions, lifetime primary infertility refers to couples who experience the problem at some time during their married life (2), while current primary infertility indicates the number of couples who have the problem at the time of study. Results The 2001 National Health Survey (NHS) estimated the prevalence of current infertility to be 2.8%, based on self-reports of infertility by 10,418 non-menopausal married women aging 15- 49 years (3). The number of cases had been proportional to that of the population in respective provinces. Tehran Study was carried out by Barouti et al. on 1992 women who had been married for at least one year and were 15-49 years old in Tehran and its suburban areas in 1997 (4). The prevalence of lifetime infertility was estimated to be 21.9% while the lowest prevalence (15.8%) was observed in the age group between 19-27 years. Vahidi et al. studied the prevalence of current and lifetime primary infertility in all provinces of Iran, in sample sizes proportionate to the size of populations there during 2004-2005 (5). The project supported by the NRCMSI, studied 10,783 women aging 19-49 years. A history of lifetime primary infertility was found in 24.9% of the subjects and the prevalence of current primary infertility was 3.4%. The lowest prevalence (17.2%) was seen in the age group of 21-26 years. Figure 1 compares the prevalence of primary infertilities according to age at the first marriage between the NIS and the Tehran Study.