Prevalence of infertility in the United States as estimated by the current duration approach and a traditional constructed approach

Capsule:
The prevalence of infertility in the United States was approximately twofold higher when estimated by a current duration approach vs. a traditional constructed measure (15.5% vs. 7.0%, respectively).

Authors:
Marie E. Thoma, Ph.D., Alexander C. McLain, Ph.D., Jean Fredo Louis, B.S., Rosalind B. King, Ph.D., Ann C. Trumble, Ph.D., Rajeshwari Sundaram, Ph.D., Germaine M. Buck Louis, Ph.D.

Volume 99, Issue 5, Pages 1324-1331.e1, April 2013

Abstract:

Objective:
To estimate the prevalence of infertility using a current duration approach for comparison with a traditional constructed measure.

Design:
Cross-sectional survey.

Setting:
National Survey of Family Growth, United States, 2002.

Participants:
A nationally-representative sample of females aged 15-44 years.

Interventions:
None.

Main Outcome Measure(s):
Infertility prevalence estimated by two approaches: 1) a constructed measure derived from questions on sexual activity, contraception, relationship status, and pregnancy, and 2) a measure based on estimated time-to-pregnancy (TTP) derived from the respondents’ current duration of pregnancy attempt (i.e., current duration approach). Associations with self-reported descriptive characteristics using weighted logistic regression or parametric survival models for each respective approach.

Results:
Infertility prevalence was approximately twofold higher using the current duration approach (15.5%; 95% CI: 8.6, 27.5) versus the constructed measure (7.0%; 95% CI: 6.2, 7.8). Both methods identified similar patterns of increasing age, lower education, nulliparity, and history of gynecologic disorders as being associated with measures of impaired fecundity, while opposing patterns were seen for racial/ethnic identification and poverty status.

Conclusions:
Infertility prevalence based on a current duration approach was consistent with other U.S. prospective cohort studies with preconception enrollment. These findings underscore the importance of definition and methodologic approach for estimating the prevalence of infertility.

  • Michael Eisenberg

    Excellent study that questions assumptions of methods of calculating infertility in the US. Estimates in this paper are in line with other countries and essentially double the prevalence estimates from NSFG. Also highlights that important work can be done on datasets that are over 10 years old.

  • Audrey Gaskins

    This article does an excellent job of pointing out the inherent assumptions that lie at the basis of the two approaches to calculate infertility prevalence.
    Most notably that the constructed measure assumes women not at risk of
    pregnancy are fecund. While the current duration approach is
    advantageous in that it relaxes this likely implausible assumption it
    too has limitations in the context of NSFG data. Specifically, and as
    pointed out in the paper, the at risk time in women who are not “trying
    to become pregnant” is unknown and these women are no longer a negligible proportion of the population (5.8%). It’s interesting to postulate on how inclusion of these women might influence the US prevalence estimates.

  • laurenwroth

    This article used a different statistical approach to estimating the prevalence of infertility and came up with a much higher prevalence that previously reported. The statistical technique used was very well explained and seems to capture a more accurate prevalence, the one downside of the study is the relatively small sample size (compared to the initial sample size). I think it is very important to have an accurate estimate of prevalence of infertility (especially when the prevalence is twice as high as previously estimated) to promote change in insurance coverage for infertile patients.

  • The following statement is NOT meant to, in any way, reflect my position on
    gay marriage or the position of the institution that I work for.

    Given the current geopolitical climate in which our Supreme Court is
    trying to define “marriage,” the prevalence of infertility should also
    include non traditional couples (lesbian) as well single females that
    are attempting pregnancy via donor insemination or IVF/ICSI. To exclude
    them because they do not fit the traditional definition of “couples
    attempting pregnancy” would be underestimating the true prevalence of
    infertility.

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