{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T16:30:08Z","timestamp":1785774608803,"version":"3.56.0"},"reference-count":40,"publisher":"Public Library of Science (PLoS)","issue":"11","license":[{"start":{"date-parts":[[2025,11,11]],"date-time":"2025-11-11T00:00:00Z","timestamp":1762819200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Wuhan Natural Science Foundation Exploration Project","award":["2024040801020372"],"award-info":[{"award-number":["2024040801020372"]}]},{"name":"Wuhan Knowledge Innovation Special Project","award":["2023020201020547"],"award-info":[{"award-number":["2023020201020547"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Infertility poses a significant burden on both global and national scales. However, the epidemiology of primary infertility among reproductive-aged couples in China remains poorly understood. Therefore, this study aimed to investigate the global infertility rate and identify factors associated with primary infertility among middle-aged couples in China.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Cross-sectional data were derived from the Global Burden of Disease (GBD) study and the Chinese Health and Retirement Longitudinal Study (CHARLS), two extensive databases that examined various disease burdens and associated factors at both global and national levels.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>From 1990 to 2019, the global infertility population has shown a steady annual increase. In China, the age-standardized prevalence rate of infertility has remained relatively stable over the past three decades. However, this rate was notably higher than the global age-standardized infertility prevalence rate. Our analysis revealed that the prevalence of primary infertility among middle-aged Chinese couples was approximately 1.7% (947,953\/56,892,517). Additionally, we identified anxiety as an associated factor with infertility, highlighting the need for increased public attention to mental health in China.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Infertility continued to be a pressing issue on both global and national levels. This situation warranted widespread attention from Chinese policymakers and healthcare managers. The findings might guide future policy-making and medical interventions in China, with a particular focus on supporting the reproductive needs of middle-aged individuals.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0335926","type":"journal-article","created":{"date-parts":[[2025,11,11]],"date-time":"2025-11-11T18:38:12Z","timestamp":1762886292000},"page":"e0335926","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":2,"title":["Trends in global and national infertility and factors associated with primary infertile couples in recent middle-aged Chinese"],"prefix":"10.1371","volume":"20","author":[{"given":"Huancheng","family":"Tang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0644-816X","authenticated-orcid":true,"given":"Zeshen","family":"Wu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Biao","family":"Jiang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei","family":"Sun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chaoyang","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhi","family":"Hu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiao","family":"Fu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-5096-6088","authenticated-orcid":true,"given":"Siyu","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,11,11]]},"reference":[{"issue":"23","key":"pone.0335926.ref001","doi-asserted-by":"crossref","first-page":"10952","DOI":"10.18632\/aging.102497","article-title":"Global, regional, and national prevalence and disability-adjusted life-years for infertility in 195 countries and territories, 1990-2017: results from a global burden of disease study, 2017","volume":"11","author":"H Sun","year":"2019","journal-title":"Aging (Albany NY)"},{"issue":"4","key":"pone.0335926.ref002","doi-asserted-by":"crossref","first-page":"432","DOI":"10.1111\/1471-0528.14966","article-title":"Epidemiology of infertility in China: a population-based study","volume":"125","author":"Z Zhou","year":"2018","journal-title":"BJOG"},{"issue":"12","key":"pone.0335926.ref003","doi-asserted-by":"crossref","first-page":"3096","DOI":"10.1093\/humrep\/dep287","article-title":"The epidemiology of infertility in the North East of Scotland","volume":"24","author":"S Bhattacharya","year":"2009","journal-title":"Hum Reprod"},{"issue":"6","key":"pone.0335926.ref004","doi-asserted-by":"crossref","first-page":"1506","DOI":"10.1093\/humrep\/dem046","article-title":"International estimates of infertility prevalence and treatment-seeking: potential need and demand for infertility medical care","volume":"22","author":"J Boivin","year":"2007","journal-title":"Hum Reprod"},{"issue":"1","key":"pone.0335926.ref005","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1093\/humupd\/dmr040","article-title":"Demographic and medical consequences of the postponement of parenthood","volume":"18","author":"ESHRE Reproduction and Society Task Force","year":"2012","journal-title":"Hum Reprod Update"},{"issue":"10","key":"pone.0335926.ref006","doi-asserted-by":"crossref","first-page":"2872","DOI":"10.1093\/humrep\/det293","article-title":"Cumulative incidence rate of medical consultation for fecundity problems--analysis of a prevalent cohort using competing risks","volume":"28","author":"S Duron","year":"2013","journal-title":"Hum Reprod"},{"issue":"10258","key":"pone.0335926.ref007","doi-asserted-by":"crossref","first-page":"1160","DOI":"10.1016\/S0140-6736(20)30977-6","article-title":"Global age-sex-specific fertility, mortality, healthy life expectancy (HALE), and population estimates in 204 countries and territories, 1950-2019: a comprehensive demographic analysis for the Global Burden of Disease Study 2019","volume":"396","author":"GBD 2019 Demographics Collaborators","year":"2020","journal-title":"Lancet"},{"issue":"10258","key":"pone.0335926.ref008","doi-asserted-by":"crossref","first-page":"1204","DOI":"10.1016\/S0140-6736(20)30925-9","article-title":"Global burden of 369 diseases and injuries in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019","volume":"396","author":"GBD 2019 Diseases and Injuries Collaborators","year":"2020","journal-title":"Lancet"},{"issue":"10258","key":"pone.0335926.ref009","doi-asserted-by":"crossref","first-page":"1223","DOI":"10.1016\/S0140-6736(20)30752-2","article-title":"Global burden of 87 risk factors in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019","volume":"396","author":"GBD 2019 Risk Factors Collaborators","year":"2020","journal-title":"Lancet"},{"issue":"1","key":"pone.0335926.ref010","doi-asserted-by":"crossref","first-page":"2478875","DOI":"10.1080\/13685538.2025.2478875","article-title":"National prevalence and incidence of benign prostatic hyperplasia\/lower urinary tract symptoms and validated risk factors pattern","volume":"28","author":"L Lin","year":"2025","journal-title":"Aging Male"},{"issue":"1","key":"pone.0335926.ref011","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1093\/ije\/dys203","article-title":"Cohort profile: the China Health and Retirement Longitudinal Study (CHARLS)","volume":"43","author":"Y Zhao","year":"2014","journal-title":"Int J Epidemiol"},{"issue":"11","key":"pone.0335926.ref012","doi-asserted-by":"crossref","first-page":"1871","DOI":"10.1093\/aje\/kwz170","article-title":"Venous Blood-Based Biomarkers in the China Health and Retirement Longitudinal Study: Rationale, Design, and Results From the 2015 Wave","volume":"188","author":"X Chen","year":"2019","journal-title":"Am J Epidemiol"},{"issue":"1","key":"pone.0335926.ref013","first-page":"39","article-title":"Infertility in the Global South: Raising awareness and generating insights for policy and practice","volume":"9","author":"T Gerrits","year":"2017","journal-title":"Facts Views Vis Obgyn"},{"key":"pone.0335926.ref014","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1016\/j.maturitas.2015.08.015","article-title":"Ovarian infertility is associated with cardiovascular disease risk factors in later life: A Japanese cross-sectional study","volume":"83","author":"T Kurabayashi","year":"2016","journal-title":"Maturitas"},{"key":"pone.0335926.ref015","first-page":"1","article-title":"Infertility and impaired fecundity in the United States, 1982-2010: data from the National Survey of Family Growth","volume":"67","author":"A Chandra","year":"2013","journal-title":"Natl Health Stat Report"},{"issue":"9","key":"pone.0335926.ref016","doi-asserted-by":"crossref","first-page":"2108","DOI":"10.1093\/humrep\/dew123","article-title":"Prevalence of infertility and help seeking among 15 000 women and men","volume":"31","author":"J Datta","year":"2016","journal-title":"Hum Reprod"},{"issue":"4","key":"pone.0335926.ref017","doi-asserted-by":"crossref","first-page":"472","DOI":"10.1017\/S0021932017000244","article-title":"Prevalence and Risk Factors of Infertility in Turkey: evidence from Demographic and Health Surveys, 1993-2013","volume":"50","author":"M Sarac","year":"2018","journal-title":"J Biosoc Sci"},{"issue":"11","key":"pone.0335926.ref018","first-page":"683","article-title":"The prevalence of infertility in 20-49 years women in Yazd, 2014-2015: A cross-sectional study","volume":"16","author":"M Mirzaei","year":"2018","journal-title":"Int J Reprod Biomed"},{"issue":"2","key":"pone.0335926.ref019","doi-asserted-by":"crossref","first-page":"109","DOI":"10.5152\/tud.2018.59196","article-title":"Male infertility, azoozpermia and cryptozoospermia incidence among three infertility clinics in Turkey","volume":"44","author":"S Karabulut","year":"2018","journal-title":"Turk J Urol"},{"issue":"3","key":"pone.0335926.ref020","first-page":"278","article-title":"Prevalence of Infertility Problems among Iranian Infertile Patients Referred to Royan Institute","volume":"10","author":"M Sepidarkish","year":"2016","journal-title":"Int J Fertil Steril"},{"issue":"1","key":"pone.0335926.ref021","doi-asserted-by":"crossref","first-page":"10","DOI":"10.4314\/eamj.v83i1.9355","article-title":"Infertility in a community and clinic-based sample of couples in Moshi, Northern Tanzania","volume":"83","author":"U Larsen","year":"2006","journal-title":"East Afr Med J"},{"issue":"4","key":"pone.0335926.ref022","doi-asserted-by":"crossref","first-page":"1053","DOI":"10.1016\/j.fertnstert.2014.12.121","article-title":"Cumulative incidence of infertility in a New Zealand birth cohort to age 38 by sex and the relationship with family formation","volume":"103","author":"T van Roode","year":"2015","journal-title":"Fertil Steril"},{"issue":"3","key":"pone.0335926.ref023","doi-asserted-by":"crossref","first-page":"738","DOI":"10.1093\/humrep\/der465","article-title":"Estimating the prevalence of infertility in Canada","volume":"27","author":"T Bushnik","year":"2012","journal-title":"Hum Reprod"},{"issue":"9","key":"pone.0335926.ref024","first-page":"945","article-title":"A cross-sectional study of infertility prevalence and influencing factors in Uygur and Kazak women, Xinjiang Uygur autonomous region","volume":"36","author":"Y Jiao","year":"2015","journal-title":"Zhonghua Liu Xing Bing Xue Za Zhi"},{"issue":"1","key":"pone.0335926.ref025","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1016\/j.rbmo.2014.10.002","article-title":"Incidence of infertility and risk factors of impaired fecundity among newly married couples in a Chinese population","volume":"30","author":"Q Meng","year":"2015","journal-title":"Reprod Biomed Online"},{"issue":"10291","key":"pone.0335926.ref026","doi-asserted-by":"crossref","first-page":"2238","DOI":"10.1016\/S0140-6736(21)01295-2","article-title":"China\u2019s three-child policy","volume":"397","author":"M Tatum","year":"2021","journal-title":"Lancet"},{"issue":"8","key":"pone.0335926.ref027","article-title":"Association between generalized anxiety symptoms and semen quality in infertile men: A multicentre study in North China","volume":"54","author":"Y Pan","year":"2022","journal-title":"Andrologia"},{"key":"pone.0335926.ref028","article-title":"Evaluation of predictor factors of psychological distress in women with unexplained infertility","volume":"16","author":"I No\u00ebl","year":"2022","journal-title":"Ther Adv Reprod Health"},{"issue":"3","key":"pone.0335926.ref029","doi-asserted-by":"crossref","first-page":"546","DOI":"10.1007\/s11418-022-01619-0","article-title":"Phytomedicinal therapeutics for male infertility: critical insights and scientific updates","volume":"76","author":"SS Ramgir","year":"2022","journal-title":"J Nat Med"},{"issue":"6","key":"pone.0335926.ref030","doi-asserted-by":"crossref","first-page":"1045","DOI":"10.1016\/j.rbmo.2022.01.015","article-title":"Tailored support may reduce mental and relational impact of infertility on infertile patients and partners","volume":"44","author":"J Boivin","year":"2022","journal-title":"Reprod Biomed Online"},{"issue":"3","key":"pone.0335926.ref031","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1080\/17437199.2022.2058582","article-title":"Evaluating group psychological interventions for mental health in women with infertility undertaking fertility treatment: A systematic review and meta-Analysis","volume":"17","author":"E Warne","year":"2023","journal-title":"Health Psychol Rev"},{"issue":"4","key":"pone.0335926.ref032","doi-asserted-by":"crossref","first-page":"1970","DOI":"10.3390\/ijerph19041970","article-title":"Perceived Partner\u2019s Self-Control and Social Support Effects on Relationship Satisfaction in Couples Experiencing Infertility or Miscarriage: Dyadic Analyses","volume":"19","author":"A Wendo\u0142owska","year":"2022","journal-title":"Int J Environ Res Public Health"},{"issue":"1","key":"pone.0335926.ref033","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1186\/s12978-021-01140-9","article-title":"Prevalence of anxiety and its associated factors among infertile patients after \u201ctwo-child\u201d policy in Chongqing, China: a cross-sectional study","volume":"18","author":"W Gui","year":"2021","journal-title":"Reprod Health"},{"key":"pone.0335926.ref034","doi-asserted-by":"crossref","first-page":"1245","DOI":"10.2147\/PRBM.S326994","article-title":"Effects of Self-Esteem on the Associations Between Infertility-Related Stress and Psychological Distress Among Infertile Chinese Women: A Cross-Sectional Study","volume":"14","author":"C Cui","year":"2021","journal-title":"Psychol Res Behav Manag"},{"key":"pone.0335926.ref035","doi-asserted-by":"crossref","first-page":"643395","DOI":"10.3389\/fpsyg.2021.643395","article-title":"Pregnancy or Psychological Outcomes of Psychotherapy Interventions for Infertility: A Meta-Analysis","volume":"12","author":"R Zhou","year":"2021","journal-title":"Front Psychol"},{"issue":"3","key":"pone.0335926.ref036","article-title":"SGLT2 inhibition and three urological cancers: Up-to-date results","volume":"40","author":"L Lin","year":"2024","journal-title":"Diabetes Metab Res Rev"},{"issue":"1","key":"pone.0335926.ref037","doi-asserted-by":"crossref","first-page":"398","DOI":"10.1038\/s42003-024-06114-8","article-title":"Investigating the causal associations between metabolic biomarkers and the risk of kidney cancer","volume":"7","author":"L Lin","year":"2024","journal-title":"Commun Biol"},{"key":"pone.0335926.ref038","article-title":"Exploring the Impact of 5-Alpha Reductase Inhibitors on Bladder Cancer: Insights from a Large-Scale Prospective Cohort Study","author":"L Lin","year":"2025","journal-title":"Ann Surg Oncol"},{"issue":"3","key":"pone.0335926.ref039","doi-asserted-by":"crossref","first-page":"5039","DOI":"10.1007\/s11357-025-01623-8","article-title":"Uncovering somatic genetic drivers in prostate cancer through comprehensive genome-wide analysis","volume":"47","author":"L Lin","year":"2025","journal-title":"Geroscience"},{"issue":"1","key":"pone.0335926.ref040","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1186\/s13578-025-01453-3","article-title":"Multi-omics analysis unveiled fibroblast-mediated pathogenesis in male genital lichen sclerosus","volume":"15","author":"L Lin","year":"2025","journal-title":"Cell Biosci"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0335926","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,11]],"date-time":"2025-11-11T18:38:17Z","timestamp":1762886297000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0335926"}},"subtitle":[],"editor":[{"given":"Mohammad Ishraq","family":"Zafar","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2025,11,11]]},"references-count":40,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2025,11,11]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0335926","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,11]]}}}