Urgent need for inclusion of male infertility in global health strategies: insights from the GBD 2021 Study

Abstract This study examines the global burden and prevalence of male infertility using data from the Global Burden of Disease Study 2021 (GBD 2021 Study), encompassing 204 countries from 1990 to 2021. By analyzing disability-adjusted life years (DALYs) and prevalence trends, alongside lifestyle, environmental, and disease-related factors, including the impact of coronavirus disease 2019 (COVID-19), we identified significant temporal and regional disparities. Using joinpoint regression, decomposition analysis, and Bayesian age-period-cohort models, the results revealed a rising global burden, with DALYs increasing from 15.8 to 18.6 per 100 000 and the age-standardized prevalence rising from 2752.5 to 3218.9 per 100 000 over three decades. Low- and middle-sociodemographic index (SDI) regions presented the highest burden, driven by demographic shifts and epidemiological challenges. The COVID-19 pandemic further exacerbated healthcare disparities, particularly in resource-limited settings. These findings underscore the urgent need to integrate male infertility into global health agendas, emphasizing tailored interventions and policy reforms to address socioeconomic impacts and mitigate rising burdens, especially in low- and middle-SDI regions.