Modeled Burden and Trends of Infertility Among People Aged 15–49 Years in the Original BRICS Countries: Comparisons with G7 and Global Estimates, 1990–2023, with Projections to 2050

Yinuo Zhang,1– 3,* Shangkun Si,3– 5,* Xingxin Wang,6 Jumei Shi,1– 3 Saihua Ma,1,2 Huifang Zeng,1– 3 Zheng Gong,1,2 Tian Xia1,21Department of Reproductive Medicine, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, People’s Republic of China; 2Department of Reproductive Medicine, National Clinical Research Center for Chinese Medicine, Tianjin, People’s Republic of China; 3Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin, People’s Republic of China; 4Department of Acupuncture, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, People’s Republic of China; 5Department of Acupuncture, National Clinical Research Center for Chinese Medicine, Tianjin, People’s Republic of China; 6Department of Traditional Chinese Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, People’s Republic of China*These authors contributed equally to this workCorrespondence: Zheng Gong; Tian Xia, Email gongzhengdmw@126.com; xiatian76@163.comBackground: Infertility is a major global reproductive health challenge. The BRICS countries (Brazil, Russia, India, China, South Africa), representing over 40% of the world’s population, have undergone profound social and demographic transitions, yet infertility burden and trends in these countries remain incompletely characterized.Methods: Using data from the Global Burden of Disease (GBD) 2023 study, we assessed the prevalence, disability-adjusted life years (DALYs), and age-standardized rates (ASRs) of infertility in BRICS countries from 1990 to 2023. Joinpoint regression, age-period-cohort modeling, decomposition analysis, and Bayesian projection were used to evaluate temporal trends, contributing factors, and future burden through 2050. Estimates were compared with G7 countries and global averages.Results: In 2023, BRICS countries accounted for an estimated 106.18 million prevalent infertility cases, representing 51.40% of global cases. The point estimate of age-standardized prevalence rate (ASPR) in BRICS was 6134.24 per 100,000 population, numerically higher than those in G7 countries and globally. Across BRICS, both estimated ASPR and age-standardized DALY rate (ASDR) were approximately threefold higher in females than in males. Decomposition analysis indicated that population growth was the largest contributor to the increase in DALYs in BRICS, followed by epidemiological change. Cause-specific analysis showed that other sexually transmitted infections (STIs) consistently ranked among the leading categories, while polycystic ovarian syndrome (PCOS) exhibited an upward shift in relative ranking over time. Exploratory trend-based projections suggest that by 2050, the modeled ASPR in BRICS countries may remain higher than in G7 countries but lower than the global average.Conclusion: Infertility remains a major reproductive health challenge in BRICS countries, with substantial heterogeneity across countries. These findings highlight the need for context-specific strategies to reduce the infertility burden.Keywords: infertility, Global Burden of Disease, BRICS, age-standardized prevalence rate, disability-adjusted life years