Objective: To assess the current prevalence of and risk factors for infertility among couples of reproductive age in China. Design: Population-based cross-sectional study. Setting: We approached 25 270 couples in eight provinces/municipalities, of whom 18 571 (response rate 74%) were interviewed. Population: Couples living together and married for more than 1 year, of whom the female spouse was 20–49 years old. Methods: Women were approached via telephone and face-to-face conversation to complete the standardised and structured questionnaire by trained interviewers. Main outcome measures: Prevalence of and risk factors for infertility. Results: Among women ‘at risk’ of pregnancy, the prevalence of infertility was 15.5% (2680/17 275). Among 10 742 women attempting to become pregnant, the prevalence of infertility was 25.0% (2680/10 742), which increased with age in the second population. Among women who failed to achieve pregnancy in the last 12 months, 3470 finished our questionnaire about fertility care, and 55.2% (1915/3470) of them had sought medical help. Sociodemographic risk factors for infertility included lower educational level [adjusted odds ratio (aOR) 3.4, 95% CI 2.0–5.5] and employment (aOR 2.3, 95% CI 1.9–2.9). Clinical risk factors were irregular menstrual cycle (aOR 1.8, 95% CI 1.2–2.5), light menstrual blood volume (aOR 1.6, 95% CI 1.2–2.0), history of cervicitis (aOR 1.5, 95% CI 1.2–2.0) and endometriosis (aOR 3.1, 95% CI 1.1–9.3), previous stillbirth (aOR 2.1, 95% CI 1.3–3.3) and miscarriage (aOR 2.7, 95% CI 2.1–3.5). In addition, history of operation was a significant risk factor of infertility. Conclusions: Among couples of reproductive age in China, the prevalence of infertility was 25%, and almost half of the couples experiencing infertility had not sought medical help. Tweetable abstract: In China, 25% of couples actively attempting to become pregnant suffered infertility.

Original languageEnglish
Pages (from-to)432-441
Number of pages10
JournalBJOG: An International Journal of Obstetrics and Gynaecology
Issue number4
Early online date28 Dec 2017
Publication statusPublished - Mar 2018

Bibliographical note

This study was supported by Assisted Reproductive Technology Development Cooperation Projects from the Centre for international exchanges and cooperation in the National Health and Family Planning Commission of the People's Republic of China (No. (2010)237), National Key Technology R&D Programme in the Twelfth Five-Year Plan (No. 2012BAI32B01) and Research Fund of National Health and Family Planning Commission of China (No. 201402004). The study funders had no role in the study design, implementation, analysis, manuscript preparation, or decision to submit this article for publication.

Data Availability Statement

Additional Supporting Information may be found in the online version of this article.


  • Epidemiology
  • infertility
  • medical help
  • prevalence
  • risk factors


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