Global Trends and Burden of Infertility Attributable to Polycystic Ovary Syndrome, 1990–2021: A Comprehensive Analysis from the Global Burden of Disease Study

Objective : To assess the global trends, geographic disparities, and sociodemographic determinants of infertility attributable to polycystic ovary syndrome from 1990 to 2021, using data from a large-scale global health database. Design : A population-based observational study. Subjects : Women aged 15 to 49 years diagnosed with infertility due to polycystic ovary syndrome in 204 countries and territories. Exposure (for observational studies) : The burden and prevalence of infertility associated with polycystic ovary syndrome, analyzed by age, time period, birth cohort, and sociodemographic index levels. Main Outcome Measures : Age-standardized prevalence rates of infertility related to polycystic ovary syndrome, stratified by primary and secondary infertility, age group, world region, and sociodemographic index. Results : Between 1990 and 2021, the global age-standardized prevalence of infertility due to polycystic ovary syndrome increased from 475.54 to 638.15 per 100,000 women. Secondary infertility increased at a faster rate than primary infertility. The highest burden was observed in high-income regions, but the most rapid increases occurred in low- and middle-income regions. The peak age-specific burden occurred in women aged 25 to 39 years. Time period and birth cohort effects both showed rising trends, particularly in younger generations in lower-income settings. Decomposition analysis attributed the rising burden to population growth and changing epidemiological patterns. Inequality analysis revealed widening absolute disparities and a shifting burden toward lower-income countries. Conclusion : Infertility related to polycystic ovary syndrome has increased steadily over the past three decades, with growing disparities between countries. Future policies should prioritize early diagnosis, targeted interventions, and expanded reproductive care, particularly in lower-resource settings, to mitigate this rising global health burden.