Endometriosis-Associated Infertility in China: Epidemiological Trends, Future Projection, and Real-World Clinical Insights

Yiran Liu,1 Siyi Hua,1 Fang Wang,2 Caixia Zhou,3 Guiping Wan,1 Weiwei Tang11Department of Obstetrics and Gynecology, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, 210028, People’s Republic of China; 2Department of Biostatistics, School of Public Health, Xuzhou Medical University, Xuzhou, Jiangsu, 221004, People’s Republic of China; 3Reproductive Medicine Center, Xuzhou Municipal First People’s Hospital, Xuzhou, Jiangsu, 221000, People’s Republic of ChinaCorrespondence: Weiwei Tang, Department of Obstetrics and Gynecology, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, 210028, People’s Republic of China, Email [email protected] Guiping Wan, Department of Obstetrics and Gynecology, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, 210028, People’s Republic of China, Email [email protected]: Endometriosis-associated infertility (EAI) has emerged as an increasingly pressing reproductive health problem. Nevertheless, existing epidemiological research on EAI remains inadequate.Methods: This study integrated the Global Burden of Disease (GBD) 2023 data and single-center clinical data. We analyzed time trends in prevalence and years lived with disability (YLDs) of EAI in China, Japan, and the Republic of Korea. For China, we conducted age-period-cohort analysis and adopted the Bayesian age-period-cohort model to forecast disease burden trends up to 2030. Clinical data from a single center were used to compare age, BMI, and surgical stage among EAI subgroups.Results: In 2023, the number of prevalent cases of EAI in China was 181587 (95% UI: 114233, 278960), with the age-standardized prevalence rate (ASPR) of 26.38 (95% UI: 16.45, 39.91) per 100,000 population. Although the overall ASPR of EAI in China showed a downward trend from 1990 to 2023, with an average annual percent change of − 0.57% (95% CI: − 0.80, − 0.43), an increase was observed during the recent period from 2021 to 2023, with an annual percent change of 9.75% (95% CI: 4.06, 13.51). Trends in YLDs were consistent with prevalence patterns. ASPR and prevalent cases are projected to rise through 2030. Both GBD and real-world data identified a peak in secondary infertility at ages 35– 39; for primary infertility, the peak age was 20– 24 years based on GBD data and 25– 29 years according to real-world data. Secondary infertility is the predominant type, and most patients were classified as the American Society for Reproductive Medicine (ASRM) stage III.Conclusion: The recent rebound in EAI burden reveals a growing hidden threat to female reproductive health. Its upward trend is expected to continue to 2030. Early screening for primary infertility in women aged 20– 29 years and targeted management of secondary infertility in those aged 35– 39 years are warranted.Keywords: endometriosis, primary infertility, secondary infertility, prevalence, years lived with disability