Long-Term Epidemiological Trends and Regional Disparities in Male Infertility in Central Asia (1991–2023)

BACKGROUND: Male infertility (MI) has become an important public health concern in Central Asia (CA), where declining fertility coincides with limited integration of male reproductive health into national strategies. This study analyzed trends in the prevalence and burden of MI in CA countries and assessed associations with selected modifiable behavioral risk factors. METHODS: A longitudinal analysis of Global Burden of Disease (GBD) 2023 data was conducted to estimate the age-standardized prevalence and incidence of MI among men aged 15-49 years in five CA countries from 1990 to 2023. Trends were examined, and fixed-effects panel regression models were applied to evaluate associations between MI burden and alcohol use, drug use, and sexually transmitted infections (excluding HIV). RESULTS: From 1991 to 2023, the age-standardized prevalence increased in four CA countries, whereas Tajikistan showed a decline; the incidence rose across all countries. The peak incidence was most commonly observed at ages 35-39 years, although Tajikistan shifted toward a younger age group, and regression analyses revealed heterogeneous country-specific associations with sociobehavioral risk factors. CONCLUSIONS: MI represents a significant demographic and public health challenge in CA, highlighting the need to strengthen surveillance, standardize diagnostics, improve access to care, and integrate male reproductive health into national prevention strategies.