Global, Regional, and National Burden of Female Infertility Attributable to Chlamydia Infections, 1990–2023: An Analysis Based on the Global Burden of Disease Study 2023

Background: Chlamydia infection, the most common bacterial sexually transmitted infection worldwide, frequently leads to tubal infertility. With the rising global prevalence of female infertility, the World Health Organization has highlighted untreated sexually transmitted infections as a preventable cause. Chlamydia has been identified as a leading contributor to infertility attributable to sexually transmitted infections; however, comprehensive and up-to-date estimates specifically focused on chlamydia-attributable female infertility remain limited. This study aimed to quantify the global, regional, and national burden of female infertility due to chlamydia infection from 1990 to 2023. Methods: Data on the prevalence and years lived with disability (YLD) due to chlamydia-induced female infertility in women aged 15– 49 years were sourced directly from the Global Burden of Disease Study 2023. Estimates for the number of cases, age-standardized prevalence rate(ASPR), age-standardized YLD, average annual percentage changes (AAPCs)in both prevalence and YLD were calculated globally, regionally, and nationally, stratified by age, and Socio-demographic Index (SDI). Results: Between 1990 and 2023, the global prevalence of female infertility attributable to chlamydia infection surged, with cases rising from 2.76 million to 4.76 million. Moreover, infertility attributed to chlamydia infections was most frequently observed among women aged 40 to 44 years (ASPR 342.04/100,000, 95% UI[287.27-402.88]). The ASPR of female infertility caused by chlamydia was markedly higher in low and low-middle SDI regions compared with other SDI regions. The middle SDI region experienced the greatest increase in ASPR (AAPC 0.61, 95% CI[0.59 - 0.63]). Regionally, Western Sub-Saharan Africa reported the highest ASPR and age-standardized YLD rate for chlamydia-induced infertility. At the national level, Cabo Verde had the highest ASPR and age-standardized YLD rate for this condition. Brazil demonstrated the most rapid growth in ASPR and YLD for infertility from 1990 to 2023. These burden estimates were positively but weakly correlated with the SDI level (all P < 0.05). Conclusion: From 1990 to 2023, the global prevalence of female infertility attributable to chlamydia infection increased. The highest ASPR was observed among women aged 40– 44 years, and the burden was disproportionately higher in low and low-middle SDI regions. These findings highlight the need to expand routine chlamydia screening and treatment services, particularly in Western Sub-Saharan Africa and countries such as Brazil, to curb the rising burden of chlamydia-induced infertility.