Association of Infertility with Socioeconomic Indicators in Iran: An Ecological Study

Fatemeh-sadat  Hosseini; Farzad  Younesian; Masud  Yunesian

doi:10.18502/ijre.v21i3.20504

Fatemeh-sadat Hosseini Assistant Professor of Reproductive Biology, Department of Obstetrics and Gynecology, Golestan University of Medical Sciences, Gorgan, Iran
Farzad Younesian Master of Science in Civil Engineering, Holoo Information Technology Group, Tehran, Iran
Masud Yunesian Professor of Epidemiology, Center for Air Pollution Research, Institute for Environmental Research, Tehran University of Medical Sciences, Tehran, Iran

DOI: https://doi.org/10.18502/ijre.v21i3.20504

Keywords: Infertility, Illiteracy, Unemployment, Ecological study, Socioeconomic factors

Abstract

Background and Objectives: Infertility, as one of the most critical public health and reproductive issues globally, has extensive impacts on the physical, psychological, and social well-being of couples. Previous studies have shown that socioeconomic components, alongside biological variables, influence the occurrence and aggravation of infertility. We aimed to evaluate the relationship between some socioeconomic variables and prevalence of infertility at the province level.

Methods: This ecological study examined the relationship between infertility (dependent variable) and key socioeconomic indicators (independent variables) at the provincial level in Iran. Primary and secondary infertility defined using lifetime clinical, current clinical, and epidemiological definitions served as dependent variables. Statistical analysis employed univariate and multiple linear regression using the stepwise method, with a significance level of 0.05.

Results: Although numerous variables showed significant associations with infertility in simple regression models, only illiteracy and unemployment rates in the multiple regression model retained significant relationships with infertility. Furthermore, unemployment retained its significance only in epidemiological definition of primary infertility at the multiple model. Other variables lost their significance.

Conclusion: Provincial illiteracy rates emerged as the strongest predictor of infertility prevalence. Illiteracy is directly associated with infertility and also represents an important indicator of broader socioeconomic conditions. However, due to its ecological design, this study cannot distinguish between these two pathways.