Reacción a "A study warns of a global rise in infertility among women over the age of 35"

This study uses a widely recognized data source, the Global Burden of Disease (GBD) 2023 study, which serves as a benchmark for analyzing epidemiological trends on a global scale. The methods employed are robust and appropriate for describing trends over time and differences between countries, using standardized indicators such as age-adjusted prevalence and disability-adjusted life years (DALYs). However, it is important to note that the GBD does not directly measure infertility through clinical studies in each country, but rather generates estimates based on multiple sources and statistical models. Therefore, the results are very useful for analyzing global trends, but should not be interpreted as exact prevalence figures for each country. The study confirms a well-known reality: female infertility increases with age, and as childbearing is delayed, the number of women affected will continue to grow. Its main innovation is its specific focus on women aged 35 to 49 and its analysis of trends in 204 countries over more than three decades, in addition to projecting the future burden through 2036. The authors estimate that the number of affected women in this age group could increase by nearly 50% over the next ten years if current trends continue. In Spain, as in other high-income countries, the figures likely reflect a combination of several factors. The most important is delayed childbearing, a consequence of social, occupational, and economic changes that lead many women to try to conceive at ages when fertility has already naturally declined. In addition, improved access to diagnosis and assisted reproductive technologies means that more cases are detected than in countries where these resources are less accessible. Therefore, a higher estimated burden does not necessarily imply poorer reproductive health among the population, but rather greater diagnostic capacity and increased use of health services. A major limitation is precisely that the estimates may be influenced by differences among countries in access to health care, the seeking of medical help, the availability of assisted reproductive technologies, and the quality of records. The authors themselves acknowledge that infertility may be underdiagnosed in countries with fewer resources and, conversely, detected more frequently in more developed health care systems. Furthermore, the study does not allow for the identification of the specific causes of the observed increase or for distinguishing the relative importance of biological, environmental, or social factors. From a clinical and public health perspective, the most important message is that infertility must be addressed as a health issue requiring prevention, information, and equitable access to care. In Spain, in addition to continuing to improve access to treatments when indicated, the measures likely to have the greatest impact would be to make it easier for those who wish to have children to do so sooner if they so desire, through policies promoting work-life balance, job stability, and support for parenthood. At the same time, it is essential to improve education about the effect of age on fertility, since advances in assisted reproduction do not fully compensate for the physiological decline in female fertility associated with aging. I have met many patients during my 25 years of experience. Some thought age didn’t matter because that’s what assisted reproduction clinics were for; others thought that newborns might have genetic problems but that it was easy to achieve a spontaneous pregnancy; and still others simply believed that they were in great shape at age 48 and that, therefore, their ovaries were also wonderful and capable of releasing healthy eggs. The main point I would convey to journalists is to avoid headlines such as “Infertility skyrockets by 50%.” That 50% corresponds to a projection of the number of cases among women aged 35–49, driven largely by population aging and delayed childbearing, and does not mean that the individual biological risk of infertility will increase by 50%. Nor should it be interpreted to mean that countries with the highest estimated burden necessarily have poorer reproductive health, since differences in access to diagnosis and assisted reproduction also significantly influence the estimates.