**2. Epidemiology of HIV-related infertility**

The data on the magnitude and burden of HIV-related infertility derive mostly from studies conducted among HIV-infected women. A previous study using data from case–control studies and theoretical predictions from a model of the proximate determinants of fertility and HIV incidence in African countries demonstrated the 25–40% lower rate of fertility among HIV-infected women compared to HIV-negative women.[4] In a prospective cohort study from the United States during 1994–2002, women with HIV were less likely to conceive than uninfected women (pregnancy rates 7.4 vs.15.2 per 100 person-years, respectively).[5] Using demographic and health surveys between 2003 and 2007, the Joint United Nations Program on HIV/AIDS (UNAIDS) estimated that the global age-specific fertility ratio for HIV-infected women in the reproductive age group of 20–44 years is 0.53 to 0.76 compared to that of women without HIV.[6] A survey study conducted at HIV fertility clinics in the United Kingdom demonstrated a 40% prevalence of tubal factor infertility among HIV-infected women.[7] Despite the infertility in women living with HIV, pregnancy rates among this population have increased steadily over the past 10 years to between 4 and 6 pregnancies per 100 person-years, varying by region due to the advances in HIV treatment and mother-to-child transmission prevention.[8] This may reflect an increase in reproductive desire and/or unexpected preg‐ nancies and indicate the need for reproductive health care, fertility management, and family planning along with HIV comprehensive care among PLWHIV.
