Male Infertility in Central Asia: Epidemiology and Risk Factors from a Multicenter Study

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BSTRACT

Male infertility represents a substantial yet undercharacterized component of reproductive health in Central Asia, a region shaped by unique environmental exposures, heterogeneous healthcare systems, and evolving demographic patterns. Importantly, the current evidence base is predominantly derived from the clinic-based populations and should not be interpreted as reflecting population-level prevalence, which remains largely undefined across the region. This mini-review synthesizes the available evidence on the epidemiology and risk factors of male infertility across Kazakhstan, Uzbekistan, Kyrgyzstan, Tajikistan, and Turkmenistan, with a focus on multicenter cross-sectional research frameworks. Among clinic-based cohorts of infertile couples, male-factor infertility rates have been reported to reach up to 52.9%, although these estimates are influenced by care-seeking patterns, referral bias, and diagnostic variability. Environmental and occupational exposures – including particulate air pollution, pesticide residues, and dust–salt aerosols from the Aral Sea – emerge as biologically plausible contributors to impaired spermatogenesis. Lifestyle and metabolic factors such as smoking and obesity, along with infectious and inflammatory conditions (e.g., sexually transmitted infections and genitourinary tuberculosis), further contribute to the regional burden. Genetic etiologies are likely underdiagnosed due to limited diagnostic infrastructure. Methodological challenges, including variability in semen analysis standards, lack of harmonized laboratory practices, and incomplete surveillance systems, constrain robust epidemiological inference. Future multicenter studies integrating standardized World Health Organization protocols, exposure-stratified sampling, and comprehensive phenotyping – alongside efforts to establish population-based sampling frameworks – are essential to generate reliable prevalence estimates and inform targeted interventions in Central Asia.