Infertility is a growing public health concern in Iraq, with significant medical, psychological, and social implications. This cross-sectional study aimed to assess the prevalence and risk factors of infertility among couples in Al-Muthanna Province and to evaluate its underlying causes and impact. The study was conducted from January to December 2024 and included 150 couples with a history of infertility, defined as the failure to conceive after 12 months of regular unprotected intercourse. Participants were categorized into two groups: primary and secondary infertility. Data were collected via structured interviews, clinical examinations, hormonal assessments, pelvic ultrasounds for women, and semen analyses for men. The mean age of female participants was 28.9 years and of males was 31.9 years. Urban residency, low socioeconomic status, and smoking were common features among participants. Primary infertility was found in 59.3% of couples, while 40.7% had secondary infertility. A significant association was observed between secondary infertility and longer duration of marriage, prior contraceptive use, and obesity. Female obesity was significantly more prevalent among those with secondary infertility (p=0.003). Regarding etiologies, female causes accounted for 49.3% of infertility cases, male causes for 40%, and combined causes for 10.7%. The most common female diagnoses included ovulation dysfunction and tubal obstruction, with the latter being significantly more associated with secondary infertility (p<0.001). Among males, abnormal semen analysis and varicocele were the leading causes. Uterine abnormalities were significantly more common among women with primary infertility (p=0.02). This study highlights the multifactorial nature of infertility in Iraq, emphasizing the roles of obesity, reproductive history, and modifiable lifestyle factors. Early screening, education, and tailored interventions are essential to reduce the burden of infertility, improve access to fertility care, and address the associated psychosocial challenges in affected couples.

Index Terms: Infertility, Primary and Secondary Infertility, Risk Factors, Reproductive Health, Iraq