Infertility remains a significant public health concern in Bangladesh, with evolving socio-demographic, medical, and lifestyle factors influencing reproductive health. This study compares infertility patterns among Bangladeshi couples between 2007 and 2024 to identify key contributing factors and assess changes over time. A comparative cross-sectional study was conducted using data from 2007 and 2024. The study population included couples seeking infertility treatment at selected healthcare centers in Bangladesh. Data were collected through structured questionnaires and medical record reviews. Statistical analyses were performed using STATA 17 to evaluate trends in infertility prevalence, associated factors, and reproductive health outcomes. Among couples seeking infertility treatment, the proportion of female infertility cases increased from 43% in 2007 to 94.2% in 2024, while male infertility cases declined from 36% to 9.1%. Primary infertility cases accounted for 67% in 2007 but decreased to 51.9% in 2024, whereas secondary infertility increased from 33% to 48.1% over the same period. The proportion of women with irregular menstrual cycles and endocrine disorders, such as polycystic ovary syndrome (PCOS), rose significantly. Positive lifestyle modifications were observed, including reduced smoking and increased physical activity. Surgical histories showed a decline in laparotomy procedures among females and a shift toward minimally invasive interventions. The findings highlight shifting infertility trends, with a rise in female infertility and associated endocrine disorders. Improvements in lifestyle factors and reproductive healthcare access suggest progress in infertility management. Targeted public health strategies, enhanced diagnostic capabilities, and evidence-based interventions are essential to address the evolving infertility landscape in Bangladesh.