The World Health Organization (WHO) has released its first-ever global guideline on infertility, calling on countries to make fertility care safer, fairer, and more accessible for all. The guidance provides 40 recommendations covering the prevention, diagnosis, and treatment of infertility, emphasizing integration of fertility services into national health systems.
Infertility affects an estimated one in six people of reproductive age at some point in their lives. Despite rising demand, access to fertility services remains limited, particularly in low- and middle-income countries, where testing and treatment are often out-of-pocket and financially burdensome. A single cycle of in vitro fertilization (IVF) can cost twice the average annual household income, placing treatment out of reach for many families.
The guideline defines infertility as the inability to achieve pregnancy after 12 months or more of regular, unprotected sexual intercourse. Beyond its medical implications, infertility can cause emotional distress, social stigma, and financial hardship. WHO emphasizes both clinical management and preventive strategies, including education on fertility and infertility through schools, primary care, and reproductive health services, raising awareness of age and lifestyle factors, and addressing environmental and health risks.
Key preventive measures include the prevention and early treatment of sexually transmitted infections, tobacco cessation, healthy diets, and regular physical activity. Early education on fertility is encouraged to support informed reproductive choices. For clinical management, WHO recommends a stepwise approach, starting with fertility awareness and counseling, and progressing to medical procedures such as intrauterine insemination and IVF, guided by diagnostic results and patient preferences. Recognizing the emotional burden of infertility, the guideline calls for psychosocial support to address anxiety, depression, and social isolation.
WHO urges countries to adapt the recommendations to local contexts and monitor implementation. Effective delivery requires collaboration among ministries of health, professional societies, civil society organizations, and patient groups, ensuring fertility care aligns with rights-based approaches and gender equality principles.
The guidelines identify current evidence gaps and areas for future research, with upcoming editions expected to address fertility preservation, third-party reproduction, and the impact of pre-existing medical conditions. WHO stresses that equitable access to fertility care is both a health imperative and a matter of social justice.
Key recommendations:
- Provide education on fertility and infertility through schools, primary health care, and reproductive health services.
- Raise awareness of fertility factors such as age and lifestyle influences.
- Prioritize prevention and management of sexually transmitted infections.
- Promote healthy diets, physical activity, and tobacco cessation for individuals and couples planning pregnancy.
- Use clinical pathways to diagnose common male and female infertility causes.
- Apply a stepwise treatment approach, from fertility awareness and counseling to advanced interventions such as intrauterine insemination and IVF, guided by diagnostic results and patient preferences.
- Ensure ongoing psychosocial support to address anxiety, depression, and social isolation associated with infertility.
- Integrate fertility care into national health systems, policies, and financing frameworks.
- Ground care in gender equality and reproductive rights, empowering individuals to make informed reproductive choices.
- Adapt guidelines to local contexts and monitor implementation through collaboration with relevant stakeholders.
- Support research on fertility preservation, third-party reproduction, and the impact of pre-existing medical conditions.
- Provide affordable, accessible, and respectful fertility care aligned with rights-based approaches to sexual and reproductive health.
Reference
- World Health Organization (WHO) [Internet]. [cited 2025 Nov 29]. Available from: https://www.who.int