NEW DELHI: The World Health Organisation has released its first-ever global guideline for the prevention, diagnosis and treatment of infertility, calling on countries to make fertility care safer, fairer and more affordable, as infertility is estimated to affect one in six people of reproductive age at some point in their lives.
The WHO said that while the demand for infertility services is rising worldwide, access to care remains severely limited.
In many countries, tests and treatments are largely funded out-of-pocket, often leading to catastrophic financial expenditure. In some settings, even a single round of in vitro fertilisation (IVF) can cost double the average annual household income, the agency said.
“Infertility is one of the most overlooked public health challenges of our time and a major equity issue globally,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “Millions face this journey alone – priced out of care, pushed toward cheaper but unproven treatments, or forced to choose between their hopes of having children and their financial security. We encourage more countries to adopt this guideline, giving more people the possibility to access affordable, respectful, and science-based care.”
The guideline includes 40 recommendations aimed at strengthening the prevention, diagnosis and treatment of infertility. It promotes cost-effective options at every stage, and advocates the integration of fertility care into national health strategies, services and financing.
Infertility, defined as the failure to achieve pregnancy after 12 months or more of regular unprotected sexual intercourse, can lead to significant distress, stigma and financial hardship, affecting people’s mental and psychosocial well-being.
The guideline provides detailed steps for the effective clinical management of infertility and calls for greater investment in prevention, including education on fertility and infertility, and information on factors such as age, in schools, primary health care centres and reproductive health facilities.
It also stresses the need to address leading risk factors for infertility, including untreated sexually transmitted infections and tobacco use.
Lifestyle interventions such as healthy diet, physical activity and tobacco cessation are recommended for individuals and couples planning or attempting pregnancy. Informing people about fertility and infertility early can help them make reproductive plans.
The guideline outlines clinical pathways to diagnose common biological causes of male and female infertility. Considering clinical findings and patient preferences, it provides guidance on gradually progressing from simpler management strategies, where clinicians offer advice on fertile periods and fertility promotion without active treatment, to more complex options such as intrauterine insemination or IVF.
Recognising the emotional toll of infertility, which can lead to depression, anxiety and social isolation, the guideline emphasises the need to ensure ongoing psychosocial support for those affected.
The WHO encouraged countries to adapt the recommendations to their local contexts and monitor progress. Successful implementation, it said, will require collaboration across ministries of health, professional societies, civil society and patient groups.
Implementation should also align with comprehensive, rights-based approaches to sexual and reproductive health, including fertility care, that empower people to make informed decisions about whether and when to have children.
“The prevention and treatment of infertility must be grounded in gender equality and reproductive rights,” said Dr Pascale Allotey, Director of WHO’s Department of Sexual, Reproductive, Maternal, Child and Adolescent Health and Ageing, and the United Nations’ Special Programme on Human Reproduction (HRP). “Empowering people to make informed choices about their reproductive lives is a health imperative and a matter of social justice.”
While comprehensive, the guideline acknowledges existing evidence gaps and areas requiring further research. Upcoming editions are expected to cover fertility preservation, third-party reproduction and the impact of pre-existing medical conditions.