The World Health Organization (WHO) today called on countries to make fertility care safer, fairer and more accessible for all in the first global guideline on the prevention, diagnosis and treatment of infertility.
Infertility is estimated to affect 1 in 6 people of reproductive age at some point in their lives. While demand for services is increasing worldwide, access to care remains severely limited. In many countries, infertility tests and treatments are largely funded out of pocket – often resulting in devastating financial costs. In some settings, even a single round in vitro Insemination (IVF) can cost twice the average annual household income.
Infertility is one of the most overlooked public health challenges of our time and an important global justice issue. 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 adapt this guideline, enabling more people to access affordable, respectful and science-based care.”
Dr. Tedros Adhanom Ghebreyesus, WHO Director-General
The guideline includes 40 recommendations that seek to enhance the prevention, diagnosis and treatment of infertility. It promotes cost-effective options at every stage, while supporting the integration of fertility care into national health strategies, services and funding.
Evidence-based person-centered care
Infertility, defined as the failure to achieve pregnancy after 12 months or more of regular unprotected intercourse, can cause significant distress, stigma and financial hardship, affecting people’s mental and psychosocial well-being.
The guideline provides guidance on steps for effective clinical management of infertility. It also calls for increased investment in prevention, including information on fertility and infertility, factors such as age, schools, primary health care and reproductive health facilities.
It emphasizes the need to address the main risk factors for infertility, including untreated sexually transmitted infections and tobacco use. Lifestyle interventions – such as healthy eating, physical activity and smoking cessation – are recommended for individuals and couples planning or attempting pregnancy. Early information about fertility and infertility can help people make reproductive plans.
The guideline describes clinical pathways for diagnosing common biological causes of male and female infertility. Taking into account findings from clinical trials as well as patient preferences, it provides guidance on how to progressively advance treatment options from simpler management strategies – where clinicians first provide advice on fertile periods and fertility promotion without active treatment – to more complex treatment courses such as intrauterine insemination or IVF.
Recognizing the emotional toll of infertility, which can lead to depression, anxiety and feelings of social isolation, the guideline emphasizes the need to ensure ongoing access to psychosocial support for all those affected.
Fertility in a changing world
WHO encourages countries to adapt the recommendations to their local contexts and monitor progress. Successful implementation will require collaboration between Ministries of Health, health professional societies, civil society and patient groups.
Implementation should also be aligned with comprehensive, rights-based approaches to sexual and reproductive health – including fertility care – that empower people throughout their lives to make informed, individual decisions about whether and when to have children.
“The prevention and treatment of infertility must be based on gender equality and reproductive rights,” said Dr Pascale Allotey, Director of the WHO Division of Sexual, Reproductive, Maternal, Child and Adolescent Health and Aging and the United Nations Special Program on Human Reproduction (HRP). “Empowering people to make informed choices about their reproductive lives is a health imperative and a matter of social justice.”
Although comprehensive, the guideline recognizes current gaps in evidence as well as areas for future research and additional recommendations. Future editions of the guideline are expected to cover issues such as fertility preservation, surrogate reproduction and the impact of pre-existing medical conditions.
