The World Health Organization (WHO) today called on countries to make fertility care safer, fairer and more accessible for all in its first global guidelines for the prevention, diagnosis and treatment of infertility.
It is estimated that infertility affects 1 in 6 people of reproductive age at some point in their lives. While demand for services is growing worldwide, access to care remains severely limited. In many countries, infertility tests and treatments are largely financed out of pocket - often resulting in catastrophic financial outlays. In some settings, even one round in vitro insemination (IVF) can cost twice the average annual household income.
"Infertility is one of the most neglected public health challenges of our time and a major global equity issue," said Dr. Tedros Adhanom Ghebreyesus, WHO Director-General. "Millions face this journey alone - pushed out of care, pushed towards 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, giving more people access to affordable, respected and science-based care."
The guideline includes 40 recommendations that seek to strengthen the prevention, diagnosis and treatment of infertility. It promotes cost-effective options at every stage, while advocating for the integration of fertility care into national health strategies, services and funding.
Infertility, defined as the failure to achieve pregnancy after 12 or more months of regular unprotected sex, can cause significant distress, stigma and financial hardship, affecting people's mental and psychosocial well-being.
The guidelines provide 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, in schools, primary health care and reproductive health facilities.
It emphasizes the need to address the leading risk factors for infertility, including untreated sexually transmitted infections and smoking. Lifestyle interventions -- such as healthy eating, physical activity, and smoking cessation -- are recommended for individuals and couples planning or trying to conceive. Informing people early about fertility and infertility can help them make reproductive plans.
The guidelines outline clinical pathways for diagnosing common biological causes of male and female infertility. Taking into account clinical test findings as well as patient preferences, it provides guidance on how to gradually advance treatment options from simpler management strategies - where clinicians first provide advice on fertile periods and fertility stimulation 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 guidelines emphasize the need to ensure ongoing access to psychosocial support for all those affected.
WHO encourages countries to adapt the recommendations to their local contexts and to 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 across the lifespan to make informed individual decisions about whether and when to have children.
"Prevention and treatment of infertility must be based on gender equality and reproductive rights," said Dr. Pascale Allotey, Director of the Division of Sexual, Reproductive, Maternal, Child and Adolescent Health and Aging at WHO and the United Nations Special Program on Human Reproduction (HRP). "Empowering people to make informed decisions about their reproductive lives is a health imperative and a matter of social justice."
Although comprehensive, the guideline acknowledges current gaps in the evidence, as well as areas for future research and additional recommendations. Future editions of the guidelines are expected to cover issues such as fertility preservation, third-party reproduction and the impact of pre-existing medical conditions.