The World Health Organisation has released its first-ever global guideline on infertility, calling on countries to make fertility care safer, fairer and more affordable.
It comes as infertility affects 1 in 6 people of reproductive age worldwide, while access to tests and treatments remains limited and, in many places, financially devastating.
Announcing the guideline, WHO Director-General, Dr Tedros Ghebreyesus, said, “Infertility is one of the most overlooked public health challenges of our time and a major equity issue globally.
“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, giving more people the possibility to access affordable, respectful, and science-based care.”
WHO urges countries to integrate fertility care into national health systems rather than leave it to private or out-of-pocket payment, emphasising that infertility services must be accessible and clinically sound.
The organisation says care should begin with proper history-taking and physical examination, rely only on necessary and cost-effective tests, respect patient preferences, and include psychological support. It also stresses the need to weigh risks, benefits and costs before choosing treatments and to track outcomes after care.
These principles, WHO notes, apply across all stages of infertility management.
The guideline contains 40 recommendations covering prevention, diagnosis, treatment and system-wide implementation.
• Infertility in men. Image source WINFertility
Below is an harmonised explainer and summary of the WHO’s Guideline for the Prevention, Diagnosis and Treatment of Infertility – Summary of Recommendations.
1. General Principles for Infertility Care
WHO advises that care for individuals and couples should:
Be based on thorough history and physical examination.
Use only necessary, cost-effective diagnostic tests.
Respect patient preferences and offer psychological or peer support when needed.
Consider benefits, harms, costs and feasibility when choosing treatments.
Plan follow-up and manage treatment risks.
Document pregnancy outcomes after treatment.
2. Prevention of Infertility
Information & Lifestyle
Provide low-cost fertility and infertility information to all people of reproductive age (e.g., schools, primary care, reproductive health clinics).
Provide lifestyle advice (diet, alcohol, smoking, physical activity, weight management) to people with infertility before and during treatment.
Tobacco Smoking
Give brief cessation advice (30 seconds–3 minutes) to all tobacco users, including those trying to conceive.
Explain smoking’s link to infertility (especially for women).
Offer or refer for cessation support.
Sexually Transmitted Infections (STIs)
Inform all individuals/couples planning pregnancy about STIs and their infertility risks.
Encourage prompt care and treatment for STI symptoms.
3. Diagnosis of Female-Factor Infertility
A. Ovulatory Dysfunction
For women with regular cycles and normal exams:
Use mid-luteal serum progesterone to confirm ovulation; repeat if abnormal.
For suspected anovulation/oligo-ovulation:
Assess HPO-axis hormones (FSH, LH; sometimes estradiol/testosterone, TSH, prolactin).
Low ovarian reserve:
Base diagnosis mainly on age; if testing needed, use AFC, AMH, or day 2–3 FSH.
B. Tubal Disease
Use HSG or HyCoSy to assess tubal patency, depending on feasibility.
C. Uterine Cavity Disorders
Preferred assessment (where resources allow):
SIS over 3D ultrasound
3D ultrasound over 2D ultrasound
SIS over 2D ultrasound
SIS over HSG
4. Diagnosis of Male-Factor Infertility
If semen analysis is abnormal: repeat after ≥11 weeks.
If normal: do not repeat.
5. Diagnosis of Unexplained Infertility
Diagnose when ALL conditions are met:
No pregnancy after 12 months unprotected intercourse.
Normal history and physical exam (both partners).
Confirmed female ovulation and tubal patency.
Normal semen parameters.
6. Treatment of Female-Factor Infertility
A. Ovulatory Dysfunction (PCOS)
First-line: Letrozole over clomiphene citrate or metformin.
If letrozole use is restricted: clomiphene + metformin preferred.
Lifestyle advice (diet, exercise, weight management).
If oral therapy fails → gonadotrophins rather than ovarian drilling.
If gonadotrophins fail → IVF rather than expectant management.
Hyperprolactinaemia
Use cabergoline over bromocriptine.
B. Tubal Disease
