WHO launches first global guidelines on infertility, calls for safer and more accessible care

The World Health Organisation (WHO) has released its first-ever global guidelines on infertility, calling on countries to make fertility care “safer, more equitable, and more affordable.”

Infertility affects an estimated one in six people of reproductive age at some point in their lives. Although global demand for fertility services is rising, access to such care remains severely limited, with many countries relying on out-of-pocket payments for tests and treatments. In some cases, a single round of in vitro fertilisation (IVF) can cost double the average annual household income.

“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 designed 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 financing.

Infertility, defined by WHO as the failure to achieve pregnancy after 12 months or more of regular unprotected sexual intercourse, can cause significant distress, stigma, and financial hardship, affecting mental and psychosocial well-being.

The guideline guides effective clinical management, emphasising prevention measures such as education on fertility and infertility, addressing leading risk factors like untreated sexually transmitted infections and tobacco use, and promoting healthy lifestyle interventions including diet, physical activity, and tobacco cessation for individuals and couples planning pregnancy.

It also outlines clinical pathways to diagnose common biological causes of male and female infertility, advising a stepwise approach that begins with simpler interventions such as fertility-awareness guidance and progresses to more complex treatments like intrauterine insemination or IVF based on clinical findings and patient preferences.

Recognising the emotional toll of infertility, which can lead to depression, anxiety, and social isolation, the guideline underscores the importance of ongoing psychosocial support.

WHO encourages countries to adapt these recommendations to their local contexts and monitor progress, highlighting that successful implementation requires collaboration across ministries of health, professional societies, civil society, and patient groups.

“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. “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 current gaps in evidence and identifies areas for future research, including fertility preservation, third-party reproduction, and the impact of pre-existing medical conditions.

With these new global guidelines, countries now have a unified, evidence-based roadmap to build or strengthen fertility care services from prevention to advanced treatment, ensuring care that respects human rights, reduces inequities, and supports reproductive health as an integral part of health systems.

According to the WHO, infertility has significant health, social, and psychological impacts, and its causes, risk factors, and treatment options are multifaceted.

Infertility can cause substantial emotional and social distress for individuals and couples. It may lead to anxiety, depression, feelings of isolation, and stigma in some communities, particularly in cultures where parenthood is highly valued.

Infertility can also strain relationships and affect overall quality of life. Beyond the personal impact, infertility can have public health implications, as many people lack access to affordable and effective fertility care, especially in low- and middle-income countries.

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Risk factors

WHO identifies several key risk factors that can contribute to infertility in both men and women. These include untreated sexually transmitted infections, age-related decline in fertility, hormonal disorders, lifestyle factors such as smoking, excessive alcohol consumption, poor diet, and obesity.

Environmental exposures, chronic diseases, and genetic conditions can also affect reproductive health. For women, conditions such as polycystic ovary syndrome (PCOS), endometriosis, or thyroid hormone imbalance may play a role, while in men, low sperm count or poor sperm quality can contribute.

WHO recommends a stepwise, evidence-based approach to infertility management. Treatment begins with prevention and lifestyle interventions, such as promoting reproductive health education, treating infections early, and encouraging healthy behaviours.

For diagnosis, WHO emphasises appropriate clinical evaluation to identify underlying causes in both partners. Treatment options progress from simpler, low-cost interventions, such as fertility-awareness methods, ovulation induction, or timed intercourse, to more complex procedures like intrauterine insemination (IUI) or assisted reproductive technologies (ART) such as IVF.

WHO stresses that treatment should be patient-centred, taking into account individual preferences, psychosocial support, and minimising stigma or discrimination.

The WHO also highlights that infertility care should be integrated into national health systems, ensuring equitable access for underserved populations and reducing reliance on out-of-pocket payments, which often create financial hardship. By addressing both medical and social aspects, infertility care can improve reproductive health outcomes and overall well-being.

In Kenya, various reports indicate that approximately 4.2 million people, around 10 per cent of the population, experience infertility and may require medical intervention. Other estimates suggest that between 10 and 15 per cent of couples in the country are unable to conceive.

A hospital-based study conducted at a national referral centre found that among couples seeking infertility treatment, 41.8 per cent of cases were attributed solely to female factors, 16.5 per cent solely to male factors, 35.4 per cent involved both male and female factors, and about 6.3 per cent remained unexplained.