WHO Issues First Global Guideline to Make Fertility Care Safe, Fair and Affordable

“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.

The World Health Organization (WHO) has launched its first-ever global guideline dedicated to the prevention, diagnosis, and treatment of infertility, calling on governments worldwide to overhaul fertility care systems and make them more safe, affordable, equitable, and rights-based. The landmark guidance comes at a time when infertility affects an estimated 1 in 6 people of reproductive age—a public health challenge that has long been overlooked and chronically underfunded.

A Growing Global Crisis: High Demand, Low Access

Infertility affects people across regions, income levels, and social backgrounds. Yet access to diagnosis and treatment varies dramatically around the world. In many low- and middle-income countries, infertility services remain scarce, with infrastructure gaps, unaffordable medicines, and limited specialist expertise.

Even where services exist, patients typically face massive out-of-pocket costs. The WHO notes that in some settings, a single round of in vitro fertilization (IVF) can cost twice the average annual household income, pushing families into catastrophic financial distress. As a result, many people abandon treatment altogether or turn to unregulated, ineffective, and sometimes dangerous alternatives.

“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 unproven treatments, or forced to choose between their dreams of having children and their financial security.”

A Comprehensive Framework of 40 Recommendations

The new WHO guideline provides 40 evidence-based recommendations aimed at strengthening fertility care across every phase of the reproductive journey—from prevention to advanced clinical treatment. The guidance urges countries to integrate infertility services into national health strategies and benefit packages, ensuring they are accessible through universal health coverage rather than dependent on personal wealth.

Key recommendations include:

• Strengthening early prevention by integrating fertility awareness into school curricula, community health programmes, and primary care

• Managing risk factors such as untreated sexually transmitted infections (STIs), tobacco use, exposure to toxins, and harmful environmental conditions

• Improving diagnostic pathways for identifying both male and female infertility

• Providing stepwise treatment options, progressing from low-cost interventions to advanced technologies like intrauterine insemination (IUI) or IVF

• Ensuring access to psychosocial support, recognising the emotional, mental, and social burden of infertility

• Expanding equitable financing, reducing reliance on out-of-pocket spending

• Embedding human rights and gender equality in fertility care policies and programmes

The WHO emphasizes that fertility care must be people-centred, non-discriminatory, and culturally sensitive, and that patients’ preferences should guide treatment pathways.

Addressing the Social and Emotional Impact of Infertility

Infertility is not solely a medical issue—it carries profound emotional, social, and cultural implications. In many societies, people experiencing infertility face:

• Stigma and discrimination

• Social exclusion

• Marital or family pressure

• Emotional stress, anxiety, or depression

Women, in particular, often shoulder blame and psychological burden, even though infertility affects men and women equally. The guideline underscores the need for integrated psychosocial care, ensuring that individuals and couples have support systems throughout testing and treatment.

Prevention Begins with Education and Awareness

Recognizing that many infertility cases could be prevented, the WHO calls for stronger public awareness initiatives. Factors such as age, untreated STIs, smoking, poor nutrition, and environmental hazards contribute significantly to reduced fertility, yet awareness remains limited.

The guideline urges governments to:

• Expand fertility education in schools

• Improve sexual and reproductive health counselling

• Promote healthy lifestyles

• Strengthen STI prevention and treatment services

• Integrate fertility counselling into family planning programmes

By informing people earlier in life, individuals can make better decisions about reproductive planning.

Modernizing Clinical Practice

The guideline outlines clear pathways for diagnosing infertility, beginning with a thorough medical history and simple tests, and advancing to imaging, hormonal analyses, and semen evaluation. It encourages clinicians to follow progressive care models, offering patients:

1. Low-cost counselling and fertility-awareness methods

2. Lifestyle and behavioural interventions

3. Hormonal therapies

4. IUI where appropriate

5. Assisted reproductive technologies such as IVF

Importantly, recommendations emphasize the need to avoid unnecessary tests or treatments that may inflate costs without improving outcomes.

Fertility Care in a Changing World

WHO officials stress that fertility care must be embedded within rights-based, gender-responsive reproductive health systems. This involves collaboration among ministries of health, professional medical associations, 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, and head of the UN’s Special Programme on Human Reproduction (HRP). “Empowering people to make informed choices about their reproductive lives is a matter of social justice.”

Gaps in Evidence and the Path Forward

While the guideline offers comprehensive recommendations, the WHO acknowledges ongoing research gaps in areas such as:

• Fertility preservation technologies

• Third-party reproduction (surrogacy, gamete donation)

• Fertility care for people with chronic or pre-existing medical conditions

• Emerging treatments and technologies

Upcoming editions will expand these areas as evidence grows.

A Global Call to Action

With infertility affecting millions worldwide, the WHO urges countries to act swiftly. Ensuring equitable access to safe, effective fertility care is not merely a health intervention—it is a commitment to human dignity, equity, and reproductive autonomy.

The message from the WHO is clear: fertility care must no longer be a luxury reserved for the few. It must become a core component of universal health coverage for all.