WHO Releases First-Ever Framework for Infertility Care

The World Health Organization (WHO) releases its first global guideline for the prevention, diagnosis, and treatment of infertility, urging countries to expand affordable and evidence-based fertility services as demand rises amid persistent gaps in access. The organization says infertility affects one in six people of reproductive age worldwide, yet testing and treatment remain largely limited to those able to pay high out-of-pocket costs.

“Infertility is one of the most overlooked public health challenges of our time and a major equity issue globally,” says Tedros Adhanom, Director General, WHO. “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.” WHO encourages governments to integrate the guideline into national strategies to help more people access care grounded in scientific evidence.

WHO’s document makes 40 recommendations intended to standardize prevention, strengthen clinical pathways, and promote cost-effective interventions. It highlights the need for investment in public education on fertility, preventive measures against avoidable risk factors, and expansion of diagnostic and treatment options from basic counseling to intrauterine insemination and in vitro fertilization (IVF). In some countries, a single IVF cycle can cost twice the average annual household income, a barrier the organization said reinforces inequality.

The announcement comes at a moment when reproductive health systems worldwide are undergoing rapid change. Advances in genetic testing, precision medicine, and early disease detection are expanding what is clinically possible, but access often remains uneven. Gustavo Rodríguez, Founder and CEO, NutriADN, writes that many people lack the resources or guidance needed to benefit from technologies that could prevent health complications or support informed reproductive decisions. He notes that delayed diagnosis of genetic or reproductive conditions remains a public-health challenge that can affect fertility outcomes. For individuals and families, he says, the stakes extend beyond clinical care, underscoring the need for services that consider financial, social, and psychological impacts. 

Researchers and health systems are also tracking how new tools could reshape long-standing gaps. Efforts such as the ovarian cancer prevention vaccine OvarianVax, developed by the Mayo Clinic and slated to begin Phase 1 trials, reflect an expanding pipeline of interventions designed to detect or reduce reproductive-health risks earlier. Scientists report preclinical evidence that the vaccine activates CD4 and CD8 T-cell responses without harming healthy tissue. Its development has drawn philanthropic support, including a US$1.5 million grant from investment firm Forge Health. While still experimental, projects like this illustrate how innovation is influencing broader conversations about reproductive well-being, especially for people with BRCA1 or BRCA2 mutations.

Equity concerns surrounding reproductive health extend beyond infertility. Endometriosis affects an estimated 10% of women and girls globally, with diagnosis often taking seven to 10 years. The condition has significant economic and workforce implications due to chronic pain, reduced productivity, and repeat medical visits. The Bill & Melinda Gates Foundation recently committed US$10 million to strengthen research on the disease. In Mexico, endometriosis is a leading cause of infertility, and advocates have urged more coordinated public-health planning and earlier screening to reduce long-term impacts. Analysts warn that delayed diagnosis and limited treatment options also reflect broader gaps in women’s health investment, an area often labeled an underserved market despite its scale.

The WHO guideline places similar emphasis on mental health, noting that infertility can lead to depression, anxiety, and social isolation, and recommends psychosocial support as part of routine care. It defines infertility as the inability to achieve pregnancy after 12 months or more of regular unprotected intercourse and outlines evaluation protocols for men and women, including semen analysis, ovulation assessment, and imaging to identify conditions such as endometriosis, uterine abnormalities, or tubal obstruction. The agency also calls for stronger prevention strategies in primary care settings, including education on age-related fertility changes, untreated infections, and tobacco use.

In Mexico, clinicians report increased demand for assisted reproduction services but persistent financial and geographic barriers. DEMESA, a reproductive-medicine network, notes that IVF effectiveness varies by age and underlying conditions and says many patients first seek evaluation only after years of unsuccessful attempts. Specialists argue that broader insurance coverage, standardized care pathways, and earlier referral could improve outcomes.

WHO says that implementation of its guideline will require coordination across governments, health-professional societies, civil-society groups, and patient advocates. Future editions are expected to address fertility preservation, the use of donor gametes and the impact of pre-existing medical conditions. Pascale Allotey, Director of the Department of Sexual, Reproductive, Maternal, Child, and Adolescent Health, WHO, says that reproductive-care policy must be grounded in reproductive rights and gender equality. She adds that empowering people to make informed decisions about whether and when to have children is both a health priority and a matter of social justice.

Governments are now expected to review the recommendations and assess their applicability to national systems. WHO says progress will depend on long-term investments in prevention, diagnostics and treatment and on closing the financial and social barriers that prevent many from seeking care.