What is the WHO 2025 Infertility Guideline?
The WHO 2025 Infertility Guideline for the Prevention, Diagnosis, and Treatment is the first comprehensive World Health Organization guideline dedicated to infertility care. It provides evidence-based recommendations for preventing, diagnosing, and treating female-, male-, and unexplained-factor infertility and is intended for healthcare professionals, policymakers, reproductive medicine specialists, and fertility care providers.
Introduction
The guideline was developed using rigorous WHO guideline-development methods, including systematic reviews of the literature and the GRADE (Grading of Recommendations Assessment, Development and Evaluation) framework. Recommendations were formulated after considering the balance between benefits and harms, certainty of evidence, feasibility, costs, acceptability, equity, and patient values.
One of the document's most important contributions is its recognition that infertility is not solely a specialist issue. Instead, fertility care should be integrated into routine sexual and reproductive healthcare and should be available to all individuals who need it without discrimination or stigma.
Healthcare professionals will also appreciate that the recommendations are supported by diagnostic algorithms, treatment pathways, evidence summaries, and implementation guidance, making the document useful both as a clinical reference and as a policy resource.
Whether you are an obstetrician-gynecologist, reproductive endocrinologist, urologist, embryologist, fertility nurse, primary care physician, or trainee in reproductive medicine, this guideline offers a structured evidence-based framework for improving infertility care.
Book Overview
|
Title |
Guideline for the Prevention, Diagnosis and Treatment of Infertility |
|
Edition |
First edition (WHO Guideline) |
|
Organization |
World Health Organization (WHO) |
|
Publisher |
World Health Organization |
|
Publication
Year |
2025 |
|
ISBN
(Electronic) |
978-92-4-011577-4 |
|
ISBN
(Print) |
978-92-4-011578-1 |
|
Medical
Specialty |
Reproductive Medicine, Obstetrics
& Gynecology, Andrology, Fertility Medicine |
|
Document
Type |
Evidence-based Clinical Practice
Guideline |
|
Length |
262 pages |
|
Primary
Audience |
Healthcare professionals, fertility
specialists, policymakers, reproductive health programs, educators, and
researchers |
WHAT THIS GUIDELINE COVERS
Comprehensive Evidence-Based Fertility Care
The WHO 2025 Infertility Guideline provides a comprehensive framework covering the continuum of infertility care—from prevention through diagnosis, treatment, implementation, and future research.
Major areas addressed include:
1. Global Burden of Infertility
The guideline begins by reviewing the following:
- Epidemiology of infertility
- Global prevalence
- Public health impact
- Human rights considerations
- Health system challenges
- Inequities in access to fertility care
It highlights infertility as a worldwide health issue and discusses the need for stronger national policies and improved access to evidence-based reproductive healthcare.
2. Guideline Development Methodology
Readers are introduced to:
- Guideline objectives
- Scope
- Target audience
- WHO methodology
- GRADE evidence assessment
- Evidence-to-decision framework
- Recommendation development process
This transparency allows clinicians to understand how each recommendation was developed and how evidence quality influenced recommendation strength.
3. Evaluation and Management of Infertility
The guideline presents an organized approach to infertility evaluation, emphasizing:
- Comprehensive medical history
- Physical examination
- Appropriate diagnostic testing
- Patient-centered counselling
- Cost-effective investigation
- Clinical follow-up
- Psychological and social support
Rather than recommending indiscriminate testing, the guideline advocates individualized evaluation based on clinical findings.
4. Prevention of Infertility
The prevention chapter focuses on strategies to reduce infertility risk, including:
- Fertility education
- Public awareness
- Lifestyle counselling
- Tobacco cessation
- Prevention and management of sexually transmitted infections (STIs)
- Information for individuals and couples planning pregnancy
These recommendations reflect the WHO's emphasis on preventive reproductive healthcare rather than treatment alone.
5. Diagnosis of Female and Male Infertility
A substantial portion of the guideline is devoted to evidence-based diagnosis.
Topics include:
- Ovulatory dysfunction
- Confirmation of ovulation
- Reproductive hormone assessment
- Ovarian reserve testing
- Tubal disease assessment
- Uterine cavity evaluation
- Male-factor infertility
- Semen analysis
- Unexplained infertility
The document also includes diagnostic algorithms to guide clinical decision-making.
6. Evidence-Based Treatment Recommendations
Treatment recommendations cover:
- Ovulatory infertility
- Polycystic ovary syndrome (PCOS)
- Hyperprolactinemia
- Tubal disease
- Hydrosalpinx
- Uterine septum
- Male-factor infertility
- Varicocele
- Antioxidant therapy
- Unexplained infertility
- Intrauterine insemination (IUI)
- In vitro fertilization (IVF)
Each recommendation is accompanied by its strength and certainty of evidence.
7. Implementation and Future Research
The guideline concludes with chapters discussing the following:
- Dissemination
- Local adaptation
- Monitoring
- Evaluation
- Research priorities
- Future updates
This broader perspective makes the document valuable not only for clinicians but also for healthcare administrators and policymakers.
Key Features
- First comprehensive WHO guideline dedicated exclusively to infertility care.
- Developed using WHO guideline-development standards and the GRADE methodology.
- Covers prevention, diagnosis, treatment, implementation, and research priorities.
- Includes recommendations for female-factor, male-factor, and unexplained infertility.
- Integrates evidence quality with recommendation strength.
- Emphasizes patient-centered, equitable, and rights-based fertility care.
- Incorporates diagnostic algorithms and clinical management pathways.
- Addresses lifestyle factors, fertility education, tobacco use, and STI prevention.
- Includes recommendations applicable across different healthcare settings.
- Designed to support national guideline development and health policy adaptation.
Who Should Read This Guideline?
The WHO states that this guideline is intended primarily for healthcare professionals involved in fertility care while also serving policymakers and organizations responsible for reproductive health programs.
Reproductive Endocrinologists and Fertility Specialists
These clinicians will benefit from the guideline's evidence-based recommendations for infertility evaluation and management, including diagnostic pathways and treatment recommendations.
Obstetricians and Gynecologists
The document provides practical guidance on the investigation and management of common causes of female infertility, including ovulatory disorders, tubal disease, uterine abnormalities, and unexplained infertility.
Urologists and Andrologists
Recommendations addressing semen analysis, male-factor infertility, varicocele management, and related clinical issues make the guideline relevant to specialists caring for male reproductive health.
Primary Care Physicians
Family physicians and general practitioners involved in reproductive healthcare can use the guideline to improve early recognition, counseling, referral decisions, and preventive care.
Nurses and Midwives
Healthcare professionals providing fertility counseling and reproductive health services will find the recommendations valuable for patient education and coordinated care.
Embryologists and Assisted Reproductive Technology Teams
Although broader than ART alone, the guideline discusses IVF, IUI, and other fertility treatments within an evidence-based clinical framework.
Public Health Professionals and Policymakers
The WHO specifically notes that the recommendations are intended to inform national health policy, financing, service delivery, implementation strategies, and equitable access to fertility care.
Why This Guideline Is Useful
The WHO 2025 Infertility Guideline for the Prevention, Diagnosis, and Treatment is more than a compilation of recommendations—it provides an evidence-based framework for delivering fertility care that is clinically effective, patient-centered, and adaptable to different healthcare systems.
Developed through systematic evidence reviews and the GRADE methodology, the guideline considers not only clinical effectiveness but also patient values, feasibility, resource implications, equity, and implementation challenges.
1. Evidence-Based Clinical Decision Making
One of the guideline's greatest strengths is its rigorous methodology. Recommendations are based on systematic reviews of the available literature and are accompanied by an assessment of the certainty of evidence and the strength of each recommendation.
This transparent approach enables clinicians to understand both the evidence supporting each recommendation and the degree of confidence that can be placed in it.
Healthcare providers can therefore make informed clinical decisions while also considering individual patient preferences and local healthcare resources.
2. Covers the Entire Fertility Care Pathway
Unlike many references that focus mainly on assisted reproductive technologies, this WHO guideline addresses infertility from a broader perspective.
It provides guidance on:
- Prevention strategies
- Initial evaluation
- Diagnostic investigations
- Female infertility
- Male infertility
- Unexplained infertility
- Evidence-based treatment
- Service implementation
- Monitoring and evaluation
- Future research priorities
This comprehensive scope makes the guideline valuable throughout the continuum of fertility care rather than only during specialist treatment.
3. Supports Patient-Centred Care
The guideline consistently emphasizes individualized management.
It recommends that healthcare professionals:
- Select investigations based on clinical findings.
- Respect patient preferences.
- Discuss psychological and social support needs.
- Base treatment decisions on benefits, harms, patient values, feasibility, costs, and available resources.
- Plan appropriate follow-up during infertility treatment.
These principles encourage holistic fertility care that extends beyond laboratory investigations and medical interventions.
4. Useful Across Different Healthcare Settings
The recommendations are intended to be adaptable to both high-resource and resource-limited settings.
Throughout the document, WHO discusses:
- Feasibility
- Resource availability
- Equity
- Acceptability
- Cost considerations
This makes the guideline particularly relevant for clinicians practicing in diverse healthcare environments around the world.
5. Practical Diagnostic Algorithms
The guideline includes several clinical algorithms that help clinicians organize investigations logically.
Examples include algorithms for:
- Female-factor infertility
- Uterine cavity assessment
- Male-factor infertility
- PCOS-related infertility
- Unexplained infertility
These visual pathways help simplify complex clinical decision-making and improve consistency of care.
6. Balances Clinical Effectiveness with Resource Use
Another notable feature is the emphasis on cost-effective care.
The guideline encourages clinicians to:
- Avoid unnecessary investigations.
- Use diagnostic tests according to clinical indications.
- Choose effective but economical treatment strategies when appropriate.
- Consider healthcare resources during treatment planning.
This balanced approach supports both high-quality patient care and responsible resource utilization.
Table of Contents Overview
The guideline is organized into a logical sequence that mirrors the clinical management of infertility, progressing from epidemiology and methodology to prevention, diagnosis, treatment, implementation, and future research.
1. Introduction
The opening chapter reviews:
- Epidemiology of infertility
- Global burden
- Human rights considerations
- Need for improved fertility care worldwide
2. Rationale and Methodology
This section explains the following:
- Guideline objectives
- Scope
- Target audience
- Guiding principles
- WHO guideline-development process
- GRADE methodology
3. Approach to Evaluation and Management
Focuses on:
- Clinical assessment
- Medical history
- Physical examination
- Appropriate diagnostic evaluation
- General management principles
4. Prevention of Infertility
Topics include:
- Fertility education
- Information for the general population
- Counselling for individuals and couples
- Tobacco-related risk reduction
- Prevention of sexually transmitted infections
5. Diagnosis of Infertility
This extensive chapter covers the following:
- Ovulatory dysfunction
- Confirmation of ovulation
- Hormonal evaluation
- Ovarian reserve assessment
- Tubal disease
- Uterine cavity disorders
- Male infertility
- Unexplained infertility
6. Treatment of Ovulatory Dysfunction
Includes evidence-based recommendations for:
- PCOS-related infertility
- Hyperprolactinemia
- Pharmacological treatment
- Gonadotrophins
- IVF when appropriate
7. Treatment of Tubal Disease
Discusses:
- Surgical management
- IVF
- Hydrosalpinx
- Tubal occlusion
- Salpingectomy
8. Treatment of Uterine Disorders
Focuses primarily on:
- Management of uterine septum
- Surgical considerations
9. Treatment of Male Infertility
Addresses:
- Antioxidant therapy
- Varicocele treatment
- Surgical options
- Radiological interventions
10. Management of Unexplained Infertility
Provides recommendations regarding:
- Expectant management
- Intrauterine insemination (IUI)
- Ovarian stimulation
- IVF
- IVF versus ICSI
11. Implementation
Discusses:
- Dissemination
- Local adaptation
- Implementation strategies
- Monitoring and evaluation
12. Research Priorities
The final chapter highlights the following:
- Current evidence gaps
- Areas requiring future research
- Planned expansion of future guideline editions
Several annexes supplement the main text with information on causes of infertility, expert contributors, components of medical history and physical examination, and links to evidence-based decision tables.
Strengths of the Guideline
The WHO 2025 guideline has several notable strengths that enhance its value for both clinical practice and health policy.
Comprehensive Scope
It addresses prevention, diagnosis, treatment, implementation, and future research within a single evidence-based document, offering a unified framework for fertility care.
Rigorous Methodology
The recommendations were developed using WHO guideline-development standards, systematic reviews, and the GRADE framework, providing transparency in both evidence appraisal and recommendation formulation.
Multidisciplinary Development
The Guideline Development Group included clinicians, researchers, policymakers, patient representatives, and experts from multiple countries, ensuring diverse perspectives throughout the development process.
Global Applicability
The document explicitly considers equity, feasibility, resource availability, and implementation across a wide range of healthcare settings, making it relevant internationally.
Practical Clinical Guidance
Diagnostic algorithms, treatment pathways, good-practice statements, and evidence summaries support day-to-day clinical decision-making and facilitate consistent care.
Strong Public Health Perspective
The guideline extends beyond clinical interventions by emphasizing prevention, education, policy development, equitable access, and integration of fertility care into broader sexual and reproductive health services.
Limitations
Not All Areas of Fertility Care Are Covered
The guideline acknowledges that it does not address every aspect of infertility or fertility care and that future editions are expected to expand its scope.
Variable Certainty of Evidence
Many recommendations are accompanied by low or very low certainty evidence, reflecting limitations in the available research rather than weaknesses in the guideline development process. Clinicians should interpret such recommendations within the context of individual patient circumstances and evolving evidence.
Adaptation May Be Necessary
WHO emphasizes that implementation should be adapted to local healthcare systems, available resources, workforce capacity, and national regulations. Consequently, some recommendations may require modification before adoption into national clinical practice.
Comparison With Similar Books
The WHO 2025 Infertility Guideline for the Prevention, Diagnosis, and Treatment differs from traditional infertility textbooks and specialty references in several important ways.
Unlike comprehensive reproductive medicine textbooks, which typically focus on explaining disease mechanisms, reproductive physiology, and procedural techniques, this publication is a clinical practice guideline. Its primary purpose is to provide evidence-based recommendations for clinical decision-making rather than detailed educational chapters on basic science.
Compared with society guidelines produced by regional professional organizations, the WHO guideline adopts a broader global public health perspective.
It explicitly considers resource availability, equity, feasibility, patient values, and implementation across diverse healthcare settings, making it applicable to countries with varying healthcare infrastructures.
Another distinguishing feature is its transparent use of the GRADE methodology, with each recommendation accompanied by its strength and certainty of evidence. This allows clinicians to understand not only what is recommended but also how confident the expert panel is in the supporting evidence.
For healthcare professionals seeking current, evidence-based guidance on infertility prevention, diagnosis, and management, this WHO publication serves as a valuable complement to standard reproductive medicine textbooks rather than a replacement for them.
WHO 2025 Infertility Guideline
Or: Link 2
FAQs
The WHO 2025 Infertility Guideline for the Prevention, Diagnosis, and Treatment is the World Health Organization's first comprehensive evidence-based guideline dedicated to infertility care. It provides recommendations on preventing, diagnosing, and treating female-, male-, and unexplained-factor infertility using systematic reviews and the GRADE methodology. The guideline is intended to support healthcare professionals, policymakers, and health systems in delivering high-quality fertility care.
The guideline is primarily intended for healthcare professionals involved in fertility care, including physicians, obstetricians and gynecologists, reproductive endocrinologists, embryologists, nurses, midwives, laboratory specialists, and other fertility care providers. It is also designed to inform policymakers, professional societies, advocacy organizations, and reproductive health programs responsible for developing or updating national infertility policies and services.
The guideline covers:
- Prevention of infertility
- Fertility education and counselling
- Lifestyle interventions
- Female infertility diagnosis
- Male infertility diagnosis
- Evaluation of unexplained infertility
- Evidence-based treatment recommendations
- Assisted reproductive technologies (ART)
- Clinical management pathways
- Guideline implementation
- Research priorities
It also includes diagnostic algorithms, treatment recommendations, and evidence summaries to support clinical decision-making.
The recommendations were developed according to the WHO Handbook for Guideline Development. The process involved systematic reviews of the scientific literature, multidisciplinary expert review, evidence-to-decision frameworks, and assessment using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology. Each recommendation is accompanied by its strength and the certainty of the supporting evidence.
Yes. The guideline provides evidence-based recommendations for the diagnosis and treatment of female-factor infertility, male-factor infertility, and unexplained infertility. It also discusses preventive strategies and general principles for evaluating and managing individuals and couples experiencing infertility.
Yes. Depending on the underlying cause of infertility, the guideline discusses interventions such as lifestyle modification, ovulation induction, management of polycystic ovary syndrome (PCOS), treatment of hyperprolactinemia, surgery for selected tubal disease, management of varicocele, intrauterine insemination (IUI), and in vitro fertilization (IVF). Recommendations vary according to the clinical scenario and are accompanied by their corresponding evidence ratings.
Infertility affects approximately one in six people during their reproductive years worldwide. This guideline provides a standardized, evidence-based framework that promotes equitable access to fertility care, supports informed clinical decision-making, and assists countries in developing or updating national infertility policies and clinical practice guidelines.
Yes. Although written primarily for healthcare professionals and policymakers, the guideline is also a valuable educational resource for medical students, residents, fellows, and researchers seeking an up-to-date overview of evidence-based infertility care and current WHO recommendations.
Conclusion
The WHO 2025 Infertility Guideline for the Prevention, Diagnosis, and Treatment represents a landmark publication in reproductive medicine, providing the first comprehensive WHO framework dedicated exclusively to infertility prevention, diagnosis, and treatment.
Developed through a rigorous evidence-based process using systematic reviews and the GRADE methodology, the guideline offers transparent recommendations that balance clinical effectiveness with patient preferences, resource considerations, feasibility, and equity.
A major strength of this publication is its broad scope. Rather than focusing solely on assisted reproductive technologies, it addresses the entire continuum of fertility care—from prevention and early evaluation to diagnosis, treatment, implementation, and future research priorities.
This integrated approach makes the guideline relevant not only to fertility specialists but also to primary care clinicians, obstetricians and gynecologists, urologists, reproductive health teams, educators, and policymakers.
Healthcare professionals will find practical value in the guideline's structured diagnostic pathways, evidence-based treatment recommendations, and emphasis on individualized, patient-centered care. At the same time, policymakers and health system leaders can use its recommendations to strengthen national reproductive health services and improve equitable access to fertility care.
For readers seeking an authoritative and globally applicable reference on infertility management, this WHO publication is an excellent resource that complements standard reproductive medicine textbooks and supports evidence-informed clinical practice.
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