International Journal of Gynecology & Obstetrics: Early View
by M. Louise Hull, Kurt T. Barnhart, Nikhil C. Purandare, Aparna Sridhar, E. Göknur Topçu, Scott M. Nelson, on behalf of the FIGO REI committee
First published: 12 September 2026. https://doi.org/10.1002/ijgo.71380
SPECIAL ARTICLE: Open Access
Abstract
The WHO ‘Guideline for the prevention, diagnosis and treatment of infertility’ heralds a significant global shift towards recognizing infertility as a medical condition requiring prevention, diagnosis, treatment and policy support. This recognition is vital for the one in six people with infertility worldwide and for policymakers trying to address the societal consequences of fertility decline. The guideline’s 40 recommendations and six good practice statements emphasize pragmatic diagnostic pathways, cost-effective interventions, psychosocial support and shared decision-making. Preventive measures, including fertility education, lifestyle counselling, smoking cessation and early management of sexually transmitted infections, are recommended in routine care to improve future reproductive health outcomes. The guideline aligns closely with the International Federation of Gynecology and Obstetrics (FIGO) vision for equitable, context-specific fertility care. FIGO supports adaptation of fertility services according to local resources while promoting access to fertility services irrespective of marital status, gender, sexual orientation or socioeconomic circumstances. Both WHO and FIGO advocate the incorporation of infertility care within national reproductive health strategies to improve access and affordability, particularly in low- and middle-resource settings. Compared with regional fertility society guidelines, the WHO recommendations prioritize scalable and affordable approaches suitable for diverse health systems. Although important gaps remain, including fertility preservation, third-party reproduction, and expanded guidance on male-factor infertility and endometriosis, this guideline provides a practical framework for clinical uptake across nations. Its greatest contribution is the reframing of infertility from a neglected and stigmatized condition to a public health priority within universal health coverage.
From the Introduction:
For too long, infertility has been treated as a predestined condition, with couples finding themselves ‘blessed’ or ‘cursed’, based on their ability to have children. This is often a private struggle relegated to the margins of global health priorities. However, WHO’s new ‘Guideline for the prevention, diagnosis and treatment of infertility’ marks a fundamental shift: infertility is now recognized as a medical condition warranting systematic investigation, prevention and evidence-based treatment. By acknowledging that one in six people globally will experience infertility, WHO frames reproductive autonomy as a fundamental human right requiring systematic support.
A defining feature of the WHO guideline is its emphasis on a pragmatic, history-driven, diagnostic approach. Rather than promoting extensive upfront testing, the guideline recommends targeted evaluation based on clinical findings, including selective use of mid-luteal progesterone to confirm ovulation, tubal assessment and structured semen analysis with repeat testing only when abnormal. This approach reinforces cost-effectiveness while maintaining diagnostic rigor.
The guideline explicitly aims to make fertility care ‘safer, fairer and more affordable’, and it includes 40 recommendations plus six good practice statements spanning prevention, diagnosis and treatment. Importantly, prevention is operationalized through specific, low-cost interventions rather than broad principles alone. The guideline recommends routine provision of fertility education, lifestyle counselling, tobacco cessation and early treatment of sexually transmitted infections, highlighting that even brief clinical interactions can meaningfully reduce infertility risk. Psychosocial support and patient values are placed at the centre of care, reinforcing shared decision-making over purely technology-driven approaches. By providing an evidence-based framework, WHO supports inclusion of fertility care in national health policies, financing plans and essential medicine lists….
SUMMARY
WHO acknowledges that future editions should incorporate refinements. As countries implement these recommendations, infertility should transition from a source of shame, social isolation and financial hardship to a recognized medical condition supported within national health systems. Ultimately, the strength of this guideline lies not only in its recommended pathways to improve treatment access, but in its reframing of infertility care as a broader public health concern requiring attention to prevention, early diagnosis and reproductive health awareness. This guideline signals that fertility care is not an optional extra but a core element of reproductive health and universal health coverage.