One in six people of reproductive age will be affected by infertility, yet health services to address this are “severely limited” and largely funded out-of-pocket, according to the first ever global guideline  on the issue by the World Health Organization (WHO).

“In some settings, even a single round of in vitro fertilization (IVF) can cost double the average annual household income,” WHO notes.

“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. “

Tedros encouraged countries to adopt the guideline, giving “more people the possibility to access affordable, respectful, and science-based care”.

Basic prevention

The guideline includes 40 recommendations, starting with “basic prevention first” then advancing to more expensive options, scientist Dr Gitau Mburu, first author of the report, told a media briefing.

The starting point is basic education sessions at the primary health care level about issues that can affect fertility, including age, untreated sexually transmitted infections, alcohol and tobacco consumption.

“Informing people about fertility and infertility early can assist them in making reproductive plans,” the WHO notes in a media release.

Much of the guideline outlines the clinical pathways to diagnose and treat common biological causes of male and female infertility. 

“It provides guidance about how to progressively advance treatment options from simpler management strategies – where clinicians first provide advice on fertile periods and fertility promotion without active treatment – to more complex treatment courses such as intrauterine insemination or IVF,” according to the WHO media release.

The guidance also recognises that infertility can lead to depression, anxiety and social isolation, recommending ongoing psychosocial support for all those affected.

The report is based on information from 95 countries, only half of which have policies on infertility, Mburu said.

The recommendations address male and female infertility, Mburu said, adding that men are responsible for 45.1% of infertility. 

However, in many cultures, women are blamed if they don’t fall pregnant – and 36% of women with infertility face intimate partner violence. 

“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.”

She stressed that people delaying having children should not be equated with infertility, which the WHO defines as the “failure to achieve pregnancy” after 12 months or more of regular, unprotected sex.