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WHO 2025 Infertility Guideline — Key Takeaways
Infertility = no pregnancy after 12 months of regular unprotected intercourse.
It affects 1 in 6 people worldwide, regardless of country income level.
🔹 Why this matters
- Infertility is a health and human rights issue.
- People deserve accurate information, access to diagnosis/treatment, and support without stigma.
- WHO emphasizes cost-effective, evidence-based care that avoids unnecessary testing.
🔵 1. Prevention
- Educate the public early about fertility, age-related decline, and when to seek help.
- Lifestyle actions: quit smoking, reduce alcohol, maintain healthy weight, exercise.
- Prevent and promptly treat STIs, a major global cause of tubal disease.
🔵 2. Diagnosis
Female
- If cycles are regular → confirm ovulation with mid-luteal progesterone, not routine ultrasound.
- Assess hormones only if clinically indicated: FSH, LH, E2, PRL, TSH.
- Check tubal patency with HSG or HyCoSy.
- Evaluate the uterine cavity with SIS (preferred) or 3D ultrasound.
Male
- Semen analysis:
- Abnormal → repeat after ≥11 weeks
- Normal → no need to repeat
Unexplained Infertility
- Normal exam, normal ovulation + tubes, and normal semen → classify as unexplained.
🔵 3. Treatment
Female
- PCOS:
- First-line: Letrozole
- If unsuccessful → Gonadotropins → IVF
- Tubal disease:
- Age <35 + mild/moderate disease → Surgery first
- Severe or age ≥35 → IVF preferred
- Hydrosalpinx:
- Salpingectomy or tubal occlusion before IVF improves outcomes
Male
- Varicocele:
- Treat surgically or radiologically rather than observation
- Microsurgical repair preferred when available
Unexplained infertility
- Begin with expectant management (3–6 months)
- If unsuccessful → Stimulated IUI (S-IUI) with letrozole or clomiphene
- If unsuccessful → IVF
- Use IVF alone, not routine ICSI, unless true male factor exists
🔵 4. WHO emphasizes
- Listening to patients, addressing psychological stress, and offering support
- Using systematic, not excessive, diagnostic testing
- Choosing treatments based on effectiveness, feasibility, and cost
- Documenting treatment outcomes for continuous quality improvement
