November 2025 marked a significant milestone in reproductive medicine. The World Health Organization (WHO) published its very first infertility guideline, setting a new global standard for prevention, diagnosis, and treatment.
But what does this mean for you and your fertility journey?
Prevention: Steps to Take Early
Your fertility can be influenced by age, so understanding how timing affects your chances of conceiving is important. Taking proactive steps early can make a real difference. Here’s how you can support your reproductive health:
- Eat well: A balanced, nutrient-rich diet lays the foundation for fertility.
- Limit alcohol and avoid smoking: Both can negatively affect your reproductive health.
- Stay active and maintain a healthy weight: Regular exercise and a healthy body weight can boost your fertility.
Sexually transmitted infections (STIs) can also impact fertility, particularly by affecting the fallopian tubes. Prompt diagnosis and treatment are important in protecting long-term reproductive health.
Diagnosis
If pregnancy has not occurred after an appropriate period of trying (12 months if under 35, 6 months if 35 or older), both partners should be fully assessed before starting any fertility treatment.
Female Partner Evaluation
Ovulation Assessment
If you have regular menstrual cycles, ovulation may be confirmed with a mid-luteal progesterone blood test. If your cycles are irregular (infrequent or absent), alternative hormonal evaluation is needed.
Hormonal Testing
Other tests to assess your reproductive hormones should include::
- Follicle Stimulating Hormone (FSH)
- Luteinising Hormone (LH)
- Oestradiol (E2)
- Prolactin (PRL)
- Testosterone
- Thyroid Stimulating Hormone (TSH)
These tests help identify ovulatory disorders, thyroid dysfunction, hyperprolactinemia, and features of PCOS.
Ovarian Reserve Assessment
Your ovarian reserve (the quantity of remaining eggs) which is strongly influenced by age should also be assessed. Tests for this should include:
- Antral follicle count (AFC) via ultrasound
- Anti-müllerian hormone (AMH) blood testing
Tubal Assessment
To check whether your fallopian tubes are open, you may undergo:
- Hysterosalpingogram (HSG)
- Hysterosalpingo-contrast sonography (HyCoSy)
Uterine Evaluation
To assess your uterine cavity you may undergo:
- Saline infusion sonohysterography (SIS)
- 2D or 3D ultrasound imaging
Male Partner Evaluation
A semen analysis should be the first and standard test to assess sperm health.
If any sperm parameters are abnormal, the test should be repeated after at least 11 weeks. If all results are normal, repeating the test is usually unnecessary.
Treatment
For women with Polycystic Ovary Syndrome (PCOS):
- Letrozole is recommended as first-line therapy for ovulation induction.
- Clomiphene with or without metformin may be used when appropriate.
- Hormonal ovulation induction is preferred over surgical ovarian drilling.
- IVF is considered if ovulation induction treatments are unsuccessful.
For other ovulation disorders:
- Elevated prolactin levels are typically treated with cabergoline, which often restores ovulation.
For tubal problems:
- Surgery may help if you’re under 35 with mild tubal disease.
- IVF is preferred for severe problems or if you’re over 35.
- Blocked tubes filled with fluid should be treated before IVF.
For uterine abnormalities:
- Surgery is only recommended if you’ve had a pregnancy loss.
For men:
- Varicoceles (enlarged veins) are usually treated with surgery.
- The benefits of antioxidants aren’t as yet proven.
If infertility is unexplained:
- Try naturally for 3–6 months first.
- If needed, 3–6 cycles of IUI with medications like letrozole may be offered.
- IVF is recommended if IUI doesn’t work.
NOW-fertility has also explored the recommendations from the clinician’s perspective here.
