Infertility affects millions, and now there’s a global roadmap to tackle it. In November 2025, the World Health Organisation (WHO) published its first ever guideline on infertility, offering comprehensive, evidence-based recommendations that cover prevention, diagnosis, and treatment. This is a landmark step in making fertility care more accessible and effective worldwide.
NOW-fertility is aligned with the WHO statement that individuals and couples have the right to decide how and when to build their own families. Healthcare professionals and policy makers should remove as many constraints as possible and assist people’s desire to realise their own reproductive goals by improving availability, accessibility and acceptability of fertility care worldwide.
Prevention by providing early information about the impact of age and advice on lifestyle and other factors.
- Healthcare professionals should always give their patients lifestyle advice to help make an informed decision about diet, alcohol intake, smoking, physical exercise and weight management.
- Healthcare professionals should counsel their patients about the sexually transmitted infections (STIs)-associated infertility risks and highlight the importance of adequate and prompt management in the presence of symptoms.
Diagnosis by promptly investigating the cause(s) of infertility in women and men.
- Both the female partner and male partner should always be investigated prior to being recommended any fertility management.
- Investigations include confirmation of ovulation by mid-luteal serum progesterone measurements in women with regular menstrual cycles, whereas this test is not recommended in women who have oligomenorrhoea and amenorrhoea.
- Assessment of the reproductive hormones including baseline (day 2-3 of the menstrual cycle) follicle stimulating hormone (FSH), luteinising hormone (LH) and oestradiol (E2) levels, as well as prolactin (PRL), testosterone (Test) and thyroid stimulating hormone (TSH).
- Evaluation of the ovarian reserve should take in to account chronological age, as being the most important predictor, and testing such as antral follicle count (AFC) and anti-Müllerian hormone (AMH) in addition to baseline FSH and E2.
- Tubal patency should be assessed using either hysterosalpingogram (HSG) or hysterosalpingo contrast sonography (HyCoSy).
- Assessment of the uterine cavity should be done with saline infusion sonohysterography (SIS), which is preferred to HSG as well as both three-dimensional (3D) and two-dimensional (2D) ultrasound.
- The semen analysis remains the standard initial test to assess male factor infertility. If one or more sperm parameters are reported as abnormal, then the analysis should be repeated after no less than 11 weeks, whereas if the sperm parameters are all normal there is no need to repeat the analysis.
Treatment by providing tailored and step-by-step therapies and approaches.
- For women with polycystic ovary syndrome (PCOS)-associated ovulatory problems letrozole is preferred to clomiphene citrate or metformin. The combination of clomiphene citrate with metformin is preferred to clomiphene citrate alone or metformin alone. The approach of ovulation induction using gonadotrophins is preferred to laparoscopic ovarian drilling (LOD).
- In vitro fertilisation (IVF) is preferred to expectant management in women with PCOS who have been unsuccessful to therapies with letrozole, clomiphene citrate with metformin or gonadotrophins.
- For women with hyperprolactinaemia-associated ovulatory problems cabergoline is preferred to bromocriptine.
- For women under the age of 35 years with mild to moderate tubal disease surgery is preferred to IVF.
- For women under the age of 35 years with severe tubal disease IVF is preferred to surgery.
- For women over the age of 35 years with any tubal disease IVF is preferred to surgery.
- For women with tubal factor infertility due to hydrosalpinx, either salpingectomy or proximal tubal occlusion must be done before IVF.
- For women with infertility and the presence of a uterine septum surgery such as hysteroscopic excision of septum should be done only if previous pregnancy loss.
- The full benefit of antioxidant supplements for men with one or more abnormal sperm parameters is still unknown.
- For men with infertility and varicocele surgical or radiological treatment is preferred to expectant management. Microscopic surgery is preferred to other surgical procedures.
- For couples with unexplained infertility, 3-6 months expectant management is preferred to unstimulated intrauterine insemination (U-IUI) or ovarian stimulation with timed intercourse.
- For couples with unexplained infertility who have been unsuccessful to expectant management, 3-6 cycles of stimulated IUI (S-IUI) with letrozole or clomiphene citrate rather than gonadotrophins should be offered.
- For couples with unexplained infertility, where S-IUI has been unsuccessful IVF rather than IVF with intracytoplasmic sperm injection (ICSI) or expectant management should be offered.
