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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

1. Begin with expectant management (3–6 months)
2. If unsuccessful → Stimulated IUI (S-IUI) with letrozole or clomiphene
3. If unsuccessful → IVF
4. 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