Infertility affects approximately one in six people globally, making it a major public health issue rather than a niche medical concern. In 2025, the World Health Organization (WHO) published its first comprehensive guideline on the prevention, diagnosis, and treatment of infertility, marking a pivotal moment in reproductive medicine.
This guideline consolidates global evidence, clinical expertise, and patient-centred values into a single framework intended to guide clinicians, health systems, and policymakers worldwide. Below, we translate the scientific core of this guideline into clear, clinically relevant insights.
Infertility as a Global Health Priority
The WHO formally recognizes infertility as a disease of the reproductive system, defined as the failure to achieve pregnancy after 12 months of regular, unprotected intercourse. Importantly, prevalence rates are similar across high-, middle-, and low-income countries, highlighting infertility as a universal challenge rather than a condition limited to specific regions or lifestyles.
The guideline reinforces reproductive autonomy as a fundamental right: individuals and couples should be supported in deciding if, when, and how they wish to have children.
A Shift Toward Prevention: The Role of Information and Lifestyle
For the first time, WHO places prevention alongside diagnosis and treatment as a formal pillar of infertility care.
Information as Prevention
WHO recommends that people of reproductive age receive timely, accessible information about:
- Fertility and age-related fertility decline
- Risk factors for infertility
- When to seek medical advice
Low-cost strategies—such as digital resources, primary care encounters, or reproductive health visits—are emphasized to ensure equity and broad access.
Lifestyle Modifications
The guideline explicitly acknowledges lifestyle as a modifiable risk factor for infertility. For individuals and couples with infertility, WHO suggests providing lifestyle advice before and during treatment, including:
- Nutritional quality of diet
- Physical activity
- Weight management
- Alcohol consumption
- Smoking cessation
Although the certainty of evidence is rated as low, lifestyle guidance is positioned as foundational care, not optional advice. In clinical practice, lifestyle assessment is considered part of standard infertility evaluation.
Diagnosis: A Rational, Evidence-Based Approach
The guideline promotes a systematic, cost-effective diagnostic pathway, avoiding unnecessary testing while ensuring clinically meaningful evaluation.
Female-Factor Infertility
Key diagnostic principles include:
- Presumptive confirmation of ovulation using mid-luteal progesterone rather than routine ultrasound
- Tubal patency assessment with HSG or HyCoSy
- Structured evaluation of uterine cavity abnormalities using ultrasound-based methods
Importantly, age is emphasized as the most powerful predictor of ovarian reserve. Ovarian reserve testing should support—rather than replace—age-based clinical judgment.
Male-Factor Infertility
WHO reinforces:
- Standardized semen analysis following WHO laboratory criteria
- Repeat semen testing only when parameters are abnormal
This approach avoids over-testing while maintaining diagnostic accuracy.
Unexplained Infertility
Unexplained infertility is defined only after thorough evaluation of both partners, including confirmed ovulation, patent tubes, and normal semen parameters.
Treatment: Stepwise, Proportionate, Patient-Centered
Treatment recommendations are largely conditional, reflecting the reality that evidence quality varies and that patient values must guide decision-making.
PCOS and Ovulatory Dysfunction
For infertility related to PCOS:
- Letrozole is recommended as first-line ovulation induction
- Lifestyle interventions (diet, physical activity, weight management) are considered good clinical practice
- IVF is reserved for cases where less invasive treatments fail
Lifestyle modification is embedded as the starting point, not an adjunct.
Tubal and Uterine Factors
- Surgery may be considered in younger women with mild tubal disease
- IVF is preferred for severe tubal disease or advanced maternal age
- Routine septum resection is not recommended in the absence of recurrent pregnancy loss
Male-Factor Infertility
- Varicocele repair may be beneficial in selected cases
- Notably, WHO does not recommend for or against antioxidant supplementation in men, citing insufficient evidence
Unexplained Infertility
Management follows a graduated model:
- Expectant management (including lifestyle advice and cycle awareness)
- Stimulated intrauterine insemination (IUI)
- IVF, without routine use of ICSI unless indicated
Why This Guideline Matters
This WHO guideline is not designed to replace national or specialty-specific recommendations. Instead, it provides a global, equity-oriented framework that:
- Normalizes infertility as part of universal health care
- Emphasizes proportional, evidence-based interventions
- Integrates prevention, lifestyle, and clinical treatment into a single continuum
Perhaps most importantly, it reframes infertility care as both biological and contextual, shaped by age, health, behavior, access to care, and informed decision-making.
Expert Perspective: Why Lifestyle Modifications Matter More Than Ever
As an IVF specialist actively working at the forefront of reproductive medicine—and as CEO of a company deeply involved in fertility and pregnancy care—I believe the WHO guideline sends a message that is subtle, but profoundly important: advanced technology does not replace human biology; it must work in harmony with it.
We are entering an era where artificial intelligence, automation, and increasingly sophisticated IVF technologies shape clinical decision-making. These tools are invaluable. They improve embryo selection, optimize laboratory conditions, and refine treatment protocols.
Yet even the most advanced algorithm ultimately depends on the biological quality of the gametes, the metabolic and inflammatory state of the body, and the endocrine environment in which implantation occurs.
This is where lifestyle modifications become not merely supportive, but strategic.
Lifestyle as a Biological Modulator
Lifestyle interventions influence fertility through well-established biological pathways:
- Regulation of insulin sensitivity and androgen levels, particularly critical in PCOS
- Reduction of systemic and reproductive inflammation
- Optimization of mitochondrial function and cellular energy metabolism
- Improvement of hormonal signaling across the hypothalamic–pituitary–ovarian axis
In conditions such as PCOS, lifestyle modification is not an optional add-on. It directly affects ovulatory function, oocyte competence, and treatment responsiveness. This is precisely why the WHO guideline embeds lifestyle interventions as good clinical practice in PCOS-related infertility—before escalation to pharmacological or assisted reproductive techniques.
Technology Works Best on a Prepared Biology
In daily clinical practice, we increasingly observe that patients who engage in meaningful lifestyle changes—nutritional quality, metabolic regulation, physical activity, sleep, and reduction of harmful exposures—often demonstrate:
- More predictable responses to ovarian stimulation
- Improved endocrine balance
- Greater resilience during fertility treatment
AI-driven IVF tools can optimize decisions, but they cannot compensate for chronic metabolic dysregulation, persistent inflammation, or unmanaged lifestyle-related risk factors. Technology amplifies biology; it does not override it.
A Modern, Integrated View of Fertility Care
Encouraging lifestyle modification is not about shifting responsibility onto patients, nor about delaying access to treatment.
It is about respecting the biology we are working with and using every evidence-informed lever available to improve outcomes.
The WHO guideline does not exaggerate lifestyle. It places it exactly where it belongs: at the foundation of fertility care, alongside accurate diagnosis and proportionate treatment. In a world moving rapidly toward high-tech reproductive medicine, this reminder is not regressive—it is essential.
A Final Thought
The message of the WHO guideline is clear: infertility care should be scientific, humane, and individualized. Prevention and lifestyle are not oversold—but they are no longer ignored. Diagnosis should be precise, not excessive. Treatment should escalate thoughtfully, respecting both evidence and the lived experience of patients.
This marks a new era in reproductive medicine—one where fertility care is recognized not as a luxury, but as an essential component of health across the life course.
“This article discusses and interprets key concepts from the 2025 World Health Organization (WHO) guideline on infertility, combined with expert clinical perspective.”
