Infertility impacts one in six individuals of reproductive age globally, yet it remains one of the most disregarded public health issues of our era. For years, countless individuals and couples have traversed this path in silence, bearing grief, stigma, financial burdens, and significant uncertainty about their reproductive prospects. Despite its commonality, infertility has seldom been regarded as a worldwide health priority.
This year marked a change as the World Health Organization issued its inaugural global guideline on the prevention, diagnosis, and management of infertility.
This eagerly anticipated document does more than offer clinical advice; it recontextualizes infertility as a matter of health equity, human rights, and social justice.
As a reproductive endocrinologist who has devoted over twenty years to serving a diverse community of women and families, I regard this moment not only as a scientific achievement but also as a moral imperative. Additionally, as the author of the upcoming book The Quest for Fertility, which examines fertility through biological, social, cultural, and environmental perspectives, the WHO’s global guidance feels remarkably timely and deeply affirming.
Infertility transcends being a clinical issue; it embodies a global equity challenge.
The WHO guideline recognizes the realities that clinicians have noticed for years:
– The emotional impact of infertility is akin to that of cancer or heart disease.
– Financial obstacles continue to drive individuals towards unsafe or unverified treatments.
– Cultural stigma in various regions leads to social isolation, marital tension, or even domestic violence.
– Health systems frequently lack trained practitioners, standard procedures, or equal access.
By explicitly identifying infertility as a global public health issue, the WHO conveys a strong message: Fertility care is not a luxury; it is an essential aspect of the right to health.
This is particularly significant for women in cultures where motherhood is closely linked to identity, worth, or societal acceptance. I have worked with patients who postponed seeking assistance for years due to fears of being blamed, shamed, or silenced. A global guideline validates their experiences and provides them, along with their healthcare providers, with words and affirmation.
The guideline’s strengths: equity, practicality, and evidence.
One of the guideline’s most significant advantages is its practicality. The WHO acknowledges significant disparities in resources among nations and provides tiered recommendations based on practicality and availability. For instance, it endorses the use of 2D ultrasound instead of more sophisticated imaging techniques in low-resource settings, with explicit follow-up steps to ensure diagnostic precision.
This strategy recognizes what practitioners in real-world conditions already know: Evidence-based care must also be context-sensitive.
The guideline further emphasizes:
– Progressive, systematic diagnostic pathways
– Inclusion of male-factor infertility
– Preventive measures addressing weight, diet, infections, and quitting tobacco
– Psychosocial support for individuals and couples
– Integration of fertility services with primary care and national health systems
These principles embody a broader, more compassionate view of infertility, in harmony with the comprehensive approach many of us have championed throughout our careers.
Where the guideline is lacking, and where future efforts must lead.
While thorough, the guideline is not designed to encapsulate the full depth of lived experiences. Certain aspects warrant ongoing investigation:
1. The cultural aspects of infertility. The WHO acknowledges stigma but doesn’t fully delve into how cultural norms, faith beliefs, gender roles, and family dynamics shape fertility experiences. These influences are typically the main drivers of emotional distress, particularly for women.
2. Environmental and epigenetic influences. The guideline mentions prevention but does not explore the rapid developments in understanding the exposome, including how air pollution, endocrine disruptors, microplastics, and contemporary toxins affect reproductive health. It also does not adequately address emerging studies on epigenetic imprinting and intergenerational consequences.
3. Emotional and relational distress. Algorithms can assist in diagnosis but cannot alleviate the anxiety of receiving another negative result. They cannot tackle the pressure infertility places on relationships, identities, or mental wellbeing. These are gaps that healthcare providers must continue to bridge with empathy and patient-focused care.
4. Global accessibility and financial hurdles. Recognizing inequity is merely the first step. The next phase will necessitate governments, insurers, and health systems to invest in affordable, standardized, ethically administered fertility services.
A global guideline is only as impactful as our commitment to implement it.
The WHO’s document signifies a pivotal moment, but it is merely the start. Implementation will demand investment, collaboration, and courageous dialogue. It will require healthcare providers to advocate for fertility as an integral aspect of overall health, rather than a luxury service on the fringes of medicine. It will require societies to confront stigma, and policymakers to create pathways that are affordable, accessible, and respectful.
This is where healthcare professionals, educators, and advocates (including myself) must engage.
I am more convinced than ever that the world is prepared for a richer, more profound dialogue regarding fertility: one that merges science with culture, equity with empowerment, and medicine with humanity.
The WHO has given us the framework. Now it is our collective responsibility to transform that framework into understanding, action,