Infertility: Disease of reproductive system affecting millions globally
Infertility: Global health issue affecting one in six people worldwide
Priya and Raj Sharma (Mumbai, India) sat silently in the doctor’s office, holding hands, bracing for the verdict. Five years of trying. Five years of failure. Five years of mounting desperation, medical tests, treatments, hope, disappointment, hope again, crushing disappointment again. Five years of whispered family gossip, pitying glances from relatives, increasingly aggressive questions from Raj’s mother about when the grandchildren would arrive.
“The tests are conclusive,” the fertility specialist said gently. “You have severe endometriosis affecting your fallopian tubes, Priya. And Raj, your sperm count is significantly below normal. You’re both contributing factors. Natural conception is extremely unlikely. Your best option is in vitro fertilization—IVF.”
“How much does IVF cost?” Raj asked, already knowing they couldn’t afford it on their modest salaries.
“About 150,000 rupees per cycle—roughly $1,800. Most couples need multiple cycles. Three to four attempts are common. Some need more. Total cost could be 400,000 to 600,000 rupees—$5,000 to $7,000. And there’s no guarantee of success.”
Priya’s heart sank. That was more than their combined annual income. Their small apartment cost everything they earned. They had no savings. No assets. No way to borrow that kind of money. The doctor might as well have quoted ten million rupees. It was equally impossible.
“We can’t afford that,” Priya whispered, tears streaming down her face. “We’ll never have a child. Never.”
But the emotional and financial devastation was only the beginning. Raj’s family blamed Priya entirely—despite medical evidence showing both partners had fertility problems. His mother demanded Raj divorce Priya and remarry someone “capable of giving grandchildren.” Extended family members ostracized Priya at gatherings, treating her as defective, worthless, a failure as a woman.
According to WHO, Infertility is a global health issue affecting millions of people of reproductive age worldwide. Available data suggests that globally one in six people experience infertility in their lifetime. Infertility is a disease of the male or female reproductive system defined by the failure to achieve a pregnancy after 12 months or more of regular unprotected sexual intercourse. Primary infertility is the inability to have any pregnancy, while secondary infertility is the inability to have a pregnancy after previously successful conception.
For more on reproductive health, see our articles on sexual health and women’s health issues at ObserverVoice.com.
Causes and Contributing Factors
Infertility may occur due to male factors, female factors, a combination of male and female factors or may be unexplained. For both women and men, however, lifestyle factors such as smoking, excessive alcohol intake and obesity have been associated with higher chances of infertility. WHO’s International Classification of Diseases provides more information on the many primary and secondary causes of infertility in both women and men.
Every human being has a right to the enjoyment of the highest attainable standard of physical and mental health. Individuals and couples have the right to decide the number, timing and spacing of their children. Addressing infertility is therefore an important part of realizing the right of individuals and couples to found a family. A wide variety of people globally may require infertility management and fertility care services. Disparities in access to fertility care services adversely affect the poor, unmarried, uneducated, unemployed and other underserved and marginalised populations.
Infertility has significant negative impacts on the lives of infertile couples. Women in particular are at greater risk of violence, divorce, social stigma, emotional stress, depression, anxiety and low self-esteem. In some settings, fear of infertility can deter women and men from using contraception if they feel socially pressured to prove their fertility at an early age because of a high social value of childbearing. Infertility can also have negative economic impact when households incur catastrophic out-of-pocket expenditure to access treatment.
April 2023 WHO reported 1 in 6 people globally affected by infertility. February 2020 WHO discussed Multiple definitions of infertility. WHO provides Infertility fact sheet with comprehensive information.
Related topics include Sexual health and Sexually transmitted infections (STIs). For more on reproductive health challenges, see our article on global reproductive health at ObserverVoice.com.
Access and Treatment Challenges
Availability, access, and quality of interventions to address infertility remain a challenge in most countries. Prevention, diagnosis and treatment of infertility are often not prioritized in national policies and are rarely covered through public health financing. A lack of necessary equipment and trained personnel, together with the high costs of treatment, are additional barriers preventing universal access to fertility care. While assisted reproduction technology (ART) has been available for over three decades, it is still largely unaffordable in many parts of the world.
The World Health Organization is committed to addressing infertility and is currently working on a programme on infertility research and fertility care. It is also developing guidelines on the prevention, diagnosis and treatment of male and female infertility, as part of global norms and standards. WHO is engaging with countries to address infertility within an enabling legal and policy environment and to support the generation of data on the burden of infertility. WHO is working with relevant stakeholders including academic centres, ministries of health, UN organizations, non-state actors and other partners to strengthen political commitment, and health system capacity related to fertility care.
WHO’s Sexual and Reproductive Health and Research including the UN cosponsored Special Research Programme in Human Reproduction (HRP) coordinates efforts. WHO provides Policy database on infertility.
Recent Guidelines and Publications
November 2025 WHO issued first global guideline on infertility providing evidence-based recommendations. November 2025 WHO published Guideline for the prevention, diagnosis and treatment of infertility providing source for countries to develop policies and protocols. November 2025 WHO published Guideline for the prevention, diagnosis and treatment of infertility: summary of recommendations presenting summary of recommendations.
April 2023 WHO published Infertility Prevalence Estimates, 1990–2021 documenting that infertility is disease of male or female reproductive system defined by failure to achieve pregnancy after 12 months or more of regular unprotected sexual intercourse. July 2021 WHO launched updated manual to ensure high quality testing of human semen in clinical and research settings. July 2021 WHO published WHO laboratory manual for the examination and processing of human semen, 6th ed. as reference document for procedures and methods.
November 2025 WHO featured Living with infertility highlighting personal stories. April 2023 WHO featured Infertility: When having a child feels out of reach documenting struggles.
WHO provides infographics showing Fertility care is part of health care, Tobacco use causes infertility, Most cases of infertility can be successfully treated, and 1 and 6 people of reproductive age experience infertility at some stage.
Hope Through Policy Change
Priya and Raj’s story changed when India began implementing WHO-supported fertility care policies in public hospitals. The Maharashtra state government launched subsidized IVF program for low-income couples, covering 70% of treatment costs. Priya and Raj qualified.
“We paid 45,000 rupees—about $550—instead of 150,000 rupees. Still significant for us, but manageable with family help and savings. The public hospital fertility clinic had WHO-trained specialists, modern equipment, quality care. We weren’t second-class patients because we were poor. We received the same treatment wealthy couples got at private clinics,” Priya explained.
“The first IVF cycle didn’t work. Neither did the second. We were devastated. But the program covered up to three cycles. The third cycle succeeded. I became pregnant. Nine months later, our daughter was born—healthy, perfect, beautiful. We named her Asha—’hope’ in Hindi—because she represents hope for millions of couples like us who thought infertility meant permanent childlessness,” Priya continued.
“But even more important than Asha’s birth was the education and counseling we received. The clinic provided information showing that infertility affects men and women equally—it’s not exclusively a ‘women’s problem.’ They counseled Raj’s family about the medical facts, the unfairness of blaming only me, the emotional damage caused by stigma. They explained that infertility is a medical condition, not a moral failure or divine punishment,” Priya noted.
“WHO’s first global guideline on infertility issued in November 2025 is transforming fertility care globally. The guidelines emphasize that infertility is a disease requiring medical treatment, that fertility care is a human right, that access must be equitable regardless of income or social status, that both partners must be evaluated and treated, and that psychological support is essential,” Priya emphasized.
“One in six people experience infertility in their lifetime—that’s hundreds of millions of people worldwide. Most cases can be successfully treated with medicines, surgical procedures, or assisted reproduction technologies like IVF. But treatment remains inaccessible and unaffordable for millions. WHO’s leadership on infertility is changing that—establishing global standards, supporting national policies, promoting public financing, training healthcare workers, generating data, fighting stigma. Every child born through WHO-supported fertility programs represents hope realized—for couples who thought parenthood impossible, and for health systems moving toward universal coverage that includes fertility care as essential healthcare, not luxury treatment for the wealthy.”
For more information, visit WHO’s infertility topic page or explore related content at ObserverVoice.com.
Frequently Asked Questions (FAQs)
Infertility is global health issue affecting millions of people of reproductive age worldwide. Available data suggests that globally one in six people experience infertility in their lifetime. Infertility is disease of male or female reproductive system defined by failure to achieve pregnancy after 12 months or more of regular unprotected sexual intercourse. Primary infertility is inability to have any pregnancy, while secondary infertility is inability to have pregnancy after previously successful conception. Infertility may occur due to male factors, female factors, combination of male and female factors or may be unexplained. For both women and men, lifestyle factors such as smoking, excessive alcohol intake and obesity have been associated with higher chances of infertility. April 2023 WHO reported 1 in 6 people globally affected by infertility. April 2023 WHO published Infertility Prevalence Estimates, 1990–2021. WHO provides Infertility fact sheet. Related: Sexual health, Sexually transmitted infections.
Infertility has significant negative impacts on lives of infertile couples. Women in particular are at greater risk of violence, divorce, social stigma, emotional stress, depression, anxiety and low self-esteem. In some settings, fear of infertility can deter women and men from using contraception if they feel socially pressured to prove their fertility at early age because of high social value of childbearing. Infertility can also have negative economic impact when households incur catastrophic out-of-pocket expenditure to access treatment. Every human being has right to enjoyment of highest attainable standard of physical and mental health. Individuals and couples have right to decide number, timing and spacing of their children. Addressing infertility is therefore important part of realizing right of individuals and couples to found family. Wide variety of people globally may require infertility management and fertility care services. Disparities in access to fertility care services adversely affect poor, unmarried, uneducated, unemployed and other underserved and marginalised populations. November 2025 WHO featured Living with infertility. April 2023 WHO featured Infertility: When having a child feels out of reach. Related: Sexual health.
Availability, access, and quality of interventions to address infertility remain challenge in most countries. Prevention, diagnosis and treatment of infertility are often not prioritized in national policies and are rarely covered through public health financing. Lack of necessary equipment and trained personnel, together with high costs of treatment, are additional barriers preventing universal access to fertility care. While assisted reproduction technology (ART) has been available for over three decades, it is still largely unaffordable in many parts of world. World Health Organization is committed to addressing infertility and is currently working on programme on infertility research and fertility care. WHO is developing guidelines on prevention, diagnosis and treatment of male and female infertility, as part of global norms and standards. WHO is engaging with countries to address infertility within enabling legal and policy environment and to support generation of data on burden of infertility. WHO is working with relevant stakeholders to strengthen political commitment, and health system capacity related to fertility care. WHO’s Sexual and Reproductive Health and Research coordinates efforts. WHO provides Policy database. Related: Sexually transmitted infections.
November 2025 WHO issued first global guideline on infertility providing evidence-based recommendations for prevention, diagnosis and treatment. November 2025 WHO published Guideline for the prevention, diagnosis and treatment of infertility providing source for countries to develop policies and protocols for managing infertility. November 2025 WHO published Guideline summary of recommendations. April 2023 WHO published Infertility Prevalence Estimates, 1990–2021 documenting global burden. July 2021 WHO launched updated manual for high quality testing of human semen. July 2021 WHO published WHO laboratory manual for examination and processing of human semen, 6th ed.. February 2020 WHO discussed Multiple definitions of infertility. WHO provides infographics showing Fertility care is part of health care and Most cases can be successfully treated. Related: Sexual health.
For both women and men, lifestyle factors such as smoking, excessive alcohol intake and obesity have been associated with higher chances of infertility. Infertility may occur due to male factors, female factors, combination of male and female factors or may be unexplained. WHO’s International Classification of Diseases provides more information on many primary and secondary causes of infertility in both women and men. WHO provides infographic showing Tobacco use causes infertility noting that nicotine damages genetic material in eggs and sperm. WHO provides infographic 1 and 6 people of reproductive age experience infertility at some stage. November 2025 WHO published Guideline for prevention, diagnosis and treatment of infertility addressing preventable causes. April 2023 WHO reported 1 in 6 people globally affected by infertility. July 2021 WHO published WHO laboratory manual for examination of human semen, 6th ed. for male infertility assessment. WHO’s Sexual and Reproductive Health and Research team coordinates efforts. WHO provides Infertility fact sheet. Related: Sexual health, Sexually transmitted infections.
- WHO Infertility Topic Page
- WHO Guideline for Prevention, Diagnosis and Treatment of Infertility
- WHO Infertility Prevalence Estimates
- WHO Sexual and Reproductive Health and Research Team
- WHO Infertility Policy Database
Disclaimer: This article is an adaptation of publicly available information from WHO’s Infertility
health topic page (WHO, Geneva. Licence: CC BYNC-SA 3.0 IGO). WHO is not responsible for the
content or accuracy of this adaptation. This content is for informational and educational purposes
only and does not constitute medical advice. ObserverVoice.com is a news and information platform
— not a healthcare provider.
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