Male Infertility in the 2025 WHO Infertility Guideline: A Comparative Analysis With AUA/ASRM, EAU, ESHRE, and NICE...

The recently published World Health Organization (WHO) infertility guideline introduces a global approach to infertility care with significant implications for male reproductive health. This review examines the male infertility components of the WHO guideline and compares them with those from the American Urological Association/American Society for Reproductive Medicine (AUA/ASRM), European Association of Urology (EAU), European Society of Human Reproduction and Embryology (ESHRE) and National Institute for Health and Care Excellence (NICE). The WHO guideline adopts a public health perspective, emphasizing infertility prevention, standardized diagnostic algorithms, and the central role of semen analysis, while prioritizing feasibility across diverse healthcare settings. In contrast, AUA/ASRM and EAU guidelines offer comprehensive, specialist-oriented recommendations, including endocrine evaluation, genetic testing, and a wide range of therapeutic interventions, whereas ESHRE and NICE follow a couple-centered approach with limited focus on male-specific pathways. The WHO guideline provides a more selective approach to management, with a neutral stance on antioxidant therapy and specific recommendations for varicocele, highlighting it as a key, potentially treatable condition. Across guidelines, there is broad consensus on core diagnostic principles, but differences remain in scope, depth, and implementation strategies. These variations reflect not only differences in target populations and healthcare contexts but also notable gaps in the evidence base. Strengthening evidence for commonly used interventions, including antioxidants, hormonal therapies, and advanced diagnostics, and promoting greater harmonization across guidelines are essential to advancing male infertility care.