World Health Organization has estimated that 186 million women in developing countries suffer from infertility, i.e, they were not able to conceive after trying for five years. The figure translates to the fact that one in every couple has an unfulfilled desire to have a child.

Infertility is a disease of the reproductive tract or impairment of reproductive functions. Infertility has been labelled as a rich man’s disease and access to proper infertility care is limited to a small section of the society. Therefore, infertility treatment is often available only in private medical practices. Poor infertility practices and reproductive medicine pose severe risks to the safety of the woman and the unborn child.

Infertile women are stigmatized and face the wrath of their immediate family. They can be abandoned by their husbands and can become victims of violence and even run the risk of being completely ostracized from society.

Contraceptives are sometimes wrongly used and can lead to a state of infertility. Improving mental health and avoiding alcohol can also improve fertility. The stigma behind infertility has to be removed by educating couples on the causes and solutions for infertility.

Health problems	Issues to maternal health	Issues to infant health
Overweight and obesity, maternal underweight	Difficulty becoming pregnant or maintaining pregnancy; complications during pregnancy/ delivery; polycystic ovarian syndrome.	Preterm birth, stillbirth.
Lack of HIV/STI screening and interventions before/after diagnosis and attempting infertility interventions	Pelvic inflammatory disease, tubal adhesions and tubal blockage (resulting in infertility); horizontal transmission of HIV/STIs.	Congenital disease linked to STIs, vertical transmission of HIV/STIs.
Lack of interventions to address embryo implantation, inadequate development of the endometrium, and assessment (including maternal ageing (>40-45 years of age)	Repetitive miscarriage, repetitive spontaneous abortion, preterm delivery.	Spontaneous abortion, stillbirth, birth defects (due to ageing of gametes).
Unsafe practices, Lack of (or lack of adherence to) guidelines on fertility interventions (e.g. modified ovarian stimulation)	Ovarian hyperstimulation syndrome, multiple births.	Preterm birth, stillbirth.
Unsafe practices, Lack of (or lack of adherence to) guidelines on fertility interventions (e.g. multiple embryo transfer)	Multiple births.	Preterm birth, stillbirth.
High stigmatization associated with infertility	Depression, suicidal tendencies, violence.	Preterm birth, stillbirth.

Health problems	Preventive interventions
Consequences of misunderstanding contraceptives by the woman, her family and the community (thus decreased uptake of contraceptive use)	Anticipatory guidance from health care providers to create awareness and understanding of fertility and infertility (e.g. the temporary state of subfertility/ infertility during contraceptive use and following discontinuation of long-acting contraceptives).
Consequences of misunderstanding biological causes of infertility/ subfertility (e.g. mental health disorders, depression, broader chronic diseases)	Anticipatory guidance from health care providers to improve understanding of preventable and unpreventable causes of infertility/subfertility; guidance on actions that individuals and couples could take to address preventable causes of infertility/subfertility (improving nutrition, improving mental health, immunization, avoiding alcohol abuse); counselling for individuals/couples diagnosed with unpreventable causes of infertility/sub-fertility.
Consequences of unprotected sex to achieve pregnancy, especially in populations at high risk of HIV/STIs	Screening and diagnosis of couples following 6–12 months and following 12 months of attempting pregnancy, using an algorithm involving minimal intervention at the primary level; screening diagnosis and management at the tertiary level; diagnosis and management of underlying causes of infertility/sub-fertility, including past STI/ RTI; need for specific guidance directed towards populations at high risk.
Consequences of misunderstanding social causes of infertility/subfertility	Defusing stigmatization of infertility and assumption of fate by introducing evidence-based educational tools to understand causes and care solutions of infertility; expand beyond misunderstanding that prevention will solve most underlying diseases/disabilities and infertility; introduce tools for national-level discussions to address ethics and legal/social implications of introducing infertility diagnosis/care; advocacy targeting communities, civil society, governments, policymakers and funding agencies.