Infertility is a major reproductive health problem with a lot of different factors. One in 6 couples in South Africa is diagnosed with infertility.
What is worrisome is that the number keeps rising, and doctors are uncovering more causes of infertility among men and women of child-bearing age.
Parent24 spoke to a fertility specialist and consulted studies that look at the different causes of infertility to unpack some of the leading causes of infertility in South Africa.
The same research found that in Sub-Saharan Africa, the region with the highest fertility levels, went from 6.3 births per woman in 1990 to 4.6 in 2019.
Why is this? One study on fertility and childbearing in South Africa put forward certain factors that impact fertility negatively, and revealed how factors such as education, residence, and work status can harm fertility, especially for women.
This study claims that as the education levels increase in young adults, marriage tends to be postponed, which hurts fertility and counters the initial effect of fertility increases.
It is argued that educated women desire relatively fewer children. They also have a high contraceptive prevalence and a high chance of working away from their homes.
When it comes to residence and fertility, the study notes that fertility is higher for women whose childhood residence up to 12 was in rural areas, compared to those who grew up in urban areas.
This implies that rural fertility in every African country is higher than urban fertility.
The study also finds that working women experience lower fertility than their counterparts who are not working, reporting that "working women, especially those engaged in non-domestic enterprises, have a conflict between work and reproduction."
"They find the care of children more difficult than those women who are not working and hence tend to have fewer children than the latter group."
Parent24 spoke to Dr Skye de Jongh, a reproductive medicine assistant at Vitalab Centre for Assisted Conception, about the leading factors for infertility in men and women, based on her experience in the medical field.
She told us that age is one of the most common causes of infertility in women. Women of "advanced age", or over 35 years old, often struggle to conceive.
Other factors include blocked fallopian tubes, fibroids, polycystic ovaries (PCOS) and endometriosis.
Dr de Jongh says that male infertility is responsible for about 35% of infertility.
For men, infertility is often caused by an obstruction due to infection, previous testicular trauma, and medical illnesses affecting sperm production.
She also unpacked how age affects men and women differently when it comes to fertility.
She says for women advanced age is associated with decreased egg reserve and quality and therefore lower conception rates and increased miscarriage rates.
When it comes to men, "sperm quality starts to deteriorate after the age of 50, but continues to be produced until the day they die", he explains.
This article is one of a series on Infertility in South Africa. Find the complete series here.
Over the years, we have seen a decline in fertility in Sub-Saharan Africa. Dr de Jongh explains that one of the causes of this decline in fertility includes changes in our society.
"For example," She says, "Women are now working just like men and are choosing to defer pregnancy until their mid-30s."
"Many of us lead relatively sedentary lifestyles, and this has resulted in the levels of obesity increasing and thereby, the incidence of infertility," she added.
Dr de Jongh explains that obesity affects women by causing irregular menstruation and anovulation - an absence of ovulation due to hormonal imbalance - and increases miscarriage rates and diabetes in pregnancy.
Whereas for men, She says obesity is associated with heart disease and erectile dysfunction - which happens when a men can't get or keep an erection firm enough for sexual intercourse. There is also an increased chance of passing on the risk of obesity to their offspring.
Find the complete series here: Infertility in South Africa
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