Understanding biological timeline to address infertility among women

TANZANIA: Infertility has become a pressing global issue, affecting both men and women while also drawing the attention of medical professionals and health practitioners actively seeking solutions.

As the desire to have children and start families remains a vital aspect of human life, many women find themselves torn between pursuing academic and career ambitions or entering motherhood early.

In previous generations, marriage and family life were sources of pride for women and their families. However, with the rise of women’s empowerment initiatives, more women are pursuing ambitious careers, striving for goals beyond traditional roles as wives and mothers. As a result, some women delay motherhood, prioritizing career development.

While this shift represents progress, it has introduced new challenges. Many women struggle to conceive later in life, particularly after the age of 35, when fertility declines significantly.

To address this issue, health experts emphasize the importance of understanding the biological timeline for childbearing. Dr. Edem Hiadzi of Ghana’s Lister Hospital and Fertility Center, speaking at a recent special training on infertility and diabetes in Dar es Salaam, underscored the need for women to monitor their egg levels to plan effectively and avoid complications.

Dr. Edem Hiadzi

Dr. Hiadzi explained that the best reproductive age for women is between 18 and 35, after which egg quality declines. He highlighted the finite nature of female eggs, contrasting this with men, who continuously produce sperm throughout their lives.

“Most women find it difficult to conceive after 35,” says Dr. Hiadzi. “Even with IVF, the process isn’t straightforward at that age. Checking egg levels allows women to plan better. It’s not about pressuring them but giving them the knowledge to make informed decisions.”

He further advised women considering advanced degrees to prioritize childbearing during their prime reproductive years.

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On this, he urged women planning to pursue a master’s degree to keep in mind that “there is a specific period for a woman to have children. Education can be pursued at any time, even after menopause, without affecting her schedule.”

“I would say for most women, the ideal age is between 18 and 35. You can go beyond that, but 18 to 35 is best when egg quality is optimal. After 35, egg quality starts declining, which is why older women often struggle to conceive,” Dr. Hiadzi said.

Infertility: A Shared Responsibility
Dr. Hiadzi also addressed the widespread misconception that infertility is solely a female issue. He emphasized that infertility cases are equally distributed: 40% are attributed to men, 40% to women, 15% to both partners, and 5% remain unexplained.

“Infertility affects both men and women. It is crucial for couples to undergo medical check-ups together when pregnancy is delayed,” he said. “A past child does not guarantee ongoing fertility. Both partners should seek answers together.”

Regarding concerns about blood groups and infertility, Dr. Hiadzi clarified that DNA does not cause infertility but may affect the fetus if partners have incompatible blood types. He noted that infertility rates in Africa are lower than in some Western countries, recalling cases where African couples, even with conflicting blood groups, have multiple children.

A World Health Organization (WHO) report corroborates Dr. Hiadzi’s statements, indicating that women are born with all the eggs they will ever have. The number of eggs declines over time, from 1–2 million at birth to fewer than 1,000 at menopause.

Egg Count at Different Life Stages (WHO Data)
Birth: 1–2 million eggs
Puberty: 300,000–400,000 eggs
Age 40: 25,000 eggs
Menopause: Less than 1,000 eggs
WHO further notes that both the quality and quantity of eggs are crucial for fertility. A woman’s chances of conceiving and having a healthy baby are higher if she has a good egg supply. However, there are no precise methods to assess egg quality apart from age.

Egg Count Tests
Dr. Hiadzi explains that a woman’s egg count can be determined using the Anti-Müllerian Hormone (AMH) test or a transvaginal ultrasound.

The AMH test measures the level of AMH in the blood, which helps estimate the number of follicles in the ovaries.
A transvaginal ultrasound allows a fertility specialist to visually count the number of follicles.
Community Perspectives on Infertility and Family Planning
Apart from expert opinions, community members also shared their views on infertility awareness and family planning.

Gerald Nalugendo, an accountant at Kibaha Health Center, stressed the importance of women being aware of menopause and planning for children before the age of 35.

“If you ask me, a woman can get as much education as she wants and pursue any ambition, but the truth is, there is a proper time for having children. Once that age passes, conceiving becomes difficult, and there may be health complications. Women should take this seriously,” Nalugendo says.

Tanzanian gospel singer Christina Francis urged the government to mandate male participation in infertility education programs.

“Men often disregard infertility education. Reaching them through their workplaces and various sectors is crucial. Education should dismantle patriarchal attitudes that leave women to bear the burden alone,” she says.

“Men must understand that family challenges affect them too, and attending tests together can provide solutions. Some men fear infertility diagnoses, thinking it will affect their self-esteem or relationships, but knowing that solutions exist can ease these fears.”

Journalist James Kamala encouraged couples to foster mutual understanding and address fertility issues together rather than casting blame.

“I believe educational programs can help couples open up and seek medical attention,” Kamala says.

Dar es Salaam resident Mr. Livingstone Gusowa highlighted the role of ignorance and outdated traditions in male disengagement from fertility issues.

“Regular medical check-ups and shared responsibility can improve outcomes,” he said.

Global Infertility Statistics
A recent WHO report found that approximately 17.5% of the adult population—about 1 in 6 people worldwide—experiences infertility. This underscores the need for greater access to affordable, high-quality fertility care globally. Infertility affects individuals regardless of socioeconomic status, and addressing it requires holistic education and medical intervention.

Defined as the inability to conceive after 12 months of regular, unprotected sex, infertility can lead to emotional distress, stigma, and financial burdens. By fostering awareness and encouraging shared responsibility between men and women, society can better navigate the complexities of infertility and promote healthier family planning practices.