Understanding your fertility cycle

DAR ES SALAAM: I NFERTILITY has become a pressing global issue, affecting both men and women while 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 today navigate the challenge of balancing career ambitions with family planning.

Unlike previous generations, where marriage and family life were often prioritized, today’s women are pursuing ambitious careers and personal goals beyond traditional roles.

While this progress is a sign of empowerment, it also presents new challenges—one of which is delayed motherhood, often leading to struggles with conception.

Medical experts stress the importance of understanding the biological clock when planning for children.

Dr Edem Hiadzi of Ghana’s Lister Hospital and Fertility Centre, speaking at a recent special training on infertility and diabetes in Dar es Salaam, said that knowledge of fertility windows allows women to make informed decisions about their reproductive health.

“The best reproductive age for women is between 18 and 35, after which egg quality declines,” explains Dr Hiadzi.

He added, “It’s important to provide women with this knowledge, not as pressure but as empowerment. When women understand their reproductive health, they can make choices that align with their personal and professional aspirations.”

Unlike men, who continuously produce sperm throughout their lives, women are born with a finite number of eggs. Over time, the quantity and quality of these eggs decline.

According to a World Health Organization (WHO) report, a woman’s egg count decreases as follows: at birth 1–2 million eggs, at puberty 300,000–400,000 eggs, at age 40, at around 25,000 eggs and at menopause fewer than 1,000 eggs.

Due to this decline, conception becomes more difficult with age. Even with assisted reproductive technologies like IVF, success rates are lower in older women due to reduced egg quality.

This is why fertility specialists encourage women to monitor their reproductive health through tests such as the Anti-Müllerian Hormone (AMH) test or a transvaginal ultrasound, which can help estimate the number of eggs remaining.

As more women pursue higher education and career growth, family planning becomes an increasingly complex decision.

Dr Hiadzi advises women who plan to further their education or advance their careers to factor in their reproductive health.

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“Education and career advancement are important, but so is reproductive health,” he says.

“Women should have the right information so they can make decisions that suit their aspirations without compromising their fertility.”

It is essential to reframe the discussion around career and motherhood in a way that does not suggest one must come at the expense of the other.

With proper planning and knowledge, women can pursue both, utilizing options such as egg freezing or early family planning discussions with healthcare providers.

In Tanzania, the prevalence of infertility among women is approximately 1.2 per cent, according to the 2015/2016 Tanzania Demographic and Health Survey (TDHS).

While this percentage may seem small, infertility still has profound emotional, social, and financial impacts on affected couples.

In many Tanzanian communities, women bear the burden of infertility stigma, despite medical evidence showing that infertility is a shared issue between men and women.

Infertility awareness is gaining traction in Tanzania, but cultural norms still play a role in shaping perceptions.

Gerald Nalugendo, an accountant at Kibaha Health Center, highlights the need for better education on menopause and family planning.

“A woman can pursue any level of education and career, but it’s important to recognize that fertility has a window,” Nalugendo says.

“Delaying childbearing without planning can make conception more challenging later in life.” Journalist James Kamala also stresses the importance of fostering open conversations about fertility within families and communities.

“Instead of casting blame, couples should support each other in seeking medical guidance,” he says.

“Infertility should not be a source of stigma or shame, but rather a health issue that both men and women address together.”

A common misconception is that infertility is primarily a female issue.

However, medical statistics show that infertility cases are equally distributed: 40 per cent due to male factors, 40 per cent due to female factors, 15 per cent due to both partners and 5 per cent remain unexplained.

Dr Hiadzi stresses that both men and women should seek medical check-ups together when experiencing fertility issues.

“A past child does not guarantee ongoing fertility,” he explains.

“Many men assume that if they have fathered a child before, they will always be fertile, but this is not the case. Sperm quality can decline due to various factors such as lifestyle choices, underlying health conditions, and age.”

Despite this, male infertility remains a sensitive and often overlooked topic. Christina Francis, a Tanzanian gospel singer, advocates for government-led initiatives to increase male participation in infertility education.

“Men often disregard infertility education,” she says.

“We need targeted programs in workplaces and communities to help dismantle patriarchal attitudes that leave women carrying the burden alone.” A Dar es Salaam resident, Mr Livingstone Gusowa, agrees, emphasizing that ignorance and outdated beliefs prevent men from engaging in fertility discussions.

“Many men avoid fertility tests because they fear the results will impact their masculinity or social status,” he says.

“However, shared responsibility and medical check-ups can improve outcomes for couples.” According to the WHO, about 17.5 per cent of the adult population, approximately 1 in 6 people worldwide experiences infertility.

This underscores the need for accessible, high-quality fertility care across all socioeconomic backgrounds. In many countries, fertility treatments remain costly and out of reach for many couples.

In Tanzania, access to fertility services is improving, but awareness and affordability remain key challenges.

More specialized fertility clinics have emerged, yet many couples, particularly in rural areas, lack access to information and resources.

Expanding fertility education and services, especially in government hospitals, could bridge this gap. Beyond medical interventions, shifting societal attitudes is crucial.

In many African cultures, infertility is still seen as a woman’s issue, leading to stigma and emotional distress.

By fostering awareness and promoting shared responsibility between men and women, society can better navigate the complexities of infertility.

Encouraging early reproductive health education, expanding fertility treatment accessibility, and challenging cultural misconceptions can help create a more informed and supportive environment for those facing fertility challenges.

Infertility is a global issue that affects both men and women equally. While medical advancements provide solutions, awareness, education, and societal support are equally important.

By normalizing discussions on fertility, empowering individuals with accurate information, and ensuring accessible medical care, we can break the stigma and support individuals on their path to parenthood—whenever they choose to take that step.