Fertility levels decline, but technology gives hope

Social factors lead to SA having lowest number of children per woman in region

It could be that the dystopian predictions movie directors have fed us for years may become a reality.

Not where the entire world is covered in ice or where human beings hunt each other for sport — rather that we’ll exist in a world where fewer children are born, with fewer women choosing to give birth.

That reality may not be too far-fetched as, according to recent research findings that is, fertility levels in the country are on a steady decline.

One research report — titled Patterns of fertility in contemporary SA: Prevalence and associated factors published by scholarly research group Informa in 2020 — cited a United Nations population division study which revealed that between 1990 and 2019 the global fertility level fell from 3.2 to an average of 2.5 children per woman.

In Sub-saharan Africa, SA was found to have the lowest fertility rates in the region, with an average national fertility rate of 2.4 children per woman.

The study explained the determinants of this fertility decline among South African women of child bearing age are delayed marriage and consequent delayed first birth, an extended interval between subsequent births and the use of modern contraceptive methods.

But the trend is not new. Back in 2007, SA’S statutory research agency, the Human Sciences Research Council, published a report titled Fertility and Childbearing in SA which had similar findings.

In this study, abortion, late age marriage, high divorce rate, high rate of single parenthood and high contraceptive use were found to be the main determinants of low fertility.

Then there is infertility, the medical inability to conceive babies.

The World Health Organisation (WHO) said infertility is a global health issue estimated to affect as many as 48m couples, or 186m individuals, globally.

Infertility has been an enemy couples faced privately, and silently, for centuries.

But thanks to the information sharing age in which we live, it’s become commonplace to see blogs, vlogs and social media posts detailing infertility struggles.

It does beg the question; could infertility be worsening?

East London based gynaecologist Dr Robyn Spring said the numbers of those seeking help for infertility have remained stable over the years.

“But because of the de-stigmatisation of infertility, and the accessibility of investigations and treatments, one hears about it more frequently.”

According to Spring, infertility is a unique medical condition because it involves a couple, rather than a single individual.

She defined the condition as a couple’s inability to conceive after 12 months of regular intercourse without the use of contraception in women under 35 years of age; and after six months of regular intercourse without contraception use in women 35 years and older.

The WHO said infertility could be due to male factors, female factors, a combination of male and female factors or remain unexplained.

Spring unpacked the causes, and prevalence, of infertility in both genders as:

Male factors such as hypogonadism, post-testicular defects or seminiferous tubule dysfunction accounted for 26% of infertility; Ovulatory dysfunction 21%; Tubal damage 14%; Endometriosis 6%; Coital problems 6%; Cervical factors 3%; and Unexplained reasons 28%.

She said treatment might involve drug therapy, surgery and procedures such as intrauterine inseminations or in vitro fertilisation, depending on the cause.

“Once the cause of infertility is identified, therapy aimed at correcting reversible aetiologies and overcoming irreversible factors can be implemented,” Spring explained.

For intrauterine inseminations, a doctor uses a tube to place sperm directly inside the woman’s uterus right before ovulation.

An IVF procedure involves taking eggs from a woman’s uterus which are fertilised with her partner’s sperm.

The fertilised egg is then placed in the woman’s uterus with the hope that it will grow into a pregnancy.

The biggest drawback with IVF is the hefty price tag.

Depending on the types of investigations and treatment done, and the amount of medication required, IVF could easily cost between R50,000 to R150,000.

Most medical aids do not cover this procedure, while some pay part of the costs.

Spring added: “The couple is also counselled on lifestyle modifications to improve fertility, such as stopping smoking, reducing excessive caffeine and alcohol consumption, and appropriate timing and frequency of coitus.”

There are many old wives’ tales advising on how to boost a woman’s chances of falling pregnant: “Quaff gallons of cough syrup each day” or “pierce your left nostril as this is said to be linked to the female reproductive organs; or, perhaps worst of all, “try a sip of baboon’s urine”.

Professor Salome Kruger, a registered dietitian and pharmacist at the Centre of Excellence for Nutrition at North West University, rubbishes these myths, saying the many beliefs people have about supplements and fertility boosting food are backed by limited or no scientific proof.

Rather, ensuring general health and taking measures to live a healthy lifestyle, are key.

Curbing high alcohol intake and smoking is essential as these are risk factors for the condition called endometriosis, a possible cause of infertility.

Kruger said many studies have been done on this topic and there is clear evidence that compared to non-drinkers, even low alcohol intake among women was linked to lower fertility.

Obesity in both men and women, as well as underweight women, is another issue couples should address before trying to get pregnant, should there be a need. “With higher alcohol intake the possibility to fall pregnant decreases further.

“A possible explanation for these findings may be that alcohol has an effect on hormone levels necessary for ovulation, ripening of the ovum and implantation in the uterus,” she explained.

“Couples should ensure they stick to a well-balanced diet with a combination of meat, dairy, fruit, vegetables, wholegrains and healthy oils.

“Getting enough sleep, learning to cope with stress and getting enough physical activity are also essential. Unfortunately, there is no magic bullet.”

Egg donation is another route eager, prospective parents could try, with several reputable South African agencies to choose from.

Once such company gives women a modicum of control of the entire process, such as being able to select their preferred donor from a donor list.

Strict measures are taken to protect the identity of both the donor and the recipient, with no identifying information made available to the public. No adult photos of the donor are used.

Once chosen, the donor is put through medical and psychological assessments and once the team of doctors gives the thumbs up, the woman and her donor start their treatment plan simultaneously to sync both their cycles.

Again, this option is not cheap, with basic costs starting at R20,000. The ultimate price tag is determined by the necessary treatment, number of doctor’s visits, possible travel and accommodation costs.

If all else fails, eager parentsto-be can look at adoption. According to the National Adoption Coalition of SA (NACSA) website, adoption is the permanent placement of a child with parents other than the child’s biological mother or father.

Just who can adopt? NACSA says adoption is open to married couples, a widower or widow and a divorced or single person.

A child can also be adopted by the spouse of the biological parent, the biological father of a child born out of wedlock as well as the foster parents of the child.

“In SA, the only way in which you can legally adopt a child is by working through an accredited adoption agency, or with the assistance of an adoption social worker functioning within the statutory accredited adoption system,” their website reads.

“All prospective adoptive parents are required to undergo a screening and preparation process.

“The screening process basically allows social workers to get to know prospective adopters as a family, their motivation to adopt and their ability to offer a child a warm, loving and stable home.”

We may still not be flying to work in hovering cars or have invisible cellphones attached to our ears.

And despite the grey, sombre futures movies have sold us for years; they do at least have one thing right.

Medical technology is at its most advanced; and that alone gives the human race a fighting chance to thrive.

But because of the de-stigmatisation of infertility, and the accessibility of investigations and treatments, one hears about it more frequently