Male and female factors associated with infertility among couples attending an assisted reproductive technologies clinic in Harare, Zimbabwe

Tinovimba Mhlanga, Mugove Madziyire, Sydney Farayi, Tinei Makurumure, Tasariraushe B. Chizhande, Yolanda WC. Marufu, Collins Timire

Abstract

Characterising causes of infertility is crucial to inform interventions that maximise chances of conception. In this descriptive cross-sectional study, we analysed records of 276 couples who visited an ART centre in Harare to determine the proportions of male and female factor infertility. We summarised categorical variables using percentages and determined associations between male and/or female causes of infertility and exploratory variables using the chi-square test. Around 67% of men had abnormal spermiograms; the commonest were oligoasthenozoospermia (28%) and teratozoospermia (24%). Around 65% of women had female factor infertility. The odds of female infertility were higher among women who reported irregular menstrual cycles (OR=2.26, 95% CI: 1.14-4.47). Overall, 111/267 (42%) of couples had both female and male factor infertility. We observed high proportions of male and female factor infertility. Timely access to fertility assessments is likely to maximise ART and pregnancy outcomes. This will require policy interventions to remove financial barriers to accessing ART services.

Full Text:

PDF

References

.World Health Organisation. Infertility. https://www.who.int/news-room/fact-sheets/detail/infertility.

World Health Organisation. 1 in 6 people globally affected by infertility. https://www.who.int/news/item/04-04-2023-1-in-6-people-globally-affected-by-infertility (2023).

Abebe, M. S., Afework, M. & Abaynew, Y. Primary and secondary infertility in Africa: systematic review with meta-analysis. Fertil. Res. Pract. 6, 1–11 (2020).

AlShamlan, N. A. et al. Primary versus secondary infertility: Epidemiology and characteristics from a referral

hospital in Saudi Arabia. SAGE Open Med. 13, 1–9 (2025).

Gedef, G. M., Taye, E. B., Mohammed, O. Y. & Abegaz, M. Y. Prevalence of infertility and its risk factors in Sub-Saharan Africa : a systematic review and meta-analysis. Contracept. Reprod. Med. 10, 1–12 (2025).

Bakkensen, J. B. et al. Childbearing , Infertility , and Career Trajectories Among Women in Medicine. JAMA Netw. Open 6, 1–14 (2023).

Sande, N. & Takawira-Mtwaya, T. Assisted Reproductive Technologies, Infertility and Women in Zimbabwe. in Religion, Women’s Health Rights, and Sustainable Development in Zimbabwe (eds. Chirongoma, S., Manyonganise, M. & Chitando, E.) 33–50 (Palgrave Macmillan, 2022).

Dube, S. Battling with Failed Procreativity: Involuntarily Childless Patients’ Experiences in Bulawayo Public Hospitals, Zimbabwe. J. Humanit. Soc. Sci. Stud. 1, 136–150 (2019).

Mabweazara, G. M., Hammarberg, K. & Mhazo, P. When assisted reproductive technology (ART) opens the door for inclusivity in a highly charged cultural milieu: an exploration of news articles on the establishment of ART clinics in Zimbabwe. Cult. Health Sex. 27, 947–962 (2025).

Moyo, S. & Muhwati, I. Socio-cultural perspectives on causes and intervention strategies of male infertility: a case study of Mhondoro-Ngezi, Zimbabwe. Afr. J. Reprod. Health 17, 89–101 (2013).

Moyo, S. Indigenous knowledge systems and attitudes towards male infertility in Mhondoro-Ngezi, Zimbabwe. Cult. Health Sex. 15, 667–79 (2013).

Folkvord, S., Odegaard, O. A. & Sundby, J. Male infertility in Zimbabwe. Patient Educ. Couns. 59, 239–43 (2005).

Mashaah, T., Gomo, E., Maradzika, J. C., Madziyire, M. G. & January, J. Psychological, sociocultural, and coping experiences of women with infertility using traditional healthcare services in Harare urban, Zimbabwe: A qualitative study. Afr. J. Reprod. Health 28, 25–38 (2024).

Chingombe, A., Evans, M. & Nenji, S. Perception and Management of Human Fertility: A Shona Landscape. Int. J. Manag. Sustain. 1, 1–12 (2012).

Mabweazara, G. Hope and Heartache: Unpacking the invisible struggles of involuntary childlessness and Assisted Reproductive health Technology (ART) use in Zimbabwe and New Zealand. (Victoria University of Wellington, New Zealand, 2024).

Mazvarirwofa, K. Fertility Treatment Helps Women Overcome Shame and Secrecy. Global Press Journal (2020).

Collins, J. An international survey of the health economics of IVF and ICSI. Hum. Reprod. Update 8, 265–77 (2002).

Pablo, J. L. de et al. What Is the Average Cost of IVF In the USA? Invitra (2025).

Smith, J. F. et al. Socioeconomic disparities in the use and success of fertility treatments: analysis of data from a prospective cohort in the United States. Fertil. Steril. 96, 95–101 (2011).

Benjamin J. Peipert1, Montoya, M. N., Bedrick, B. S., Seifer, D. B. & Jain, T. Impact of in vitro fertilization state mandates for third party insurance coverage in the United States: a review and critical assessment. Reprod. Biol. Endocrinol. 20, 1–12 (2022).

Sundaram, V., Morris, J. R., Anderson, J. & Noel, M. The cost of infertility (COIN) study: Associations with income and burden of treatment. Fertil. Steril. 114, e110–e111 (2020).

Zimbabwe National Statistics Agency (ZIMSTATS). 2022 Population and Housing Census: A Preliminary Report on Population Figures. https://zimbabwe.unfpa.org/sites/default/files/pub-pdf/2022_population_and_housing_census_preliminary_report_on_population_figures.pdf (2022).

United Nations Development Programme [UNDP]. Unstacking global poverty: data for high impact action, Briefing note for countries on the 2023 Multidimensional Poverty Index, Zimbabwe. https://hdr.undp.org/sites/default/files/Country-Profiles/MPI/ZWE.pdf (2023).

Ministry of Health and Child Care. National Health Strategy 2021-2025.

Zimbabwe National Statistics Agency & ICF Macro. Zimbabwe Demographic and Health Survey 2023–24. (2025).

World Health Organization. WHO Laboratory Manual for the Examination and Processing of Human Semen. CC BY-NC-SA 3.0 IGO (2021).

Madziyire, M. G., Magwali, T. L., Chikwasha, V. & Mhlanga, T. Investigations and treatment offered to women presenting for infertility care in Harare, Zimbabwe: a cross sectional study. Pan Afr. Med. J. 40, 191 (2021).

Ugwuja, E. I., Ugwu, N. C. & Ejikeme, B. N. Prevalence of low sperm count and abnormal semen parameters in male partners of women consulting at infertility clinic in Abakaliki, Nigeria. Afr. J. Reprod. Health 12, 67–73 (2008).

Mbizvo, M., Chimbira, T. & Mkwananzi, J. Aetiological Factors of Male Infertility in Zimbabwe. Cent. Afr. J. Med. 30, 233–238 (1984).

Mawuli, R., Djokoto, K., Owusu, V. B. & Agana, E. A. Lifestyle factors and prevalence of semen abnormalities among men undergoing infertility evaluation at Oak Specialist hospital: A retrospective cohort study. PLoS One 21, e0340902. (2026).

Boeri, L., Pederzoli, F., Capogrosso, P. & Abbate, C. Semen infections in men with primary infertility in the real-life setting. Fertil. Steril. 113, 1174–1182 (2020).

Paira, D. A. et al. Results from a large cross ‑ sectional study assessing Ureaplasma spp . and Mycoplasma hominis urogenital infections in patients with primary infertility. Sci. Rep. 1–8 (2021) doi:10.1038/s41598-021-93318-1.

Chabata, S. T. et al. High Prevalence of Sexually Transmitted Infections and Poor Sensitivity and Specificity of Screening Algorithms for Chlamydia and Gonorrhea Among Female Sex Workers in Zimbabwe: Analysis of Respondent-Driven Sampling Surveys in 3 Communities. Sex. Transm. Dis. 52, 117–124 (2025).

Osuafor, G. N. & Ayiga, N. Risky Sexual Behaviour Among Married and Cohabiting Women and its Implication for Sexually Transmitted Infections in Mahikeng, South Africa. Sex. Cult. 20, 805–823 (2016).

World Health Organisation. Zimbabwe scores gains in HIV control. https://www.afro.who.int/countries/zimbabwe/news/zimbabwe-scores-gains-hiv-control (2024).

Yonko, E. A. et al. The Relationship Between HIV Preexposure Prophylaxis Use and Laboratory-Confirmed Bacterial Sexually Transmitted Infection Positivity Among a Diverse, Multi-City Cohort of Sexually Active Sexual and Gender Minorities in the United States. AIDS Patient Care STDS (2025) doi:10.1177/10872914251390196.

Bui, H. T. M., Adamson, P. C., Klausner, J. D., Le, G. M. & Gorbach, P. M. Doxycycline prophylaxis for bacterial sexually transmitted infection prevention in Vietnam: awareness, attitudes and willingness to use among men who have sex with men using HIV-PrEP. Sex. Transm. Infect. 101, 367–373 (2025).

Havens, J. P., Singh, N., Lyden, E. & Bares, S. H. Doxycycline as Post-Exposure Prophylaxis: Awareness, Beliefs, and Interest Among Patients with and at Risk for HIV. AIDS Behav. 29, 546–555 (2025).

Columbia University. Zimbabwe Population-Based HIV Impac Assessment (ZIMPHIA) 2020. https://phia.icap.columbia.edu/zimbabwe-2020-summary-sheet/ (2020).

West, S. et al. Irregular menstruation and hyperandrogenaemia in adolescence are associated with polycystic ovary syndrome and infertility in later life: Northern Finland Birth Cohort 1986 study. Hum. Reprod. 29, 2339–51 (2014).

Madziyire, M. G., Magwali, T. L., Chikwasha, V. & Mhlanga, T. The causes of infertility in women presenting to gynaecology clinics in Harare, Zimbabwe; a cross sectional study. Fertil. Res. Pract. 7, 1 (2021).

Tarrash, M., Kuyoro, O., Goldman, R. H. & Mullin, C. Original article Characteristics of patients seeking fertility care in a low-income setting. 28, 59–65 (2024).

Sterling, L., Carroll, K. & Harris, L. Laptop and tablet use and their influence on total motile sperm count parameters : are laptops linked to infertility in Jamaican men ? 22, 25–32 (2024).

Salar, S. M. Prevalence of HSV‐1/HSV‐2 and CMV Infections in Infertile Men and Their Impact on Sperm Parameters : A Cross ‐ Sectional Study in Iran. Heal. Sci. Reports 8, 1–7 (2025).

Priam, A. et al. Human papillomavirus carriage in the semen of men consulting for infertility : prevalence and correlations with sperm characteristics. 1–8 (2024) doi:10.4103/aja202458.

Grimm, P. Social desirability bias: Part 2 Marketing Research. Wiley Int. Encycl. Mark. 2, 165–168 (2010).

Refbacks

  • There are currently no refbacks.