The future of fertility healthcare in South Africa

Introduction: The South African fertility healthcare sector offers world-class clinical expertise, advanced infrastructure, and increasing international appeal. Despite these strengths, the sector faces persistent challenges related to access, regulatory enforcement, and workforce capacity. This study aimed to analyse the sector's strategic position and identify key areas for development. Methods: Semi-structured interviews were conducted with twelve leaders in the fertility healthcare sector. Data were analysed using a SWOT (Strengths, Weaknesses, Opportunities, Threats) framework to evaluate internal and external factors influencing the sector. Results: Stakeholders identified key strengths, including the availability of donors from diverse racial and ethnic backgrounds and the relative affordability of high-quality treatment compared to international markets. However, weaknesses included unaffordable costs for most South Africans, limited training opportunities for reproductive medicine subspecialists, and gaps in regulatory enforcement. Opportunities were identified in expanding fertility tourism, leveraging the recent legalisation of preimplantation sex selection, and adopting operational innovations such as low-cost in vitro fertilisation (IVF). Major threats included political inertia, rising operational costs, and professional emigration. Discussion: These findings highlight the sector's strong global competitiveness alongside significant domestic structural challenges. Based on stakeholder insights, this study proposes strategic interventions to expand specialist training, modernise donor practices, establish statutory regulation, and position South Africa more effectively as a global leader in fertility healthcare.