ABSTRACT The purpose of this work was to examine the patterns and determinants of fertility in Nsukka region, Enugu State, Nigeria. This was necessarily because most fertility studies across the nation lay emphasis on single or selected determinants, and using the findings to make recommendations on generalized terms which may not be applicable in different parts of the country. The data for this work was generated from questionnaire survey administered to 840 women of the reproductive age cohort of 15-49 years who have ever married. These women were sampled from 21 communities within the 7 Local Government Areas that make up the Nsukka cultural region. Other sources of data were interviews, reference from relevant literature and similar research themes. Statistical techniques such as Descriptive statistics, Analysis of Variance (ANOVA), and Multiple Regression analysis were employed as tools for the analysis. The data were analysed using the Statistical Package for the Social Sciences (SPSS). The results of the descriptive statistics revealed incidence of high fertility within the region. It did not show any variation in the levels of fertility in the region. It is uniform in the rural and urban areas. The result of the ANOVA showed significant variation in the patterns of fertility in the communities and in the urban and rural areas. The multiple regression result identified key indicators of fertility within the region which were; mother’s education, mother’s age at marriage, father’s occupation, knowledge and use of contraceptives, age at first birth, mother’s occupation, duration of abstinence and breastfeeding. 94% of the variation in fertility was explained by these variables. Based on these findings, compulsory education for the girl child, increase in contraceptive prevalence and use, increase in age at marriage, reduction in family size, improvement in medical facilities and services were recommended.