Fertility transitions are historically thought to have started in cities and then spread to the rest of the country. This would suggest that in Egypt we would find that Cairo was well ahead of the rest of the nation in its fertility transition. The data suggest otherwise and highlight the fact that many parts of Cairo are still experiencing high levels of fertility. Population geographers have generally examined differences only between urban and nonurban areas, but incorporating census tract level data from the 1996 and 1986 censuses of Egypt into a geographic information system, we are able to show that there are substantial intraurban geographic variations in fertility within the greater Cairo area. These spatial patterns are indicative of underlying clusters of differences in human reproduction that have important implications for understanding the decline of fertility within Cairo and the spread of that decline throughout the remainder of Egypt.