The fertility myth: Israeli students' knowledge regarding age-related fertility decline and late pregnancies in an era of assisted reproduction technology

[Infertility over forty: Pros and cons of IVF]

The population attempting pregnancy and having babies is ageing. The declining fertility potential and the late age of motherhood are increasing significantly the number of patients over forty consulting infertility specialists. Assisted reproductive technologies (ART) cannot compensate the natural decline in fertility with age. In France, in public hospital, ART is free of charge for women until 43 years, over 43, social insurance does not reimburse ART. Hence, 43 years is the usual limit, but between 40 and 42 is ART useful? The answer varies according to physicians, couples or society. On medical level, the etiology of the infertility must be taken into account. If there is an explanation to infertility (male or tubal infertility) ART is better than abstention. If the infertility is only due to age the question is raised. In France, the reimbursement by the society of a technique with very low results is discussed. However efficacy is not absolutely compulsory in Medicine. On the opposite to give false hopes may be discussed too. To obtain a reasonable consensus is rather difficult.

First contact: the intersection of demographics, knowledge, and appraisal of treatment at the initial infertility visit

OBJECTIVE

To determine the impact of the initial infertility visit on treatment-related knowledge, patient anxiety, and appraisals of treatment.

DESIGN

Prospective survey.

SETTING

Academic medical center.

PATIENT(S)

Two hundred thirty-four English-speaking women aged 18-50 years attending their first infertility visit.

INTERVENTION(S)

Participants completed a survey assessing health literacy, knowledge, anxiety, and appraisals of the treatment process before and after their infertility visit.

MAIN OUTCOME MEASURE(S)

Knowledge of infertility and treatment and anxiety and appraisal scores.

RESULT(S)

Most participants were white and earned >$100,000/year and had at least a college education. Baseline knowledge of reproductive anatomy, assisted reproductive technology (ART), and fertility factors was modest but improved after the initial visit. Factors associated with higher knowledge included higher education and income, white or Asian ethnicity, and English as a primary language. Patient appraisals of treatment represented by the positive (Challenge) and negative (Threat and Loss) subscale scores on the Appraisal of Life Events (ALE) scale changed over time Negative appraisals of treatment and anxiety scores decreased and positive appraisals of treatment increased after the initial visit. Lower knowledge was associated with higher positive appraisal scores; lower health literacy was associated with higher anxiety and appraisal scores (positive and negative) after the visit. Black women had higher Challenge scores compared with white and Asian women. Hispanic women had higher anxiety scores than non-Hispanic women.

CONCLUSION(S)

Infertility patients have modest baseline knowledge of fertility and infertility treatment. The initial infertility visit can improve this knowledge and decrease both negative appraisals of treatment and anxiety levels. Differences in knowledge and appraisal were seen across ethnic groups and other demographic variables. Physicians should individualize patient counseling to improve patients' knowledge and provide realistic treatment expectations while also reducing patient anxiety.

Knowledge of ovarian reserve and reproductive choices

OBJECTIVE

To determine the factors that influence the reproductive choices of health care professionals, and to assess whether knowledge of ovarian reserve would modify those choices.

METHOD

A cross-sectional survey utilizing anonymous questionnaires that assessed demographics, knowledge, attitudes and choices of female and male health care professionals between the ages of 20-55 (N = 185) who work at an academic medical center

RESULT(S)

Of the 185 respondents, 75% were female, 35% were residents and 35% were married. Among those who were delaying childbearing 39% wanted to complete their education, 25% had no identified partner, 10% were too active professionally and 4% could not afford children at the time. If testing of the individual or individual's partner indicated diminished ovarian reserve, 48% of those responding would try to have a child sooner, 21% would opt for oocyte cryopreservation, 7% would try to find a partner sooner, 7% would pursue adoption, and 3% would select embryo cryopreservation. Only 14% would not actively pursue treatment or make lifestyle changes. These results varied significantly with marital status but did not differ between participants with and without children. Similarly, choices did not vary significantly with religious belief or ethnicity.

CONCLUSION(S)

Increased information about a woman's reproductive reserve would lead individuals to modify life choices. Physicians caring for reproductive-age women and men should inquire about their childbearing plans, and educate those who are postponing childbearing regarding the normal pattern of reproductive decline.

New Zealand University students' knowledge of fertility decline in women via natural pregnancy and assisted reproductive technologies

Female fertility declines with age. University students are the group of people most likely to postpone parenthood, yet several international studies have shown that they overestimate their fertility. We designed a questionnaire based on a previous study in Israel, where university students were asked to answer questions related to their awareness of fertility decline in spontaneous and in vitro fertilisation (IVF) pregnancies, and methods they considered would prolong their reproductive lifespan. Our study has shown that New Zealand University students overestimated the rates of pregnancy for both spontaneous natural and IVF pregnancies. Students are mainly aware of the availability of assisted reproductive technologies (ARTs), but overestimate their effectiveness. Few students mentioned non-medical or well-being initiatives as measures to prolong parenthood. It is important that university students are aware of the rate of fertility decline in women, as although ARTs can be effective at times, they are not a guaranteed solution to an ageing woman's fertility. New Zealand University students, like other cohorts, overestimated the chances of a woman getting pregnant and predicted the fertility decline to occur much later than it does in reality.

Fertility awareness online: the efficacy of a fertility education website in increasing knowledge and changing fertility beliefs

STUDY QUESTION

How effective is online education in increasing knowledge of fertility and assisted reproductive technologies (ART), and changing beliefs about the timing of parenthood?

SUMMARY ANSWER

Exposure to an online educational intervention resulted in immediate changes in participants' beliefs about the ideal timing of parenthood, and a significant increase in their knowledge of fertility and ART treatments and options; most of these changes were not sustained over time, particularly for men.

WHAT IS KNOWN ALREADY

Research has identified significant gaps in men's and women's knowledge of fertility and ART, contributing to the trend to delay childbearing. Effective educational programs need to be developed, to support informed fertility and child-timing decisions.

STUDY DESIGN, SIZE, DURATION

Pre-post intervention study of 199 currently childless men and women, and a 6-month follow-up of 110 of these participants.

PARTICIPANTS/MATERIALS, SETTING, METHODS

One hundred and ninety-nine childless participants between the ages of 18 and 35 were asked to complete 4 beliefs and 22 knowledge questions prior to, and immediately after, reading 10 online posts related to: fertility testing and preservation, fertility history and lifespan, the effects of health and fitness on fertility, and assisted reproduction. Six months later, 110 of the original sample repeated the 26-item survey.

MAIN RESULTS AND THE ROLE OF CHANCE

Participants' fertility and ART knowledge scores increased significantly immediately after the intervention, as did their confidence in their fertility and ART knowledge. Participants' beliefs about the ideal and latest age a woman or man should consider producing a child decreased. However, 6 months later, participants' beliefs and knowledge levels largely returned to their pre-intervention levels, particularly for the men in the study.

LIMITATIONS, REASONS FOR CAUTION

The sample size and the recruitment methods may limit the generalizability of these findings.

WIDER IMPLICATIONS OF THE FINDINGS

Previous studies have demonstrated the short-term efficacy of online educational approaches to increase fertility knowledge and support informed family planning decisions. Web-based approaches have the benefit of being easily and conveniently accessed by individuals worldwide. However, the findings of the current study call into question the long-term efficacy of online fertility education, and suggest that variables such as gender and relevance need to be considered in assessing the efficacy of online fertility education strategies.

A cross sectional study on fertility knowledge in Japan, measured with the Japanese version of Cardiff Fertility Knowledge Scale (CFKS-J)

Background

A recent survey of 79 countries showed that fertility knowledge was lower in Japan than in any other developed country. Given the fertility decline in Japan and the importance of fertility knowledge, we conducted an online survey to examine fertility knowledge and the related factors for effective public education.

Methods

We studied people aged 18-59 years old, n = 4,328 (the “General” group), and also people who had been trying to conceive for at least six months, 18-50 years old, n = 618 (the “Triers” group). Fertility knowledge was assessed using the Japanese version of the 13-item Cardiff Fertility Knowledge Scale (CFKS-J). All participants provided socio-demographic and fertility information. Participants also completed a 14-item health literacy scale and an 11-item health numeracy scale. We asked participants who were aware of age-related decline in fertility when and where they first acquired that knowledge.

Results

The average percentages of CFKS-J items answered correctly were 53.1% in the Triers group and 44.4% in the General group (p < 0.001). Multivariate linear regression models showed in the Triers group greater fertility knowledge was associated with greater health literacy and prior medical consultation regarding their fertility. In the General group greater fertility knowledge was associated with being female, younger, university educated, currently trying to conceive, non-smoking, having higher household income, having higher health literacy and having higher health numeracy. Of those who were aware of the age-related decline in fertility, around 3% first learned the fact “at school”, and around 65% first learned it “through mass media” or “via the Internet”. More than 30% of the respondents first learned it “less than 5 years before” the survey.

Conclusions

Although fertility knowledge had improved since a previous study, possibly due to recent media coverage of age-related infertility, it was still low. Educational interventions, both in schools and in the community, may be needed to increase fertility knowledge in the general population because most people obtain fertility knowledge from mass media, which has been shown to often present distorted and inaccurate fertility information.

[Should we better inform young women about fertility? A state-of-knowledge study in a student population]

OBJECTIVES

To assess midwifery students' knowledge in the field of female fertility and to study their decision if they had diagnosis of diminished ovarian reserve (DOR).

SUBJECTS AND METHODS

A prospective observational study by self-administered questionnaire was conducted among female midwifery students of seven French schools from June to December 2013. The questionnaire had three parts: (1) questions designed to gather information on the study population; (2) a questionnaire consisting of 10 items to test knowledge about female fertility and ovarian reserve; (3) a self-administered questionnaire simulating a DOR diagnosis and quantifying the decision that students would make using a Likert scale of 5 points.

RESULTS

The participation rate was 72.5% (n=285/393). The average age was 22, 6 years±1.9. Among the 285 participants, the ovarian reserve concept was known by 93% of them (n=265) thanks to the midwifery studies (77%, n=204), the media (9%, n=24) and other sources of information. In total, 83.5% of midwifery students (n=238) were interested in assessing their ovarian reserve, and 48.3% of them were interested in evaluating it immediately (n=115). Among midwifery students, 22.5% of them (n=64) reported that female fertility began to decline from the age of 35 years old; 85.6% (n=244) thought that in vitro fertilization allowed women to conceive if fertility is related to a diminished ovarian reserve; 43.9% (n=125) answered that physical activity and a healthy diet had a beneficial effect on the ovarian reserve. If a DOR was diagnosed to them, 76.8% of students (n=219) would be likely to conceive their first child earlier than expected. Among them, 57.9% (n=165) would agree to have oocyte freezing in this context.

CONCLUSION

This study is the first in France that assessed students' knowledge on fertility. We observed: (1) gaps and misconceptions about female fertility despite a medical training in midwifery students; (2) a belief that in vitro fertilization is effective to overcome infertility related to age; (3) that some of these young students would be favorable to oocyte social freezing (technique not allowed in France); (4) that an adequate information on the decrease of fertility with age could lead some students to anticipate their first pregnancy. Specific information regarding the decrease of fertility with age should be offered to all reproductive-aged young women.

Intentions and attitudes towards parenthood and fertility awareness among Chinese university students in Hong Kong: a comparison with Western samples

STUDY QUESTION

What are the levels of awareness regarding female fertility and the intentions and attitudes towards parenthood among Chinese university students in Hong Kong compared with their counterparts in the West?

SUMMARY ANSWER

Chinese university students in Hong Kong were similarly over-optimistic about the age-related fertility decline, although they were less inclined to have children and undergo fertility treatment compared with their Western counterparts.

WHAT IS KNOWN ALREADY

Past studies of highly educated young adults in Europe and the USA have found that they are not sufficiently aware of the age-related decline in female fertility, and falsely believe that advanced reproductive treatments such as IVF will overcome fertility problems associated with age. Little is known about the perceptions of Chinese students in Hong Kong, a modernized Chinese city where the fertility rate is among the lowest in the world.

STUDY DESIGN, SIZE, DURATION

An online cross-sectional survey of Chinese university students in Hong Kong was conducted in 2013. Results were compared with two similar studies in Sweden and the USA.

PARTICIPANTS/MATERIALS, SETTING, METHODS

A total of 367 university students in Hong Kong (275 female, 92 male; mean age 23) responded to an e-mail invitation to participate in an online survey. Intentions and attitudes towards parenthood and awareness regarding female fertility were assessed using the Swedish Fertility Awareness Questionnaire.

MAIN RESULTS AND THE ROLE OF CHANCE

Like their Western counterparts, a large proportion of Chinese university students underestimated the age-related fertility decline (92%) and overestimated the fertility treatment success rate (66%). However, they were less inclined to have children, were more aware of and less concerned with infertility and were less motivated to seek solutions in the event of a fertility problem. These comparisons were significant at P < 0.05.

LIMITATIONS, REASONS FOR CAUTION

Self-selection bias was inevitable in the questionnaire survey, and the anonymous nature of the survey did not permit the collection of characteristics of non-responders. International comparisons warrant caution because the Hong Kong sample was older than the US sample (mean age 20), but not older than the Sweden sample (mean age 24).

WIDER IMPLICATION OF FINDINGS

While this study was consistent with past Western studies on the lack of fertility awareness among highly educated young people, the findings reveal significant cultural differences in family planning and responses to infertility between Asia and the West.

Fertility awareness among medical and non-medical students: a case-control study

BACKGROUND

To compare the understanding and perceptions of fertility issues among medical and non-medical University students.

METHODS

In a prospective case-control study, using a 43 item questionnaire with 5 sections and 43 questions regarding personal data (8 questions), lifestyle factors (9 questions), plans on having children (5 questions), age and fertility (5 questions), and lifestyle and fertility (16 questions), knowledge of fertility and influencing factors, desired age at commencement and completion of childbearing, among male and female medical and non-medical students in their first academic year at Vienna University, Vienna, Austria were evaluated.

RESULTS

340 students were included. 262/340 (77%) participants planned to have children in the future. Medical students (n = 170) planned to have fewer and later children and had a higher awareness of the impact of age on fertility than non-medical students (n = 170; estimated knowledge probability 0.55 [medical students] vs. 0.47 [non-medical students]; F (1, 336) = 5.18 and p = .024 (η p = .015). Gender did not independently affect estimated knowledge probability (F (1, 336) = 1.50 and p = .221). More female and male medical students had a positive attitude towards Assisted Reproductive Technology in case of infertility than non-medical students (47 and 55% vs. 23 and 29%, respectively; p = <.001). Medical students had a healthier lifestyle than non-medical students. A healthy lifestyle and female gender were associated with higher fertility awareness.

CONCLUSIONS

Medical students have a higher awareness of fertility issues than non-medical students. Choice of academic study, gender, and personal life style are important factors affecting fertility awareness. These data may be helpful to address knowledge gaps among young non-medical Academics.

Risk Knowledge and Psychological Distress During Pregnancy Among Primiparous Women of Advanced Age and Their Partners

INTRODUCTION

First childbirth at advanced maternal age has become a growing public health concern due to its increased risks for maternal-fetal health. The present study aimed to characterize the risk knowledge of primiparous women of advanced age and their partners and to examine interindividual variability on risk knowledge depending on sociodemographic and reproductive characteristics. The study also examined the influence of one partner's risk knowledge on both partners' psychological distress.

METHODS

The present study is part of an ongoing longitudinal project focusing on 2 timings of assessment: the prenatal diagnosis visit (time 1) and the third trimester of pregnancy (time 2). A total of 95 primiparous women of advanced age and their partners were consecutively recruited in a Portuguese referral urban hospital. Participants completed a questionnaire on knowledge of maternal age-related risks of childbearing at time 1 as well as the Brief Symptom Inventory-18 at time 2.

RESULTS

Both partners showed incomplete risk knowledge, with the exception of the impact of maternal age on fertility, the probability to request medical help to conceive, and increased risk of Down syndrome. Women's risk knowledge did not vary depending on sociodemographic and reproductive characteristics. Male partners with prior infertility and medically assisted reproduction treatments reported higher risk knowledge. Higher risk knowledge in male partners increased psychological distress during pregnancy in both members of the couples.

DISCUSSION

The findings indicated that first childbirth at advanced maternal age is rarely an informed reproductive decision, emphasizing the need to develop preventive interventions that may enhance couples' knowledge of maternal age-related risks. Given the influence of the risk knowledge of male partners on women's psychological distress, antenatal interventions should be couple-focused. Interventions should inform couples about maternal age-related risks, enhance their perceived control, and promote effective dyadic communication and coping strategies to address risk.

Attitudes towards motherhood and fertility awareness among 20-40-year-old female healthcare professionals

OBJECTIVE

To explore attitudes towards family formation and fertility awareness among Danish female healthcare professionals.

METHODS

We collected cross-sectional baseline data from a prospective cohort study of 863 women, ranging in age from 20 to 40 years, working at a hospital in Denmark. Information about participants' intentions and attitudes towards family formation and fertility knowledge was gathered by means of a questionnaire.

RESULTS

Only 2% of the respondents did not want children. Most women believed that motherhood is important, and hoped to have two to three children. About half of the respondents intended to have their last child after the age of 35 years. The most important prerequisites for family formation included: living in a stable relationship, having completed one's studies, a sound financial situation, a job that can be kept when having children, access to public child day care, and the possibility of travelling. As many as 50% of women underrated the impact of a woman's age on fertility, and overestimated the success rates of assisted reproductive technology (ART) treatments.

CONCLUSIONS

Many female healthcare professionals contemplated giving birth after the age of 35 years. Knowledge of fertility and ART success rates is needed to make well-informed decisions about when to have children.

Knowledge, attitudes, and practices regarding conception and fertility: a population-based survey among reproductive-age United States women

OBJECTIVE

To assess overall knowledge, attitudes, and practices related to conception and fertility among reproductive-age women in the United States.

DESIGN

Online survey of a cross-sectional sample of 1,000 women.

SETTING

United States, March 2013.

PATIENT(S)

Women aged 18-40 years.

INTERVENTION(S)

None.

MAIN OUTCOME MEASURE(S)

Knowledge, attitudes, and practices regarding selected topics in reproductive health.

RESULT(S)

Forty percent of women across all age groups expressed concerns about their ability to conceive. Yet one-third of women were unaware of adverse implications of sexually transmitted infections, obesity, or irregular menses for procreative success, and one-fifth were unaware of the effects of aging. Approximately 40% were unfamiliar with the ovulatory cycle. Overall, younger women (18-24 years) demonstrated less knowledge regarding conception, fertility, and ovulation, whereas older women tended to believe in common myths and misconceptions. Respondents in all age groups identified women's health care providers (75%) and Web sites (40%) as top sources of reproductive health-related information; however, engagement with providers on specific factors affecting fertility is sparse.

CONCLUSION(S)

Knowledge regarding ovulation, fertility, and conception is limited among this sample of reproductive-age US women. Future initiatives should prioritize improved provider engagement and accurate information dissemination in Web-based venues.

Women's views of a fertility awareness and hormonal support approach to subfertility

The aim of this study was to determine the satisfaction among subfertile women of a fertility awareness-based approach, including hormonal therapy to achieve a pregnancy by natural conception. Eighty four women attending a natural fertility service completed a postal questionnaire exploring (1) the acceptability of the sympto-thermal method and (2) the acceptability of using hormone support. Acceptability rates for the fertility charting, clinical service and clinical care were 64.9-91.6%. Acceptability rates were higher in women who did conceive or had experienced past recurrent miscarriages. Taking hormonal luteal support, by any method, was more acceptable for women over 35 years compared to those under 35 years (100% vs. 69.4%, p = 0.014). Vaginal pessaries were the preferred route of administration. The use of a fertility awareness-based method appears to be acceptable amongst subfertile women intending to conceive naturally. Most women using such a method for conception would be open to the use of hormonal support during the fertility cycle or early pregnancy.

A qualitative study of Ottawa university students' awareness, knowledge and perceptions of infertility, infertility risk factors and assisted reproductive technologies (ART)

BACKGROUND

Awareness of infertility risk factors is an essential first step to safeguard future fertility. Whereas several studies have examined university students' awareness of female fertility and related risk factors, the topic of male infertility has not been well examined. The objective of this study was to assess young men and women's awareness, knowledge and perceptions of infertility, male and female infertility risk factors and assisted reproductive technologies (ART).

METHODS

Semi-structured interviews were conducted in 2008 with a multi-ethnic sample of sixteen male and twenty-three female Ottawa university students, followed by qualitative data analysis to identify major themes. Interview topics included awareness of male and female infertility risk factors, infertility diagnosis/treatments and personal options in the event of future infertility.

RESULTS

Participants were generally familiar with infertility as a biomedical health problem, could identify sex-specific risk factors but overestimated fertility of women in their thirties and ART success rates. Reproductive health knowledge gaps and confusion of the physiological life-stage of menopause with infertility were apparent. Most participants would pursue in vitro fertilization or international adoption in the event of personal infertility. Some participants wished to use a 'natural' approach and were concerned with potential side effects of ART-related medications.

CONCLUSIONS

The general awareness of infertility in young adults is promising and supports the potential uptake for health promotion of fertility preservation. This study underscores the continued need for comprehensive sexual and reproductive health education and promotion for adolescents and young adults.

What do reproductive-age women who undergo oocyte cryopreservation think about the process as a means to preserve fertility?

OBJECTIVE

To better understand women's beliefs, priorities, and attitudes toward oocyte cryopreservation, to appreciate the extent of their reproductive education, and to track the reproductive paths of women who chose to undergo oocyte cryopreservation treatment.

DESIGN

An anonymous 30-question survey.

SETTING

Not applicable.

PATIENT(S)

From 2005-2011, 478 women completed ≥1 oocyte cryopreservation treatment cycle at our center to defer reproduction.

INTERVENTION(S)

None.

MAIN OUTCOME MEASURE(S)

Demographics, motivations, desires, fertility knowledge, and outcomes related to oocyte cryopreservation.

RESULT(S)

A total of 183 patients (38%) completed the survey with >80% being aged ≥35 years; white; having no partner at time of oocyte cryopreservation; undergoing oocyte cryopreservation after an optimal reproductive age; feeling they had improved their reproductive future after oocyte cryopreservation and being empowered by the process; aware of age-related infertility; sensing popular media falsely portrayed the upper age limit for natural conception; and recorded lack of partner as the primary rationale for not yet starting a family. Nineteen percent of respondents added that workplace inflexibility contributed to their reproductive dilemma. Half stated they learned about oocyte cryopreservation from a friend; others became aware through a medical provider, the media, and the internet. Most patients (93%) have not yet returned to use their frozen oocytes; 11 stated they had. Overall, 20% reported a successful conception after oocyte cryopreservation.

CONCLUSION(S)

Surveying oocyte cryopreservation patients provides a glimpse into the knowledge base and motivations surrounding current female reproductive practices. Oocyte cryopreservation technology may prove to bridge the gap between reproductive prime and when a woman is realistically "ready" to have children.

Introducing reproductive life plan-based information in contraceptive counselling: an RCT

STUDY QUESTION

Can reproductive life plan (RLP)-based information in contraceptive counselling before pregnancy increase women's knowledge of reproduction, and of the importance of folic acid intake in particular?

SUMMARY ANSWER

The RLP-based information increased women's knowledge of reproduction including knowledge of folic acid intake.

WHAT IS KNOWN ALREADY

Many women have insufficient knowledge of reproduction, including a health-promoting lifestyle prior to conception, and highly educated women in particular postpone childbearing until an age when their fertile capacity has started to decrease.

STUDY DESIGN, SIZE, DURATION

The study was an randomized controlled trial with one intervention group (IG) and two control groups (CG1, CG2). A sample size calculation indicated that 82 women per group would be adequate. Recruitment took place during 3 months in 2012 and 299 women were included. The women were randomized in blocks of three. All groups received standard care (contraceptive counselling, Chlamydia testing, cervical screening). In addition, women in the IG were given oral and written RLP-based information about reproduction.

PARTICIPANTS/MATERIALS, SETTING, METHODS

A total of 299 out of 338 (88%) Swedish-speaking women visiting a Student Health Centre were included (mean age 23 years); response rate was 88%. Before the counselling, women in the IG and the CG1 completed a baseline questionnaire, including questions about lifestyle changes in connection to pregnancy planning, family planning intentions and knowledge of reproduction (e.g. the fecundity of an ovum). At follow-up 2 months after inclusion, a structured telephone interview was performed in all groups (n = 262, 88% participation rate).

MAIN RESULTS AND THE ROLE OF CHANCE

There was no difference between the groups regarding the mean knowledge score at baseline. The IG scored higher at follow-up than at baseline (P < 0.001); the mean increased from 6.4 to 9.0 out of a maximum 20 points. The women in the CG1 scored no differently at follow-up than at baseline. The difference in the knowledge score between the IG and the two CGs was significant (P < 0.001), whereas no difference was shown between the two CGs. There was no difference between the groups at baseline regarding how many women could mention folic acid intake among the things to do when planning to get pregnant. At follow-up, 22% in the IG, 3% in CG1 and 1% in CG2 mentioned folic acid intake (P < 0.001). At follow-up, more women in the IG also wished to have their last child earlier in life (P < 0.001) than at baseline, while there was no difference in the CG1.

LIMITATIONS, REASONS FOR CAUTION

As the study sample consisted of university students, it is possible that the effect of the intervention was connected to a high level of education and conclusions for all women of reproductive age should be drawn with caution.

WIDER IMPLICATIONS OF THE FINDINGS

The provision of RLP-based information seems to be a feasible tool for promoting reproductive health.

STUDY FUNDING/COMPETING INTEREST(S)

Study funding was received from the Faculty of Medicine, Uppsala University, Sweden. There are no conflicts of interest.

TRIAL REGISTRATION NUMBER

ClinicalTrial.gov Identifier NCT01739101.

Conceiving of change: a brief intervention increases young adults' knowledge of fertility and the effectiveness of in vitro fertilization

OBJECTIVE

To examine the effectiveness of an educational intervention in increasing knowledge of fertility and the effectiveness of IVF among university students in Australia.

DESIGN

Two-group, pretest-posttest design.

SETTING

A large metropolitan university in Queensland, Australia.

PATIENT(S)

One hundred thirty-seven male and female undergraduate students.

INTERVENTION(S)

Online information brochure on fertility (intervention group), or an online information brochure on home ownership (control group).

MAIN OUTCOME MEASURE(S)

Knowledge of fertility, knowledge of IVF effectiveness, and desired age at commencement and completion of childbearing, assessed immediately before and after exposure to the brochure.

RESULT(S)

Exposure to the brochure resulted in significant increases in knowledge of fertility and knowledge of IVF effectiveness in the intervention group and significant decreases in desired age at commencement and completion of childbearing. No changes were observed in the control group.

CONCLUSION(S)

Educational intervention is a worthwhile endeavor that can increase knowledge of fertility and IVF effectiveness in the short-term. Further research is needed to evaluate whether increased knowledge persists and affects intentions in the longer-term. Because the determinants of timing of childbearing are highly multifactorial, fertility education should be paired with policies and practices that support men and women to make informed decisions about the timing of childbearing.

Cassandra's prophecy: why we need to tell the women of the future about age-related fertility decline and 'delayed' childbearing

This anonymized paper describes the author's experience of age-related infertility and unintended childlessness. It outlines her journey from diagnosis to treatment success and clinical pregnancy through assisted reproduction using oocyte donation, followed by subsequent early miscarriage. It makes subjective observations about treatment she received and presents her impressions of how discourses of knowledge dissemination, communication and care were constructed in the organizations she encountered. It sets her own reflections alongside broader observations on the challenges facing women today when planning a family and draws attention to what she perceives to be the misleading myths and misunderstandings concerning reproduction that these women are now subject to. In the light of this, it offers some suggestions for modified public health messages and new approaches to sex education and health screening that may consequently help to empower tomorrow's women (and men) to take full control over their reproductive lives in the 21st century. The paper takes as its mascot the figure of Cassandra, daughter of King Priam and Queen Hecuba. She was loved by Apollo, but resisted him. In consequence, he rendered useless the gift of prophecy that he had bestowed on her by causing her predictions never to be believed.

Fertility knowledge and beliefs about fertility treatment: findings from the International Fertility Decision-making Study

STUDY QUESTION

How good is fertility knowledge and what are treatment beliefs in an international sample of men and women currently trying to conceive?

SUMMARY ANSWER

The study population had a modest level of fertility knowledge and held positive and negative views of treatment.

WHAT IS KNOWN ALREADY

Few studies have examined general fertility treatment attitudes but studies of specific interventions show that attitudes are related to characteristics of the patient, doctor and context. Further, research shows that fertility knowledge is poor. However, the majority of these studies have examined the prevalence of infertility, the optimal fertile period and/or age-related infertility in women, in university students and/or people from high-resource countries making it difficult to generalize findings.

STUDY DESIGN, SIZE, DURATION

A cross-sectional sample completed the International Fertility Decision-making Study (IFDMS) over a 9-month period, online or via social research panels and in fertility clinics.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Participants were 10 045 people (8355 women, 1690 men) who were on average 31.8 years old, had been trying to conceive for 2.8 years with 53.9% university educated. From a total of 79 countries, sample size was >100 in 18 countries. All 79 countries were assigned to either a very high Human Development Index (VH HDI) or a not very high HDI (NVH HDI). The IFDMS was a 45-min, 64-item English survey translated into 12 languages. The inclusion criteria were the age between 18 and 50 years and currently trying to conceive for at least 6 months. Fertility knowledge was assessed using a 13-item correct/incorrect scale concerned with risk factors, misconceptions and basic fertility facts (range: 0-100% correct). Treatment beliefs were assessed with positive and negative statements about fertility treatment rated on a five-point agree/disagree response scale.

MAIN RESULTS AND THE ROLE OF CHANCE

Average correct score for Fertility Knowledge was 56.9%, with greater knowledge significantly related to female gender, university education, paid employment, VH HDI and prior medical consultation for infertility (all P < 0.001). The mean agreement scores for treatment beliefs showed that agreement for positive items (safety, efficacy) was correlated with agreement for negative items (short/long-term physical/emotional effects) (P > 0.001). People who had given birth/fathered a child, been trying to conceive for less than 12 months, who had never consulted for a fertility problem and who lived in a country with an NVH HDI agreed less with negative beliefs. HDI, duration of trying to conceive and help-seeking were also correlates of higher positive beliefs, alongside younger age, living in an urban area and having stepchildren. Greater fertility knowledge was associated with stronger agreement on negative treatment beliefs items (P < 0.001) but was unrelated to positive treatment beliefs items.

LIMITATIONS, REASONS FOR CAUTION

There was volunteer bias insofar as more women, people of higher education and people with fertility problems (i.e. met criteria for infertility, had consulted a medical doctor, had conceived with fertility treatment) participated and this was true in VH and NVH HDI countries. The bias may mean that people in this sample had better fertility knowledge and less favourable treatment beliefs than is the case in the general population.

WIDER IMPLICATIONS OF THE FINDINGS

Educational interventions should be directed at improving knowledge of fertility health. Future prospective research should be aimed at investigating how fertility knowledge and treatment beliefs affect childbearing and help-seeking decision-making.

Childless Canadian men's and women's childbearing intentions, attitudes towards and willingness to use assisted human reproduction

STUDY QUESTION

What are the childbearing intentions of currently childless men and women? What is their attitude towards, and willingness to use, assisted human reproduction (AHR) treatments and family-building options should they be faced with fertility challenges in the future?

SUMMARY ANSWER

Men and women expect to become parents significantly later in life than they believe is ideal. If faced with future fertility challenges, respondents were open to using IVF, but were not positively predisposed to third-party family-building options.

WHAT IS KNOWN ALREADY

Delayed childbearing is an increasing worldwide phenomenon that has considerable health and fertility-related implications. Research to date has focused primarily on women, and indicates a lack of knowledge about the fertility life span and the limitations of AHR in fully compensating for age-related fertility declines.

STUDY DESIGN, SIZE, DURATION

Cross-sectional study of 2000 childless women and 599 childless men, conducted between April 2010 and May 2011.

PARTICIPANTS/MATERIALS, SETTING, METHODS

A total of 2599 childless, presumed fertile individuals between the ages of 20 and 50 years. An online questionnaire assessed fertility beliefs and intentions and willingness to use AHR.

MAIN RESULTS AND THE ROLE OF CHANCE

The findings indicate that men and women expect to become parents significantly later in life than they believe is ideal. If faced with fertility challenges in the future, both men and women were open to using IVF. Men were significantly more willing to consider using donated eggs and embryos, gestational surrogacy and fertility preservation. Women were significantly more willing to consider using home fertility testing, IVF, ICSI and donor sperm. Overall, the childless respondents were not positively predisposed to third party-family-building options.

LIMITATIONS

The geographic specificity of the sample, the online format and recruitment methods may limit the generalizability of these findings.

WIDER IMPLICATIONS OF THE FINDINGS

Given the worldwide trend towards delayed childbearing, and the widespread availability of AHR, it is likely that these findings could extend to the wider North American, European and Australasia populations of English- and French-speaking childless men and women. However, it should be noted that international differences exist, especially concerning regulations governing the funding of AHR and payment for gametes and surrogacy. It is significant that women and men in this study indicated a lack of willingness to consider the use of third third-party treatments--the very options they may need to use in building their families, if the increasing trend towards delayed childbearing continues.

STUDY FUNDING/COMPETING INTERESTS

This research was funded by a grant from the Canadian Institutes of Health Research and Assisted Human Reproduction Canada #PAH-103594, 2009/10. No competing interests.