Development of a health promotion programme to improve awareness of factors that affect fertility, and evaluation of its reach in the first 5 years

Young adult's views on using a poster to learn about fertility: redesigning the fertility education poster

Fertility awareness should be taught to everyone. The International Reproductive Health Education Collaboration (IRHEC) designed a fertility poster in 2019 but did not have a specific target group in mind. Studies have been conducted in Denmark and Sweden to determine how the poster can be redesigned. In this study, we carried out focus groups with young adults in the UK to ask their views of the poster, with the aim of redesigning it. Six focus groups were undertaken with twenty seven, 18-25 year olds. Five questions were asked: 1. What are your thoughts, feelings, and reactions to the poster? 2. Did you learn anything from the poster? 3. How has reading the poster impacted your opinions or thoughts about having children? 4. What are your opinions about using a poster format to inform and start reflections regarding family building? 5. Reading through each point are there any changes to be made? Content analysis was performed. Themes identified revealed the information on the poster gave the participants some anxiety and apprehension, especially regarding the effect of age on fertility, perceptions of IVF, and gaps in knowledge. The fertility education poster is a good resource for education, but other resources should be developed.

Knowledge about Fertility in Croatia, Measured with the Croatian Version of the Cardiff Fertility Knowledge Scale (CFKS-Hr), in Relation to Attitudes toward Having a Child and Associated Factors in a Cross-Sectional Survey

BACKGROUND

Fertility is a crucial component of population maintenance and growth. A declining fertility trend has been observed over the past two decades, and it continues. The birth rate in the Republic of Croatia is continuously decreasing, which is insufficient to maintain its population.

OBJECTIVE

This research aimed to examine the level of fertility knowledge, factors influencing fertility knowledge, and the relationship between fertility knowledge and the decision to have a child.

METHODS

A cross-sectional study was conducted on a sample of mothers in five hospitals on the Adriatic coast of the Republic of Croatia, involving 1541 mothers, 18 years and older, from September 2021 to December 2023. The Cardiff Fertility Knowledge Scale (CFKS) was used for the research. The participants were divided into four groups according to age. The analysis was conducted using SPSS software (version 22.0). Descriptive statistics, chi-squared tests, t-tests, and Pearson's correlations were used for the data analysis.

RESULTS

The average percent correct score on the CFKS was 51.8% (SD 22.6), with greater knowledge being significantly related to married status and higher education status (both p < 0.05). A total of 83% of mothers who have one child want to have more children. Fewer mothers who have two children want to have more children (42%), while only 11% of mothers who have three or more children want to have more children. There is no significant relationship between the CFKS and the importance of childbearing in the future (p = 0.12). Respondents indicated that they gained most of their knowledge from the internet (31%) and from the healthcare system (33%).

CONCLUSIONS

The research results reveal a lack of fertility knowledge among participants, as well as an intention to have a child in the later stages of life. The lack of formal education on this topic leads to information gathering from friends, newspapers, television, and the internet. This study was not registered.

A critical systematic review and meta-analyses of risk factors for fertility problems in a globalized world

Globally, fertility awareness efforts include well-established risk factors for fertility problems. Risks disproportionately affecting women in the Global South, however, are neglected. To address this gap, we conducted a systematic review and meta-analyses of relevant risk factors to examine the association between risk factors and fertility problems. MEDLINE, Embase, Cochrane Library, regional databases and key organizational websites were used. Three authors screened and extracted data independently. Studies assessing exposure to risk (clinical, community-based samples) were included, and studies without control groups were excluded. Outcome of interest was fertility problems, e.g. inability to achieve pregnancy, live birth, neonatal death depending on study. The Newcastle-Ottawa Scale was used to assess study quality. A total of 3843 studies were identified, and 62 were included (58 in meta-analyses; n = 111,977). Results revealed the following: a ninefold risk of inability to become pregnant in genital tuberculosis (OR 8.91, 95% CI 1.89 to 42.12); an almost threefold risk in human immunodeficiency virus (OR 2.93, 95% CI 1.95 to 4.42) and bacterial vaginosis (OR 2.81, 95% CI 1.85 to 4.27); a twofold risk of tubal-factor infertility in female genital mutilation/cutting-Type II/III (OR 2.06, 95% CI 1.03 to 4.15); and postnatal mortality in consanguinity (stillbirth, OR 1.28, 95% CI 1.04 to 1.57; neonatal death, OR 1.57, 95% CI 1.22 to 2.02). It seems that risk factors affected reproductive processes through multiple pathways. Health promotion encompassing relevant health indicators could enhance prevention and early detection of fertility problems in the Global South and disproportionately affected populations. The multifactorial risk profile reinforces the need to place fertility within global health initiatives.

Belgian Fertility Clinic Staff Value Healthy Lifestyle Promotion but Lack Access to a Structured Lifestyle Modification Programme: An Observational Study

OBJECTIVES

Guidelines advise promoting a healthy lifestyle among patients with fertility problems as the lifestyle of women and men proved to be associated with their fertility. Australian fertility nurses were shown to lack access to structured lifestyle modification programmes, although they value healthy lifestyle promotion. This study aimed to examine whether gynaecologists also value promoting a healthy lifestyle and whether structured lifestyle modification programmes are available in Belgian fertility clinics.

DESIGN

An observational study was conducted among health care professionals (HCPs) working in Belgian fertility clinics.

PARTICIPANTS/MATERIALS, SETTING, METHODS

An Australian questionnaire on attitudes and practices related to promoting a healthy lifestyle among patients with fertility problems was reciprocally back-to-back translated and three open-ended questions were added. All HCPs of Belgian fertility clinics, including gynaecologists, fertility nurses/midwives, psychologists, and embryologists, were invited by e-mail to complete the questionnaire online. Responses to closed and open-ended questions were analysed with, respectively, descriptive statistics and qualitative thematic analysis. Finally, differences in perspectives between different groups of HCPs were explored.

RESULTS

A total of 50 fertility nurses/midwives, 42 gynaecologists, and 19 other HCPs completed the survey (n = 111). Regarding attitudes, all respondents valued informing patients about the impact of lifestyle on fertility. The vast majority of HCPs (n = 96; 86%) stated that fertility clinics have the responsibility to address unhealthy lifestyles prior to offering fertility treatment. Fertility nurses/midwives were significantly more likely than gynaecologists to state that fertility clinics have this responsibility (p = 0.040). Regarding practices, the patient's lifestyle was most commonly discussed by the gynaecologist (n = 107; 96%) during the first appointment (n = 105; 95%). The lifestyle factors that were being addressed, according to the vast majority of respondents, were smoking, weight, age, alcohol, and recreational drugs. Only three HCPs (from three different clinics) stated that their clinic offered a structured lifestyle modification programme. HCPs explained that they lacked the resources and expertise for offering a structured lifestyle modification programme.

LIMITATIONS

Response rates were limited, but the responding Belgian gynaecologists and fertility nurses/midwives confirmed the findings of the previous study in Australian fertility nurses.

CONCLUSIONS

HCPs working in Belgian fertility clinics value healthy lifestyle promotion but lack access to structured lifestyle modification programmes to implement in their daily clinical practice. Future studies should focus on developing and evaluating structured lifestyle modification programmes for patients with fertility problems.

Mapping intentions to adopt fertility protective behaviours: the role of couple congruence and the importance of relationship and fertility awareness

Several studies worldwide have shown that reproductive-aged people often have inadequate fertility awareness (FA). Since attitudes and health behaviours are influenced by the partner, there is a need for studies exploring the role of these influences on the individuals' adoption of fertility protective behaviours (FPB). This study explores the role of FA and relationship quality on couples' intention to adopt FPB. One hundred and twelve childless couples answered an online questionnaire about reproductive life plan, FA and intentions to adopt FPB. The results showed that couples were moderately congruent on their reproductive life plan. The female partners who reported higher female relationship quality and higher female willingness to undergo fertility treatments were more willing to adopt FPB. The male partners who had heightened FA also reported higher intention to adopt FPB. The influences of male and female FA, relationship quality and congruence on reproductive life plan were neither associated with couples' congruence on the intention to adopt FPB. Although the cross-sectional design restricts our ability to draw causal conclusions, these findings emphasize that future interventions should be targeted at couples and designed according to their expectations and reproductive desires.

The importance of the 'family clock': women's lived experience of fertility decision-making 6 years after attending the Fertility Assessment and Counselling Clinic

This study explored women's lived experience of making fertility decisions six years after attending the Fertility Assessment and Counselling (FAC) clinic in Copenhagen, Denmark, which is a personalised fertility awareness intervention. We conducted a qualitative interview study with 24 women who attended the FAC clinic 6 years earlier. Interviews were semi-structured and broadly examined the women's perceptions and experience of the intervention during follow-up. Data was analysed using a phenomenological framework and themes were identified related to women's experience of making fertility decisions after attending the FAC clinic. The overarching theme regarding the women's lived experience of making fertility decisions after attending the FAC clinic was: Fertility decisions were guided by the 'family clock'. There were four themes: (i) Deciding to 'get started' by attending the FAC clinic; (ii) Sense of making informed and empowered decisions; (iii) Influence of partner status on fertility decisions; and (iv) Decisions dictated by circumstance over preference and knowledge. At follow-up, the majority (21 women, 88%) had become parents. More than half of the women said that they had not achieved their desired family size. Consideration of women's 'family clock' is necessary in personalised fertility awareness interventions to enable women to achieve their family goals.

Relationships between Women's and Men's Modifiable Preconception Risks and Health Behaviors and Maternal and Offspring Health Outcomes: An Umbrella Review

Parental health before conception effects maternal and offspring health outcomes. Preconception care provides healthcare to prospective parents addressing modifiable preconception risks and health behaviors. This umbrella review aimed to consolidate evidence on women's and men's modifiable preconception risks or health behaviors associated with maternal and offspring health outcomes. MEDLINE, EMBASE, Maternity and Infant Care, CINAHL, and PsycINFO were searched from March 4, 2010, to March 4, 2020. Eligible studies were systematic reviews or meta-analyses of observational studies examining associations between modifiable preconception risks or health behaviors and maternal and offspring health outcomes. Screening, data extraction, and methodological quality assessment (AMSTAR 2) occurred independently by two reviewers. Degree of overlap was examined. Findings were summarized for evidence synthesis. Twenty-seven systematic reviews were included. Modifiable preconception risks and health behaviors were identified across categories: body composition (e.g., overweight, obesity), lifestyle behaviors (e.g., caffeine, smoking), nutrition (e.g., micronutrients), environmental exposures (e.g., radiation), and birth spacing (e.g., short interpregnancy intervals). Outcomes associated with exposures affected embryo (e.g., embryonic growth), maternal (e.g., gestational diabetes mellitus), fetal/neonate (e.g., preterm birth), and child (e.g., neurocognitive disorders) health. For real-world practice and policy relevance, evidence-based indicators for preconception care should include body composition, lifestyle, nutrition, environmental, and birth spacing.

How Media Use Influences the Fertility Intentions Among Chinese Women of Reproductive Age: A Perspective of Social Trust

Background

The low fertility level has become a serious social problem in China. Previous research has argued the significant influence of media use and social trust on fertility intentions, but the interaction between the two variables and how they influence fertility intentions remain further investigation. This study explored the influence mechanism of media use on Chinese women's fertility intentions from the perspective of social trust.

Methods

This study collected data from the 2017 China General Social Survey, investigated the relationships between variables through bivariate correlation coefficients, and explored the differences in fertility intentions among women of reproductive age (20–49). Also, this paper examined the influence of media use and social trust by regression analysis and tested the mediating role of social trust between media use and fertility intentions with Bootstrap sampling.

Results

Women with different media use preferences, education levels, and family incomes have significant differences (p < 0.01) in fertility intentions. New media use negatively influences women's fertility intentions, while traditional media use has no significant influence on women's fertility intentions. Social trust significantly influenced women's fertility intentions and partially mediated the impact of new media use on fertility intentions.

Conclusion

Online communication influences fertility intentions among Chinese women of reproductive age. It tends to influence their social trust by amplifying negative social news, affecting their fertility intentions further. This paper suggests the importance of strengthening social trust and online agenda-setting to improve women's fertility intentions that strategic information communication can change their perceptions of social trust.

Parenthood aspirations and understanding of factors that affect the chance of achieving them: A population survey

Most women and men want and expect to have children. Parental age and some health behaviours affect fertility and the chance of conception. The aim of this study was to gauge people's parenthood aspirations and knowledge about the factors that affect their chance of achieving them. Members of an Australian probability-based online panel aged 18-45 years were invited to complete a survey with questions about parenthood goals and knowledge about factors known to affect fertility. Of the 965 eligible people, 716 (74.2%) completed the survey. Only 6% stated that they did not want biological children. Around one in 10 respondents had experienced infertility. Amongst respondents aged 35-45 years, almost one in five (18%) had experienced infertility. Overall, respondents reported high levels of confidence about their understanding of preventative measures associated with safe sex and avoiding unwanted pregnancies. However, confidence in understanding of factors affecting ability to conceive was lower. Almost one-third of respondents believed that female fertility starts to decline between the ages of 35 and 39 years, and another one-third of respondents believed that the decline starts at 40 years of age or later. One in four respondents believed that male fertility starts to decline at 50 years of age or later. Findings suggest that people of reproductive age in Australia have inadequate knowledge about the factors that affect the chance of achieving their parenthood goals. Fertility health education initiatives are needed to allow people to make informed decisions about childbearing, and reduce the risk of unfulfilled parenthood aspirations.

Smartphone application improves fertility treatment-related literacy in a large-scale virtual randomized controlled trial in Japan

People of reproductive age have unmet needs related to deficiencies in fertility literacy. Here, we aimed to investigate whether providing fertility-related information via a smartphone application could improve fertility treatment-related literacy in participants. We performed a randomized control-group pretest posttest study and recruited participants between June 18 and 25, 2020. Participants’ fertility treatment-related literacy was assessed with a pretest that comprised of 28 questions and participants were allocated with stratified randomization to either intervention group or control group. The intervention comprised a one-week smartphone application-based provision of information on fertility-related information and the control group received general information about women’s healthcare. Effectiveness of intervention was assessed using a posttest. A total of 4137 participants were administered the questionnaire and pretest, among which 3765 participants (91.0 %) responded and were randomly allocated into either the intervention group (N = 1883) or the control group (N = 1882). A significantly higher posttest mean score was observed for the intervention group compared to the control group (P = 0.0017). We also observed that posttest scores were significantly improved compared to pretest scores in both the intervention and control group (P < 0.001). When examining by specific test question, the proportion answering correctly increased at posttest compared to pretest for both intervention and control groups (P < 0.001). Furthermore, the intervention group showed a greater mean difference between posttest and pretest scores than the control group (P < 0.001). In conclusion, educational intervention using a smartphone application contributed to enhancing fertility treatment-related literacy.

Reframing the Australian Medico-Legal Model of Infertility

Australian law affirms a binary construction of fertility/infertility. This model is based upon the medical categorization of infertility as a disease. Law supports medicine in prioritizing technology, such as in vitro fertilization, as treatment for infertility. This prioritization of a medico-legal model of infertility in turn marginalizes alternative means of family creation such as adoption, fostering, traditional surrogacy, and childlessness. This paper argues that this binary model masks the impact of medicalization upon reproductive choice and limits opportunity for infertile individuals to create families. While medical technology should be available to enhance reproductive opportunity, infertile individuals will benefit from regulatory change which disentangles the medico-legal construct of infertility as a disease from the desire to create a family. This paper suggests that the medico-legal model of infertility should be reframed to support all opportunities for family creation equally, including non-medical opportunities such as adoption, fostering, and childlessness.

Australian men's fertility information seeking attitudes and behaviour: A qualitative investigation

OBJECTIVE

Most women and men want and expect to have children but increasing maternal and paternal ages reduce their ability to achieve this. Most research relating to childbearing has focused on women. The aim of this study was to explore reproductive-aged men's fertility information-seeking attitudes and behaviours.

METHODS

Focus group discussions were conducted with younger (18-30 years, 3 groups) and older (31-45 years, 3 groups) men, residing in urban, peri-urban or rural settings in Victoria, Australia. The topics covered included men's fatherhood aspirations and intentions, and their attitudes and behaviours relating to seeking information about fertility. Focus group discussions were audio-recorded and transcribed, and transcripts analyzed thematically.

RESULTS

Six focus group discussions were conducted with a total of 39 participants. Four key themes were identified: 1. 'No need for fertility-related information'; 2. 'Knowledge and awareness of fertility'; 3. 'Fertility is women's business'; and 4. 'Fertility and manhood'. Fertility and fertility information seeking was perceived by many participants as women's domain. While men did not seek information about fertility unless they experienced fertility difficulties, they reported learning about fertility through the lived experiences of others, predominantly family and friends who experienced infertility.

CONCLUSION

Fertility-related health promotion initiatives and reproductive health information targeting men are needed to encourage men to be active participants in reproductive decision making to optimize the chance of both women and men achieving their parenthood goals. Narrative health messages may be a successful way to convey fertility information to men.

Fertility awareness and intentions among young adults in Greece

BACKGROUND

Greece has a mean age of first motherhood at 31.5 years, higher than the European average age of 29.4. Delaying conception, however, may be an important non-reversible cause of infertility. The aim of this study was to identify possible knowledge deficits regarding fertility in young adults.

METHODS

This was an online survey of young adults, regarding information on intention to parenthood and knowledge on issues affecting fertility. This study was conducted from February to December 2020, aiming for a representative sample of Greek men and women aged 18 and 26 years. The questionnaire was designed by a multidisciplinary group based on the Cardiff Fertility Knowledge Scale, which contained 22 multiple-choice or Likert-scale questions.

RESULTS

We obtained responses from 1875 young adults, whose mean age was 22.1 years. About 91.8% of men and 94.0% of women declared an intention to have children, out of which 44.0% wanted to have two and 29.0% three children. About 52.0 and 50.8% men and women, respectively, aimed to start a family between 31 and 35 years. Residents of rural areas and those with a lower education level more likely aimed to have children before the age of 30. The most prevalent answers for age of ideal parenthood were between 26 and 30 years for a woman and 31-35 years for a man. Smoking, alcohol consumption and sexually transmitted infections were identified as factors affecting both female and male fertility. Half of men and women, respectively, overestimated general success rates of reproductive techniques.

CONCLUSION

The knowledge of fertility, particularly with regards to assisted reproductive techniques' success rates, may be overestimated as more young adults plan for having children after the age of 30.

Women's perceptions of fertility assessment and counselling 6 years after attending a Fertility Assessment and Counselling clinic in Denmark

STUDY QUESTION

What are women's perceptions and experience of fertility assessment and counselling 6 years after attending a Fertility Assessment and Counselling (FAC) clinic in Denmark?

SUMMARY ANSWER

Women viewed the personalized fertility knowledge and advice they received as important aids to decision-making and they felt the benefits outweighed the risks of receiving personalized fertility information.

WHAT IS KNOWN ALREADY

Many young people wish to become parents in the future. However, research demonstrates there is a gap in women's and men's knowledge of fertility and suggests they may be making fertility decisions based on inaccurate information. Experts have called for the development of interventions to increase fertility awareness so that men and women can make informed fertility decisions and achieve their family-building goals. Since 2011, the FAC clinic in Copenhagen, Denmark has provided personalized fertility assessment and guidance based on clinical examination and evaluation of individual risk factors. Available qualitative research showed that attending the FAC clinic increased fertility awareness and knowledge and was experienced as a catalyst for change (e.g. starting to conceive, pursuing fertility treatment, ending a relationship) in women 1-year post-consultation.

STUDY DESIGN SIZE DURATION

The study was a 6-year follow-up qualitative study of 24 women who attended the FAC clinic between January and June 2012. All women were interviewed during a 2-month period from February to March 2018 at Rigshospitalet, their home or office, in Copenhagen, Denmark. Interviews were held in English and ranged between 60 and 94 min (mean 73 min).

PARTICIPANTS/MATERIALS SETTING METHODS

Invitations to participate in an interview-based follow-up study were sent to 141 women who attended the FAC clinic in 2012. In total, 95 women read the invitation, 35 confirmed interest in participating and 16 declined to participate. Twenty-five interviews were booked and 24 interviews held. Interviews followed a semi-structured format regarding reasons for attending the FAC clinic, if/how their needs were met, and perceptions of fertility assessment and counselling. Data were analysed using thematic analysis.

MAIN RESULTS AND THE ROLE OF CHANCE

At the follow-up interview, women were on average 39.5 years old. Ten were currently single or dating and 14 were married/cohabiting. All were childless when they attended the FAC clinic. At the follow-up interview, 21 women were parents (14 women with one child; 6 with two children; 1 with three children) and the remaining three women intended to have children in the future. The most common reason for originally attending the FAC clinic was to determine how long they could delay childbearing. Most of the women now believed their needs for attending had been met. Those who were dissatisfied cited a desire for more exact ('concrete') information as to their remaining years of fertility, although acknowledged that this was likely not realistic. Women stated that they had felt reassured as to their fertility status after attending the FAC clinic whilst receiving the message that they could not delay childbearing 'too long'. Women viewed personalized fertility knowledge as an important aid to decision-making but cautioned about developing a false sense of security about their fertility and chance of conceiving in the future based on the results. Although women were generally satisfied with their experience, they wished for more time to discuss options and to receive additional guidance after their initial meeting at the FAC clinic.

LIMITATIONS REASONS FOR CAUTION

Participants were from a group of Danish women attending the FAC clinic and interviews were conducted in English, which means they are not representative of all reproductive-aged women. Nevertheless, the study group included a broad spectrum of women who achieved parenthood through different means (heterosexual/lesbian relationship, single parent with donor, co-parent) with various family sizes, and women who were currently childless.

WIDER IMPLICATIONS OF THE FINDINGS

Our study provides support for an individualized approach to fertility education, assessment and counselling provided at a time when the information is relevant to the individual and their current fertility decision-making. The findings suggest that although satisfied with their visit to the FAC clinic, the women wished for more information and guidance after this visit, suggesting that the current intervention may need to be expanded or new interventions developed to meet these additional needs.

STUDY FUNDING/COMPETING INTERESTS

E.K. was funded by an ESHRE Travel/Training grant by ReproUnion, co-financed by the European Union, Interreg V OKS. J.B. reports that the risk evaluation form used at the Fertility Assessment Clinic was inspired by the Fertility Status Awareness Tool FertiSTAT that was developed at Cardiff University for self-assessment of reproductive risk. J.B. also reports personal fees from Merck KGaA, Merck AB, Theramex, Ferring Pharmaceuticals A/S and a research grant from Merck Serono Ltd outside the submitted work. A.N.A. has received personal fees from both Merck Pharmaceuticals and Ferring and grants from Roche Diagnostics outside the submitted work. The other authors report no conflicts of interest.

Promoting fertility awareness and preconception health using a chatbot: a randomized controlled trial

RESEARCH QUESTION

What are the effects of using a fertility education chatbot, i.e. automatic conversation programme, on knowledge, intentions to improve preconception behaviour and anxiety?

DESIGN

A three-armed, randomized controlled trial was conducted using an online social research panel. Participants included 927 women aged 20-34 years who were randomly allocated to one of three groups: a fertility education chatbot (intervention group), a document about fertility and preconception health (control group 1) or a document about an irrelevant topic (control group 2). Participants' scores on the Cardiff Fertility Knowledge Scale and the State-Trait Anxiety Inventory, their intentions to optimize preconception behaviours, e.g. taking folic acid, and the free-text feedback provided by chatbot users were assessed.

RESULTS

A repeated-measures analysis of variance showed significant fertility knowledge gains after the intervention in the intervention group (+9.1 points) and control group 1 (+14.9 points) but no significant change in control group 2 (+1.1 points). Post-test increases in the intentions to optimize behaviours were significantly higher in the intervention group than in control group 2, and were similar to those in control group 1. Post-test state anxiety scores were significantly lower in the intervention group than in control group 1 and control group 2. User feedbacks about the chatbot suggested technical limitations, e.g. low comprehension of users' words, and pros and cons of using the chatbot, e.g. convenient versus coldness.

CONCLUSIONS

Providing fertility education using a chatbot improved fertility knowledge and intentions to optimize preconception behaviour without increasing anxiety, but the improvement in knowledge was small. Further technical development and exploration of personal affinity for technology is required.

College students responding to the Chinese version of Cardiff fertility knowledge scale show deficiencies in their awareness: a cross-sectional survey in Hunan, China

Background

Fertility knowledge is vital to the fertility health of young people and greatly impacts their fertility choices. Delayed childbearing has been increasing in high-income countries, accompanied by the risk of involuntary childlessness or having fewer children than desired. The aim of this study was to investigate knowledge about fertility issues, the related influencing factors, the method of acquiring fertility knowledge, and the relationship between fertility knowledge and fertility intentions among college students.

Methods

An online cross-sectional survey of Chinese college students was conducted in Hunan Province from March to April 2018. A total of 867 college students from three comprehensive universities responded to a poster invitation utilizing the Chinese version of the Cardiff Fertility Knowledge Scale (CFKS-C). Data were explored and analysed by SPSS (version 22.0) software. Descriptive statistics, chi-squared tests, T-tests, and Pearson’s correlations were used for the measurements.

Results

The average percent-correct score on the CFKS-C was 49.9% (SD = 20.8), with greater knowledge significantly related to living in a city district, being not single status, majoring in medicine, being in year 4 or above of study, and intention to have children (all p<0.05). A total of 81.9% of the participants reported that they would like to have children, the average score of the importance of childbearing was 6.3 (SD = 2.7), and the female score was lower than the male score (p = 0.001). A small positive relationship was observed between the CFKS-C and the importance of childbearing (r = 0.074, p = 0.035). Respondents indicated that they gained most of their knowledge from the media and internet (41.4%) and from schools (38.2%).

Conclusion

Yong people in college have a modest level of fertility knowledge, a relatively low intention to have a child, and deficiencies in fertility health education. There is a need to improve the accessibility of fertility health services by developing a scientific and reliable fertility health promotion strategy.

Acceptability of screening for pregnancy intention in general practice: a population survey of people of reproductive age

Background

Optimal parental preconception health benefits reproductive outcomes. However, preconception health promotion is not routinely offered in primary health care settings to people of reproductive age. The aim was to gauge the planned preconception health behaviours and attitudes towards being asked about pregnancy intention by a general practitioner (GP) among people of reproductive age in Australia.

Method

The research was conducted on a single wave of Australia’s first and only probability-based online panel, Life in Australia™. Members of the Life in Australia™ panel are Australian residents aged 18 years or over. All active members between the ages of 18 and 45 years were eligible to participate. Eligible panel members were invited to complete a survey about fertility and childbearing. Data were collected from 18 February to 4 March 2019.

Results

In all 965 female and male members of Life in Australia™ aged between 18 and 45 years were invited to complete the survey. Of these, 716 (74.2%) agreed. Most respondents indicated that if they were planning to have a child they would try to optimise their preconception health by adopting a healthier diet (80%), seeing a GP for a health check-up (78%), reducing alcohol consumption (78% of those consuming alcohol), getting fitter (73%), and stopping smoking (70% of smokers). Three in four (74%) stated that they would not mind if their GP asked them about their pregnancy intentions.

Conclusion

Findings suggests that routinely asking people of reproductive age about their pregnancy intentions and advising those who are planning pregnancy about what they can do to ensure optimal preconception health would be acceptable to most people and may improve reproductive outcomes.

A wonderful experience or a frightening commitment? An exploration of men's reasons to (not) have children

Research on reproductive decision-making mainly focuses on women's experiences and desire for children. Men included in this type of research usually represent one-half of a heterosexual couple and/or men who are involuntarily childless. Perspectives from a broader group of men are lacking. This study is based on the results of a baseline questionnaire answered by 191 men aged 20-50 years who attended two sexual health clinics in two major Swedish cities. The questionnaire included questions about sociodemographic background, reproductive history and fertility, but also two open-ended questions focusing on reasons for having or not having children. The results of these two questions were analysed by manifest content analysis and resulted in five categories: '(non-)ideal images', 'to pass something on', 'personal development and self-image', 'the relationship with the (potential) co-parent' and 'practical circumstances and prerequisites'. Reasons for having children were mainly based on ideal images of children, family and parenthood. Meanwhile, reasons for not having children usually concerned practical issues. The type of answer given was related to men's procreative intentions but not to background characteristics. In conclusion, men raised many different aspects for and against having children. Therefore, reproductive decision-making should not be considered a non-choice among men.

Two-year follow-up of a randomized controlled trial: knowledge and reproductive outcome after online fertility education

STUDY QUESTION

What are the long-term effects of fertility education on knowledge and reproductive outcome?

SUMMARY ANSWER

Participants in the intervention group retained some knowledge after 2 years and the partnered women had a new child more quickly than the comparison group.

WHAT IS KNOWN ALREADY

Fertility education improves knowledge, at least in the short-term. Attitudes toward childbearing and its timing can change after exposure to educational materials.

STUDY DESIGN, SIZE, DURATION

Participants were recruited via an online social research panel. In the original randomized controlled trial (RCT), knowledge of reproductive-aged participants was assessed before (T1) and immediately after (T2) receiving one of three information brochures: fertility (intervention group), healthy pre-pregnancy (focused on intake of folic acid during pregnancy, control group 1), or family policies in Japan (childcare provision, control group 2). The present follow-up study was conducted 2 years later in January 2017 (T3) with the same participants.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Of the T1 participants (n = 1455), 383 men and 360 women (51%) responded to the T3 survey. Fertility knowledge measured with the Japanese version of the Cardiff Fertility Knowledge Scale (CFKS-J) and fertility status (e.g. new births, new medical consultations, and the timing of new birth) was assessed.

MAIN RESULTS AND THE ROLE OF CHANCE

Baseline (T1) characteristics of the T3 participants were well balanced between groups, but T3 participants were older, married, and more educated compared to those lost to follow-up. A repeated-measures analysis of variance showed significant knowledge gains among the intervention group from T1 to T3 (11.2% and 7.0% among men and women, respectively) but no significant change over time for the control groups. There were no differences between groups in the incidence of new births or new medical consultations. However, subgroup analysis showed that timing of new births was accelerated for partnered individuals in the intervention group. Specifically, the proportion of partnered participants at T1 who had a new birth in the first year subsequent to presentation of information was higher in the intervention group versus control group 1 (folic acid): 8.8% versus 1.4% (P = 0.09) among men and 10.6% versus 2.3% (P = 0.03) among women, respectively. The odds ratios (adjusted for age) were 7.8 (95% CI: 0.86-70.7) and 5.2 (95% CI: 1.09-25.0) among men and women, respectively. The timing of births and the proportion of new births during the 2-year follow-up period in the intervention group were similar to that of control group 2 (family policy). The incidence of new medical consultation was higher in the male intervention group (12.0%) than in male control group 2 (family policy, 1.5%, P = 0.04) but similar among women in all groups.

LIMITATIONS REASONS FOR CAUTION

First, the high attrition rate may limit the generalizability of these findings for longer-term acquisition of fertility knowledge, especially when applied to younger people who were more likely to be lost to follow-up. Second, this is a 2-year follow-up study and the results may change in the longer-term. Finally, we relied on self-reported questionnaire data and there is a possibility that some women were unknowingly pregnant at T1 but this risk should be distributed equally in the three groups through randomization.

WIDER IMPLICATIONS OF THE FINDINGS

Effects of one-time education were limited but retained beyond baseline levels. Importantly, education was found to potentially accelerate decision-making about achieving births in partnered subgroups compared to receiving healthy pre-pregnancy information. However, this finding should be confirmed in future stratified RCTs designed to evaluate effects in these subgroups. Follow-up 'booster' education sessions might help people retain knowledge and facilitate reproductive decisions for longer. In view of the high attrition rate, especially among young populations, novel educational strategies to retain young people in fertility education cohorts should be explored.

STUDY FUNDING/COMPETING INTEREST(S)

This study was funded by National Center for Child Health and Development, the Daiwa Anglo-Japanese Foundation, Pfizer Health Research Foundation, and the Japan Society for the Promotion of Science. E.M. reports joint research funds from a public interest incorporated foundation '1 more Baby Ohendan.'

An experimental evaluation of the benefits and costs of providing fertility information to adolescents and emerging adults

STUDY QUESTION

Does the provision of fertility (compared to control) information affect fertility-related knowledge, perceived threat of infertility, anxiety, physical stress and fertility plans in adolescents and emerging adults?

SUMMARY ANSWER

The provision of fertility information was associated with increased fertility knowledge (emerging adults) and greater infertility threat (adolescents and emerging adults).

WHAT IS KNOWN ALREADY

According to fertility education research, adolescents and emerging adults know less than they should know about fertility topics. Fertility knowledge can be improved through the provision of information in older adults.

STUDY DESIGN, SIZE, DURATION

Experimental design. Secondary and university students completed pre-information questionnaires, were randomly assigned via computer to an experimental group, read either fertility (FertiEduc group) or healthy pregnancy information (Control group), and completed post-information questionnaires. Data were collected in group sessions via an online portal.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Eligible participants were aged 16–18 (adolescents) or 21–24 years (emerging adults), childless, not currently pregnant (for men, partner not pregnant) or trying to conceive, presumed fertile and intending to have a child in the future. Of the 255 invited, 208 (n = 93 adolescents, n = 115 emerging adults) participated. The FertiEduc group received ‘A Guide to Fertility’, four online pages of information about fertility topics (e.g. ‘When are men and women most fertile?’) and the Control group received four online pages from the National Health Service (NHS) pregnancy booklet ‘Baby Bump and Beyond’. Participants completed a questionnaire (fertility knowledge, perceived threat of infertility, anxiety, physical stress and fertility plans, moderators) prior to and after the provision of information. Mixed factorial analysis of variance was used to examine the effects of information provision and hierarchical multiple regression to assess potential moderators of knowledge.

MAIN RESULTS AND THE ROLE OF CHANCE

The FertiEduc and Control groups were equivalent on age, gender, disability, relationship status and orientation at baseline. Results showed that fertility information significantly increased fertility knowledge for emerging adults only (P < 0.001) and threat of infertility for emerging adults and adolescents (P = 0.05). The moderators were not significant. Participation in the study was associated with an increase in feelings of anxiety but a decrease in physical stress reactions. Adolescents had more optimal fertility plans compared to emerging adults due to being younger.

LIMITATIONS, REASONS FOR CAUTION

This was an experimental study on a self-selected sample of men and women from selected educational institutions and only short term effects of information were studied.

WIDER IMPLICATIONS OF THE FINDINGS

Provision of fertility information can have benefits (increased fertility knowledge) but also costs (increase potential threat of infertility). Adolescents find fertility information positive but do not learn from it. Fertility education should be tailored according to age groups and created to minimise negative effects. Longitudinal examination of the effects of fertility information in multi-centre studies is warranted and should include measures of perceived threat of infertility.

STUDY FUNDING/COMPETING INTEREST(S)

Cardiff University funded this research. All authors have no conflicts of interest to declare.

Feasibility and acceptability of theatrical and visual art to deliver fertility education to young adults

The Fertility Education Initiative was established in 2016 to provide education on fertility, modern families and reproductive science for young adults, teachers, health professionals, parents and adults. We report on our study to determine the feasibility and acceptability of using the arts to delivery fertility education in schools. The evaluation was mixed methods: (i) two focus groups with young people aged 14-16 and 16-18 were conducted to investigate attitudes to fertility awareness; and (ii) seventeen 16-22 year olds were divided into two groups and each undertook a day of art workshops that consisted of two visual and two theatrical workshops and then completed questionnaires at the end of each workshop and at the end of the day. The artists were interviewed using a semi-structured interview. Young adults confirmed they were interested in learning about fertility, but current understanding varied. The majority thought that fertility education should be delivered in schools at ages 16-18. During the art workshops they learnt some facts but asked for more science and discussion. They felt using art was powerful and they wanted to hear the artists personal stories. Tools using a number of platforms need to be developed that can be taken into schools nationally and evaluated for their engagement.

Female subfertility

Subfertility is common and affects one in six couples, half of whom lack an explanation for their delay in conceiving. Developments in the diagnosis and treatment of subfertility over the past 50 years have been truly remarkable. Indeed, current generations of couples with subfertility are more fortunate than previous generations, as they have many more opportunities to become parents. The timely access to effective treatment for subfertility is important as many couples have a narrow window of opportunity before the age-related effects of subfertility limit the likelihood of success. Assisted reproduction can overcome the barriers to fertility caused by tubal disease and low sperm count, but little progress has been made in reducing the effect of increasing age on ovarian function. The next 5-10 years will likely see further increases in birth rates in women with subfertility, a greater awareness of lifestyle factors and a possible refinement of current assisted reproduction techniques and the development of new ones. Such progress will bring challenging questions regarding the potential benefits and harms of treatments involving germ cell manipulation, artificial gametes, genetic screening of embryos and gene editing of embryos. We hope to see a major increase in fertility awareness, access to safe and cost-effective fertility care in low-income countries and a reduction in the current disparity of access to fertility care.

Survey of Maternal, Child and Family Health Nurses' attitudes and practice relating to preconception health promotion

Environmental factors including poor nutrition, obesity, smoking, exposure to toxins and drug and alcohol use at the time of conception can adversely affect the future health of the offspring. As primary health care (PHC) professionals who interact with women of reproductive age, Maternal, Child and Family Health Nurses (MCaFHNs) are ideally placed to promote preconception health to women who want another child. The aim of this study was to assess MCaFHNs attitudes towards preconception health promotion, whether and under what circumstances they talk to their families about this, and what might help them start a conversation about preconception health. Of the 192 respondents, most (65%) agreed it is part of the MCaFHNs role to promote preconception health but only one in eight (13%) felt very confident that they knew as much as they needed and less than half (46%) ‘routinely’ or ‘sometimes’ promoted preconception health in their clinical practice. Almost all agreed that more information and education on the topic would increase their confidence to discuss preconception health. The findings suggest that, with adequate educational and structural support, most MCaFHNs are willing to deliver preconception health promotion in their clinical practice. As most new mothers access MCaFHNs, the potential health benefits of this are considerable.

Status one year after fertility assessment and counselling in women of reproductive age-a qualitative study

INTRODUCTION

Over the past 50 years women and men have postponed family formation in high-income societies. Fertility assessment and counselling has been suggested as a method to reduce delayed childbearing and its consequences. This study explored women's perceptions of how attending a fertility assessment intervention influenced their decisions and choices regarding family formation and childbearing.

MATERIAL AND METHODS

Follow-up data from a longitudinal semi-structured qualitative interview study including 20 women aged 35-40 years seeking individual fertility counselling at the Fertility Assessment and Counselling Clinic at Rigshospitalet, Copenhagen, Denmark. The interviews were conducted one year after their consultation. Data were analysed by qualitative content analysis.

RESULTS

The women perceived an increase in their knowledge after they had attended the counselling. The women saw the counselling as a catalyst for change-they changed their behaviour and relationship status. The women stopped thinking about the pros and cons of childbearing and acted instead. The women did not experience any regrets about acting. Some of the women felt that they were still in limbo as they were still in doubt concerning childbearing. The consultation had not given them an answer with a clear deadline in terms of delaying attempts to become pregnant, and this frustrated them.

CONCLUSIONS

Our study highlights the impact of a fertility assessment and counselling intervention which included a perceived increase in knowledge. The clinic allows for an individualized approach to fertility awareness which is necessary given the unique nature of childbearing decisions.

[Socioeconomic Factors and Policies Regarding Declining Birth Rates in Japan]

The factors contributing to the declining birthrate in Japan include the declining marriage rate, an increase in the average age of those getting married, economic burden, childcare burden, later child-bearing, and infertility. There is a gender difference in role division, with 70% of unmarried people live with their parents and continue to work while leaving the household chores to their mothers. The loss of these housekeeping services and the increase in the number of irregular workers are factors contributing to the declining marriage rate and the increase in the average age of those getting married. The expansion of the family support policy in Japan from the male breadwinner model to the earner-career model may have been delayed, but it is expected to provide economic benefits as well as actual childcare service benefits in order to reduce the economic and physical burden of childcare for married couples. It is also necessary to provide education in reproductive health to both men and women in schools and workplaces regarding late child-bearing and infertility. Furthermore, it is necessary to evaluate the cost-effectiveness analysis of improvements in fertility and disclose the relevant information in addition to sharing information on medical technology related to pregnancy/childbirth and treatment of diseases. It is urgent to prepare society for natural and healthy pregnancies/childbirths during optimal child-bearing years.

Fertility facts, figures and future plans: an online survey of university students

Most people want and expect to have children but lack of awareness about the biological limits of fertility may reduce their chance of achieving their parenthood goals. We surveyed Australian university students' intentions and expectations for future parenthood, knowledge about fertility and preferred sources of fertility information. Male and female students (n = 1215) completed an anonymous 34-item online questionnaire. Fewer than 10% did not want children. Of those who wanted children, most (75%) wanted two or more. Although most participants wanted to have children within the biological limits of fertility they also expected to achieve many other life goals before becoming parents. Most underestimated the impact of female and male age on fertility (>75% and >95%, respectively). General practitioners and the Internet were the most preferred sources of fertility information. Almost all stated they would not feel uncomfortable if their general practitioner brought up the topic of future reproductive plans. To help women and men achieve their parenthood goals better education about fertility protection; proactive discussions with young people in primary care settings about reproductive life planning; and social policies and health promotion strategies that support becoming parents during the most fertile years are needed.

Fertility-related knowledge and perceptions of fertility education among adolescents and emerging adults: a qualitative study

Research shows that young people do not know much about their fertility. In the present study, we examined fertility knowledge and perceptions of a fertility educational brochure (i.e. 'A Guide to Fertility') in five focus groups with adolescents (16-18 years, n = 19) and emerging adults (21-24 years, n = 14) who were childless, not currently pregnant (or for men partner not pregnant) or trying to conceive but intending to have a child in the future. Participants (n = 33) reported having poor knowledge of a range of fertility topics and feelings of surprise, fear and concern in response to the brochure, despite perceiving benefits of the provision of fertility education and feasibility of 'A Guide to Fertility'. Comparison between age groups showed that adolescents lacked confidence in their fertility knowledge and emerging adults more frequently referred to gender and family planning issues when considering the fertility information. The findings show the need and importance of ensuring fertility education is tailored to different age groups for it to be integrated at specific stages of the life course and optimize its benefits over costs. Results point to educators and researchers working together to determine how best to disseminate fertility information to relevant age groups.

Development of an evidence-based website on preconception health

INTRODUCTION

Many women and men lack knowledge about fertility, including timing of the fertile window, age-related decline, and lifestyle factors that may impair fertility. The Internet has become an important source of information, but evidence-based information on fertility and reproduction in Swedish on the Internet is limited. The present study aimed to develop and evaluate an evidence-based fertility awareness website, 'reproduktivlivsplan.se', to increase awareness of fertility and provide guidance for improved preconception health and care among individuals and healthcare providers.

METHODS

The website's content, design, and layout were evaluated qualitatively among a total of 20 nursing students. An expert group of researchers also provided feedback on the content. Finally, healthcare providers (n = 24) answered a questionnaire covering attitudes and views on the Reproductive Life Plan website as a tool for counselling.

RESULTS

The developing process resulted in a mobile-friendly website, 'reproduktivlivsplan.se' (in English: Reproductive Life Plan). The website, including the content and layout, was positively evaluated by most participants and was amended according to suggested improvements. Uppsala University was found to be a trustworthy source.

CONCLUSION

The evidence-based website 'reproduktivlivsplan.se' was well received among users and healthcare providers and may provide guidance for improved preconception health and care if it becomes well known and frequently used.