Knowledge and attitudes about assisted reproductive technology: Findings from a Hungarian online survey

The nexus of fertility and politics: exploring the influence of social tolerance, religiosity, and political conservatism on the acceptance of assisted reproduction in Spain

STUDY QUESTION

How do individual religious, political, and social tolerance orientations influence the acceptance of ART among Spanish citizens?

SUMMARY ANSWER

Social tolerance and religiosity are predictive factors for the acceptance of ART, with more tolerant individuals and those with lower levels of religiosity being more accepting of ART; political conservatism mediates the relationship between social tolerance and acceptance of ART, particularly for left-leaning individuals.

WHAT IS KNOWN ALREADY

The rapid advancement of ART has raised questions about its societal acceptance, especially in the context of religious, political, and social beliefs.

STUDY DESIGN, SIZE, DURATION

The analysis utilized data from the combined Europe Values Study and World Values Survey, comprising cross-sectional national surveys from 1981 to 2021. Each country's population was surveyed a maximum of seven times and a minimum of two times during this period. This study uses the cross-sectional data of 2021. After filtering for Spanish citizens and deleting cases with missing key variables, a sample of 1030 valid responses from Spanish citizens was obtained. Quotas were set for sex, age, and educational level, following guidance from the Spanish Statistics Institute.

PARTICIPANTS/MATERIALS, SETTING, METHODS

The study surveyed participants' attitudes towards ART, their religious and political orientations, and collected demographic information. The sample consisted of 51.7% women, most respondents were married or in common-law partnerships, and 61.6% had children. Catholicism was the dominant religion (53.0%) and a majority had completed secondary education (66.2%), with half earning over 1400 euros per month.

MAIN RESULTS AND THE ROLE OF CHANCE

Using two linear models to test hypotheses, the study found that social tolerance and religiosity significantly predict acceptance of ART, with more tolerant and less religious individuals being more accepting. Political conservatism mediated the relationship between social tolerance and ART acceptance, particularly among left-leaning individuals.

LIMITATIONS, REASONS FOR CAUTION

This study is cross-sectional and based on self-reported data, which may have limitations. Additionally, the findings are based on a Spanish sample and may not be universally applicable.

WIDER IMPLICATIONS OF THE FINDINGS

The results have significant implications for policymakers and healthcare professionals in the field of reproductive technologies. They also contribute to public debates on ethical considerations surrounding ART.

STUDY FUNDING/COMPETING INTEREST(S)

This work was funded by the Mineco-FrontVida Program, Frontiers of Life, Social Change, and Changing Values Around the Beginning and End of Life (grant number PID2019-106882RB-I00), as part of the State Program for Knowledge Generation and Scientific and Technological Strengthening, and the State R&D Program Oriented to the Challenges of Society, 2019, Ministry of Science, Innovation, and Universities of Spain. The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

TRIAL REGISTRATION NUMBER

N/A.

Knowledge, attitude, and practice of embryo transfer among women who underwent in vitro fertilization-embryo transfer

Introduction

The infertile patient's knowledge, attitude, and practice (KAP) toward embryo transfer may affect treatment outcomes and the mental health of women who underwent in vitro fertilization-embryo transfer (IVF-ET). This study aimed to investigate the KAP of embryo transfer among women who underwent IVF-ET.

Methods

This cross-sectional study was conducted on women who underwent IVF-ET at our Hospital between May 2023 and November 2023, using a self-designed questionnaire.

Results

A total of 614 valid questionnaires were finally included. The mean KAP scores were 19.46 ± 5.06 (possible range: 0 28), 39.41 ± 5.20 (possible range: 12-60), and 48.02 ± 6.75 (possible range: 0-60), respectively. The structural equation model demonstrated that knowledge has a direct effect on attitude (β = 0.27, p < 0.001) and attitude has a direct effect on practice (β = 0.55, p < 0.001) and anxiety (β = 0.59, p < 0.001). Moreover, multivariable linear regression analysis showed that anxiety score [coefficient = 0.09, 95% confidence interval (CI): 0.03-0.16, p = 0.003], BMI (coefficient = 0.09, 95%CI: 0.03-0.16, p = 0.003), education (coefficient = 5.65-6.17, 95%CI: 1.09-10.7, p < 0.05), monthly per capita income (coefficient = 1.20-1.96, 95% CI: 0.21-3.07, p = 0.05), reasons for IVF (coefficient = -1.33-1.19, 95% CI: -2.49-0.09, p < 0.05), and more than 5 years of infertility (coefficient = -1.12, 95% CI: -2.11-0.13, p = 0.026) were independently associated with sufficient knowledge. Knowledge (coefficient = 0.19, 95% CI: 0.12-0.26, p < 0.001), anxiety (coefficient = 0.39, 95% CI: 0.34-0.45, p < 0.001), monthly per capita household income >10,000 (coefficient = 1.52, 95% CI: 0.61-2.43, p < 0.001), and three or more cycles of embryo transfer (coefficient = -2.69, 95% CI: -3.94-1.43, p < 0.001) were independently associated with active attitude. Furthermore, attitude (coefficient = 0.21, 95% CI: 0.11-0.30, p < 0.001) and anxiety (coefficient = 0.57, 95% CI: 0.49-0.65, p < 0.001) were independently associated with proactive practice.

Discussion

Women who underwent IVF-ET had inadequate knowledge and negative attitudes but proactive practice toward embryo transfer, which were affected by anxiety, income, and reasons for IVF. It is necessary to strengthen the continuous improvement of patient education to improve the management of embryo transfer.

What Do the General Public Know about Infertility and Its Treatment?

Rates of infertility are rising, and informed decision making is an essential part of reproductive life planning with the knowledge that ART success decreases dramatically while a woman's age increases and that high costs can often be incurred during fertility treatment. We aimed to determine the current knowledge of infertility and its treatments in the general public through an online survey. We received 360 complete responses. The average age of respondents was 35 years with most respondents being female (90%), heterosexual (88%), white (85%) and university educated (79%). Of the total, 49% had children and 23% had a condition that affects their fertility; 41% had concerns about future fertility and 78% knew someone who had had fertility treatment. Participants' understanding of basic reproductive biology and causes of infertility varied with correct responses to questions ranging from 44% to 93%. Understanding of IVF outcomes was poorer with only 32% to 55% of responses being correct, and 76% of respondents felt that their education in fertility was inadequate. This survey highlights the inconsistencies in the general public's understanding of infertility in this relatively educated population. With increasing demands on fertility services and limited public funds, better education is essential to ensure patients are fully informed with regard to their reproductive life planning.

Psychometric properties of persian version of the cardiff fertility knowledge scale (CFKS-P)

Background

The level of fertility knowledge of reproductive-age people is low to moderate, and the inadequate knowledge of infertility-related factors may cause some people to unconsciously engage in activities that reduce their fertility. Given the significance of fertility knowledge, and the lack of standard instruments to evaluate it in Iran, the present study aimed at determining psychometric properties of the Persian version of the Cardiff Fertility Knowledge Scale (CFKS-P) in Iranian population.

Materials and methods

In this cross-sectional study, a total of 280 participants (comprising 140 couples) attending mandatory pre-marriage educational sessions at two public health centers in Tehran were consecutively sampled from July to September 2021. The study examined the face, content, and structural validity (through confirmatory factor analysis) of the questionnaire. The reliability of the questionnaire was assessed using measures of internal consistency.

Results

The structural validity of CFKS-P was approved with 13 items and two factors (basic knowledge of fertility and misconception about fertility) based on confirmatory factor analysis (RMSEA = 0.023, 90 % CI = 0.053-0.082, TLI = 0.916 and CFI = 0.972, χ 2 = 148.345). Kuder-Richardson coefficient of the scale was calculated to be 0.85. The overall percentage of correct answers for fertility knowledge was 50.76 %.

Conclusion

The CFKS-P is a valid and reliable instrument for measuring the fertility knowledge in Iranian men and women. This scale can help the health care providers to assess the fertility knowledge of their clients or the quality of health education provided.

Analysis of the relationship between religion, abortion, and assisted reproductive technology: Insights into cross-national public opinion

With advancement in reproductive technologies, public opinion regarding these procedures varies considerably across the world. While prominent public debates have focused on abortion, we know less about the factors shaping feelings regarding Assisted Reproductive Technologies (ART). Both procedures challenge the idea that human life starts with conception - with the fertilization of an embryo. Using European Values Survey data and multilevel modeling, we compare how religion and other personal and country-level factors shape disapproval toward abortion and ART. Conservative Protestants and people who are more engaged with their religion and live in a more religious country are more likely to disapprove of abortion and ART. More supportive polices and attitudes regarding ART, but not abortion, are correlated. Additionally, economic development moderates the relationship between personal religiosity and abortion, but not ART. This finding provides important insight into why abortion has remained such a controversial issue, even in richer nations.

Balancing career goals and parenthood desires: results from a survey of undergraduate pre-health students at a hispanic-serving institution in Texas

OBJECTIVE

To examine family planning and fertility experiences and views, as well as desired parenthood timing and career plans, of diverse undergraduate pre-health students.

PARTICIPANTS

266 pre-health undergraduate students attending a Hispanic-Serving Institution in South Texas.

METHODS

We conducted a cross-sectional, online survey with a purposive sample of undergraduate students and analyzed data descriptively.

RESULTS

Most students desired children in the future but were concerned about planning the timing of parenthood against their career training. The results highlight the need to improve both family planning and fertility knowledge, based on a high unmet need for contraceptives, low perceived knowledge about fertility/infertility treatment, and a desire to learn more about planning the timing of their career training alongside parenthood.

CONCLUSIONS

This study highlights potential gaps in reproductive health information and services among diverse, health-focused students needed to inform choices about the timing of their families and career training.

The social infertility cycle model

Infertility poses an immense challenge to contemporary society. Around one in six people worldwide trying to conceive a child are facing infertility. This situation exists in an age of great technological developments where advances in medicine have made infertility treatment widely available and increasingly effective. In this article, a model will be presented that aims to explain the individual and social functioning of individuals and couples undergoing infertility treatment using assisted reproductive methods. The model was developed on the basis of a series of studies carried out by the author and colleagues during 2015-2021. The social infertility cycle model was proposed as the outcome of further research steps that were taken. The model takes into consideration the factors and behaviours of couples with infertility that determine the quality of their everyday functioning as well as the effectiveness of infertility treatment. The successive steps of the research process will be outlined in the article along with a presentation of the developed model.

Manipulated sperm motility via soot nanoparticles-induced biochemical alterations in human seminal plasma

Obtaining spermatozoa with progressive motility, via postejaculatory activation with pharmacological agents such as theophylline and pentoxifylline, is crucial for the success rate of assisted reproduction in couples with severe male factor infertility. Regrettably, the possibility of premature acrosome reactions and impared oocyte function questions the practical applicability of phosphodiesterase inhibitors. The rapid development of nanotechnologies promotes the use of hydrophobic rapeseed oil soot as a non-cytotoxic biomaterial for sperm motility activation, but the scarcity of knowledge regarding the interactions of soot with components from the seminal plasma hinders the eventual commercialization of this cutting-edge approach. Aiming to eliminate this shortcoming, the current study shows for the first time how the soot nanomaterials alter the biochemistry of human seminal plasma. Upon 270 min incubation with soot nanoparticles, the activity of AST, ALT, CK, LDH and GGT enzymes in the seminal plasma of ten patients changes inversely to the registered sperm motility (i.e., lower enzyme activity, higher sperm motility and vice versa). This phenomenon is primarily related to termination of the enzymes-substrate binding or extraction of enzymes from the gametes via chemical bonding with the soot. These novel mechanisms depend on the physicochemical features of used carbon nanomaterials, revealing opportunities for predictable tuning of the sperm reproductive potential.

Attitudes and Knowledge of Infertile Iranian Couples Among Treatment With Assisted Reproductive Technologies During COVID-19 Pandemics

Objective: The coronavirus disease 2019 (COVID-19) pandemic affected the continuation of all non-emergency medical treatment and patients potentially suffer from restrictions including patients under infertility treatment. This study aimed to evaluate the knowledge and attitudes of infertile couples about continuing assisted reproductive technologies (ARTs) therapy during the COVID-19 outbreak, in Sari, Iran. Materials and methods : We conducted a prospective longitudinal investigation on potential infertile couples for treatment with ARTs referred to our infertility clinic from March 2020 to June 2020. Ninety-two patients were studied voluntarily and anonymously in this study. A self-developed structured questionnaire was used to assess the attitude towards continuing infertility treatment. A P-value of less than 0.05 was considered statistically significant. Results: Thirty-two patients (33.33%) had decreased motivation to continue treatment during the COVID-19 pandemic. Fear of transmission to the fetus (28.13%) had the highest frequency among the causes of decreased motivation to continue treatment (P-value = 0.011). Trust on the support of the treatment team (56.67%) was the most common reason for not reducing motivation in patients without decreased motivation (P <0.001). Conclusion: Despite the COVID-19 pandemy, in Iran most infertile patients tended to continue ARTs. Although many patients had passable knowledge on COVID-19, the stress of infertility and the high desire of infertile couples to have children did not deter them from continuing their therapy.

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.