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

A systematic review of interventions to improve male knowledge of fertility and fertility-related risk factors

Male infertility is a global health concern. The effectiveness of interventions developed to improve males' knowledge of fertility regulation and fertility-related risk factors remains unclear. This systematic review aimed to synthesize and evaluate the evidence for these interventions. Four databases were searched from inception to June 2023. Eligible studies examined interventions to increase fertility knowledge among presumed fertile males aged ≥16 years of age. Conference abstracts, protocols and studies without sex-disaggregated results for males were excluded. A narrative synthesis without meta-analysis was performed. A total of 4884 records were identified. Five studies (reported in six publications), all conducted in high-income countries, were included. Two were randomized control trials, and three were experimental studies. Interventions were delivered in person by a health professional (n = 3), online and via a mobile app. All studies showed a significant improvement in knowledge of fertility or fertility-related risk factors from baseline to follow-up. The largest improvement was observed for secondary and vocational students. A moderate, long-term retainment of knowledge was observed at two-year follow-up in one study. Available evidence suggests interventions to improve males' fertility knowledge are effective, particularly for younger, less educated males.

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.

The sexual and reproductive health knowledge of women in Australia: A scoping review

ISSUE ADDRESSED

Sexual and reproductive health (SRH) knowledge influences health literacy and promotes positive health behaviours. This scoping review explores the SRH knowledge of women in Australia and reports on knowledge assessment, ways of learning, enablers and barriers, and interventions to improve knowledge.

METHODS

Seven databases were searched for eligible articles published in English between 2012 and 2022.

RESULTS

Eighty-five sources were included for analysis. Data were mapped by knowledge topic and population group and charted against four review objectives. Assessment of knowledge was the primary focus in 59% of sources. Two sources used a validated knowledge assessment tool. Knowledge was assessed using self-assessment, a measurement of correctness, or both. Women learnt about SRH through a range of sources, including healthcare providers, peers, family, internet, and school. Enablers and barriers spanned information content, delivery, timing, accessibility, interactions with those providing information, cultural and gendered norms, pre-migration experiences, and functional health literacy. Nine sources reported on interventions to facilitate SRH knowledge.

CONCLUSIONS

This review identified topics, population groups, and gaps in assessment of SRH knowledge of women in Australia. Overall, the measurement of women's SRH knowledge is largely conducted using unvalidated tools focusing on specific topics. SO WHAT?: It is recommended a validated tool be developed to comprehensively assess the SRH knowledge of women in Australia allowing for intersectional population analysis and exploration of knowledge conceptualisation. This would enable assessment of interventions aiming to improve SRH knowledge thereby facilitating improved health literacy and outcomes.

Fertility Knowledge and Educational Experiences of Graduating Medical Students: A Multi-Institution Survey

Objective: Our goal was to assess the fertility knowledge and educational experiences of graduating U.S. medical students to evaluate areas of improvement for future educational interventions. Design: Web-based cross-sectional survey. Subjects: Medical students graduating in 2023 from the University of Miami Miller School of Medicine (SOM), New York University (NYU) Grossman SOM, Wayne State University SOM, Perelman SOM at the University of Pennsylvania, and Mayo Clinic Alix SOM. Main Outcome Measures: Fertility-related knowledge and educational experiences of U.S. medical students in their final year of school. Results: In total, 117 students (14.4%) completed the survey. The average knowledge score was 78%. Twenty-three (22%) overestimated the age of most precipitous fertility decline, and 50 (52%) overestimated the chance of getting pregnant for a 40-year-old person with ovaries. One-third of students (30, 32%) incorrectly believe that physicians have equivalent infertility rates to the general population. Students were less cognizant of male fertility issues, incorrectly believing there was no negative impact on male fertility by age (43, 42%) among other factors. Seventy-five (81%) reported less than 5 hours of fertility-related education in medical school. Only one-third (32%) were satisfied or very satisfied with the fertility education they received. In an open-response question, students expressed interest in additional education on transgender and cancer patient care, fertility preservation, assisted reproductive technologies, and reproductive life planning in medicine. Conclusions: There is a need and an opportunity for medical education programs to enhance fertility education. Giving students and trainees the knowledge required to make informed decisions for their family-building purposes and improving their ability to counsel patients adequately should be a goal of future educational endeavors. The data collected in this study will serve as a guide for the development of fertility-related learning modules for medical students and trainees.

Translation and psychometric evaluation of the Korean version of the Reproductive Concerns After Cancer Scale (RCAC)

BACKGROUND

Improving cancer survival rates highlights post-treatment fertility implications for reproductive-aged women. To provide fertility care for cancer survivors, nurses need instruments to assess and communicate reproductive concerns with cancer survivors and healthcare providers. This study aimed to translate the Reproductive Concerns after Cancer Scale (RCAC) into Korean and examine its psychometric properties in young female cancer survivors in South Korea.

METHODS

The RCAC was translated into Korean, involving expert bilingual translators for initial translation and reverse translation for cultural and semantic accuracy. In detail, the RCAC was translated into Korean and evaluated in a preliminary study involving 10 cancer survivors. Subsequently, a revised version of the instrument was administered to 182 cancer survivors and a psychometric evaluation was conducted. The process included verifying content validity, and then assessing construct validity using exploratory factor analysis and criterion validity. The reliability of the instrument was quantified by measuring its internal consistency using Cronbach's alpha.

RESULTS

The translated RCAC demonstrated an item-level content validity index of 1.0 and a scale-level index of 1.0. The content was finalized based on preliminary survey findings, which revealed that all participants thought the instrument was clear. The Korean version of the RCAC demonstrated a satisfactory level of validity per exploratory factor analysis, which resulted in a 14-item instrument consisting of three subscales: "fertility potential" (six items), "health problem" (five items), and "acceptance" (three items). The items and subscales explained 57.6% of the variance. Criterion validity was confirmed through an analysis of the correlation between the Korean version of the RCAC and both the FACT-G (r = -0.36, p < .001) and PHQ-9 (r = 0.38, p < .001). Cronbach's alpha coefficient of the Korean version of the RCAC was 0.83.

CONCLUSIONS

The Korean version of the RCAC is a valid and reliable instrument for assessing reproductive concerns in female cancer survivors. Thus, this instrument can be used to provide tailored care to female cancer survivors of reproductive age by clarifying and assess their reproductive concerns. This may support the development of guidelines or policies to provide care for those with reproductive concerns who require nursing care.

How to talk to young adults about fertility

RESEARCH QUESTION

How knowledgeable are Danish young adults about fertility and what are their attitudes towards learning about their reproductive biology?

DESIGN

The study was conducted at different educational institutions with 11 focus-group discussions that included a total of 47 participants (aged 18-29 years). Qualitative content analysis was used. The participants' fertility knowledge score was measured using the Cardiff Fertility Knowledge Scale.

RESULTS

The participants had an overall fertility knowledge score of 54%. Focus-group data showed that they thought it was important to learn about fertility and how to protect their fertility potential regardless of whether or not they wanted children. Providing knowledge is like planting a seed in the young adults. They wanted to hear about fertility in multifaceted ways and formats, and believed the information should be delivered by professionals, but developed in partnership with young people. The double-edged sword of knowledge and the consequence of knowledge made them hesitant or less open to learning.

CONCLUSIONS

Recommendations from this study are to tailor fertility information to young people, with due cognisance of their developmental stage, and ideally from an earlier age.

Exploring online reproductive health promotion in Canada: a focus on behavioral and environmental influences from a sex and gender perspective

BACKGROUND

Reproductive health promotion can enable early mitigation of behavioral and environmental risk factors associated with adverse pregnancy outcomes, while optimizing health of women + (all genders that can gestate a fetus) and babies. Although the biological and social influences of partners on pregnancy are well established, it is unknown whether online Canadian government reproductive health promotion also targets men and partners throughout the reproductive lifespan.

METHODS

Reproductive health promotion, designed for the general public, was assessed in a multi-jurisdictional sample of Canadian government (federal, provincial/territorial, and municipal) and select non-governmental organization (NGO) websites. For each website, information related to environmental and behavioral influences on reproductive health (preconception, pregnancy, postpartum) was evaluated based on comprehensiveness, audience-specificity, and scientific quality.

RESULTS

Government and NGO websites provided sparse reproductive health promotion for partners which was generally limited to preconception behavior topics with little coverage of environmental hazard topics. For women + , environmental and behavioral influences on reproductive health were well promoted for pregnancy, with content gaps for preconception and postpartum stages.

CONCLUSION

Although it is well established that partners influence pregnancy outcomes and fetal/infant health, Canadian government website promotion of partner-specific environmental and behavioral risks was limited. Most websites across jurisdictions promoted behavioral influences on pregnancy, however gaps were apparent in the provision of health information related to environmental hazards. As all reproductive stages, including preconception and postpartum, may be susceptible to environmental and behavioral influences, online health promotion should use a sex- and gender-lens to address biological contributions to embryo, fetal and infant development, as well as contributions of partners to the physical and social environments of the home.

Knowledge of fertility period among reproductive age women in Kenya: a multilevel analysis based on 2022 Kenyan demographic and health survey

BACKGROUND

Knowledge of the fertility period aids women in refraining and engaging in sexual intercourse to avoid and to get pregnant, respectively. The effect of community-level factors on knowledge of the fertility period was not yet known in Kenya. Therefore, we aimed to investigate the community- and individual-level determinants of knowledge of fertility period among women of childbearing age in Kenya.

METHODS

The 2022 Kenyan Demography and Health Survey data was used for the current study. This study included 16,901 women of reproductive age. To account for the clustering effects of DHS data and the binary nature of the outcome variable, a multilevel binary logistic regression model was applied. An adjusted odds ratio with a 95% confidence interval was reported to declare the statistical significance. In addition, the model that had the lowest deviance was the one that best fit the data.

RESULTS

The overall prevalence of knowledge of the fertility period among Kenyan women was 38.1% (95%CI = 37.3, 38.9). Women's age, women's education status, heard FP, contraceptive use, media exposure, and distance from health facility significant individual factors while place of residence, and community-level education, were all of factors were found to be strongly associated with knowledge of fertility period.

CONCLUSION

As per the findings of our study, Knowledge of the fertility period among reproductive women was low in Kenya. In the era of increasing refusal of hormone-based family planning, fertility-awareness-based family planning methods may be an option. Promoting the correct fertility period through education and media outreach may be helpful strategies for enhancing fertility decision-making.

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.

Engaging and (the Illusion of) Learning? Examining the Relationship Between Different Social Media Activities and Reproductive Health Knowledge

Social media have become fundamental platforms for learning about health, including reproductive health knowledge. However, little is known about what specific user activity is conducive to learning about reproductive health and by what means. Drawing upon the cognitive mediation model, this study examines how different social media activities function in terms of elaboration and knowledge gain. Our hypothesized model was largely supported by a nationwide online survey with 1,000 Chinese women residing in both rural and urban areas. The results revealed the crucial role of information elaboration in bridging different social media activities with both subjective and factual reproductive health knowledge. Interestingly, public reposting of reproductive health information was found to be positively related to subjective knowledge but negatively related to factual knowledge, suggesting the emergence of an illusion of knowing among our participants. Multigroup SEM analyses revealed that the positive roles of scanning and private sharing in encouraging elaboration were more pronounced among users with lower levels of need for cognition. The findings are expected to contribute to a more nuanced understanding of health learning based on users' social media activities and intrinsic motivations for learning.

Acceptance and commitment therapy adapted for women with infertility: a pilot study of the Infertility ACTion program

BACKGROUND

Approximately one in six couples are currently infertile, defined as unable to achieve pregnancy despite 12 or more months of active attempts to conceive. Experiencing infertility has been disproportionately associated with an array of psychological difficulties, particularly in women. However, currently available psychological interventions have had minimal benefits for distress, anxiety, or depression related to infertility.

METHODS

A one-arm pilot study was conducted to test the acceptability of a newly created acceptance and commitment therapy-based self-guided program-Infertility ACTion. Twenty women, located in Canada, completed the program and completed measures assessing expectancy of improvement, treatment credibility, participant satisfaction, treatment completion and retention, psychological flexibility, fertility quality of life, depression, and anxiety. Participants were also asked to provide feedback on how the researchers could improve the intervention. Paired sample t-tests were conducted to compare pre- and post-intervention outcomes.

RESULTS

Sixteen out of 20 participants completed the entire intervention. Reported treatment expectancy, credibility and satisfaction were favorable. Eighty-one percent of participants reported that they would recommend the program to a friend and 88% thought the program was worth their time. Medium increases in psychological flexibility and fertility quality of life were observed. Improvements in anxious and depressive symptoms were in the small to medium range but were not significant. Participants had several recommendations for program improvement.

CONCLUSIONS

This acceptance and commitment therapy-based self-guided program proved to be an acceptable treatment for infertility-related distress. Participant feedback will be used to adjust the current intervention in preparation for a more rigorous randomized-controlled trial testing this program.

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.

Validity and reliability study of the Cardiff Fertility Knowledge Scale in Turkish

AIM

This study aims to determine the Turkish validity and reliability of the Cardiff Fertility Knowledge Scale.

METHODS

This methodological research was conducted between April and December 2022 with 302 married individuals at a health center in Kocaeli province, Turkey. Research data were collected using a Personal Information Form and the Cardiff Fertility Knowledge Scale. Content construct and face validity, item analysis, factor analysis, and internal consistency were used to evaluate the data.

RESULTS

The content validity index of the scale was found to be 0.97, and the Cronbach's alpha coefficient for the Turkish version was 0.68. The total scores of the top 27% group were significantly higher than the scores of the bottom 27% group (p < 0.01). As a result of the analyses, the final version of the scale consisted of 11 items and had a single factor structure, explaining 44.45% of the scale's variance.

CONCLUSION

The results of the study demonstrate that the Turkish version of the Cardiff Fertility Knowledge Scale is a valid and reliable measurement tool that can be used to assess individuals' fertility knowledge.

Individual and community-level determinants of knowledge about fertile periods among adolescent girls and young women (10-24 years) in Sub-Saharan Africa: A multilevel mixed effect analysis of a recent demographic and health survey

Background

Identifying fertility periods accurately will protect teenage girls and young women from unintended pregnancies and related complications. However, in Sub-Saharan Africa, knowledge of the fertile period among adolescent girls and young women is not well studied. Thus, the purpose of this study was to assess adolescents' and young women's knowledge regarding fertility periods and its determinants in Sub-Saharan Africa.

Methods

The most recent demographic and health surveys' data were used. The study had 140,064 participants in all. The data was analyzed using STATA/SE version 14. Using a multilevel logistic regression model, factors associated with knowledge of fertile periods have been determined. P-values <0.05 showed the significance of the factors associated with the outcome variable. The data were interpreted using the adjusted odds ratio and confidence interval. The best-fit model was determined to be the one with the highest logliklihood ratio and the lowest deviance.

Results

One in five (20%) women between the ages of 10 and 24 had accurate knowledge about the fertile period. Age (AOR = 1.44, 95% CI: 1.40, 1.49), educational level (AOR = 1.68, 95% CI: 1.60, 1.77), knowledge of family planning (AOR = 1.33, 95% CI: 1.27, 1.39), distance (AOR = 2.31, 95% CI: 2.02, 2.98), residence (AOR = 1.06, 95% CI: 1.02, 1.10), and low community poverty (AOR = 3.06, 95% CI: 3.01, 3.12) had higher odds of knowledge about fertile period.

Conclusion

This research finds that adolescents and young women in sub-Saharan Africa have low knowledge of the reproductive period. It was discovered that factors at the individual and communal levels influence women's knowledge of the fertile period. While developing policies and strategies, the health ministries of Sub-Saharan African countries had to take into consideration input from women whose experiences indicated that obtaining reproductive health services was hindered by distance.

Counteracting sexual and reproductive health misperceptions: Investigating the roles of stigma, misinformation exposure, and information overload

OBJECTIVE

Sexual and reproductive health (SRH) misperceptions constitute a critical precursor to undesired health outcomes for women. Drawing on the model of stigma management communication and exposure effects, we aimed to investigate the underlying processes of SRH misperceptions.

METHODS

A nationwide survey was conducted via quota sampling with Chinese women (N = 1000). Structural equation modeling with maximum likelihood estimation and 5000 bootstrapping resamples were used to test the hypotheses.

RESULTS

Stigma perceptions positively predicted information avoidance (β = 0.207, p < 0.001), which, in turn, was positively associated with misperceptions (β = 0.195, p < 0.001). Misinformation exposure significantly predicted misperceptions (β = 0.607, p < 0.001), and this relationship was mediated by information avoidance (β = 0.020, 95% CI [0.007, 0.040]). Moreover, information overload strengthened the relationship between misinformation exposure and information avoidance (β = 0.153, p < 0.001) as well as the relationship between misinformation exposure and misperceptions (β = 0.077, p = 0.006).

CONCLUSION

Stigma and misinformation exposure play prominent roles in the formation of SRH misperceptions. Information overload facilitates the misinformation-misperception transformation.

PRACTICE IMPLICATIONS

To counteract SRH misperceptions, health education should alleviate SRH stigma perceptions and strategically design messages to avoid information avoidance and overload.

Declining global fertility rates and the implications for family planning and family building: an IFFS consensus document based on a narrative review of the literature

BACKGROUND

Family-planning policies have focused on contraceptive approaches to avoid unintended pregnancies, postpone, or terminate pregnancies and mitigate population growth. These policies have contributed to significantly slowing world population growth. Presently, half the countries worldwide exhibit a fertility rate below replacement level. Not including the effects of migration, many countries are predicted to have a population decline of >50% from 2017 to 2100, causing demographic changes with profound societal implications. Policies that optimize chances to have a child when desired increase fertility rates and are gaining interest as a family-building method. Increasingly, countries have implemented child-friendly policies (mainly financial incentives in addition to public funding of fertility treatment in a limited number of countries) to mitigate decreasing national populations. However, the extent of public spending on child benefits varies greatly from country to country. To our knowledge, this International Federation of Fertility Societies (IFFS) consensus document represents the first attempt to describe major disparities in access to fertility care in the context of the global trend of decreasing growth in the world population, based on a narrative review of the existing literature.

OBJECTIVE AND RATIONALE

The concept of family building, the process by which individuals or couples create or expand their families, has been largely ignored in family-planning paradigms. Family building encompasses various methods and options for individuals or couples who wish to have children. It can involve biological means, such as natural conception, as well as ART, surrogacy, adoption, and foster care. Family-building acknowledges the diverse ways in which individuals or couples can create their desired family and reflects the understanding that there is no one-size-fits-all approach to building a family. Developing education programs for young adults to increase family-building awareness and prevent infertility is urgently needed. Recommendations are provided and important knowledge gaps identified to provide professionals, the public, and policymakers with a comprehensive understanding of the role of child-friendly policies.

SEARCH METHODS

A narrative review of the existing literature was performed by invited global leaders who themselves significantly contributed to this research field. Each section of the review was prepared by two to three experts, each of whom searched the published literature (PubMed) for peer reviewed full papers and reviews. Sections were discussed monthly by all authors and quarterly by the review board. The final document was prepared following discussions among all team members during a hybrid invitational meeting where full consensus was reached.

OUTCOMES

Major advances in fertility care have dramatically improved family-building opportunities since the 1990s. Although up to 10% of all children are born as a result of fertility care in some wealthy countries, there is great variation in access to care. The high cost to patients of infertility treatment renders it unaffordable for most. Preliminary studies point to the increasing contribution of fertility care to the global population and the associated economic benefits for society.

WIDER IMPLICATIONS

Fertility care has rarely been discussed in the context of a rapid decrease in world population growth. Soon, most countries will have an average number of children per woman far below the replacement level. While this may have a beneficial impact on the environment, underpopulation is of great concern in many countries. Although governments have implemented child-friendly policies, distinct discrepancies in access to fertility care remain.

Women's Awareness of Reproductive Health

Background and Objectives: reproductive disorders are a serious global concern in medical, social, and demographic contexts. According to estimates, approximately 10-15% of couples around the world suffer from infertility. Numerous studies have shown that modifiable lifestyle factors, such as a high-fat diet, a postponed decision to start a family, tobacco smoking, alcohol consumption, risky sexual behavior, psychiatric diseases, and chronic stress, have a negative influence on the fertility of women. The main goal of this study is to assess the knowledge of women about reproductive health, infertility risk factors, and causes of infertility and to determine whether the level of this knowledge varies based on sociodemographic variables. Materials and Methods: a survey was conducted among 111 patients who anonymously filled in a questionnaire comprising questions regarding fertility and its deficiencies. The results were analyzed using the Chi-square test and Fisher's test. Results: the survey results indicated that women had a good or very good level of knowledge of the causes of infertility. The obtained test results were statistically significant (p < 0.05), but the studied group did not possess sufficient knowledge of the symptoms characterizing the diseases related to limited fertility (p > 0.05). The level of knowledge on the diagnosis of infertility did not depend on the age of the examined people, their educational level, or personal experience in this field (p > 0.05). The results also revealed that the awareness of women on reproductive health was poor. The studied women had a low level of knowledge of infertility risk factors, and their knowledge did not correlate with age, educational level, or personal experiences. Conclusions: information on the aspects of reproductive health should be widely disseminated through public educational campaigns, aimed at correcting erroneous convictions among women about the risk factors for infertility and assisting them in improving fertility.

Feasibility and effectiveness of preconception check-ups at workplaces in Japan

OBJECTIVES

Despite the recent increase in infertility and perinatal complications, preconception care is not commonly available in Japan. Working women are considered to have the greatest need for preconception care, as increasingly they marry and have children later in life. This study aimed to assess the feasibility and effectiveness of preconception check-ups in the workplace.

METHODS

We provided 51 female employees aged 18-39 years with free preconception check-ups, including additional blood tests and an online medical questionnaire, during mandatory health check-ups at their workplace. A doctor provided online counseling based on the check-up results. We assessed fertility knowledge using the Cardiff Fertility Knowledge Scale (CFKS-J) and childbearing desire pre- and postintervention.

RESULTS

Preconception check-ups revealed various potential risk factors for future pregnancies, including underweight (12%), obesity (20%), Chlamydia trachomatis IgG antibody positivity (22%), low rubella IgG antibody levels (47%), iron deficiency (12%), and 25-hydroxyvitamin D levels <30 ng/mL (98%). Postintervention, the participants reported high satisfaction with the check-ups and significantly advanced their reproductive plans (P = .008). Furthermore, 95% of the participants indicated an intention to seek medical attention or make lifestyle changes. The postintervention CFKS-J score (mean [SD]) was higher than the preintervention score (71.7 [19.3] vs 63.0 [22.0]; P = .006).

CONCLUSIONS

We developed a preconception check-up package that can be integrated into workplace health examinations, complemented by tailored counseling. This novel check-up package is a feasible and effective approach for improving preconception health and fertility awareness.

The effect of an educational animation on knowledge of testicular health and fertility of adolescents

STUDY QUESTION

Does the provision of an educational animation, developed with young people, about testicular health and fertility impact the knowledge of these topics among adolescents?

SUMMARY ANSWER

The development and provision of education on testicular health and fertility were welcomed by adolescents and associated with a significant increase in knowledge.

WHAT IS KNOWN ALREADY

Young people may know less than they should about testicular health and male fertility topics. Lack of knowledge can have implications for health including late medical help-seeking for signs and symptoms of scrotal disorders, such as torsion, for which late presentation frequently results in testicular damage.

STUDY DESIGN, SIZE, DURATION

A mixed methods experimental pre- and post-design was used with embedded qualitative data collection. High school students completed a pre-animation questionnaire, watched four animations on testicular health and fertility, and completed a post-animation questionnaire. Data were collected during Personal Social and Health Education lessons across a 2-week period.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Four animations on testicular health and fertility, informed by andrologists, academics, designers, boys, and young men, were developed. Eligible participants were boys and girls in the UK school years 8 and 9 (age 13-14 years). Participants completed a Time 1 (T1) survey (fertility knowledge, demographics) prior to watching the animations and a Time 2 (T2) survey (fertility knowledge, perceptions of the animations) immediately after the animations. Perceptions were rated on 10-point response scales (higher scores better). Participants additionally expressed in their own words positive and negative aspects of the animations. ANOVA was used to examine the effects of the animations using a 2 (time: T1, T2)×2 (gender: male, female) design on topic knowledge, perceived importance, usefulness, and style of the animations according to gender. Regression analysis examined the associations between gender, disability, class year, and knowledge at T2 while controlling for knowledge at T1. Qualitative data on perceptions of the animations were analyzed using inductive thematic analysis.

MAIN RESULTS AND THE ROLE OF CHANCE

Results showed that the animations significantly increased testicular health and fertility-related knowledge from T1 (x̄=41.84 ± 24.72) to T2 (x̄=79.15, ±15.04). Boys had significantly higher levels of knowledge compared to girls at T1 (x̄=44.74, SD = 25.16 versus x̄=37.79 ± 23.49, respectively) and T2 (x̄=80.07, SD = 15.68 versus x̄=77.89 ± 14.30, respectively) but knowledge gain from T1 to T2 was not significantly different according to gender (P = 0.11) as shown by non-significant gender×time interaction. There were no significant gender differences in the perceived usefulness and importance of the animations or liking of the style of the animations, with both genders considering the animations as useful, important, and likable. Regression analysis showed only knowledge at T1 to be significantly associated with knowledge at T2. Qualitative data showed three main themes: accessibility of important and useful information; information engagement and help-seeking behaviour; and inclusivity of information.

LIMITATIONS, REASONS FOR CAUTION

This was a pre- and post-study with a sample of young people from a selected educational institution without a control group. Only short-term effects of the animations were recorded.

WIDER IMPLICATIONS OF THE FINDINGS

Adolescents are interested in and learn from the provision of engaging fertility-related information. Boys and men should be considered as being a relevant target population for fertility education, not just girls and women.

STUDY FUNDING/COMPETING INTEREST(S)

This research was carried out in partnership with the British Fertility Society, was financially supported by an Economic and Social Research Council Impact Acceleration Award (520792) and commercial sponsorship from iMediCare Ltd, Bayer AG, Merck Group, Cryos International given to the British Fertility Society, and a financial contribution from Orchid Cancer Appeal. The authors are fully responsible for the content of the animations and this manuscript, and the views and opinions described in the publication reflect solely those of the authors. J.B. reports a grant from Merck Serono Ltd outside the submitted work. C.H., G.G., A.D., E.B., U.G., M.L, B.W., and M.H. declare no conflict of interest. K.M. reports honoraria from Bayer and Merck. A.P. reports paid consultancy for Cryos International, Cytoswim Ltd, Exceed Health, and Merck Serono in the last 2 years, but all monies have been paid to the University of Sheffield.

TRIAL REGISTRATION NUMBER

N/A.

Spatial variations and determinants of knowledge of ovulatory period among young women in Ethiopia: a spatial and multilevel analysis using 2016 EDHS

BACKGROUND

Knowledge of the ovulatory period enables women in avoiding and engaging in sexual intercourse either to avoid and to have pregnancy as desired. It has been reported that young people have less knowledge of the ovulatory period. There is limited evidence about the spatial variability of knowledge of the ovulatory period among young women in Ethiopia. Hence, this study aimed to assess the spatial variation and factors sociated with knowledge of the ovulatory period among youths in Ethiopia for providing geographically targeted interventions.

METHOD

A secondary data analysis was carried out using the 2016 Ethiopian Demographic and Health Surveys with a total weighted sample of 6143 youths. Multilevel logistic regression analysis was utilized to identify factors influencing knowledge of the ovulatory period. ArcGIS version 10.7 software and Kuldorff's SaTScan version 9.6 was used for the spatial analysis.

RESULTS

Being older youth [AOR = 1.98; 1.46, 2.70], youths having primary education [AOR = 1.70; 1.23, 2.35], youths having secondary & higher education [AOR = 2.30; 1.41, 3.74], youths whose husbands have primary education [AOR = 1.39; 1.02, 1.91], and youths who use contraception [AOR = 1.66; 1.24, 2.22] were significant predictors of knowledge of ovulatory period. Knowledge of the ovulatory period among youth had non random spatial distribution across Ethiopia, and the primary clusters of incorrect knowledge of the ovulatory period were observed in Somalia, SNNPR, Benishangul gumuz, and Gambella regions of Ethiopia.

CONCLUSION

There was a non-random spatial pattern in the distribution of knowledge of the ovulation period among young women in Ethiopia. Age of youth, educational status, education of husband, and contraceptive use were significant predictors of knowledge of the ovulatory period among young women in Ethiopia. Hence, interventions should prioritize at-risk youths residing in regions with limited knowledge of the ovulatory period to enhance their awareness of the fertility window.

Global fertility care with assisted reproductive technology

Assisted reproductive technology has progressed greatly since the birth of Louise Brown in 1978. The pregnancy rates have increased, care is safer with significantly reduced multiple pregnancy and complication rates, infants have good health, and millions of people have been able to have the families they desired. The major challenges facing assisted reproductive technology are to continue to increase the quality of care, increase utilization through more societal funding, and expand care to nontraditional and marginalized populations in all countries, especially lower- and middle-income countries where access is currently limited. Significant collaboration among professionals, organizations, the World Health Organization, and policymakers is occurring and will be necessary to achieve these goals.

Knowledge, attitude, and practice of infertility: a comparative study in infertile and fertile Indian women

For women who are trying to conceive, it is critical to assess their general knowledge regarding fertility and fertility-awareness practices to identify the fertile window and their agency to achieve pregnancy. The couple's ability to deal with the infertility issue may be influenced by their beliefs and attitudes concerning infertility, which are based on social and cultural influences as well as their inner aspirations. As a result, it's critical to examine infertile and fertile woman's general knowledge of reproduction and infertility risk factors. It's also crucial to learn about women's attitudes toward infertility (social beliefs), as well as the repercussions of infertility and the practises they employ to avoid it. The present study includes 250 fertile and 250 infertile women. Data collection for infertile women was done from the Gynecology Outpatient Department (OPD). Participants from both groups i.e., infertile and fertile women have little knowledge about infertility but, infertile women have significantly higher knowledge than fertile women. Knowledge of the fertile period, as well as several potential causes of infertility, were found to be significantly higher in women with infertility problem rather than fertile women, indicating that the knowledge they have acquired is not attributable to education system, but rather to their experience gained during visits to medical practitioners. In addition to differences with respect to knowledge, infertile and fertile women differed in terms of both attitude (societal beliefs and social consequences of infertility) and practices. Better knowledge regarding infertility is likely to bring positive notes among women with infertility problems. Which will further improve the attitude and practices of society towards infertile women. Therefore, its crucial to introduce reproductive health education at high school or undergraduate level, to assist women in avoiding infertility and to help infertile women develop healthier attitudes regarding infertility treatment and coping techniques.

The promise and peril of using a large language model to obtain clinical information: ChatGPT performs strongly as a fertility counseling tool with limitations

OBJECTIVE

To compare the responses of the large language model-based "ChatGPT" to reputable sources when given fertility-related clinical prompts.

DESIGN

The "Feb 13" version of ChatGPT by OpenAI was tested against established sources relating to patient-oriented clinical information: 17 "frequently asked questions (FAQs)" about infertility on the Centers for Disease Control (CDC) Website, 2 validated fertility knowledge surveys, the Cardiff Fertility Knowledge Scale and the Fertility and Infertility Treatment Knowledge Score, as well as the American Society for Reproductive Medicine committee opinion "optimizing natural fertility."

SETTING

Academic medical center.

PATIENT(S)

Online AI Chatbot.

INTERVENTION(S)

Frequently asked questions, survey questions and rephrased summary statements were entered as prompts in the chatbot over a 1-week period in February 2023.

MAIN OUTCOME MEASURE(S)

For FAQs from CDC: words/response, sentiment analysis polarity and objectivity, total factual statements, rate of statements that were incorrect, referenced a source, or noted the value of consulting providers.

FOR FERTILITY KNOWLEDGE SURVEYS

Percentile according to published population data.

FOR COMMITTEE OPINION

Whether response to conclusions rephrased as questions identified missing facts.

RESULT(S)

When administered the CDC's 17 infertility FAQ's, ChatGPT produced responses of similar length (207.8 ChatGPT vs. 181.0 CDC words/response), factual content (8.65 factual statements/response vs. 10.41), sentiment polarity (mean 0.11 vs. 0.11 on a scale of -1 (negative) to 1 (positive)), and subjectivity (mean 0.42 vs. 0.35 on a scale of 0 (objective) to 1 (subjective)). In total, 9 (6.12%) of 147 ChatGPT factual statements were categorized as incorrect, and only 1 (0.68%) statement cited a reference. ChatGPT would have been at the 87th percentile of Bunting's 2013 international cohort for the Cardiff Fertility Knowledge Scale and at the 95th percentile on the basis of Kudesia's 2017 cohort for the Fertility and Infertility Treatment Knowledge Score. ChatGPT reproduced the missing facts for all 7 summary statements from "optimizing natural fertility."

CONCLUSION(S)

A February 2023 version of "ChatGPT" demonstrates the ability of generative artificial intelligence to produce relevant, meaningful responses to fertility-related clinical queries comparable to established sources. Although performance may improve with medical domain-specific training, limitations such as the inability to reliably cite sources and the unpredictable possibility of fabricated information may limit its clinical use.

Married women's decision to delay childbearing, and loneliness, severe psychological distress, and suicidal ideation under crisis: online survey data analysis from 2020 to 2021

BACKGROUND

The COVID-19 pandemic has affected every aspect of our lives, including the decision to become pregnant. Existing literature suggests that infertility and the decision to delay childbearing at a younger age are associated with a lower level of well-being and regrets when women start to desire a baby. Thus, the decision to delay childbearing due to the pandemic could negatively affect the well-being of women. This study focuses on how pregnancy decisions affect the well-being of women during the COVID-19 pandemic.

METHODS

From the Japan COVID-19 and Society Internet Survey, a nationally representative web-based survey, 768 observations of married women aged 18 to 50 years who had the intention of getting pregnant during the pre-pandemic period (conducted in 2020 and 2021) were used. Loneliness, severe psychological distress, and suicidal ideation were used as well-being indicators. For pooled data, a generalised estimated equation (GEE) model was used to estimate how pregnancy decision related to well-being indicators. For a sub-analysis, the sample was divided by the survey year and a Poisson regression model was used.

RESULTS

The GEE analysis showed an association between delaying childbearing and severe psychological distress, with the prevalence ratio (PR) being 2.06 [95% CI (1.40-3.03)]. Furthermore, loneliness and suicidal ideation that occurred after the beginning of the pandemic were significantly related to the decision to delay childbearing-1.55 [95% CI (1.03,2.34)] and 2.55 [95% CI (1.45-4.51)], respectively. Moreover, these PRs were larger for 2021 compared to 2020.

CONCLUSION

During the COVID-19 pandemic, approximately one-fifth of married women who had childbearing intentions before the pandemic decided to postpone pregnancy. They exhibited a deteriorated mental health state. Furthermore, the negative associations were larger in 2021 compared to 2020. Loneliness has negative consequences for both mental and physical health, as well as elevated severe psychological distress and suicidal ideation among those who decided to postpone pregnancy. Therefore, the current results should not be overlooked by society.

Reproductive health education in the schools of the four UK nations: is it falling through the gap?

Reproductive health education is crucial to ensure young people understand their reproductive system and can make informed decisions about their sexual lives and fertility, including whether they want to have children or not. This study involved an investigation of the intended UK school curricula for 14-18 year-olds as they relate to reproductive health. Analysis revealed substantial differences. Most, but not all, specifications include sexually transmitted infections, hormonal aspects of reproduction, contraception, the menstrual cycle and assisted reproductive technology (ART). Important topics, such as endometriosis, fertility, preconception health, pregnancy, miscarriage, menopause and infertility (except in the context of ART) are missing from examination specifications and/or the RSE/RSHP curricula. We conclude that many young people in the UK are at risk of leaving school with inadequate understanding of concepts that have important implications for their reproductive health. There are differences between nations, with Scotland having the most comprehensive coverage of topics in its curriculum. High-quality reproductive health education should be an entitlement for all young people. It should give young people accurate and up-to-date information and enable them to discuss issues and develop their own thinking. Ideally, sex and reproductive health education would be taught comprehensively across the RSE/RSHP and science curricula.

Gender differences in willingness for childbirth, fertility knowledge, and value of motherhood or fatherhood and their associations among college students in South Korea, 2021

BACKGROUND

South Korea is a country with a very low fertility rate and there is a tendency for young adults to postpone marriage and childbirth, which affects adverse pregnancy outcomes. It is important for young adults to predict and prepare in advance for future fertility-related issues, especially by identifying their willingness and thoughts about childbirth for both women and men. This study aimed to investigate gender differences in willingness for childbirth, fertility knowledge, and the value of motherhood or fatherhood among college students in South Korea and to explore the factors influencing willingness for childbirth.

METHODS

This was a cross sectional study among 286 unmarried college students who were recruited through a campus email and online communities for college student conducted from June 20, 2021 to July 19, 2021. The data were analyzed using the chi-square test and t-test to identify gender differences in general characteristics, willingness for childbirth, fertility knowledge, and value of motherhood of fatherhood. The factors influencing willingness for childbirth were examined using multiple logistic regression.

RESULTS

Female students showed lower willingness for future childbirth than male students (χ² = 26.85, p < .001). Women valued motherhood significantly less than men valued fatherhood (t = 6.34, p < .001). Women had a lower fertility knowledge score than men (t = 2.53 p = .012). The value of motherhood or fatherhood was an important influencing factor in both male and female college students (AOR = 8.57, 95% CI = 3.79-19.41 and AOR = 10.42, 95% CI = 3.65-29.80, respectively), whereas the monthly allowance was also an important influencing factor in female students (AOR = 1.02, 95% CI = 1.01-1.03).

CONCLUSION

The findings indicate the future direction to develop effective interventions considering gender differences which will promote healthy pregnancy and childbirth in the future for informed reproductive decision-making for college students.

Determinants of knowledge of the highest conception probability period among reproductive age women in Low-Income African countries: A multilevel analysis based on the recent Demographic and Health Survey

BACKGROUND

Adequate knowledge about the highest conception probability period in the reproductive cycle allows individuals and couples to attain or avoid their fertility probabilities. Poor knowledge of conception probability period leads to undesirable outcomes like unwanted pregnancy, miscarriage, and abortion. Determinants of knowledge of highest conception probability period were not well studied on economically disadvantaged countries. Therefore, our study aimed to identify individual and community level factors of knowledge of the highest conception probability period among women of reproductive age in low income African countries.

METHODS

The appended and latest Demographic and Health Survey datasets of 15 low-income African countries was used for analysis. Model fitness was done using the Intraclass correlation coefficient, median odds ratio, and deviance. A model with the lowest deviance (model-III) was selected as the best model. Multilevel logistic regression model was used to identify determinant factors of knowledge of the highest conception probability period. In the final model, adjusted odds ratio with 95% confidence interval was reported and variables with p<0.05 were considered as statistically significant with knowledge of the highest conception probability period.

RESULTS

Total weighted sample of 235,574 reproductive aged women with a median age of 27 years were included. The correct knowledge of the highest conception probability period among the study participants was 24.04% (95%CI = 23.87-24.22%). Maternal age groups ((20-24 (AOR = 1.49; 95%CI = 1.44-1.55), 25-29 (AOR = 1.62; 1.56-1.68), 35-39 (AOR = 1.76; 1.68-1.84), 40-44 (AOR = 1.75; 1.67-1.83), and 45-49 (AOR = 1.83; 1.74-1.93)), marital status((currently in union (AOR = 1.75; 1.16; 1.13-1.20), formerly in union (AOR = 1.75; 1.11; 1.06-1.16)), better educational status ((secondary (AOR = 2.08; 2.01-2.14) and higher(AOR = 3.36; 3.18-3.55)), higher wealth index ((middle (AOR = 1.08; 1.04-1.12), richer (AOR = 1.24; 1.20-1.28), and richest (AOR = 1.51; 1.45-1.57)), knowledge of contraceptive methods (AOR = 2.63; 2.49-2.77), current contraceptive use (AOR = 1.14; 1.11-1.16), and urban residency (AOR = 1.26; 1.21-1.29) were statistically significant with knowledge of the highest conception probability period.

CONCLUSION

In this study, knowledge of the highest conception probability period among women of reproductive age in low-income African countries was low. Therefore, improving the fertility awareness through comprehensive reproductive education or counseling could be one of the operational ways to control unintended pregnancy.

Knowledge of fertility and perception of fertility treatment among adults with sickle cell disease (KNOW FERTILITY)

Introduction

This study assessed fertility knowledge in adults with sickle cell disease using the Cardiff Fertility Knowledge Scale and Fertility Treatment Perception Survey and compared knowledge scores in respondents with sickle cell disease to previously reported unaffected cohorts.

Methods

This cross-sectional study surveyed adults over age 18 with sickle cell disease at an adult sickle cell disease center using a 35-question survey addressing infertility risk factor knowledge and perceptions of fertility treatment. Analyses included summary statistics for continuous and categorical variables, univariate linear regression, and Mann-Whitney U tests for group comparisons of Fertility Knowledge Scale scores. Fertility Treatment Perception Survey scores were measured by medians of the two positive statements and four negative statements to generate separate positive and negative treatment belief scores. Statistical significance was set at p < 0.05 for all analyses.

Results

Ninety-two respondents (71 female, 21 male) with median age of 32 years (IQR: 25.0, 42.5) completed the survey between October 2020-May 2021. Sixty-five percent of respondents reported taking sickle cell disease treatment and 18% reported refusing at least one sickle cell disease treatment due to fertility concerns. The mean Fertility Knowledge Score was 49% (SD: 5.2), lower than reported in an international cohort (57% vs. 49%, p = 0.001), and higher than in a cohort of reproductive-aged Black women in the USA (49% vs. 38%, p = 0.001). Less than 50% of respondents correctly identified common infertility risk factors including sexually transmitted infections, advanced age, and obesity. Mean positive fertility perception score was 3 (IQR 3, 4), and negative fertility perception score was 3.5 (IQR 3, 4). Factors associated with agreement with negative fertility perception statements included: trying to conceive, refusing sickle cell disease treatment, and undergoing fertility treatment.

Discussion

Opportunities exist to improve knowledge of infertility risk factors among adults with sickle cell disease. This study raises the possibility that nearly one in five adults with sickle cell disease refuse SCD treatment or cure due to infertility concerns. Education about common infertility risks factors needs to be addressed alongside disease- and treatment- associated fertility risks.

Awareness and perceptions of Filipino obstetrician-gynecologists on fertility preservation: a cross-sectional survey

BACKGROUND

The demand for fertility preservation has increased substantially over the past decade as more women wish to delay childbearing and with improved survival outcomes of various medical conditions. This study evaluated the awareness and perceptions of Filipino obstetrician-gynecologists on fertility preservation.

METHODS

A cross-sectional survey was conducted among diplomates and fellows of the Philippine Obstetrical and Gynecological Society from September to December 2021. A self-administered questionnaire with 24 items was distributed online. Univariate descriptive statistics were reported as means for continuous variables and frequencies with percentage for categorical variables. Differences in responses were tested using the chi-square test.

RESULTS

A total of 215 respondents completed the survey. Majority of the respondents were female, general obstetrician-gynecologists practicing in the National Capital Region. There was an overall positive perception of fertility preservation, with 98.60% agreeing that discussions about childbearing intentions should be initiated. Most participants (98.60%) were aware of fertility preservation but had varying levels of awareness of the different techniques. Fifty-nine percent of the respondents were unaware of regulations on fertility preservation. Setting up dedicated centers for fertility preservation and offering it as a public service were viewed as necessary by the respondents.

CONCLUSIONS

This study underscored the need to increase awareness of fertility preservation techniques among Filipino obstetrician-gynecologists. Meeting the need for comprehensive guidelines and centers is essential to promote fertility preservation in the country. Efficient referral systems and multidisciplinary approaches should be established for holistic care.

Anxiety, attitudes, and education about fertility among medical students in the United States

BACKGROUND

As delayed family building is common among physicians, the goal of this study was to evaluate childbearing plans, anxiety related to future fertility, and interest in fertility education among medical students.

METHODS

Using convenience and snowball sampling methods, an electronic REDCap survey was distributed via social media and group messaging applications to medical students enrolled in medical schools across the United States. Answers were collected, and analysis of the descriptive statistics was performed.

RESULTS

The survey was completed by 175 participants, 72% of which were female (assigned at birth). The mean (± SD) age of participants was 24.9 ± 1.9 years. Of all participants, 78.3% desire to have children and 65.1% of these individuals plan to delay childbearing. On average, the planned age of first pregnancy is 31.0 ± 2.3 years. "Lack of time" was the greatest influence on decision regarding timing of childbearing. Of all respondents, 58.9% reported at least some anxiety related to future fertility. When females and males were compared, significantly more females (73.8%) versus males (20.4%) reported worrying about future fertility (p < 0.001). Participants reported that greater knowledge about infertility and potential treatments would help ease fertility related anxiety, and 66.9% of respondents showed interest in learning about how things such as age and lifestyle can impact fertility, preferably through medical curricula, videos, and podcasts.

CONCLUSION

A majority of the medical students in this cohort intend to have children and most plan to delay childbearing. A large percentage of female medical students reported anxiety related to future fertility, but many students showed interest in receiving fertility education. This study highlights an opportunity for medical school educators to incorporate targeted fertility education into their curriculum with the intention of decreasing anxiety and improving future reproductive success.

Undergraduate students have low fertility knowledge and high anxiety regarding future fertility: An opportunity for education

Objectives

To assess childbearing intentions, concerns about future fertility, knowledge about the age-related decline in fertility, and interest in receiving fertility education among undergraduate students.

Design

From March to April 2021, a cross-sectional, web-based survey with 42 reproductive and fertility-related questions was administered to and completed by actively enrolled undergraduates at Northwestern University in the United States.

Results

The survey was completed by 291 students (mean age 20.2 years). Of all participants, 62.5% plan to have children and 68.3% intend to delay childbearing. Significantly more females than males (70.7% vs 40.9%, P = 0.004) and premedical students compared to non-premedical students (78.2% vs 60.1%, P = 0.002) reported planning to delay childbearing due to educational or career aspirations. Significantly more females than males (43.5% vs 4.5%, P < 0.001) and premedical compared to non-premedical students (50.4% vs 31.5%, P = 0.002) also reported having anxiety about future fertility due to career aspirations.When surveyed about fertility knowledge, 31.1% of participants reported that females are as fertile in their forties as they are in their thirties, and 25.4% stated that female fertility does not dramatically decline until age 40 or later. When asked to estimate the oldest age a woman has conceived using autologous oocytes, 83.3% reported age 48 or older. Of all participants, 72.3% were interested in learning about fertility.

Conclusions

The majority of surveyed undergraduates plan to delay childbearing, yet they have concerns about how career goals will impact future fertility. Notably, females and premedical students reported higher rates of anxiety when compared to their male and non-premedical counterparts. Knowledge about the age-related decline in fertility was limited, but students have a strong interest in learning about fertility, highlighting an opportunity for educational intervention at the undergraduate level. With education, students may be empowered to make informed decisions about future reproductive strategy earlier in time, potentially decreasing future anxiety.

Association between heavy metals exposure and infertility among American women aged 20-44 years: A cross-sectional analysis from 2013 to 2018 NHANES data

Background

Infertility has been confirmed as a significant medical and social problem. Heavy metal exposure refers to a risk factor for infertility, which is capable of damaging the reproductive system of males and females. However, heavy metal exposure and female infertility have rarely been investigated. The aim of this study was to analyze the association between heavy metal exposure and female infertility.

Methods

A cross-sectional study using data from three cycles of the National Health and Nutrition Examination Survey (NHANES, 2013-2018) was performed. Female infertility was evaluated by positive responses to question rhq074 in the questionnaire. Cadmium (Cd), lead (Pb), mercury (Hg), and arsenic (As) levels in blood or urine were examined by inductively coupled plasma mass spectrometry. The correlation between heavy metal and female infertility was analyzed through weighted logistic regression.

Results

A total of 838 American women aged 20-44 years were covered in the study. Among all participants, 112 (13.37%) women were subjected to infertility. Urinary Cd and urinary As levels were significantly higher in infertile women than in control women (P < 0.05, P < 0.05). Urinary As showed a positive correlation with the prevalence of female infertility, and the risk of infertility rose with the increase of urinary As levels (P for trend = 0.045). Urinary Cd was associated with female infertility in some weighted logistic regression (Crude, Q2: OR = 3.99, 95% CI 1.82, 8.74, Q3: OR = 2.90, 95% CI 1.42, 5.92. Model 1, Q2: OR = 3.68, 95% CI 1.64, 8.27, Q3: OR = 2.33, 95% CI 1.13, 4.48. Model 2, Q2: OR = 4.11, 95% CI 1.63, 10.07, Q3: OR = 2.44, 95% CI 1.07, 5.53. Model 3, Q2: OR = 3.77, 95% CI 1.52, 9.35). Moreover, blood Pb (OR = 1.52, 95% CI 1.07, 2.16), urinary Pb (OR = 1.68, 95% CI 1.11, 2.55), and urinary As (OR = 1.02, 95% CI 1.00, 1.03) were positively correlated with the risk of infertility in women aged 35-44 years. The blood Pb (OR = 1.67, 95% CI 1.16, 2.40, 2.49) and urinary Pb (OR = 1.54, 95% CI 1.00, 2.38) in women with BMI ≥25 were positively correlated with the risk of infertility.

Conclusions

Urinary As was significantly associated with female infertility, and the risk of infertility increased with higher urinary As levels. To some extent, urinary Cd was correlated with infertility. Blood/urine Pb was related to infertility in advanced age and overweight/obese women. The results of this study need to be further validated in future prospective studies.

U.S. Women's Knowledge of Reproductive Biology

BACKGROUND

Having accurate knowledge of reproductive biology can help women to improve their general, sexual, and reproductive health and assert their sexual and reproductive rights.

METHODS

This cross-sectional study examined knowledge of three topics (age-related fertility decline, egg supply, fertile period) among a national probability sample of 1,779 nonsterilized, English-speaking women (aged 18-29 years) in the U.S. general population. Using bivariate and multivariable regressions, we assessed associations between knowledge of these topics and individual characteristics.

RESULTS

Most respondents were unmarried (63%), childless (78%), and intended to have children (65%); 51% did not know whether they would have difficulty conceiving, and 44% had discussed fertility-related topics with a health care provider. More respondents knew the age of marked fertility decline (62%) than the fertile period (59%) or that ovaries do not continuously produce new eggs (45%); 22% knew all three topics, and 13% knew none. In multivariable analysis, knowledge was positively associated (p < .001) with education, income, and having regular periods. Black and Asian respondents and those for whom religion was very important were less likely (all p values < .01) than White and nonreligious respondents to know all three topics. Knowledge was unrelated to relationship status, parity, childbearing intentions, receipt of fertility-related counseling or services, self-perceived infertility risk, or health status; the relationship with Hispanic ethnicity approached but did not reach significance (p = .08).

CONCLUSIONS

Young U.S. women have incomplete knowledge of aspects of their reproductive biology; these knowledge gaps could increase their risk of adverse health and reproductive outcomes. Policy-, provider-, and client-level interventions are warranted to address these knowledge gaps.

Awareness and attitude toward oocyte cryopreservation for non-medical reasons: a study on women candidates for social egg freezing

PURPOSE

The present study was to investigate awareness and attitudes toward female fertility and aging, desire for a child and motherhood, and oocyte freezing for non-medical reasons among women candidates for Social Egg Freezing (SEF).

MATERIALS AND METHODS

This was a cross-sectional study on all 216 women who sought oocyte cryopreservation for nonmedical reasons at Royan Institute. A 24-item self-administered questionnaire measured knowledge and attitudes to SEF. Responses were as yes/no or a 4-point Likert scale.

RESULTS

Only 40% of participants accurately indicated that having a sexual partner does not help to preserve their fertility. A quarter of women correctly recalled chance of pregnancy with unprotected intercourse during a period of a year, for women 20 to 40 years old. Only one-third of respondents accurately identified the age-related fertility decline at 35-39 years. Only 6.9% correctly mentioned the low chance of pregnancy after egg freezing at 35 years old. Almost a third of women knew that the age range of 31-35 years is the right age to freeze an egg with the highest chance of pregnancy. Aging and health of offspring were most influential in women's decisions on SEF.

CONCLUSION

In conclusion, there was significant gaps in knowledge about age-related fertility decline, and egg cryopreservation conditions and its complications. It is crucial to impart to these women a better knowledge about fertility and a realistic picture about SEF, especially on the number of high-quality retrieved mature oocytes and live birth rates depend on women's age.

Effects of trying to conceive using an every-other-day strategy versus fertile window monitoring on stress: a 12-month randomized controlled trial

STUDY QUESTION

Can animation videos on how to optimize the chances of pregnancy influence stress, anxiety, depression and sexual functioning of individuals trying to conceive (TTC)?

SUMMARY ANSWER

There were no differences between those educated to have intercourse every other day, on the fertile window and a control group (CG), and depression and sexual dysfunction significantly increased over time for all arms.

WHAT IS KNOWN ALREADY

Recent findings indicate that time to pregnancy can be significantly shortened by targeting the fertile period, but some reproductive care guidelines recommend instead the practice of intercourse every other day on the basis that it is less stressful to the couple. Evidence to support guidelines on how to preserve well-being and psychosocial adjustment and optimize pregnancy chances is lacking.

STUDY DESIGN, SIZE, DURATION

We conducted a prospective, double-blinded, three-arm randomized controlled trial between July 2016 and November 2019. Participants were randomized to either not having any stimulus (CG) or visualizing a short animated video explaining how to improve chances of pregnancy by having intercourse every other day (EOD group), or by monitoring the fertile window (FWM group). Assessments were made before the intervention (T0), and 6 weeks (T1), 6 months (T2) and 12 months after (T3), with follow-ups censored in case of pregnancy.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Participants were childless individuals of reproductive age actively TTC and not diagnosed or unaware of a condition that could prevent spontaneous pregnancy. Individuals were excluded from recruitment if they had previous children or had a condition preventing spontaneous pregnancy. Our primary outcome was stress and secondary outcomes included anxiety, depression, sexual functioning and pregnancy. Primary analyses were performed according to intention-to-treat principle.

MAIN RESULTS AND THE ROLE OF CHANCE

Of the 450 randomized participants 127 were educated to use an every-other-day strategy, 135 to monitor the fertile window, and 134 received no intervention. Groups were similar regarding demographics and months TTC. Repeated measures analysis revealed that there were no significant interaction effects of psychological and sexual well-being between groups over time (P > 0.05). Significant time effects were revealed for stress (F(3,855) = 4.94, P < 0.01), depression (F(3,855) = 14.22, P < 0.01) and sexual functioning (time effects P values <0.001 for female sexual functioning dimensions and <0.002 for male dimensions), but not for anxiety (F(2,299) = 0.51, P > 0.05). Stress levels lowered after 6 months (P < 0.001) and returned to baseline levels at the 1-year follow-up. Depressive symptomatology significantly increased at 6 weeks (P = 0.023), and again 1 year after (P = 0.001). There were also significant decreases in all female sexual functioning dimensions (desire, satisfaction, arousal, pain, orgasm and lubrication). In men, there were significant variations in orgasm, intercourse satisfaction and erectile function, but not desire and sexual satisfaction. Revealed pregnancy rates were 16% for participants in the EOD group, 30% for the FWM group and 20% for the CG. Pregnancies were not significantly different between arms: EOD vs FWM (odds ratio (OR) 2.32; 95% CI 0.92-5.83); EOD vs CG (OR 0.74; 95% CI 0.30-1.87); and FWM vs CG (OR 1.71; 95% CI 0.70-4.18).

LIMITATIONS, REASONS FOR CAUTION

Participants were recruited after transitioning to procreative sex. The study might be prone to bias as almost 30% of our sample fulfilled the chronological criterion for infertility, and other reproductive strategies could have been tried over time before recruitment.

WIDER IMPLICATIONS OF THE FINDINGS

Our data suggest that stress does not arise from feeling pressured on the fertile period and that advice on timing of intercourse might have to be personalized. The increasing levels of depression and sexual dysfunction over a year emphasize the crucial role of preconception care and fertility counseling in promoting psychological and sexual well-being.

STUDY FUNDING/COMPETING INTEREST(S)

This work was supported by European Union Funds (FEDER/COMPETE-Operational Competitiveness Programme) and by national funds (FCT-Portuguese Foundation for Science and Technology) under the projects PTDC/MHC-PSC/4195/2012 and SFRH/BPD/85789/2012.

TRIAL REGISTRATION NUMBER

NCT02814006.

TRIAL REGISTRATION DATE

27 June 2016.

DATE OF FIRST PATIENT’S ENROLLMENT

19 July 2016.

An online survey of UK women's attitudes to having children, the age they want children and the effect of the COVID-19 pandemic

STUDY QUESTION

What are women's views on having children, including the age they want to have them and other influences such as the coronavirus disease 2019 (COVID-19) pandemic?

SUMMARY ANSWER

Women's views on having children, at their preferred age of 30 years, included their maternal urge and concerns about their biological clock and stability, while 19% said COVID-19 had affected their views.

WHAT IS KNOWN ALREADY

Women globally are delaying the birth of their first child, with the average age of first birth approaching 32 years in some countries. The average age women have their first child in the UK is 30.7 years and over 50% of women aged 30 years are childless. The fertility rate stands at 1.3 in several European Union countries. Some people are not having their desired family size or are childless by circumstance. It is essential to understand people's attitudes to having children in different countries to identify trends so we can develop educational resources in an age-appropriate manner.

STUDY DESIGN, SIZE, DURATION

We conducted an anonymous, online survey of multiple choice and open-ended questions. The survey was live for 32 days from 15 May 2020 to 16 June 2020 and was promoted using social media.

PARTICIPANTS/MATERIALS, SETTING, METHODS

A total of 887 women from 44 countries participated in the survey. After filtering out women who did not consent, gave blank or incomplete responses, and those not in the UK, 411 responses remained. From the data, three areas of questioning were analysed: their views on having children, the ideal age they want to have children and the effects of the COVID-19 pandemic. Qualitative data were analysed by thematic analysis.

MAIN RESULTS AND THE ROLE OF CHANCE

The average age (±SD) of the women who completed the survey was 32.2 years (±5.9), and they were mainly heterosexual (90.8%) and 84.8% had a university education. One-third of women were married/in a civil partnership (37.7%) and 36.0% were cohabitating. In relation to their views on having children, the main themes identified were: the maternal urge, the ticking of the biological clock, why did no one teach us this?, the need for stability and balance in their life, pressure to start a family and considering other ways to have a family. When asked 'In an ideal world, at what age approximately would you like to have had or have children?' a normal distribution was observed with a mean age of 29.9 (±3.3) years. When asked 'What factors have led you to decide on that particular age?' the most frequent choice was 'I am developing my career'. Three themes emerged from the qualitative question on why they chose that age: the need for stability and balance in their life, the importance of finding the right time and life experiences. The majority of women felt that the COVID-19 pandemic had not affected their decision to have children (72.3%), but 19.1% said it had. The qualitative comments showed they had concerns about instability in their life, such as finances and careers, and delays in fertility treatment.

LIMITATIONS, REASONS FOR CAUTION

The survey was promoted on social media only and the women who answered the survey were highly educated.

WIDER IMPLICATIONS OF THE FINDINGS

The women surveyed ideally want children at age 30 years but there are obstacles in their way, such as the need to develop their career. Global tailored fertility education is essential to ensure people make informed reproductive choices. In addition, it is essential for supportive working environments and affordable childcare to be in place in every country.

STUDY FUNDING/COMPETING INTEREST(S)

J.C.H. is founder of www.globalwomenconnected.com and Reproductive Health at Work, and author of the book Your Fertile Years. This project was funded by the Institute for Women's Health, UCL.

TRIAL REGISTRATION NUMBER

N/A.

Residential proximity to a fertility clinic is independently associated with likelihood of women having ART and IUI treatment

STUDY QUESTION

Is geographic proximity to a fertility clinic associated with the likelihood of women of reproductive age undertaking different forms of medically assisted fertility treatment?

SUMMARY ANSWER

After adjusting for socioeconomic status (SES) and other confounders including a proxy for the need for infertility treatment, women who lived within 15 km of a fertility clinic were 21% more likely to undergo ART treatment and 68% more likely to undergo IUI treatment than those who lived further than 60 km away.

WHAT IS KNOWN ALREADY

In most countries, patients living outside of metropolitan areas are more likely to be more socio-economically disadvantaged and to have less equitable access to healthcare. However, how a woman's residential proximity to fertility clinics predicts utilization of high-cost/high-technology treatment (ART) and low-cost/low-technology treatment (IUI) is limited, and whether socio-economic disadvantage explains much of the hypothesized lower utilization is unknown. Australia's universal insurance scheme provides supportive reimbursement for almost all ART and IUI treatment regardless of age or number of cycles, providing a unique setting to investigate disparities in access to infertility treatment.

STUDY DESIGN, SIZE, DURATION

National population-based observation study of ART and IUI treatment utilization by women across socio-economic gradients and Australian residential locations between August 2015 and December 2017.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Universal insurance claims information on female patients who underwent ART or IUI were provided by Services Australia, comprising 67 670 female patients who accessed 162 795 ART treatments, and 10 211 female patients who accessed 19 615 IUI treatments over a 29-month period. Incidence rates by SES and proximity to fertility clinics were calculated to describe the number of women undergoing at least one ART or IUI treatment cycle per 1000 women of reproductive age (25-44). Treatment frequencies were calculated to describe the average number of ART or IUI treatment cycles per woman of reproductive age who had undergone at least one ART or IUI treatment during the study period. Poisson regression analyses were used to estimate the independent effect on accessibility to infertility treatment by geographic proximity (based on small area locations) to the closest fertility clinic after adjusting for SES, childbearing delay, remoteness area, and marital status.

MAIN RESULTS AND THE ROLE OF CHANCE

On average, 19.1 women per 1000 women of reproductive age underwent at least one fresh or frozen ART cycle, with an average 2.3 ART cycles each, while 3.0 women per 1000 women of reproductive age received at least one IUI cycle, with an average of 1.6 IUI cycles each. After adjusting for SES and other confounders including a proxy for the need for infertility treatment, women who lived within 15 km of a fertility clinic were 21% more likely to undergo ART treatment and 68% more likely to undergo IUI than those who lived over 60 km away. Regardless of geographic location, there was a steady and independent gradient in access to ART treatment based on increasing SES, with women residing in the most advantaged residential quartile having a 37% higher rate of receiving ART treatment compared to those in the most disadvantaged quartile. The negative effect of social disadvantage on ART use became more pronounced as distance from a fertility clinic grew, indicating that the barriers to access to ART care caused by distance were further compounded by the level of socioeconomic advantage of the women's residential location. In contrast, socioeconomic status did not modify the likelihood of using IUI over and above the distance from a fertility clinic. In relation to IUI treatment, differences in utilization by SES disappeared after adjusting for geographic proximity to a fertility clinic, childbearing delay, remoteness area, and marital status.

LIMITATIONS, REASONS FOR CAUTION

Information is aggregated by small geographic areas and it therefore may not reflect individual characteristics. Australia provides partial but comparably supportive reimbursement for both ART and IUI through its universal healthcare system and thus the results may not be fully generalizable to other settings.

WIDER IMPLICATIONS OF THE FINDINGS

Residential proximity to a fertility clinic is a persistent barrier to accessing ART and IUI treatment, regardless of SES, even in countries characterized by supportive public funding, such as Australia. SES is less of a barrier to accessing IUI than ART, presumably driven by the lower cost and fewer clinic visits required with IUI treatment. Safe and effective fertility treatment should be available to all women regardless of where they live.

STUDY FUNDING/COMPETING INTEREST(S)

This work was supported by the Australian National University Research scholarship and by the Higher Degree Research Fee Merit Scholarship. The authors have no conflict of interest.

TRIAL REGISTRATION NUMBER

N/A.

Fertility Health Knowledge in U.S. Adults: Men Narrowing the Knowledge Gap

Much of young people's fertility health knowledge has been limited to avoiding sexually transmitted infections and preventing pregnancy thus lacking what is necessary to support future overall health as well as reproductive goals. This study assesses university students' knowledge related to fertility health factors to verify consistencies and discrepancies in fertility health knowledge, with a sub-assessment focusing on men's knowledge. The Fertility Health Knowledge survey was delivered to 17,189 students at three American universities. Twenty percent or 546 of the 2,692 participants were male. The 30-question survey addresses knowledge of modifiable and non-modifiable risk factors on fertility health in men and women, and four questions regarding fertility intentions. Across all 30 questions, 63% of female responses were correct and 61% of male responses were correct. For 10 questions, less than 70% of males and females answered correctly, with men answering correctly more often than females for six of the questions. Males exhibited more knowledge regarding male fertility. Knowledge of fertility health was consistently limited, regardless of site or demographics. Men demonstrated improved overall fertility health knowledge and more knowledge regarding male factors. There are still considerable gaps in knowledge of modifiable risk factors that may impact fertility health and future overall health. Fertility health promotion through education should be comprehensive and widely available in secondary schools, colleges, and universities. As well, increased education regarding fertility health in primary care settings should become the norm-with male inclusion as a standard of their care.

An exploration of treatment seeking behavior of women experienced infertility and need for services in rural India

Background

To make informed decisions on fertility treatment, couples need to understand the treatment options available to them. A wide range of treatment options is available from the traditional and biomedical service providers in India. There is a dearth of research to find out factors that influence the treatment-seeking behavior of couples, particularly in rural areas.

Objectives

The study aimed to document the treatment-seeking behavior of women for their infertility problems. Further, the research focused on the socio-economic determinants affecting allopathic treatment-seeking of women and the services needed for couples experiencing infertility in rural India.

Methods

The study is cross-sectional. Primary data were collected from the two high infertility prevalence districts. Complete mapping and listing were carried out to identify the eligible respondents. A total of 159 ever-married women (20–49 years) out of 172 identified women were interviewed. Bivariate and multivariate analyses were performed.

Results

Among 159 interviewed women, only three did not seek any kind of treatment. Of the 156 women, 63, 65, and 28 women (mutually exclusive) received first, second and third-order treatment, respectively. The number of women decreased in the succeeding phases of infertility. Women aged above 35 years, were significantly less (OR = 0.310, p &lt; 0.05) compared to women aged below 30 years to receive allopathic treatment. The use of allopathic treatment was significantly three times higher among women who were educated (OR = 3.712, p &lt; 0.01) and two times higher among those who were exposed (OR = 2.217, p &lt; 0.5) to media. Further, for those who had felt the treatment was necessary, about 30, 44, 10, and 19% mentioned that due to unaffordability, inaccessibility, or inconveniences they couldn't consult allopathic treatment.

Conclusions

Timely diagnosis and appropriate treatment play important role in infertility management. Women who are more educated and are exposed to media tend to consult allopathic treatment. Similarly, time and money spent on care vary significantly and independently by type of treatment and socioeconomic factors. There is a need for mandatory insurance coverage for infertility treatment enacted by the state government. In addition to the public services, the private sector and the traditional healers are both important alternative sources of first help.

Causes of Infertility: Diagnosis and Management With Microfluidic Sperm Sorter

This case study refers to a three-and-a-half-year married couple who visited an infertility clinic and are facing infertility for two-and-a-half years. They started in vitro fertilization/assisted reproduction technology (IVF/ART) procedures from December 2021. In 2019, the couple underwent infertility therapy in Wardha, India, including three intra‐uterine insemination (IUI) treatments which failed. The couple was then recommended the intracytoplasmic sperm injection (ICSI) procedure in which the semen sample was separated using a microfluidic sperm sorter for separating good quality sperms. There was no past medical history of both of the partners. Since she was infertile, the desire to have a child was extremely strong. Sadness, helplessness, bewilderment, and frustration are all common feelings associated with infertility. The left fallopian tube delays spillage in females and oligoasthenozoospermia in males; women were detected with secondary infertility and male sperm samples were sorted using a microfluidic sperm sorter and fertilized frozen oocytes for ICSI. As the male partner, in this case, had oligoasthenozoospermia, he was prescribed multivitamins and other medications. After ICSI, the blastocyst formation was good with the use of a microfluidic sperm sorter.

The Use of a Two-Phase Online Delphi Panel Methodology to Inform the Concurrent Development of a School-Based Ovulatory Menstrual Health Literacy Intervention and Questionnaire

Introduction

There are a high prevalence of ovulatory-menstrual (OM) dysfunction and low levels of menstrual health literacy in adolescents, yet few evidence-based OM health education resources for schools.

Method

This two-phase study used an online Delphi methodology to build consensus across thirty-five purposively selected professionals from the diverse professions of health and education. The panellists were tasked to inform the development of a school-based OM health literacy resources.

Results

In Round One, 86% of panellists determined the scope of these resources using guided and open-ended questions. The study then split into two phases which ran concurrently. In the first phase informing the intervention's development, 57% of panellists participated in Round Two, and 29% reviewed selected lessons. In the second phase informing the questionnaire's development, 51% of panellists participated in Round Two, and 69% in Round Three. The overall consensus reached for the intervention phase and questionnaire phase were 82% and 84%, respectively. The Panel's recommendations included a strengths-based position to counter menstrual stigma, teaching accurate self-report of cycle biomarkers, addressing multiple menstrual dysfunctions and adopting a whole-school approach.

Conclusion

Although time-consuming and requiring a sustained interest, this two-phase Delphi methodology offered anonymity to panellists from distinct professions which facilitated their independent contribution to developing OM health literacy school resources.

Risk factors for infertility treatment-associated harassment among working women: a Japan-Female Employment and Mental health in assisted reproductive technology (J-FEMA) study

PURPOSE

This study aims to elucidate the risk factors of infertility treatment-associated harassment (I-harassment) among Japanese working women.

METHODS

The study participants were 1103 female patients who enrolled in the Japan-Female Employment and Mental Health in artificial reproductive technology (J-FEMA) study. Of the 1727 female patients, 1103 female patients were working during the initiation of infertility treatment and were still working during the survey. Risk factors for I-harassment were analyzed using a multivariable logistic regression model.

RESULTS

In this study, 82 female patients (7.4%) experienced I-harassment. The risk was significantly higher in those who had more in vitro fertilization (IVF) cycles than those who had fewer IVF cycles (OR, 1.06; 95% CI, 1.01-1.10). Similarly, those who disclosed their infertility treatment to their workplace were at significantly higher risk for I-harassment than those who did not (OR, 1.80; 95% CI, 1.03-3.15).

CONCLUSION

This study found that 7.4% of female patients experienced I-harassment after infertility treatment initiation. Those female patients who "experienced more IVF cycles," and "disclosed their infertility treatment in their workplace" should be carefully followed up by healthcare professionals to prevent I-harassment.

Black infertility and social media engagement: a mixed methodology analysis

Objective

To study social media engagement on Black infertility to better understand why there is lower utilization of in vitro fertilization by Black women despite higher infertility rates.

Design

The online analytics module BuzzSumo was used to quantify total engagements with the search term “Black infertility” across the commonly used social media platforms. The 10 article links with the highest engagement were selected from periods in 2020 and 2021. Sources cited in each article were reviewed to identify those that had citations of scientific peer-reviewed journals or national medical organizations. The contents of each article were reviewed for accuracy by comparing the article information against available scientific research and consensus data.

Patient(s)

Not applicable.

Intervention(s)

Not applicable.

Main Outcome Measure(s)

Not applicable.

Result(s)

After applying the exclusion criteria, nine article links remained in each date range. The highest engagement with the term “Black infertility” was found on Facebook for both 2020 and 2021. Ten percent of content regarding Black infertility in 2020 compared with 50% of content regarding Black infertility in 2021 referenced original studies in peer-reviewed journals. Links with greater social engagement were more likely to have academic sources in 2021 than in 2020 (odds ratio, 1.30). The highest user engagement was found for articles discussing the emotional toll of Black infertility.

Conclusion(s)

Social media users encounter misleading or inaccurate information regarding Black fertility at similar rates to accurate content. Social media can propagate misinformation, and this study identifies social media as an opportunity to improve education directed toward Black women to increase the utilization of in vitro fertilization services.

Racial and ethnic differences in reproductive knowledge and awareness among women in the United States

Objective

To evaluate if knowledge and awareness of concepts and concerns pertaining to reproductive health and fertility vary by race/ethnicity among reproductive-aged women in the United States.

Methods

A 2013 cross-sectional web-based survey assessed reproductive health-related knowledge, awareness, and perceptions of 1,000 women (18–40 years). Multivariable logistic regression analyses, adjusting for age, education, income, marital status, employment, region, and pregnancy history, examined the association between race/ethnicity and subfertility-related risk factor awareness; knowledge of factors that may affect pregnancy susceptibility; and future fertility-related concerns.

Results

Knowledge and awareness related to reproductive wellness and fertility differed by race/ethnicity in US women. Compared with Caucasians, Hispanic women were less likely to be aware of smoking-related harm to fertility (odds ratio [OR], 0.57; 95% confidence interval [CI], 0.38–0.86); African American women were more aware of the implications of sexually transmitted infections on fertility (OR, 2.13; 95% CI, 1.15–3.94); and Asian women demonstrated greater awareness of a possible relationship between dysmenorrhea and subfertility (OR, 2.05; 95% CI, 1.09–3.86). Asian women consider fertility socially taboo to talk about and a private affair that is difficult to discuss (OR, 2.63; 95% CI, 1.32–5.29 and OR, 1.99; 95% CI, 1.05–3.75, respectively), were more concerned about their future fertility (OR, 2.36; 95% CI, 1.24–4.52), and more likely to perceive a need for future fertility treatment (OR, 2.36; 95% CI, 1.18–4.71).

Conclusion

Among reproductive-aged women in the United States, knowledge, awareness, and perceptions relating to reproductive health vary by race/ethnicity. Our findings suggest race/ethnicity as potential modulators of population perceptions regarding reproductive health and infertility.

Clinical Trial Registration Number

NIH ZIA# HD008985.

Characteristics, experiences and actions taken by women to address delayed conception: A mixed-methods cross-sectional study protocol

Background

The impact of infertility on mental, emotional, physical and sexual health is grave, particularly in a pronatalist society. Literature is replete with evidence of wide ranging psychosocial consequences of infertility in women, indicating the need for identifying the gaps and designing appropriate context specific interventions to improve access and utilization of services. Data that are accessible, primarily from infertility clinics and women visiting hospitals for infertility treatment; information from community settings is rare. This is a protocol paper for a study to understand women’s experiences and actions taken by them to cope with delayed conception.

Methods

Mixed-methods cross-sectional design is used to obtain deep insights into the experiences of delayed conception, coping mechanisms, medical assistance and other help sought. Information is also being obtained on socio-demographic profile, fertility intentions, fertility quality of life, general medical history, obstetric, gynecological and sexual history, substance use and mental health status. A sample of 1530 women will be administered 4 modules of a quantitative survey. Focus group discussions, about four or till saturation point, will be conducted using purposive sampling. The study is recruiting from a population of women who previously participated in the ‘Women and Infants Integrated Interventions for Growth Study (WINGS) and failed to conceive during 18 months follow up period. Data collected through questionnaire will be assembled, cleaned, analyzed and reported. The findings will be disseminated through reports with the ethics review committee, government entities, academic and research publications.

Discussion

This study will provide insights on the experiences and coping strategies of women with delayed conception in the study community. Results will assist in designing appropriate interventions to meet the holistic health and psychosocial needs of women with delayed conception and promote sexual and reproductive health within the broader framework of Sustainable Development Goals and Universal health coverage.

Trial registration

Trial registration number: CTRI/2020/03/023955.

At risk of reproductive disadvantage? Exploring fertility awareness among migrant women in Germany

This study examined awareness about fertility among immigrant women and non-migrants in Germany. The social relevance of infertility and fertility treatment is increasing in Western countries due to continually low overall birth rates, a high rate of childlessness, and a gap between the desired and actual numbers of children. While there is growing interest in infertility and reproductive medicine in general, previous studies have rarely included immigrant or ethnic minorities in Europe. This study investigated whether knowledge on the age-related fertility decline (ARFD) varies between migrant groups and the majority group, and the role of education. Working hypotheses were drawn from theoretical considerations on frameworks of migrant assimilation. The analysis was based on data collected in a social science pilot study on reproductive medicine, representative of the general population ('NeWiRe' 2014-2015). The sample included 962 women aged 18-50 years living in Germany. Approximately 81% of the sample were immigrants who originated from Turkey, Poland, the Balkan countries or countries of the (post-Soviet) Commonwealth of Independent States. While rather poor overall, knowledge on ARFD was found to be significantly lower in the migrant groups compared with the majority group. This minority-group disadvantage cannot be explained by sociodemographic or cultural variables. Future research should include minority groups in empirical studies on awareness about fertility in order to better understand the causes of this disadvantage, and the potential reproductive needs of migrants.

Fertility awareness and subclinical infertility among women trying to get pregnant at home

Background

Recent studies on fertility awareness among the reproductive population have reported the lack of accurate knowledge about fertility and assisted reproductive technologies. However, there has been little information regarding women trying to get pregnant at home. The aim of this study was to explore the prevalence of subclinical infertility among women trying to get pregnant at home, and to evaluate awareness regarding infertility and reasons for not visiting infertility clinics among women who use pregnancy-assist mobile applications to help them conceive.

Methods

A total of 2084 Japanese women responded to this online survey. We selected 1541 women according to the study criteria. Based on the results of 61 questions, we evaluated knowledge regarding fertility, prevalence of subclinical infertility, and reasons for not visiting the clinic among the participants.

Results

Despite the desire to conceive, the participants had an apparent tendency to overestimate the age limit for childbearing. A total of 338 (21.9%) women answered that in general women aged > 45 years could get pregnant. Approximately 40% of the women had possible subclinical infertility and were unaware of the fact. Additionally, about 70% of the women considered themselves to have infertility problems. Women who were aware of the possibility of infertility hesitated to visit the clinic due to unfamiliarity with a gynecologist or clinic, and apprehensions about the gynecologic examination.

Conclusions

In our study, some women required treatment for infertility. Nonetheless, they hesitated to visit an infertility clinic. Sexual health education, together with proper accessibility to gynecology clinics, are necessary to reduce involuntary childlessness.

Fertility knowledge and its related factors among married men and women in Zanjan, Iran

This study aimed to investigate the fertility knowledge and its related factors in married men and women in Zanjan, Iran. In this cross-sectional study, 1200 individuals (including 600 women aged 18-49 years and 600 men aged 18-59 years) referred to urban and rural health centres in Zanjan, were recruited through cluster sampling from June to September 2020. The Cardiff Fertility Knowledge Scale was used to assess fertility knowledge. Data were analysed by descriptive statistical methods such as mean and standard deviation and analytical statistics, including independent sample t-test, ANOVA test, Pearson Correlation and Linear Regression were used. The average correct scores of fertility knowledge were 49.7%, 53.3%, and 51.55% for men, women, and in total, respectively. The multiple linear regression model showed that fertility knowledge was significantly related to being female, being from a higher economic status, having desire to have children in the future, and having desire to increase fertility knowledge (all p < 0.05). Fertility knowledge among the Iranian reproductive-age men and women was modest. The findings suggested that interventions to increase fertility knowledge are essential, especially interventions targeting men and lower socioeconomic groups.