Fertility awareness and attitudes towards parenthood among Danish university college students

Single mothers by choice - experiences of single women seeking treatment at a public fertility clinic in Denmark: A pilot study

PROBLEM

There has been an increase in the number of single women deciding to have children through the use of medically assisted reproduction (MAR). These women are referred to as 'single mothers by choice' (SMC).

BACKGROUND

Previous studies have shown how SMC can feel stigmatised.

AIM

Explore if single women seeking fertility treatment in Denmark feel stigmatised.

METHODS

Six single women undergoing MAR at a public fertility clinic in Denmark were interviewed. The interviews were audiotaped, anonymised, and transcribed in full, after provided written consent by the participants to take part in the study. Data were analysed using qualitative content analysis.

FINDINGS

The women would have preferred to have a child in a relationship with a partner. Despite their dream of the nuclear family meaning a family group consisting of two parents and their children (one or more), the women choose to become SMC because motherhood was of such importance, and they feared they would otherwise become too old to have children. The participants did not experience stigma or negative responses to their decision, but they all had an awareness of the prejudices other people might have towards SMC.

CONCLUSION

This study contributes to the understanding of the experiences of single women seeking fertility treatment in a welfare state where there are no differences in the possibilities for different social classes to seek MAR.

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.

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.

Female university students' fertility intentions and their psychosocial factors

BACKGROUND

Raising the birth rate can effectively increase the resulting labour supply and minimise the adverse impact of an ageing population on high-quality economic development since the demographic dividend is rapidly declining. The Chinese government has a "three-child" policy in place, yet the fertility rate is still falling. This study intends to investigate the present fertility intentions of female university students and assess the extent to which feminism has affected their intentions. It will next investigate the degree to which and the mechanisms by which the psychosocial factors have an impact on those intentions.

METHODS

A cross-sectional survey of female university students was conducted in Nanjing, China, from February to March 2023. To assure the representativeness of the sample, a technique of stratified proportional sampling, PPS sampling, and convenience sampling was utilized. A total of 1124 valid samples were acquired from female university students in 15 comprehensive universities. The data were mined and analysed by SPSS (version 24.0) and AMOS (version 24.0) software.

RESULTS

Overall female university students' fertility intentions are low at this stage, with more than half (53.55%) of them having no clear desire to have children. The level of feminist identity significantly negatively affected the Intensity of desire to have children (-0.32) and child-number desires (-0.7). Psychosocial factors had a greater degree of influence on fertility intentions. The direct effect of the level of feminist identity and the perception of fertility hindrances on childbearing desires was -0.63 and -0.50 respectively, and the direct effect of the perception of fertility supports on childbearing intentions was 0.79.

CONCLUSION

The level of feminist identity is significantly and negatively related to childbearing desires. Psychosocial factors have a greater degree of influence on fertility intentions, with the level of feminist identity, the perception of fertility hindrances and the perception of fertility supports all significantly impacting fertility intentions. The findings of this study emphasise the importance of the government providing a full range of social security and employers providing better employee benefits to promote a fertility-friendly society.

Frequency, morbidity and equity - the case for increased research on male fertility

Currently, most men with infertility cannot be given an aetiology, which reflects a lack of knowledge around gamete production and how it is affected by genetics and the environment. A failure to recognize the burden of male infertility and its potential as a biomarker for systemic illness exists. The absence of such knowledge results in patients generally being treated as a uniform group, for whom the strategy is to bypass the causality using medically assisted reproduction (MAR) techniques. In doing so, opportunities to prevent co-morbidity are missed and the burden of MAR is shifted to the woman. To advance understanding of men's reproductive health, longitudinal and multi-national centres for data and sample collection are essential. Such programmes must enable an integrated view of the consequences of genetics, epigenetics and environmental factors on fertility and offspring health. Definition and possible amelioration of the consequences of MAR for conceived children are needed. Inherent in this statement is the necessity to promote fertility restoration and/or use the least invasive MAR strategy available. To achieve this aim, protocols must be rigorously tested and the move towards personalized medicine encouraged. Equally, education of the public, governments and clinicians on the frequency and consequences of infertility is needed. Health options, including male contraceptives, must be expanded, and the opportunities encompassed in such investment understood. The pressing questions related to male reproductive health, spanning the spectrum of andrology are identified in the Expert Recommendation.

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.

Let's Talk About Sex: Tyrolean Online Study on Reproductive Health Issues

Introduction

The way pupils and university students talk about sex does not reflect their real understanding of reproductive health issues. Therefore, we developed a survey for pupils and students in Tyrol, Austria, to evaluate the current state of knowledge.

Methods

Two questionnaires with 39 items for pupils (n = 369) and 53 items for university students (n = 537) were developed, and an online survey was carried out in Tyrol, Austria, between April and July 2022. A sum score for each correct answer to ten identical items in both questionnaires was used to compare groups (range: 0-11 points), with analysis performed using independent sample t-test, analyses of variance (ANOVAs) and chi-square test.

Results

With regards to reproductive health issues and fertility awareness, female vs. male participants (p < 0.001), university students vs. pupils (p < 0.001) and medical students vs. other students (p < 0.001) had greater knowledge. Participants who had already had sexual intercourse showed a broader knowledge of contraception and fertility (p < 0.001).The age at which the decline of female fertility becomes relevant was misstated by the adolescents, who gave a mean age of 42.6 years compared to university students who asserted a mean age of 35.9 years (p < 0.001). Overall, the lowest rate of correct answers was found with respect to emergency contraception (30.7%), while knowledge of contraceptive methods was comparatively high (99.2%).

Conclusion

Substantial lack of knowledge of reproductive health issues exists, with differences found between pupils and university students, between genders, and according to field of study. Future health and fertility awareness programs at school and university should focus on gender-specific aspects to prevent unplanned pregnancies, sexually transmitted diseases, and childlessness.

Does information on age-related fertility decline and fertility policies affect university students' family and career expectations? Evidence from a randomized controlled trial

BACKGROUND

Past research shows that young adults have poor knowledge of age-related fertility decline and that the provision of information can improve fertility knowledge. We provide university students with information on age-related fertility and fertility-related policies and investigate whether the provision of such information affects their family formation and career expectations.

METHODS

A three-armed randomized controlled trial was conducted online in Singapore between September and October 2021. A total of 1000 undergraduate students were recruited through campus advertisements to complete a 30- to 45-minute online survey, which randomly exposed participants to one of three informational brochures on age-related fertility decline, fertility policies, or diabetes (control group). Participants answered questions on family formation and career expectations both before and after the information intervention. Analysis of covariance was used to assess the effects of the information intervention.

RESULTS

Exposure to age-related fertility information resulted in significant reductions in the ideal age at first childbirth, significant increases in the expected probability of marriage before age 30, and (among female participants) significant increases in the expected likelihood of undergoing social egg-freezing. No difference existed in child-number ideals, educational aspirations, and income expectations between groups after exposure. No difference existed between the fertility policy information group and the control group after exposure in any of the outcomes of interest.

CONCLUSIONS

Information on age-related fertility decline brought forward university students' expected timing of childbearing and marriage without reducing their educational and career expectations. The provision of fertility information at early ages, such as during university, can help correct widespread inaccurate beliefs about fertility and promote realistic family formation planning without adversely affecting educational and career goals.

TRIAL REGISTRATION

ClinicalTrials.gov.

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.

University students' fertility awareness and its influencing factors: a systematic review

INTRODUCTION

In recent years, a growing number of researchers have begun to study fertility awareness (FA). Evidence suggests that college students in their reproductive years have a common understanding of fertility, risk factors for infertility, and assisted reproductive technologies. Therefore, this systematic review summarizes these studies and explores the factors affecting college students' fertility awareness.

METHODS

A systematic literature search of databases (PUBMED/MEDLINE, Cochrane, Web of Science, Embase, and EBSCO) was conducted from inception to September 2022. Studies that assessed the levels of fertility awareness and factors influencing college students were considered for the review. The qualities of the included studies were evaluated using the Strengthening the Reporting of Observational Studies in Epidemiology guidelines. This systematic review is reported according to the preferred reporting items for systematic review (PRISMA) guidelines.

RESULTS

Twenty-one articles met the eligibility criteria and were included. The preliminary results showed that participants reported low to moderate FA. Female medical students demonstrated higher levels of fertility awareness. The association between age, years of education, and FA was insufficient.

CONCLUSION

The results of the current study suggest that increased FA interventions are warranted, especially for the male, non-medical student population. Governments and educational institutions should strengthen education programs for young students on reproductive health to help them raise awareness about childbirth, and society should provide family support for young people.

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.

Social disparities in the use of ART treatment: a national register-based cross-sectional study among women in Denmark

STUDY QUESTION

How are educational level, labor market attachment and income associated with receiving a first ART treatment in either the public or private healthcare sector among women in Denmark?

SUMMARY ANSWER

Higher educational level and income as well as labor market attachment were associated with higher probability of initiating ART treatment at public and private fertility clinics among women in Denmark.

WHAT IS KNOWN ALREADY

Infertility is common in populations worldwide, and the approach to this issue differs between societies and healthcare systems. In the public Danish healthcare system, ART treatment is free of charge, and the direct cost for patients is therefore low. In the private healthcare sector in Denmark, ART treatment is self-financed. There is limited knowledge about the association between socioeconomic factors and seeking ART treatment, although previous studies have indicated that higher socioeconomic status is associated with seeking ART treatment.

STUDY DESIGN, SIZE, DURATION

Women undergoing ART treatment during 1994-2016 registered in the Danish IVF register were individually linked with data from sociodemographic population registers using the Danish Personal Identification number. The study population consisted of 69 018 women treated with ART and 670 713 age-matched comparison women from the background population with no previous history of ART treatment.

PARTICIPANTS/MATERIALS, SETTING, METHODS

The women included in the analyses were aged 18-45 years. The associations between attained educational level, labor market attachment and income and receiving a first ART treatment attempt were investigated for women either initiating treatment in the public sector or in the private sector, respectively. Information on age and origin was included as potential confounders, and odds ratios (ORs) were estimated in logistic regression models. In addition, analyses were stratified by age group to investigate potential differences across the age span.

MAIN RESULTS AND THE ROLE OF CHANCE

Adjusted results showed increased odds of receiving a first ART treatment in either the public or private sector among women with a higher educational level. Furthermore, women in employment were more likely to receive a first ART treatment in the public or private sector compared to women outside the workforce. The odds of receiving a first ART treatment increased with increasing income level. Surprisingly, income level had a greater impact on the odds of receiving a first ART treatment in the public sector than in the private sector. Women in the highest income group had 10 times higher odds of receiving a first ART treatment in the public sector (OR: 10.53 95% CI: 10.13, 10.95) compared to women in the lowest income group. Sub-analyses in different age groups showed significant associations between ART treatment and income level and labor market attachment in all age groups.

LIMITATIONS, REASONS FOR CAUTION

Our study does not include non-ART treatments, as the national IVF register did not register these types of fertility treatments before 2007.

WIDER IMPLICATIONS OF THE FINDINGS

In Denmark, there is equal access to medically assisted reproduction treatment in the publicly funded healthcare system, and since there is no social inequality in the prevalence of infertility, social inequality in the use of ART treatment would not be expected as such. However, our results show that social inequality is found for a first ART treatment attempt across publicly and privately funded ART treatment across the socioeconomic indicators, educational level, labor market attachment and income.

STUDY FUNDING/COMPETING INTEREST(S)

The funding for the establishment of the Danish National ART-Couple II Cohort (DANAC II Cohort) was obtained from the Rosa Ebba Hansen Foundation. The authors have no conflict of interest to declare.

TRIAL REGISTRATION NUMBER

N/A.

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.

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.

A Brief Media Intervention Influences Collegiate Males' Attitude and Knowledge Towards Breastfeeding

Breastfeeding is the optimal source of infant nutrition, yet the mother's decision to breastfeed is complex and influenced by factors including social support and breastfeeding knowledge and attitudes. This study employed a two-group pretest-posttest design to examine whether brief, online video presentations (<2.5 minutes in length) could improve breastfeeding knowledge and attitude among males and compare the outcomes between a knowledge-based and attitude-based intervention. Collegiate male participants (N = 213, 18-40 years of age) demonstrated high breastfeeding exposure (90.1% had friends/family breastfeed) and positive attitudes (89.2% accepted women could breastfeed and work outside home) yet knowledge deficits concerning breastfeeding health benefits were identified. Breastfeeding exposure was positively associated with baseline attitude (r(212)=.186, p = .006 and knowledge (r(212)=.229, p = .001. Both intervention groups reported similar gains in attitude scores; only the knowledge-based intervention reported significant gains in knowledge (M = 1.5, SD = 2.63 vs M = -.07, SD = 1.44, (t = -5.496, df = 211, p < .05). Brief online video presentations may constitute an additional exposure to or nudging toward breastfeeding, and breastfeeding knowledge and attitudes can be positively influenced in young adult males with similar interventions that are affordable and require a minimal time commitment.

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.

Effect of fertility health awareness strategies on fertility knowledge and childbearing in young married couples (FertStart): study protocol for an effectiveness-implementation hybrid type I multicentre three-arm parallel group open-label randomised clinical trial

INTRODUCTION

Birth rates have been declining in many advanced societies including Singapore. We designed two interventions with vastly different resource requirements, which include fertility education, personalised fertility information and a behavioural change component targeting modifiable psychological constructs to modify fertility awareness and childbearing intentions. We aim to evaluate the effect of these two interventions on knowledge, attitudes and practice around childbearing compared with a control group among young married couples in Singapore and understand the implementation factors in the setting of an effectiveness-implementation hybrid type 1 three-arm randomised trial.

METHODS AND ANALYSIS

We will randomise 1200 young married couples to no intervention (control), Fertility Health Screening group (FHS) or Fertility Awareness Tools (FAT) in a 7:5:5 ratio. Couples in FHS will undergo an anti-Mullerian hormone test and semen analysis, a doctor's consultation to explain the results and standardised reproductive counselling by a trained nurse. Couples in FAT will watch a standardised video, complete an adapted fertility status awareness (FertiSTAT) tool and receive an educational brochure. The attitudes, fertility knowledge and efforts to achieve pregnancy of all couples will be assessed at baseline and 6 months post-randomisation. Birth statistics will be tracked using administrative records at 2 and 3 years. The primary outcome is the change in the woman's self-reported intended age at first birth between baseline and 6 months post-randomisation. In addition, implementation outcomes and cost-effectiveness of the two interventions will be assessed.

ETHICS AND DISSEMINATION

This study has been reviewed and approved by the Centralized Institutional Review Board of SingHealth (2019/2095). Study results will be reported to the study funder and there are plans to disseminate them in scientific conferences and publications, where authorship will be determined by the International Committee of Medical Journal Editors guidelines.

TRIAL REGISTRATION NUMBER

NCT04647136; ClinicalTrails.gov Identifier.

How do young men want to receive information about fertility? Young men's attitudes towards a fertility campaign targeting men in Copenhagen, Denmark

STUDY QUESTION

What are young men’s attitudes towards the Danish fertility campaign ‘How’s your sperm?’ and how do they want to receive fertility information in the future?

SUMMARY ANSWER

The young men found that the campaign had limited impact because it was not relevant to their current life situation and they believed general fertility awareness should be a mandatory part of education, while more targeted information would be helpful through web-based venues when it was more relevant to their lives (e.g. when ready to have children).

WHAT IS KNOWN ALREADY

It is estimated that 16–26% of the Danish population who want children will experience infertility at some point in their lives. In Denmark, 25% of young healthy men have decreased sperm quality, and 20% of 50-year-old men are childless. Men play an important role in the fertility decision-making of couples, thus, it is important to target men and ensure that they have sufficient fertility knowledge. However, fertility awareness is limited among men and there have been few fertility awareness initiatives targeting men. In October 2018, the Municipality of Copenhagen launched the campaign ‘How’s your sperm?’ as a tool to increase fertility knowledge among men. To identify potential barriers for the effect of fertility campaigns targeting men, evaluations of such campaigns are needed.

STUDY DESIGN, SIZE, DURATION

This study was a cross-sectional, qualitative study of six focus groups including a total of 27 currently childless young men from the Capital Region of Copenhagen, Denmark. Data collection took place between April and October 2019.

PARTICIPANTS/MATERIALS, SETTING, METHODS

The interviewed young men were currently childless and were all residents in the Capital Region of Copenhagen. They were between 23 and 32 years old with an average age of 26 years, and almost all were university students or had a university degree. The focus group discussions were audiotaped, anonymized and transcribed in full. Data were analyzed using qualitative content analysis.

MAIN RESULTS AND THE ROLE OF CHANCE

Overall, the campaign had limited influence on the young men because they believed the campaign was not relevant to their current life situation. Furthermore, the young men were confused about the aim and message of the campaign, as they thought it encouraged them to have their sperm quality tested. The young men also criticized the campaign for making a link between sperm quality and masculinity. They recognized the importance of knowledge about reproductive health but they wanted access to accurate information about fertility and risk factors for infertility. According to the young men, future initiatives should prioritize clear communication of accurate, reliable and understandable fertility information in web-based venues. In addition, the young men suggested that general fertility information should be a mandatory part of the (sexual) education curriculum in primary and secondary schools.

LIMITATIONS, REASONS FOR CAUTIONS

Participants were young and highly educated; thus the findings cannot be generalized to all men of a similar age group or to men at older ages.

WIDER IMPLICATIONS OF THE FINDINGS

Different strategies that are relevant to the lifespan are needed to increase fertility awareness in the male population. The young men’s responses underscored that any fertility awareness strategy or campaign must convey respect for the individual’s autonomy. The findings highlight that how information is communicated and the quality or type of information that is disseminated are both important in acceptability by target users.

STUDY FUNDING/COMPETING INTEREST(S)

No funding was received for this study. No conflicts were declared for all authors.

TRIAL REGISTRATION NUMBER

N/A.

Translation and psychometric evaluation of the Korean version of the fertility awareness and attitudes towards parenthood questionnaire

PURPOSE

This study presents a translation, cultural adaptation, and psychometric evaluation of two instruments of the Fertility Awareness and Attitudes Towards Parenthood (FAAP) questionnaire (Conditions and Life changes) for use in South Korea.

METHODS

This methodological study included 166 university students for psychometric evaluation in the sixth step. The first five steps included forward translation, backward translation, committee review, assessment of content validity, and a pre-test. In the sixth step, psychometric properties, including internal consistency, construct validity, and criterion validity, were evaluated. Exploratory factor analysis and confirmatory factor analysis were conducted to identify the structure of the tool and to assess its validity.

RESULTS

The Korean version showed acceptable internal consistency. Cronbach's ⍺ was .73 for FAAPC-conditions and .83 for FAAP-Life changes. FAAP-Conditions showed a four-factor structure (social conditions, relationship with partner, external environment, and child-rearing support) and FAAP-Life changes had a two-factor structure (reward and burden). In the confirmatory analysis, CMIN/DF, TLI, IFI, SRMR, CFI, and RMSEA were satisfactory.

CONCLUSION

This study provided preliminary evidence of the acceptability, reliability, and validity of the Korean version of the FAAP questionnaire in university students in South Korea. Nonetheless, further evaluation among Korean young adults is warranted to validate this instrument.

Fertility awareness and parenthood intentions among medical students in three European countries

PURPOSE

The aim of this study was to investigate medical undergraduate students' fertility awareness and parenthood intentions in three European countries, as well as possible differences across genders and countries.

MATERIALS AND METHODS

A cross sectional survey among 656 medical students in Sweden, Belgium and Greece. The utilised questionnaire comprised 23 questions.

RESULTS

Three fourth of participants (n = 472/629) correctly stated that women are most fertile at 20-25 years of age. Approximately 91% correctly answered that women's fertility starts to significantly decline before the age of 35, which differed among countries of participation. Social oocyte or sperm freezing was considered by 67% of Belgians, 49% Greeks, and 16.5% Swedes (p < 0.001). Approximately 95% expressed a wish of having a child in the future and the median age was 29 years for the first and 35 years for the last child.

CONCLUSIONS

Knowledge about fertility among medical students was in general satisfactory, albeit varying by country and gender. Medical curricula and social policies for childbearing should be respectively updated in EU countries suffering population growth.

Reproductive Health Literacy and Fertility Awareness Among Polish Female Students

The falling fertility indicators and high prevalence of infertility in Poland make it important for people of reproductive age to have good knowledge of their own fertility in order to be able to take care of their reproductive health. This paper examines reproductive health literacy and fertility awareness among Polish female students. It can help identify gaps in reproductive health education in Poland. The study group included 456 women aged 18–29, who were students of 6 public universities located in Poznan, Poland. The method used was a survey using a self-developed questionnaire assessing the students' knowledge of female and male fertility-related physiology and fertility patterns. The respondents' knowledge was assessed on the basis of the percentage of correct answers. Regression analysis and univariate analysis of variance were used to explore relationships between the students' knowledge and their age, year of study, university and source(s) of information. The average score of correct answers was 55.8%. Older students and medical university students were the most knowledgeable. 93.4% of the respondents correctly identified the optimum age for a woman to have the first child from the point of view of achieving pregnancy fast. Over 90% of the respondents knew such fertility-compromising risks as smoking, diseases and psychological distress. There was much poorer awareness of the adverse effect of unbalanced diet, irregular sleep, and long-lasting physical effort. 47.1% of the students reported gaining information from a number of sources, but as many as 28.3% said their only source was primary or middle school classes. Reproductive health knowledge among the young female students is incomplete, especially as regards lifestyle-related risks. They should be encouraged to supplement it by consulting reliable sources such as health professionals. It is advisable to ensure that the curricula of medical university students provide thorough knowledge in this area, and to arrange suitable electives for students from other universities. As primary and secondary school classes remain an important source of information, quality teaching at these levels should be offered with a focus on making the knowledge as practical and operational as possible. Relevant graduate, postgraduate and in-service courses should be available to professionals responsible for spreading reproductive health knowledge.

Fertility awareness and parenting intentions among Mexican undergraduate and graduate university students

An online, cross-sectional survey was carried out between November 2017 and January 2018 to assess fertility awareness among students attending the National Autonomous University of Mexico (UNAM) in Mexico City. A total of 371 students participated in the survey (n = 228 females, 143 males). 75% of females and 74% of males believed a woman's fertility begins to decline markedly after age 40. Over 75% of all participants overestimated the probability of couples having a live birth after undergoing one cycle of IVF. With regard to parenting intentions, only 48% of females wished to have children compared to 59% of males (p = 0.037) and men were more likely to have their first child at age 30 or later (71% men vs 55% women). In the event of infertility, participants had a higher preference not to have children or to pursue adoption rather than use in vitro fertilisation (IVF). In summary, university students in Mexico City demonstrated low levels of fertility awareness and a smaller proportion indicated a wish to have children than has been reported by young people elsewhere in the world.

Taking fertility for granted - a qualitative exploration of fertility awareness among young, childless men in Denmark and Sweden

Most previous studies about fertility knowledge and attitudes among men have been based on quantitative methods using questionnaires with fixed-choice response options. The aims of this qualitative study were to explore childless young men's reflections on fertility and infertility through semi-structured interviews. Danish (n = 17) and Swedish (n = 12) young childless men aged between 20 and 30 years in their last year of education were interviewed. Data were analysed using qualitative content analysis. Few informants had considered their own fertility, and most were positive towards fertility treatment. The young men had inadequate knowledge about factors that can potentially impair male and female fertility. On average, the young men each mentioned three different factors they believed influence male and female fertility: (i) health behaviour; (ii) factors beyond personal control; and (iii) age. None mentioned sexual transmitted infections (STIs) but most appeared aware of the effect of increasing age on fertility. The results of this study highlight the need for educational strategies to improve young men's knowledge about fertility and the factors that influence it, particularly about the potential adverse effect of STIs on fertility.

Reproductive trajectories and social-biological dimensions in parenthood: Portuguese version of the Meaning of Parenthood scale

BACKGROUND

Public meanings attributed to parenthood may shape individuals' family planning and how involuntary childlessness is supported by governmental policies. This study aimed to evaluate the influence of reproductive trajectories and gender in the meanings attributed to parenthood, and to assess the psychometric characteristics of the Portuguese version of the Meaning of Parenthood (MOP) scale.

METHODS

The sample comprised 754 participants: 246 young adults without children; 51 fathers and 159 mothers of adolescent children conceived spontaneously; and 149 infertile heterosexual couples. The scale was self-administered. Higher scores indicate attributing greater importance to parenthood to fulfill identity needs at individual, marital and social levels. Psychometric characteristics were analyzed through exploratory factor analysis; Cronbach alpha (α) assessed internal consistency.

RESULTS

Two dimensions of the MOP scale emerged, with good internal consistency (α ≥ 0.70): biological (importance of parenthood to fulfill reproductive needs as a biological being); social (importance of parenthood arising from social reproduction). Young adults attributed less importance to parenthood to fulfill both biological and social needs. The biological dimension was valued more than the social dimension in all subsamples; men highly valued the biological dimension compared to women.

CONCLUSIONS

Family planning needs to focus on a reasonable balance between biological and social dimensions of parenthood. The reinforcement of public policies providing the necessary conditions for human reproduction is essential to reverse declining fertility rates.

Attitudes towards Parenthood and Fertility Awareness in Female and Male University Students in South Korea

Purpose

This study investigated intentions and attitudes towards future parenthood and awareness of fertility among university students in South Korea.

Methods

The participants comprised 166 female and male undergraduate students enrolled at five universities. A cross-sectional survey was conducted from May to July 2019 using the Korean version of the Fertility Awareness Questionnaire and Attitudes of Parenthood. The data were analyzed using descriptive statistics based on participants' general characteristics, the x² test to identify differences in intentions, and the t-test to evaluate attitudes towards parenthood and awareness of fertility in female and male students.

Results

Both female and male students desired to have two children, but they lacked awareness about fertility. The possibility of combining work and having children, along with the availability of childcare resources, impacted the desire for parenthood. Male students tended to consider parenthood as less impactful on their lives and careers than female students. Social structures might also impact the decision to have children.

Conclusion

It is important to provide health education emphasizing fertility awareness and parenthood in young adulthood so participants can consider these facts in advance. In addition, the government should provide resources for couples making parenthood decisions.

'Doing it in the right order': childless men's intentions regarding family formation

In high-income countries, parental age at first birth has increased and this postponement increases the risk of involuntary childlessness or having fewer children than desired. This interview study was conducted in Denmark and Sweden among childless men (n = 29) in their last year of an education. The aim was to explore the role of individual and societal factors on fertility decision-making and men's reflections on barriers and enablers for earlier family formation. Data were analysed with thematic content analysis. Almost all participants wanted children in the future. Overall, there was a desire to follow the 'right chronology': get educated, having a stable relationship, employment and a good financial status before having children. While most men felt mature enough to have children, they were still not ready. Influences from within the inner social circle, societal expectations, the need for security and stability and being ready to give up freedom and individuality were factors that affected participants' preferred timing of parenthood. Most men did not have suggestions for how earlier family formation could be supported. Results suggest a gap between the ideal biological and ideal social age of family formation that may lead to unfulfilled parenthood aspirations.

Testing awareness of fertility and reproductive health among unmarried medical students at Cairo University

AIM

We aimed in this survey to assess fertility and reproductive health awareness among medical students.

METHODS

A total of 354 female and male final year medical students (193 females and 157 males) were recruited for this survey at the Kasr Al-Ainy Faculty of Medicine, who attended the lectures of the andrology and sexually transmitted disease department.

RESULTS

Our study demonstrated that the mean ages of the female and male medical students when they want to have their first child were 26.95 ± 2.924 and 28.7 ± 3.94, respectively, and and p = 0, while the mean ages of the female and male medical students when they want to have their last child were 32.5 ± 3.2 and 34.7 ± 5.1, respectively, and p = 0.001. Our study demonstrates that a majority of the female and male medical students moderately estimated the efficacy of the assisted reproductive technique to take a baby home, and the means of their estimation were 42.620% ± 12% and 43.5% ± 13.1% and p = 0.482. Moreover, our study showed that 75 (39.1%) females were convinced that vaginal delivery has a potential negative effect on the sexual functions. However, 99 (51.6%) females did not see any potential negative effect of vaginal delivery. In addition, 18 (9.4%) females responded in an indefinite way to this question. Finally, our study demonstrated that 145 (92.4%) males rejected the proposal of vasectomy.

CONCLUSIONS

Interestingly, our study revealed increased estimation by the participants of the efficacy of the assisted reproductive technique to take a baby home, despite the fact that they were medical students who had already studied the subject of gynecology in their fifth year and should have estimated it properly.

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

Background

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

Methods

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

Results

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

Conclusion

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

Knowledge about the impact of age on fertility: a brief review

Delayed childbearing is currently a major challenge in reproductive medicine as increased age has an important impact on successful conception, both in natural and in assisted reproduction. There is a lack of knowledge about the impact of age on fertility, even in highly educated populations. A number of initiatives have been taken to increase fertility awareness. Health care providers have been encouraged to talk with patients about their reproductive life plan (RLP) for almost a decade based on recommendations from the Centres for Disease Control and Prevention. This concept has been explored successfully in Swedish contraception counselling. A growing number of online interventions aim to raise fertility awareness. These websites or interactive tools provide relevant information for individuals and couples as they consider whether they want children, when they should have them, and how many they may wish to have. These interventions are important, because research depicts that knowledge helps people in their decision-making process. With new fertility preservations such as egg freezing now available, additional education is needed to be sure that women and couples are well informed about the cost and low success rates of this intervention.

Experiences of romantic relationships and desires to marry and have children among youth in a low-fertility society

Introduction: This study aims to explore experiences of romantic relationships and to examine determinants of desires to marry and have children in the future among Japanese university students.

Methods: A cross-sectional study was conducted among undergraduate students of A University, located in the capital city of a Japanese prefecture, using an anonymous self-administered and structured questionnaire developed by an online survey software.

Results: A total of 815 respondents with complete data were analyzed by logistic regression analysis. Over 80% of males and females expressed the desire to marry and have children in the future. It was found that for both female and male respondents, the “desire to marry” was associated with currently being in a romantic relationship or having experience of sexual intercourse. On the contrary, the “desire to have children” was associated with currently being in a romantic relationship or having experience of sexual intercourse only among male respondents, and no significant association was observed among female respondents.

Conclusion: “Currently being in a romantic relationship” and “having experience of sexual intercourse” were associated with wanting to marry and have children in the future among male university students. This suggests that these may be important factors in providing a positive perception regarding having children when they attain childbearing age.

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

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

Female subfertility

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

Fertility awareness, intentions concerning childbearing, and attitudes toward parenthood among female health professions students in Saudi Arabia

OBJECTIVE

Postponing childbearing is becoming increasingly common among higher education students. The awareness about the extent of the age-related decline in female fertility is unknown in Saudi Arabia. The main aim of the study was to assess fertility awareness, particularly age-related fertility decline, and attitudes toward parenthood.

METHODS

A cross-sectional study was conducted utilizing a self-administered questionnaire which was filled by 248 female students in multiple colleges at King Saud Bin Abdulaziz University for Health Science (KSAU-HS). The questionnaire adapted from the Swedish Fertility Awareness Questionnaire; it contains 31 items that can be grouped into five categories: Sociodemographic characteristics, the future intention of having children, important circumstances for the decision to have children, which have seven items, participant perception regarding motherhood impact on life, and knowledge about fertility issues.

RESULTS

Nearly 80% of undergraduate female students want to have children. They have a positive attitude toward parenthood. On the other hand, 85% of the respondents plan to postpone having children until they finish their studies and have a stable career.

CONCLUSION

The study revealed that most of the students are concerned about childbearing. However, the participants are not aware of the decline in fertility caused by aging. More effort should be directed toward spreading awareness regarding age-related fertility decline among health profession students and the general population.

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

INTRODUCTION

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

MATERIAL AND METHODS

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

RESULTS

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

CONCLUSIONS

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

Using reproductive life plan-based information in a primary health care center increased Iranian women's knowledge of fertility, but not their future fertility plan: A randomized, controlled trial

OBJECTIVES

Reproductive Life Plan (RLP)-based information in counseling has been reported in the USA and Sweden to increase women's knowledge of fertility and informed decision making about future fertility plans. This study examined if utilizing the RLP tool would have the same impact on Iranian women.

DESIGN

A randomized, three-armed, controlled trial. 181 women were randomly allocated to the intervention group (IG, n = 61), control group 1 (CG1, n = 60) or control group 2 (CG2, n = 60).

SETTING

A primary health care center in the Sari city, the Provincial capital of Mazandaran, Iran.

PARTICIPANTS

Women of reproductive age who were able to conceive.

INTERVENTIONS

The intervention group received oral and written information about fertility based on the RLP tool. Participants were contacted 2 months after the intervention. The primary outcome measure was the change in women's knowledge of fertility, particularly folic acid intake prior to pregnancy, over a 2 month period. The change in women's family planning intentions were also assessed. The participants in the IG shared their experiences at follow-up.

FINDINGS

At baseline, there was no difference between the groups regarding the mean knowledge of fertility score. At 2 months, after adjustment for age, history of pregnancy and baseline values, the between group difference in change from baseline was 5.8 (p < 0.001). While there was no significant difference between the IG and CG1 for folic acid intake prior to pregnancy at baseline, the group difference for folic acid intake prior to pregnancy post intervention was statistically significant (85% vs 25%, p < 0.001). At follow-up, women's desire to have more children, preferred age to conceive the last child and the desired age gap between children in the IG and CG1 did not significantly change over time. Women reported the RLP counseling tool used by midwives as useful.

KEY CONCLUSIONS

Provision of RLP-based information for Iranian women with a clear pregnancy intention in the context of a stable relationship, increased knowledge of fertility without changing their future fertility plan. The RPL counseling tool was appreciated by study participants. The lack of improvement in women's fertility intentions over time may reflect the involvement of other factors influencing decision making about childbearing in Iran. Whether the RLP can change women's behavior is yet to be established.

IMPLICATIONS FOR PRACTICE

The RLP can be used by health care professionals, especially midwives, as a tool to increase women's fertility knowledge, which may result in fertility behavior change.

Knowledge of age-related fertility decline in women: A systematic review

Age-related fertility decline (ARFD) knowledge has been evaluated in the past decade, showing that there is a general knowledge of the reduction of fertility with age. Here we review the studies published up to date which quantitatively measure this ARFD knowledge, to answer the question: how aware about ARFD is our society? We searched the terms "age", "fertility knowledge", "fertility awareness", "reproduction knowledge", "reproductive knowledge" and "reproductive health knowledge" in PubMed, Web of Science, PsychINFO and Scopus, within January 2000 and December 2016. We found 41 studies that quantitatively measured ARFD knowledge by asking for the most fertile age for a woman and/or when there are a slight and a marked decrease in female fertility. We obtained this searching for the questions: What is the most fertile age for a woman? (Q1). When there is a slight decrease in female fertility? (Q2) and, When there is a marked decrease in female fertility? (Q3). We further evaluated the knowledge increase in the 6 studies assessing an educational intervention, 4 of them randomized controlled trials (RCT). Participants reporting the most fertile age for women to be at 20-24 y.o. ranged 16%-89.4% (Q1); participants reporting a slight decrease in female fertility at 25-29 y.o. ranged 5.1%-83% (Q2), and those reporting that a marked decrease occurs between 35-39 y.o. ranged 5.6%-60% (Q3). On the whole, the studies included in this review conclude that ARFD knowledge is insufficient, particularly in determining when female fertility markedly decreases. ARFD knowledge can be increased through targeted campaigns, but few interventional studies have been performed up to date. In view of these results, ARFD campaigns targeted to reproductive age people and healthcare providers are necessary; this would help the society to make informed reproductive decisions throughout life.

[Trends in Research on Adolescent Sexuality Education, Fertility Awareness, and the Possibility of Life Planning Based on Reproductive Health Education]

In this paper, we describe the trends in research on adolescent sexuality education in Japan and other countries and on fertility awareness, as well as the possibility of life planning based on sex and reproductive health education. Mason-Jones AJ et al. reviewed the results of school-based intervention studies on the prevention of human immunodeficiency virus infection, sexually transmitted diseases, and pregnancy. There is little evidence supporting the idea that educational curriculum-based programs alone are effective in improving sex and reproductive health outcomes in adolescents. In another study, the effectiveness of school-based sexuality education for adolescents in Japan was evaluated. The Japan Medical Abstract Society was searched for articles published in the last 10 years. In many studies, the effects were compared before and after a single sexuality education lecture by professionals, such as doctors, midwives, and public health nurses. In Japan, effort has been directed toward sexuality education, but no systematic program based on behavior theory has been adopted. Therefore, sex education is insufficient. A third study clarified research on fertility awareness in adults and issues regarding improvements in related education and research. The Japan Medical Abstract Society and PubMed were searched for articles published in the last 10 years. The review suggested that awareness of female fertility is insufficient. Delaying childbearing based on inaccurate knowledge of the decline in female fertility could lead to unintended infertility. For males and females, sexual health education in schools and communities should include information on the age-related decline in female fertility. Although the determinants of the timing of childbearing are multifactorial, education on fertility issues is necessary to help adults make informed reproductive decisions based on accurate information. Finally, in this paper, we introduce examples of the pioneering efforts in sexual health education through collaboration between the governments of Oita and Okayama Prefectures and Oita and Okayama Universities.

Attitudes towards family formation among men attending fertility counselling

Men and women are increasingly postponing childbearing until an age where fertility has decreased, meaning that they might have difficulties in achieving their desired family size. This study explored childless men's attitudes towards family formation. Data were collected through semi-structured qualitative interviews with 21 men attending the Fertility Assessment and Counselling Clinic in Copenhagen or Horsens, Denmark. Data were analysed using content analysis. The men envisioned a nuclear family with their own biological children, but they experienced doubts and ambivalence about parenthood and feeling 'ready'. Their lack of readiness was linked to their awareness of the sacrifices and costs involved with parenthood, and their belief that they could safely delay parenthood. The men did not consider that they may be unable to have their own biological children. This study highlights the importance of considering men's attitudes and preferences towards family formation when understanding couples' decision-making. Contrary to common understanding, the findings show that men are as concerned with the planning and timing of parenthood as women, but their knowledge of the age-related decline in fertility is poor. Men need to gain more awareness of the limitations of fertility and the impact of female and male age on the ability to achieve parenthood aspirations.

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

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

What do people know about fertility? A systematic review on fertility awareness and its associated factors

INTRODUCTION

Recent evidence indicates that reproductive-age people have inadequate fertility awareness (FA) concerning fertility, infertility risk factors, and consequences of delaying childbearing. However, no study has tried to summarize these studies and to clarify the variables associated with FA, namely the role of gender, age, education, and reproductive status on FA.

METHODS

A literature search up to February 2017 was conducted using the EBSCO, Web of Science, Scielo, and Scopus electronic databases with combinations of keywords and MeSH terms (e.g. 'awareness' OR 'health knowledge, attitudes, practice' AND 'fertility'; 'fertile period'; 'assisted reprod*').

RESULTS

Seventy-one articles met the eligibility criteria and were included. The main results showed that participants report low-to-moderate FA. Higher levels of FA were shown by women, highly educated individuals, people who reported difficulties with conceiving, and those who had planned their pregnancies. Having or desiring to have children was not related to FA level. An inconsistent association between study participant age and FA was observed, with some studies indicating that older participants had higher FA, but others found an opposite result or did not find any association.

CONCLUSION

The current findings suggest that interventions to increase FA are warranted, especially those targeting men, people with low education, and in family planning settings. Interventions and campaigns should be customized to meet individuals' needs regarding FA. Because of the high heterogeneity regarding the assessment of FA, these conclusions must be interpreted with caution.

Artificial Sperm: New Horizons in Procreation

Azoospermia, the absence of any sperm cells from the ejaculated semen, poses a real challenge to the fertility urologist. While there are options to create happy families for azoospermic couples, such as the use of donor sperm and adoption, most couples still want to have genetically related offspring. Advances in urology, gynecology, and fertility laboratory technologies allow surgical sperm retrieval in azoospermic men and achievement of live births for many, but not all azoospermic couples. At present, there are extensive research efforts in several directions to create new fertility options by creating "artificial sperm cells." While these new horizons are exciting, there are significant obstacles that must be overcome before such innovative solutions can be offered to azoospermic couples. The present review article defines the problem, describes the theoretical basis for creation of artificial genetically related sperm cells, and provides an update on current successes and challenges in the long tortuous path to achieve the ultimate goal: enabling every azoospermic couple to have their own genetically related offspring. Hopefully, these research efforts will ripen in the foreseeable future, resulting in the ability to create artificial sperm cells and provide such couples with off-the-shelf solutions and fulfilling their desire to parent genetically related healthy babies.

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

Awareness among people of reproductive age about the factors that influence fertility and reproductive outcomes, including medically assisted reproduction outcomes, is generally low. To improve awareness about the potentially modifiable factors that affect fertility and reproductive outcomes, 'Your Fertility', a fertility health promotion programme funded by the Australian Government, was established in 2011. This paper describes the development and evaluation of the reach of the Your Fertility programme from its inception in 2011 to June 2016. Systematically recorded outcomes for the programme's key focus areas and Google Analytics data were collated. Key achievements include developing and maintaining an internationally renowned website that experiences high growth and demand for fertility-related information; by 2016, over 5 million users had viewed more than 10 million webpages, and over 96,000 users had engaged in programme messages across social media. Programme messages have reached more than 4 million Australian social media users, and a potential audience of 150 million through media coverage across more than 320 media features. More than 4200 education and health professionals have completed online learning modules, and external partnerships have been established with 14 separate organizations. Data collected over 5 years indicate that the Your Fertility programme meets a need for targeted, evidence-based, accessible fertility-related information.

Maternal age and child morbidity: A Danish national cohort study

INTRODUCTION

The mean age at delivery has increased over the latest half of a century. Women of advanced maternal age have increased obstetrical risks and increased risk of chromosomal abnormalities and some other specified diagnoses in the offspring. The aim of this study was to assess the association between maternal age and overall child morbidity according to main diagnosis groups.

MATERIAL AND METHODS

We conducted a national cohort study including 352 027 live firstborn singleton children. The children were born between Jan 1994 and Dec 2009 and followed to Dec 2012. Children were divided into groups according to maternal age: 15-24, 25-29, 30-34, and 35+ years. Poisson regression analyses calculated adjusted incidence rate ratios (IRR) of child morbidities according to main diagnoses groups A-Q of the International Classification of Disease 10 with adjustment for year of birth, body mass index, smoking, and mother's level of education.

RESULTS

Average follow-up time was 11 years. Compared to children born to women 25-29 years, firstborn children to mothers aged 35+ had higher child morbidity in 8 of 19 main diagnosis groups and firstborn children to mothers 15-24 years had higher child morbidity in 12 of 19 main diagnosis groups. Thus, for a majority of diseases a U-shaped correlation was found, with lowest rates in women 25-29 years.

CONCLUSION

Firstborn children to both older and younger mothers have higher overall morbidity as compared to children born by mothers 25-29 years.