January 16, 2023

Assessing Young Women’s Knowledge About Fertility and Their Fertility Health Risk Factors: A Research Review

By: Callie Hillman

Editor’s Note: Fertility, ovulation and the normal female cycle are important aspects of one’s health and well-being. [1] Even the American College of Obstetricians and Gynecologists recommends the menstrual cycle as a vital sign for women.[2] Education in fertility awareness-based methods (FABMs) can empower young women to identify risks to their reproductive health, make lifestyle changes to improve their fertility and seek early treatment for underlying health conditions, such as PCOS and endometriosis. These conditions are associated with infertility and subfertility, as well as have overall health consequences. Unfortunately, young women often are uninformed of the risks to their fertility and are generally unaware of their own reproductive health as observed in a study, summarized by Callie Hillman, as part of her participation in our FACTS elective.



In this 2019 study, Mu et al. sought to assess young women’s perceptions versus their actual knowledge of fertility. Researchers also examined the individual risk factors that can affect one’s fertility in 18 to 24-year-old women. [3] As noted in this article, a number of studies suggest women overestimate their knowledge of fertility and underestimate their own risk factors. Women may benefit from more accurate knowledge of their own fertility, so they can make informed and timely family-planning decisions. [4]

“A number of studies suggest women overestimate their knowledge of fertility and underestimate their own risk factors.”


This quantitative, cross-sectional study used an online questionnaire to survey women from two different sources: a college campus and a Facebook group for FABMs. The online survey was composed of 81 questions, including 15 that were demographic. These included age, ethnicity, education, relationship status, methods of contraception, and pregnancy history. Additional questions assessed perceived knowledge about fertility, using an adapted Knowledge of Fertility and Fertility Preservation scale. [5]  Participants used a 5-point scale to indicate their knowledge of fertility and normal reproductive function, with higher scores indicating greater perceived knowledge.

There were an additional 26 items used to assess actual knowledge, using the Mu Fertility Knowledge Assessment Scale [3]. Participants were asked to answer questions with either true (1 point), false (0 points), or don’t know (0 points), with higher scores indicating more actual knowledge.

Lastly, the assessment addressed fertility health risk factors of the participants using a modified version of FertiSTAT, a yes or no response to identify whether or not a patient possessed a certain risk factor. Male fertility and age-related questions were omitted.


Although 422 women completed the survey, only 342 participants met the inclusion criteria for the study. The majority of participants had some college education and were white, Catholic, and heterosexual. Women using FABMs for contraception were also more likely to be married, experienced at least one pregnancy, and used ≥4 other types of contraception. Most participants considered themselves to have some knowledge of their fertility health, with only 20% thinking they had “no” or “a little” knowledge and 29% believing they had “a lot” of knowledge.

The Mu fertility scale provided assessment scores ranging from 27 to 100, with 100 indicating greater knowledge of fertility. This scale was able to identify women who may have had surface-level knowledge, but were either uncertain or not properly educated in the nuances of ovulation and fertility. This study found that while most women understood risk factors that are associated with fertility issues, many were still unaware that sexually transmitted infections (STIs) may contribute to problems with fertility. [6] Additionally, women who used FABMs, and demonstrated higher actual knowledge about fertility, had a decreased risk of infertility and related fertility risk factors.

Focused female student working on laptop.

“This study found that while most women understood risk factors that are associated with fertility issues, many were still unaware that sexually transmitted infections (STIs) may contribute to problems with fertility.”

Overall, the results of this study demonstrated that young women with higher actual knowledge scores tended to report fewer fertility or risk factors.  Whereas, there was a positive correlation between self-perceived fertility knowledge scores and the number of reported health risk factors.


The results of this study were consistent with the findings of previous studies that assessed the knowledge of young women about their fertility and health risk factors. This study emphasizes the need for further education in fertility awareness among young women, including lifestyle factors that impact their fertility.

Current education in women’s health lacks basic knowledge about the female menstrual cycle, the importance of ovulation, and how women can track external signs that reflect internal hormonal changes. This results in young women with a greater perceived knowledge but a deficit in actual knowledge, especially in regards to the female cycle biomarkers. Upon completion of the study, numerous women indicated that the survey helped them become more interested in learning about their reproductive health.

“Current education in women’s health lacks basic knowledge around the female menstrual cycle, the importance of ovulation and how women can track external signs that reflect internal hormonal changes.”

The study possessed several limitations. Due to the limited demographics of the women who participated in this study, the results are not generalizable. This is secondary to lack of representation of women from differing racial and ethnic backgrounds, as well as those with decreased levels of education. Further studies will need to be conducted with broader demographic participation and educational levels in order to be applicable to the general population

In order to accurately depict ongoing educational efforts, additional research is also required to assess long-term improvement on increasing knowledge of fertility and women’s health and decreasing health risk factors.

Increasing access to information can empower women to take control of their reproductive health and fertility at a younger age. Adolescent girls who learn about FABMs may be able to make better decisions regarding their health, and decrease their fertility risk factors. Young women are ready and willing to learn about these topics, and health professionals should be prepared to have these discussions at annual wellness visits.



[1] ACOG Committee Opinion No. 651: Menstruation in Girls and Adolescents: Using the Menstrual Cycle as a Vital Sign. Obstet Gynecol. 2015;126(6):e143-e146. doi:10.1097/AOG.0000000000001215
[2] Vigil P, Lyon C, Flores B, Rioseco H, Serrano F. Ovulation, a sign of health. Linacre Q. 2017;84(4):343-355. doi:10.1080/00243639.2017.1394053
[3] Mu, Q., Hanson, L., Hoelzle, J., Fehring, R. “Young Women’s Knowledge About Fertility and Their Fertility Health Risk Factors.” Journal of Obstetric, Gynecologic, and Neonatal Nursing, 2019. https://pubmed.ncbi.nlm.nih.gov/30684446/
[4] García D, Vassena R, Prat A, Vernaeve V. Increasing fertility knowledge and awareness by tailored education: a randomized controlled trial. Reprod Biomed Online. 2016 Jan;32(1):113-20. doi: 10.1016/j.rbmo.2015.10.008. Epub 2015 Oct 30. PMID: 26611499.
[5] Duncan, F., Brannigan, R., & Woodruff, T. (2014). Fertility Preservation.  Jaffe’s Reproductive Endocrinology, 791-821.e7. doi: 10.1016/b978-1-4557-2758-2.00033-0
[6] Goundry AL, Finlay ER, Llewellyn CD. Talking about links between sexually transmitted infections and infertility with college and university students from SE England, UK: a qualitative study. Reprod Health. 2013;10:47. Published 2013 Sep 11. doi:10.1186/1742-4755-10-47


Callie Hillman

Callie Hillman is a 4th year osteopathic medical student at Arkansas College of Osteopathic Medicine in Fort Smith, AR. She completed her undergraduate education at the University of Central Arkansas in Conway, AR. She plans to pursue either Obstetrics and Gynecology or Family Medicine. She hopes to help spread awareness to women of all ages to empower them to learn about their own health and fertility.

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