July 24, 2023

Efficacy of a Fertility Education Website: A Review

By: Francesca Ferrante, DO

Director’s Note: To mark National Natural Family Planning (NFP) Awareness Week, we are featuring research that assessed the efficacy of online education in fertility awareness. The research was summarized by Dr. Francesca Ferrante, a first-year resident and former FACTS elective participant. The study [1] by Daniluk et al published in Human Reproduction noted significant increases from baseline in fertility knowledge and beliefs following intervention. The results highlight the lack of accurate, comprehensive fertility knowledge among both men and women of reproductive age. To address this knowledge gap, FACTS offers a presentation, The FACTS about Fertility Explained, that provides an overview of fertility, including the signs of the female cycle and a basic introduction to modern evidence-based natural or fertility awareness-based methods (FABMs). Invite a FACTS Speaker to give the presentation in-person or register for the webinar.

In recent years, there has been an increased propensity to delay starting a family until later in life. This trend is more common in developed countries, where the average age of females giving birth to their first child is 30 years old.[2] Advanced parental age comes with increased risks of infertility, miscarriage, use of assisted reproductive technology (ART), and adverse outcomes for both mother and baby, as well as the potential for a smaller family size than desired.[3]

The decision to delay parenthood is complicated by numerous social, professional, and economic factors. However, recent research shows many women and men appear to choose to have children later based on inaccurate information regarding fertility and the other risks that come with childbearing at an older age.[4][5] Men and women share a common misconception that if conceiving naturally becomes too difficult as they get older, in vitro fertilization (IVF) can easily be used. Research also suggests that men seem to underestimate the potential risks of fathering children for older men.[6]

“Research shows many women and men appear to choose to have children later based on inaccurate information regarding fertility and the other risks that come with childbearing at an older age.”

In the study[1] published in 2015, Daniluk and Koert evaluated the effectiveness of online fertility education on the knowledge of men and women regarding reproduction and fertility lifespan. They assessed whether reading ten posts about fertility online would increase knowledge immediately after reading, and their knowledge was reassessed six months later. The researchers also sought to find out whether certain demographic factors, such as age or gender, had an influence on the results.

Methodology

The participants in this study included 48 men and 151 women from Canada. All participants were between the ages of 18 and 35 years old (mean age 28), had no children, and had never completed a fertility awareness survey. Among participants, 80.4% were Caucasian and 14.8% were Asian or Southeast Asian; 52.8% were single and 45.2% were married, and 92.5% identified as heterosexual. The majority (67.3%) reported having completed college.

Each participant was asked to complete parts of the Fertility Awareness Survey, which had been used in a prior study done by Daniluk and Koert in 2013.[7] The participants completed the survey right before and immediately after reading ten posts about fertility from the myfertilitychoices.com website. The survey included four questions about beliefs surrounding age and reproduction, two questions on perceived fertility and ART knowledge, and twenty questions assessing general fertility and ART knowledge. Demographic questions collected information about age, sexual orientation, education, occupation, income, and relationship status. Six months after the initial survey, the participants were invited to complete a post-survey to evaluate whether the changes in beliefs and/or increase in knowledge were sustained over time. The six-month survey was completed by 110 participants.

The researchers used the Statistical Package for the Social Sciences (SPSS) program to conduct paired t-tests on pre to post-scores and to compare responses to some of the specific questions. Two-tailed t-tests were used to compare gender, relationship status, and age to see if there were significant differences in participant scores based on demographic factors.

Result

Participant perception of the “ideal age for a woman to give birth to her first child” dropped from 26.87 in the pre-survey to 25.87 in the immediate post-survey. However, it increased to 27.19 in the survey re-administered six months later. Similar results were seen with the question regarding the latest age at which a woman should give birth, with the average age initially decreasing but returning to pre-survey numbers six months later. The researchers also noted the answers did not differ significantly based on age or relationship status.

General knowledge of fertility increased immediately upon reading the ten posts online and remained high at the six-month mark. The number of correct answers increased after reading the articles and the percentage of “uncertain” answers decreased as well. At the six-month mark, participant scores differed from the pre-intervention survey for four of the questions asked. The number of correct answers was the same, but there remained a decrease in the percentage of “uncertain” answers.

“General knowledge of fertility increased immediately upon reading the ten posts online and remained high at the six-month mark.”

Of note, there were significant differences found between the pre-and post-intervention scores on 13 questions for women and 9 questions for men. The number of questions answered correctly by 50% or more of the women after reading the ten posts increased from 10 to 14, while for men, it increased from 7 to 13. There were significant changes in knowledge scores on only 6 questions for the 81 women who participated in the six-month follow-up survey, and on 1 question for the 29 men who participated.

Discussion

This research is very relevant to women’s health and fertility; knowledge and understanding are essential for both. Many men and women lack a solid education about fertility health in general and may not understand the potential or even likely ramifications of starting a family at an older age. Interestingly, this article hypothesizes the discrepancy between answers about maternal age at the time of her first child immediately after reading the ten posts versus six months later may be related to the difference between perceptions and beliefs. External factors influence perceptions to a larger extent, making them more subject to change. On the other hand, beliefs are firmer and steadier and form over a longer period. It would be difficult to completely change someone’s beliefs based on ten online posts; however, it might be sufficient to provoke further thought. This concept emphasizes that beliefs and opinions involve more than knowledge, although that is an essential piece.

This research highlights the idea that many men and women are potentially basing their decisions of when to start a family on inaccurate information regarding fertility. Yet, perhaps it is not so simple. While this article acknowledges other factors that may play a role in deciding when to have children, those variables likely have a greater influence than the researchers ascribe to them. Despite having increased knowledge six months later, the participants still reverted to their pre-intervention opinions regarding the best age for a woman to have her first child. Further research into fertility knowledge should incorporate other confounding variables, such as professional goals, that can be integral in timing a family.

“Despite having increased knowledge six months later, the participants still reverted to their pre-intervention opinions regarding the best age for a woman to have her first child.”

Another interesting outcome of this study was that women’s fertility knowledge level was higher than men’s at all points of the assessment. This is likely due to the perceived direct relevance of fertility awareness and information to a woman’s life compared to men. This idea suggests the importance of marketing information about fertility differently based on gender. While all people should receive a similar education about fertility lifespan and related topics, perhaps the information should be targeted differently to distribute the information more effectively. Overall, this research highlights the fact that fertility knowledge is still lacking for many men and women of reproductive age. Online methods of disseminating this information may be effective short term, but further research is needed to determine how well this method teaches information that will endure for an extended period.

References

[1]Daniluk JC, Koert E. Fertility awareness online: the efficacy of a fertility education website in increasing knowledge and changing fertility beliefs. Hum Reprod. 2015;30(2):353-363.
[2]Bewley S, Davies M, Braude P. Which career first? The most secure age for childbearing remains 20–35. BMJ. 2005;331:588–589.
[3]Leridon H. Can assisted reproduction technology compensate for the natural decline in fertility with age? A model assessment. Hum Reprod. 2004;19:1548–1553.
[4]Adashi EY, Cohen J, Hamberger L, Hones HW, De Kretser DM, Lunenfield B, Rosenwaks Z, van Steirteghem A. Public perception on fertility and its treatment: an international survey. Hum Reprod. 2000;15:330–334.
[5]Benzies K, Tough S, Tofflemire K, Frick C, Faber A, Newburn-Cook C. Factors influencing women’s decisions about timing of motherhood. J Obstet Gynecol Neonatal Nurs. 2006;35:625–633.
[6]Peterson BD, Pirritano M, Tucker L, Lampic C. Fertility awareness and parenting attitudes among American male and female undergraduate university students. Hum Reprod. 2012;27:1375–1382.
[7]Daniluk JC, Koert E. The other side of the fertility coin: a comparison of childless men’s and women’s knowledge of fertility and assisted reproductive technology. Fertil Steril. 2013;99:839–846.

ABOUT THE AUTHOR

Francesca Ferrante, DO

Francesca Ferrante, DO is a PGY-1 psychiatry resident at Stony Brook Eastern Long Island Hospital. She completed medical school at Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine in Ft. Lauderdale, FL.