FACTS Spotlight: National NFP Awareness Week
July 26, 2021
By Mary Ann Nyc, MD, MPH
Fertility Knowledge Gaps in Medical Education: A Research Review
Editor’s Note: This week, FACTS celebrates National NFP Awareness Week by sharing a review of research that is highly relevant to medical professionals. Later in the week, we will summarize an important statement by the American College of Obstetricians and Gynecologists (ACOG) supporting fertility awareness education.
In 2019, we published a review of research[i] that validated the ‘Fertility and Infertility Treatment Knowledge Score’ (FIT-KS). In that 2017 study, reproductive age women were interviewed in Phase 1; medical students and obstetrics and gynecology (OB-Gyn) resident physicians were added in Phase 2.
The 2020 research[ii] reviewed below built on the 2017 FIT-KS study and focused on assessing knowledge of fertility and infertility among OB-Gyn resident physicians. Dr. Mary Ann Nyc summarized the 2020 study while on the FACTS fertility awareness online elective taught through Georgetown University School of Medicine.
Women’s fertility is often an overlooked subject which does not receive the attention it deserves. Many women are not familiar with how to monitor their gynecological health and do not seek medical advice until their health starts to suffer. Our society receives information about fertility through the media, where fertility is discussed in relation to its decline as women age, and women learn very little else. Yet, many people don’t realize that even professional women in the medical field can lack knowledge of their fertility, which presents challenges when needing to counsel their patients.
Fertility awareness is a science that allows a woman to use signs from her body to monitor health and predict fertile days. With appropriate guidance, anyone can learn to observe these signs and gain a better understanding of their fertility. At the very least, one would hope medical professionals would be well-versed in understanding how these signs relate to female fertility.
Sadly, those aspects of fertility awareness are not part of the medical school or residency curriculum. The specialty of obstetrics and gynecology encompasses obstetrics (pregnancy, childbirth, postpartum) and gynecology (matters related to the female reproductive system). Even this specialty does not currently teach physicians in training about the physical signs of fertility, benefits of charting the menstrual cycle, fertility awareness-based methods (FABMs) or their medical applications at all or with much emphasis. To investigate this further, research was done to survey OB-Gyn residents to assess their knowledge of fertility.
To evaluate fertility knowledge among OB-Gyn residents, a recently validated survey was used, the Fertility and Infertility Treatment Knowledge Score. This tool consists of 21 questions about natural fertility and 8 questions on infertility. In April 2018, researchers emailed all OB-Gyn residency directors requesting they forward the web-based survey to their residents. Of the 5,000 OB-Gyn residents across the U.S. at the time, 177 responded to the survey, and 166 of them completed the survey.
Respondents were fairly evenly distributed across all post-graduate years (PGY), including 40 PGY1 residents, 47 PGY2 residents, 39 PGY3 residents, and 40 representing fourth-year residents (PGY4). The majority (92%) of the participants were female, with 69% between the ages of 26 and 30 years old.
The maximum survey score was 29 points, with 1 point per question. The mean scores were as follows:
|Year in Training||
Mean FIT-KS Score
When asked whether they were concerned about their own future fertility, 33% of respondents reported not being concerned. The majority (95%) of residents reported never having discussed fertility with their patients.
Topics revealing significant knowledge gaps included fertility, age of fertility decline, and in vitro fertilization (IVF) success rates. Additionally, 59% of respondents could not identify pregnancy rates per cycle for women under 35 years who undergo IVF. Approximately 73% of respondents knew about male fertility, 48% knew that moderate alcohol consumption did not affect fertility, and 70% knew that certain lubricants affect fertility.
This study confirms that knowledge gaps about fertility persist in medical education that must be addressed. The validated FIT-KS survey specifically developed for physicians is an effective way to collect this type of data. In the future, it would be beneficial to include other specialties as well. If more comprehensive fertility training is incorporated in OB-Gyn residencies, the FIT-KS could help provide pre- and post- analysis of residents’ knowledge.
Unfortunately, the low rate of respondents (166 out of 5,000 OB-Gyn residents nationwide) is not ideal for research analysis. Those who did respond may have biased the results if they had a personal interest in fertility medicine; this is known in statistics as ‘response bias.’ Furthermore, it is unclear if all residency directors forwarded the survey to their residents, and if there is a better way to disseminate the survey to increase resident participation and interest in this important data.
Still, the findings are eye opening. Knowledge gaps were identified involving age-related declining fertility, IVF success rates, and natural fertility among the OB-Gyn residents who responded to the survey. It would be interesting to know if these results were similar to residents in other specialties as well, particularly those in family medicine, internal medicine, and pediatrics.
The message is clear: there is a lack of training and understanding of fertility medicine. If medical professionals do not have this knowledge base, they are not likely to adequately help patients with their fertility needs or concerns.
Editor’s Note: At FACTS, we see it as our mission to bridge gaps in education identified in this and other studies to benefit medical professionals and patients alike. Medical students and residents consistently praise our online elective in fertility awareness for educating them with evidence-based information they never learned in medical school or residency training. We reached over 220 students in 2020-21 and anticipate educating even more students next year.
These research studies constitute a call to action we are proud to continue to answer at FACTS. This summer we launched a 4-part CME course for medical professionals interested in learning more about fertility awareness, charting the female cycle, and clinical applications of FABMs as well as their use in women’s health monitoring and family planning. Learn more and enroll in the course HERE.
[i] Kudesia R, Chernyak E, McAvey B. Low fertility awareness in United States reproductive-aged women and medical trainees: creation and validation of the Fertility & Infertility Treatment Knowledge Score (FIT-KS). Fertil Steril. 2017 Oct;108(4):711-717. doi: 10.1016/j.fertnstert.2017.07.1158. Epub 2017 Sep 11. PMID: 28911930.
[ii] Roberts, L.M., Kudesia, R., Zhao, H. et al. A cross-sectional survey of fertility knowledge in obstetrics and gynecology residents. Fertil Res and Pract 6, 22 (2020). https://doi.org/10.1186/s40738-020-00091-2.
About the Author
Mary Ann Nyc, MD, MPH
Mary Ann Nyc, MD, MPH, wrote this review as a fourth-year medical student at Geisinger Commonwealth School of Medicine in Scranton, Pennsylvania. She is completing family medicine residency training at UC Riverside in Riverside, CA. Dr. Nyc is proud to serve as a FACTS ambassador.
The FACTS CME Course is HERE!
The FACTS 4-part CME Course – Fertility Awareness Based Methods (FABMs) for Family Planning and Restorative Reproductive Women’s Healthcare prepares you as a medical professional to present more comprehensive options for family planning and women’s health monitoring and management of a range of reproductive health concerns. Through online lectures, live case study discussions, and readings, this course will explore the broad applications of modern Fertility Awareness-Based Methods (FABMs) and their role in pregnancy prevention, infertility, and women’s health.
The course is divided into four parts; you may elect to do any or all of them and they may be completed in any order. Each part is worth up to 14 AAFP-approved CME credits.
• Part A, An Introduction to Modern FABMs for Family Planning
• Part B, Special Topics in FABMs for Helping Couples Achieve or Avoid Pregnancy
• Part C, FABMs for Restorative Reproductive Medicine and at Various Stages of Life
• Part D, Medical Applications of FABMs
Click here to download the full lesson schedule for the course.