By: Vy Phan
Editor’s Note: This article was written by Vy Phan, MD, during her fourth year of medical school while participating in the FACTS elective. In her review of Doxsey et al.’s 2024 study, Phan highlights important gaps in fertility knowledge among medical students and physicians, including misconceptions about natural fertility, infertility, and infertility treatments.
These findings underscore the need for continued educational and institutional support for comprehensive family-planning options throughout medical training and beyond. Equipping future physicians and other medical professionals with a fuller understanding of fertility and fertility awareness-based methods (FABMs) can strengthen their ability to provide patients with informed, comprehensive reproductive healthcare options while also supporting their own family-planning decisions. You can help by encouraging students or residents to sign up for our FACTS electives or by making a donation to support student scholarships.
Introduction
The decline in birth rates among women aged 20 to 24 and the rise in birth rates among women aged 35 to 39 in the United States have led to an increase in the average age at which women have their first birth [1]. For female medical students and physicians, the demands of medical training often delay childbearing. Several factors can influence family-planning decisions for physicians, such as busy work schedules, limited maternity leave, and financial and childcare challenges. Female physicians also face higher risks of pregnancy complications and infertility, with some studies showing infertility rates that double the national average [2]. Despite these realities, fertility education is lacking during medical training. This study by Doxsey et al. aims to assess fertility knowledge among female medical trainees using a validated knowledge score instrument: the Fertility and Infertility Treatment Knowledge Score (FIT-KS) [1].
“Female physicians also face higher risks of pregnancy complications and infertility, with some studies showing infertility rates that double the national average. Despite these realities, fertility education is lacking during medical training.”
Methodology
The FIT-KS survey was used to assess fertility knowledge among medical trainees. The survey contains 29 multiple-choice questions on natural fertility and infertility treatments. To ensure accuracy, the items were reviewed and updated using the latest data from the Society for Assisted Reproductive Technology (SART) and the 2019 Centers for Disease Control and Prevention (CDC) [3]. The survey was administered via REDCap to medical students, residents, fellows, and attending physicians at Penn State College of Medicine in April 2022, with a follow-up email in July 2022. Participation was voluntary, anonymous, and approved by the Institutional Review Board (IRB). Demographic data were also collected. Descriptive statistics were calculated using SAS software to analyze the results. Outcome measures included participant age, stage of training, parity, specialty, and FIT-KS.
Results
Out of 311 participants, 291 completed the FIT-KS survey. Participants included medical students, residents, fellows, and attending physicians. Participants’ ages ranged from 22 to 72 years, with an average age of 34 years. Most participants were white (71.3%), Christian (55.9%), and married (52.1%). Many had not given birth (65.4%) but expressed a desire for children.
On average, participants answered 20 out of 29 questions correctly on the FIT-KS. Nine questions had less than a 50% correct response rate, especially those related to infertility treatments. Many participants overestimated the likelihood of conception for a 30-year-old woman (44.8%) and underestimated miscarriage rates (36.9%) during peak reproductive years. Only 20.6% of participants correctly identified the success rate of in vitro fertilization (IVF) for women under 35 years old, and many overestimated the cost of IVF. Participants in obstetrics and gynecology scored higher than those in other specialties with an average score of 21.7 compared to 19.5.
“Many participants overestimated the likelihood of conception for a 30-year-old woman (44.8%) and underestimated miscarriage rates (36.9%) during peak reproductive years. Only 20.6% of participants correctly identified the success rate of in vitro fertilization (IVF).”
Discussion
This study explored fertility and infertility knowledge among female medical students and physicians, highlighting the relevance of these issues in women’s health and fertility awareness. The findings underscore a general lack of knowledge about fertility, particularly regarding infertility treatment success, even among medical professionals. This knowledge gap is concerning given the high rates of infertility among female physicians. Moreover, delayed childbearing is common among physicians; therefore, misconceptions about fertility could influence these decisions. Previous studies show that over half of female physicians would have tried to conceive earlier if they had known infertility could be a problem [2]. The findings underscore the need for enhanced fertility education during medical training to better equip physicians with the knowledge necessary for informed family planning.
“The findings underscore the need for enhanced fertility education during medical training to better equip physicians with the knowledge necessary for informed family planning.”
The study’s strength lies in its use of the validated FIT-KS instrument, which ensures that the assessment is both reliable and consistent with previous research on fertility knowledge. This study’s limitations include the inability to calculate a response rate given the open survey platform. Additionally, the participants included were predominantly married White Christian women raised in the Mid-Atlantic region, limiting the generalizability of the findings. Key insights from the study include the need for enhanced fertility education and greater institutional support for comprehensive family planning, especially among medical professionals.
Future research should explore fertility knowledge among a more diverse population and aim to enhance medical school and residency curricula by integrating comprehensive fertility education and empowering medical trainees with greater awareness about reproductive health and family planning. In parallel, policy reforms are crucial to create institutional support systems that promote work-life balance, facilitate informed family-planning decisions, and improve outcomes for medical professionals throughout their careers.
REFERENCES
[1] Doxsey M, Patel K, Faschan K. Assessing student and physician fertility awareness utilizing the fertility and infertility treatment knowledge score (FIT-KS). Cureus. 2024;16(9). doi:10.7759/cureus.70244.
[2] Stentz NC, Griffith KA, Perkins E, Jones RD, Jagsi R. Fertility and childbearing among American female physicians. J Womens Health (Larchmt). 2016;25:1059-65. doi:10.1089/jwh.2015.5638.
ABOUT THE AUTHOR
Vy Phan, MD, is a resident in the Physical Medicine and Rehabilitation Residency Program at MedStar Health–Georgetown/National Rehabilitation Hospital. She earned her medical degree from Georgetown University School of Medicine in Washington, DC, and completed her undergraduate education at Trinity College in Hartford, CT. She is particularly interested in the rehabilitation of pelvic floor disorders and health equity. She enrolled in the FACTS elective to better understand fertility awareness-based methods and how they can support patients.
Inspired by what you read?
You can support the ongoing work of FACTS here. To connect with a member of our team, please email development@FACTSaboutFertility.org. Interested in becoming an individual or organizational member? You can learn more and register here. To discuss with a member of our team, please email membership@FACTSaboutFertility.org.
