MARCH 13, 2023

What Do People Know about Fertility? Summary of a Systematic Review

By: Justine Garfinkel

Director’s Note: The mission of FACTS is to share the best evidence available with our healthcare colleagues and students, empowering them to educate their patients more effectively about their fertility, and in turn equipping them with the knowledge necessary to make informed choices about their health and family planning. Former FACTS elective student Justine Garfinkel summarizes a systematic review about what people know about fertility and the importance of informing reproductive-age men and women about fertility and individual infertility risk factors.  If you are interested in learning more on this important topic, please join us for an upcoming webinar or register for our online CME course.

Introduction

Infertility is a public health problem affecting women and men around the world. Fertility education is crucial to address infertility and needs to be more widespread to ensure reproductive justice.[1] As this topic has been discussed more openly, it has led researchers around the globe to assess fertility awareness. Fertility awareness is defined as “the understanding of reproduction, fecundity, fecundability, and related individual risk factors and non-individual risk factors, including the awareness of societal and cultural factors affecting options to meet reproductive family planning, as well as family building needs.”[2] Studies focused on fertility awareness have shown that young adults of reproductive age want children but are not informed about infertility risk factors.

“Studies focused on fertility awareness have shown that young adults of reproductive age want children but are not informed about infertility risk factors.”

The primary aim of this systematic review was to examine and summarize the current evidence on fertility awareness and its risk factors while also identifying gaps in the literature based on the available studies.[2] The authors sought to answer two questions: (1) “Are reproductive-age people informed about fertility and individual infertility risk factors?” and (2) “Do differences exist in fertility awareness based on gender, age, education, and reproductive status?” Reviewing and summarizing the current data gives researchers and clinicians the ability to target specific populations in need of fertility-related information and education.

Methodology

This study gathered data through a literature search on electronic databases including EBSCO, Web of Science, Scielo, and Scopus from the database start date to February 2017. A combination of keywords and terms was searched such as “awareness” or “health knowledge, attitudes, practice,” and “fertility.” The authors followed the PRISMA guidelines, and the initial search in all databases identified 7,982 studies. After duplicate studies were removed and an initial screening based on article titles and abstracts was completed, 103 full text articles were eligible. Of those, only 71 full text studies were deemed relevant and eligible for the qualitative synthesis.

Results

The 71 studies used were published between 1994 and 2017, and originated from 26 different countries. Sample sizes ranged from 20 to 7,036 individuals. The majority of studies included reproductive-age women and men from one of three categories: college students, people attempting to conceive and/or seeking fertility treatment, or gynecology patients. Most studies were cross-sectional and varied in their assessment of fertility awareness, either via interviews or self-reported questionnaires.

The articles reviewed generated mixed results but, overall, the findings of this systematic review demonstrate that fertility awareness among reproductive-age individuals is low. Women, more educated individuals, couples struggling to conceive, and couples who planned their pregnancies tend to have more fertility awareness. Individuals with children or desiring children did not necessarily have more fertility awareness. Across studies, age was inconsistently associated with fertility awareness; in some studies, higher age was linked to higher fertility awareness, while others found an association between age and lower awareness, and still others identified no association at all.

“Overall, the findings of this systematic review demonstrate that fertility awareness among reproductive-age individuals is low.”

Discussion

Based on the results of this systematic review, fertility awareness among reproductive-aged individuals is not as prevalent as one would hope. There is a clear difference in fertility awareness between men and women and based upon level of education, with less of a difference between age groups or based upon reproductive status.

This study has numerous strengths and limitations. One strength is that it was an all-encompassing systematic review that followed the PRISMA guidelines and review protocol. The search was conducted across twelve databases and two independent researchers performed the study selection and quality assessment, strengthening these findings. Additionally, the studies included originated from different countries, leading to a global view on fertility awareness. Lastly, most studies reviewed included male perspectives which are often underrepresented in infertility research.

One specific limitation of the study was the challenge of summarizing the findings from such diverse samples with varying sample sizes. It was difficult to clearly identify a consensus on the results because each study included a different sample size and used distinct assessment instruments. The use of different analytical strategies and the lack of subgroup analyses likely contributed to the mixed findings. Furthermore, even though the study included studies from several continents, the majority of samples were from the USA or Europe, making cultural bias likely.

Despite these limitations, the study findings are relevant as they demonstrate that different populations have various viewpoints and knowledge regarding fertility awareness. These results offer clues on what to focus on when creating new fertility education materials and campaigns in the future. The lower fertility awareness identified in men across studies highlights the need to increase and implement reproductive health education directed towards men, as they are an integral part of childbearing decisions. To decrease educational barriers, health care services and reproductive education programs should also target adolescents with low socioeconomic status and low education. Healthcare professionals can collaborate with educators teaching sexual education courses in schools to develop and deliver more comprehensive education on fertility awareness. Given the study findings that individuals have learned inaccurate information about infertility and its associated risk factors, it is vital to ensure people receive accurate education, and that health professionals continue to work towards debunking myths.

“The lower fertility awareness identified in men across studies highlights the need to increase and implement reproductive health education directed towards men, as they are an integral part of childbearing decisions.”

In summary, more research and more conversations about fertility and infertility are warranted. It is important to normalize conversations about fertility awareness and focus on education to decrease barriers to quality care.

[1] Nargund, G. Why Fertility Education is needed in schools. Facts Views Vis Obgyn. 2015; 7(3):189-191.

[2] Pedro J, Brandao T, Schmidt L, Costa M, Martins M. What do people know about fertility? A systematic review on fertility awareness and its associated factors. Upsala Journal of Medical Sciences. 2018; 123(2):71-81.

ABOUT THE AUTHOR

Justine Garfinkel

Justine Garfinkel is a fourth-year medical student at Philadelphia College of Osteopathic Medicine (PCOM) in Philadelphia, PA. She completed her undergraduate education at the University of Michigan in Ann Arbor, MI. She plans to pursue a residency in obstetrics and gynecology, as she is extremely passionate about women’s health and health equity & education.