By: Amy Modi
Editor’s Note: Fertility awareness and body literacy should be taught early in an age-appropriate manner, adapting the educational methods and resources as children grow into young adulthood. In 2017, Conceição et al published results of their randomized controlled trial testing a video intervention to educate university students about fertility. [1] Amy Modi summarized their findings as a third-year medical student on the FACTS elective. For nearly a decade, this elective has educated more than 1,000 future physicians and other medical professionals on the evidence-based fertility awareness-based methods (FABMs) available for family planning and management of common women’s health conditions.
Introduction
During the early 1990s, the U.S. government shifted its focus from teaching reproductive biology, contraception, and sexually transmitted infections toward abstinence and pregnancy prevention. [2] Many people in that generation grew up hearing “it only takes one time to get pregnant,” though the reality of the female reproductive cycle is far more complex. This approach may have contributed to a generation that overestimates the ease of achieving pregnancy, overlooking the fertility challenges that increase with age. Furthermore, growing up in an era of advanced technology – including in vitro fertilization (IVF) and egg-freezing – may have given younger generations a sense of optimism about deferring parenthood, while the effectiveness of these technologies declines with age.
Birth rates are dropping sharply. According to the Pew Research Center, 57% of adults under 50 report they are unlikely to have children. [3] Those who choose to become parents start their families later. The average age of first-time mothers in the U.S. is now 27.5 years, up from an average age of 24.9 years two decades ago.[4] The CDC reports some reasons for delayed childbearing include access to reliable contraception, pursuit of higher education, increased labor force participation, shifting family values, and financial considerations. [4]
“Birth rates are dropping sharply… The average age of first-time mothers in the U.S. is now 27.5 years, up from an average age of 24.9 years two decades ago.”
Infertility is diagnosed when a couple has difficulty conceiving after at least 12 months of unprotected sex. It can result from reproductive conditions such as endometriosis and polycystic ovary syndrome (PCOS) in women, or varicocele and cryptorchidism in men. It may also stem from medical conditions such as thyroid dysfunction or diabetes. Some modifiable lifestyle risk factors include body weight and sexually transmitted infections.
The study by Conceição et al summarized below aimed to address gaps in fertility awareness among university students, a demographic often found to have misconceptions about reproductive health and fertility timing. Using a randomized pre- and post-test study design, the authors examined the impact of an easily accessible, inexpensive video-based educational intervention to improve fertility knowledge among university students. [1]
Methodology
This randomized controlled trial was conducted between October and December 2014 to evaluate the impact of an educational video on fertility knowledge among 174 undergraduate students at the University of Porto. After excluding participants with known fertility issues, 173 students were randomized equally into intervention (n=89) and control (n=84) groups. Both groups attended a pre-test session, after which the intervention group viewed a 2-minute, 34-second video covering fertility topics, including fertility rates, age-related conception, and infertility definitions and risk factors.
Following the video, the intervention group rejoined the control group, and all participants completed a post-test ten minutes later. Data collected included sociodemographic information and responses to various fertility knowledge measures, which had undergone careful translation, adaptation, and pilot testing. Statistical analyses using mixed ANOVA assessed changes in fertility knowledge over time, with significant effects further analyzed through paired sample t-tests. Results aimed to assess whether the brief educational intervention could increase students’ awareness of fertility issues.
Results
At baseline, the intervention and control groups had similar sociodemographic characteristics and initial knowledge levels. The study found that participants, primarily young women, generally overestimated female fertility and the likelihood of conception through natural or assisted means. On average, they accurately identified some infertility risk factors and the definition of infertility, scoring above half on both measures.
“The study found that participants, primarily young women, generally overestimated female fertility and the likelihood of conception through natural or assisted means.”
Post-intervention, participants who watched the video demonstrated significant improvement in fertility knowledge, particularly around the ages of peak fertility, decreasing pregnancy likelihood with age, and reduced fertility treatment success with age. The intervention group also showed increased awareness of male infertility risk factors, while both groups improved in identifying female risk factors. Unlike the control group, the intervention group showed a marked improvement in defining infertility.
These results highlight the video’s effectiveness to increase knowledge on fertility timelines, risk factors, and infertility definitions, and demonstrate that a brief educational video can improve awareness among young adults.
Discussion
This study highlights the potential for accessible, inexpensive tools such as videos in university curricula or community initiatives to enhance reproductive health education, particularly benefitting regions with limited in-person educational resources. By gaining a clearer understanding of fertility basics and factors affecting infertility, men and women can make more informed choices about achieving or avoiding pregnancy. Fertility literacy education can help reduce unintended pregnancies, abortions, and fertility challenges by enabling individuals and couples to plan for parenthood at an optimal age, balancing personal, educational, and career goals with biological factors. Improved fertility education may also correct misconceptions, potentially helping couples avoid difficulties conceiving and costly interventions such as IVF.
“Fertility literacy education can help reduce unintended pregnancies, abortions, and fertility challenges by enabling individuals and couples to plan for parenthood at an optimal age, balancing personal, educational, and career goals with biological factors.”
While the study’s findings are promising, there are limitations to consider. The sample primarily consisted of heterosexual young women in higher education, so the results may not be generalizable. Including participants of different genders, sexual orientations, and socioeconomic backgrounds in future studies could provide a more comprehensive view of the impact of fertility education. The study design could improve by offering the control group an unrelated intervention to reduce the likelihood of performance bias. Also, there was only a short time between the intervention and the post-test; future research could seek to identify the most effective strategies to provide reproductive health education with lasting results. Despite these limitations, this research makes a meaningful contribution to enhance fertility awareness, which is fundamental to women’s health and family planning.
In addition to video-based interventions, programs like TeenFEMM offer a science-based approach to educating adolescent girls and boys about hormonal health changes, empowering them with knowledge of their bodies and future fertility. Women and men who understand their reproductive systems are also more likely to seek preventive care or timely medical advice, fostering long-term health and well-being.
References
[1] Conceição C, Pedro J, Martins MV. Effectiveness of a video intervention on fertility knowledge among university students: a randomised pre-test/post-test study. The European Journal of Contraception & Reproductive Health Care. 2017;22(2):107-113. doi:https://doi.org/10.1080/13625187.2017.1288903
[2] Hall KS, McDermott Sales J, Komro KA, Santelli J. The State of Sex Education in the United States. Journal of Adolescent Health. 2016;58(6):595-597. doi:https://doi.org/10.1016/j.jadohealth.2016.03.032
[3] Aragão RM Juliana Menasce Horowitz and Carolina. The Experiences of U.S. Adults Who Don’t Have Children. Pew Research Center. Published July 25, 2024.https://www.pewresearch.org/social-trends/2024/07/25/the-experiences-of-u-s-adults-who-dont-have-children/
[4] Martinez G, Daniels K. National Health Statistics Reports.; 2023. https://www.cdc.gov/nchs/data/nhsr/nhsr179.pdf
ABOUT THE AUTHOR
Amy Modi
Amy Modi is a rising fourth-year medical student at Philadelphia College of Osteopathic Medicine in Philadelphia, PA. She completed her undergraduate education at the University of Pittsburgh in Pittsburgh, PA.
She plans to pursue internal medicine and enrolled in the FACTS elective to empower women to advocate for their own well-being, make informed choices, and improve overall health outcomes for themselves and their families.
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.
