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Many recent societal trends have led to the need for fertility education, including the age at which individuals become parents, the development of new reproductive technologies, and family diversity. Fertility awareness has emerged as a concept very recently and is increasingly gaining recognition. However, fertility education is often neglected as there is no consensus on the appropriate content, target populations, or on who should provide it. This article attempts to provide an overview of the use of interventions to improve fertility education. We emphasize the importance of delivering evidence-based information on fertility and reproductive health through various methods while providing guidelines for their standardization and systematization. Recommendations are provided to aid the development and implementation of fertility education tools, including: the establishment of a comprehensive understanding of the target populations; the incorporation of theories of behavioural change; the inclusion of the users’ perspectives and the use of participatory research; and the use of specific guidelines for increasing engagement. By following these recommendations, it is expected that fertility education resources can contribute to improving fertility literacy, empowering individuals and couples to make informed reproductive decisions, and ultimately reducing the incidence of infertility and need for fertility treatment.
Profound sociodemographic changes occurred within the last few decades: gender roles are more fluid, families are more diverse and smaller, and parents are older than previously. Developments in ART have accompanied these changes with increasing possibilities of parenting a child (Inhorn and Birenbaum-Carmeli, 2008), and legislation across different countries is adjusting to these changes. The number of fertility treatment cycles undertaken increases every year around the world (Wyns et al., 2022). While medically assisted reproduction (MAR) accommodates new ways of forming families, the leading cause behind the rise in infertility is the increasing age of parenthood in high income countries (Kuhnt and Passet-Wittig, 2022). The chance of conception is largely (female) age dependent (Raymer et al., 2020), but many individuals and couples feel shocked by a diagnosis of age-related infertility and regret not having been educated about this earlier on (Lee, 2019).
The World Health Organization (WHO) recently recognized the need for fertility education. The term ‘fertility awareness’ was included in the latest revision of the International Glossary on Infertility and Fertility Care and defined as ‘the understanding of reproduction, fecundity, fecundability, and related individual risk factors (e.g. advanced age, sexual health factors such as sexually transmitted infections (STIs), and lifestyle factors such as smoking, obesity) and non-individual risk factors (e.g. environmental and workplace factors); including the awareness of societal and cultural factors affecting options to meet reproductive family planning, as well as family building needs’ (Zegers-Hochschild et al., 2017). The need to improve fertility awareness was demonstrated in a systematic review, which revealed that fertility knowledge is in general low to moderate and that neither age nor child wish predict higher levels of fertility awareness (Pedro et al., 2018). There is also strong evidence that individuals overestimate the probability of pregnancy (Ekelin et al., 2012), the age at which fertility declines (Delbaere et al., 2020), and the success rates of treatments (Conceição et al., 2017).
Although fertility awareness is essential for making informed reproductive decisions, fertility education is still omitted in reproductive health guidelines (Bakkensen and Goldman, 2021; Practice Committee of the American Society for Reproductive Medicine and Practice Committee of the Society for Reproductive Endocrinology and Infertility, 2022). Furthermore, school sex education programmes focus on how to reduce the risk of STIs and unintended pregnancy (Haberland and Rogow, 2015), but fertility education remains ignored (Harper et al., 2021). Similarly, family planning is mainly directed at contraception and reducing fertility (Cleland et al., 2006; Frayne, 2017), but few preconception health programmes exist (Berglund and Lindmark, 2016). While the need for fertility education and infertility prevention has been emphasized (Bakkensen and Goldman, 2021; Harper et al., 2021), we have yet to implement it.