Fertility Awareness Research Articles

Examining engaged couples’ opinions and attitudes towards fertility awareness, family planning and parenting in terms of gender

ABSTRACT Being a parent that is part of the social life of individuals and getting married should be evaluated together with fertility to improve the health of society. Because individuals who are unaware of fertility may tend to make wrong decisions about how to manage their reproductive abilities. This study was conducted to determine by gender difference the fertility awareness of engaged couples and their attitudes toward parenthood and family planning. This cross-sectional study included 504 people who had decided to marry. In this study, a male/female questionnaire developed by the researcher and the Family Planning Attitudes Scale were used. When the couples evaluated the importance of having children to them on a scale from 0 to 10, no statistically significant differences by gender could be found (p = .589). Among the criteria for having children, the rate of agreement with the condition of having sufficient economic strength was higher among women than men (p = .031). The rate of agreement with the conditions of reaching a certain level of expertise in one’s occupation (p = .014) and living in a big enough house (p = .040) was higher among men than women. The Family Planning Attitudes Scale total mean score was 112.5 for the male participants and 117.0 for the female participants (p = .004). The scale evaluates the family planning attitude as positive and negative. Higher scores indicate more positive attitudes toward family planning. It was determined that couples’ were at a similar level of fertility awareness and women had a more positive family planning attitude than men. There were differences by gender in couples’ views on parenting.

The history of Fertility Awareness Methods

Fertility Awareness Methods (FAM) are based on the observation of physiologically occurring symptoms, so-called fertility indicators, which include: cervical mucus, basal body temperature (BBT) and changes in cervical morphology/consistency. Observations of clinical symptoms in a female patient, which change depending on periodic hormonal fluctuations, were used to determine the first and second phases of the menstrual cycle and the period around ovulation. For many years, FAMs have been successfully used by women who want to plan their motherhood in accordance with their beliefs and chosen lifestyle, in an ecological manner, without pharmacological intervention or unnecessary medical treatments.FAMs have developed over the centuries and are now a well-documented field of reproductive medicine. Initially, FAMs were used only as a tool for planning or postponing the conception of a child, now they are more and more often perceived as an effective and easy-to-use tool in the diagnosis, treatment and monitoring of the therapy of cycle disorders and infertility. The aim of the study is to present the history of FAM development, to present groundbreaking discoveries and people to whom we owe the current state of knowledge about the symptoms of human fertility. A review of the medical literature was made, also referring to historical works, which included information on breakthrough discoveries in the field of human fertility. The selection of literature was made on the basis of a review of original papers and review publications in the PubMed and Google Scholar databases with the use of the following keywords: „Fertility Awareness Methods”, „Family Planning” and the „Pearl index”.

Analysis of the menstrual chart observation characteristics, meeting the typical cycle criteria among women of procreation age according to the symptom-thermal double-check method

Background: Knowledge concerning value of menstrual cycle observation and its use to monitor procreative health is underestimated and limited in women's health promotion, education and health care. Academy of Pediatrics, Committee on Adolescence and , American College of Obstetricians and Gynecologists recommends starting to observe the forming cycle as early as puberty in order to pre-screen girls , from groups at risk of fertility disorders such as polycystic ovary syndrome. In view of the numerous reports on the increase in fertility problems, such a simple tool as self-observation of the menstrual cycle becomes particularly useful to learn about the natural rhythm of fertility and in the case of abnormalities, i.e. deviation from the typical course shortens the time to the first medical consultation. In Poland there are several non-governmental non-profit organizations, which through certified teachers of fertility awareness methods can professionally support the teaching of adolescents, adults and interested people working in the health service in the field of fertility awareness, health education and natural family planning.
 Aim of the presented study was to analyze 105 menstrual cycle observation charts among polish women not using contraception according to the principles of the symptom-thermal double-check method.
 Method: The study was performed using the method of documentation analysis, 105 menstrual cycle observation charts using the statistical package SPSS Statistica version 25. The level of p < 0.05 was considered statistically significant.
 Results: The average age of the women studied was 29 years. The majority of the women , i.e. more than 58%, were unmarried and childless (79.1%). The average length of the menstrual cycle was: 28.6 days. The average duration of the luteal phase was almost 13 days. The average length of days of highly fertile mucus was nearly 4 days. The average length of cycles of women over 35 years of age was: 28.88 days, while for women under 35 years of age. 28.48 days. The age of onset of the first menstrual period of the women studied varied between 10 and 17 years of age.
 Conclusions: The studied group of women was homogeneous in terms of the adopted eligibility criteria, i.e. they had typical cycles and did not use contraceptive methods. The examined parameters of the menstrual cycle, i.e.: the average length of the cycle , the course of the luteal phase and the average length of the occurrence of highly fertile mucus met the criteria for a normal cycle according to the symptom-thermal double-check method.

How effective is digital educational content in shaping fertility awareness? An interventional, cross-sectional study.

To determine whether exposure to digital educational content affects fertility awareness and attitudes towards fertility preservation treatments? A total of 957 women ages 20 to 45years participated in this internet-based, interventional, cross-sectional study. A questionnaire assessing knowledge of the reproductive span and attitudes towards fertility preservation treatment was completed by these women before and after exposure to online educational content on ovarian reserve and fertility preservation treatments. Responses before and after exposure to the educational content were compared. Knowledge about female age-related fertility decline improved significantly after exposure to educational content (51.6% vs. 79.6%, p < 0.001). Increased willingness to pursue fertility preservation treatments (38.6% vs. 42.9%, p < 0.001) and to recommend fertility preservation treatments to friends (55% vs. 65.2%, p < 0.001) was observed. Participants who desired to conceive were more positively influenced by the exposure to educational content in their attitudes towards fertility treatments compared to those who do not desire to conceive. Online educational content has the potential to improve fertility awareness and shape a more positive attitude towards fertility preservation treatments for the public.

Fertility Awareness and Attitudes Among Women Embarking on a Career in Medicine

Background: Previous international studies suggest professional women are more likely to delay childbearing whilst pursuing career goals. Due to prolonged education and training pathways, female medical students may be particularly at risk of fertility difficulties from delayed childbearing. Aim: To explore, among female medical students, the understanding of age-related fertility decline, attitudes toward prophylactic fertility interventions, and beliefs about potential effects of childbearing on training and career opportunities. Method: Cross-sectional online survey of female medical students at The University of Queensland, Brisbane, Australia. Results: The average response rate was 81% (n=113). 95% of respondents were aged 18 to 29, and most (98%) did not have children. 72% intend to have children; 24% within five years, and over 60% intending to delay for 10-15 years. 62% of respondents intend to undertake specialty training, 29% planning to delay childbearing until after training. Of these, 50% perceive that having children sooner would negatively impact career prospects or compromise financial security. Half of respondents reported their fertility knowledge as sound or high. Age of significant fertility decline was well understood, although 90% overestimated the chance of spontaneous pregnancy at age 30. 88% respondents recognise oocyte cryopreservation in their 20’s as a fertility preservation option, though only 28% would consider this in next 10 years with 21% not considering it at all. Respondents strongly believe they should be informed of age-related fertility decline (100%) and of fertility preservation options (98%). 79% believe medical students should seek individualised assessment. Conclusion: Future fertility is important to these at-risk women, who intend to undertake a prolonged education and training pathway. Despite reasonable understanding of age-related fertility decline, most intend to delay childbearing, perceiving financial and career disadvantages of earlier childbearing. Information about age-related fertility decline and fertility preservation strategies is strongly desired by this group.

Smartphone Technology Paired with a Vaginal Conforming Cap to Enhance the Fertility Awareness Method for Modern Women

Background: Fertility Awareness Method (FAM) cost-effective and the safest contraceptive method yet it is rarely used. Objectives: A) Familiarize women, and clinicians with the enhancement to the fertility awareness method. B) Persuade investigators to validate this pilot study by providing additional research. C) Allow women to pinpoint the precise day of ovulation. Materials and Methods: We recruited 40 healthy women with regular periods to participate in this pilot research for 3 months. 20 used the traditional FAM with basal body temperature and fertile cervical mucus. The other 20 women used the conforming vaginal cap to collect their fertile cervical mucus (Spinnbarkeit). Starting at day 9 they collected samples directly from the cervix until they detected fertile mucus. We also instructed them to record their findings and any side effects. Results: Women using the vaginal conforming cap identified preovulatory fertile cervical secretions in 95% of cases. They also verified ovulation with a positive urinary L.H. (Luteinizing Hormone) surge. Basal Body Temperature charts were biphasic and consistent with the L.H. surge results. The control group who used the subjective detection were only 55% successful. Conclusions: Collecting mucus directly from the cervix yielded a large quantity and excellent quality of (Spinnbarkeit). This allowed women to pinpoint the day of ovulation with astonishing precision. This shortened the fertile window to 4 days for conception and 9 days for contraception. The Synergy created between the vaginal conforming cap and a Smartphone application will provide the safest, most cost-effective birth control without side effects

Fertility Awareness, Knowledge, Attitude, and Practices among Nursing Students of a Tertiary Care Hospital of East Sikkim

Fertility Awareness, Knowledge, Attitude, and Practices among Nursing Students of a Tertiary Care Hospital of East Sikkim

Fertility Intentions, Parenting Attitudes, and Fear of Childbirth among College Students in China: A Cross-Sectional Study

This study aimed to investigate the current situation regarding fertility intentions, parenting attitudes, and fear of childbirth among college students in mainland China and the factors related to these variables. A cross-sectional study SETTING: Colleges across China PARTICIPANTS: Five hundred and eighty-three college students attending regular institutions of higher education MAIN OUTCOME MEASURES: Fertility intentions and fear of childbirth were measured using the Swedish Fertility Awareness Questionnaire and the Childbirth Fear Prior to Pregnancy scale. Only 38.8% of participants expressed their willingness to have children, and there was a significant difference between male and female students (P < .02). Males regarded having children as more important (P < .01), and females were more concerned about the negative effects of becoming parents, including difficulties in the labor market, having less freedom, and having less money. When deciding whether to have children, factors such as work, economics, and childcare were more important to females. Students who did not want children had higher levels of fear of childbirth than those who wanted children or were unsure (P < .02). The fertility intentions of college students were not optimistic. In addition to the 2-child Chinese fertility policy, interventions aimed at reducing the cost of raising children, eliminating gender inequality in the workplace, and normalizing childcare institutions might help alleviate conflict between work and childrearing.

The impact of policy changes from the perspective of providers of family planning care in the US: results from a qualitative study

In recent years, there have been several state and federal policies that have disrupted access to publicly supported family planning care in the United States, including the 2019 rule that altered the federal Title X family planning program. In late 2020, we conducted in-depth interviews with health care providers from 55 facilities providing family planning care in Arizona, Iowa, and Wisconsin with the aim of learning how sites were affected by policy changes. We identified perceived effects on clinic finances, patient confidentiality, contraceptive counselling and service provision, and options counselling resulting from state and federal policy changes. Some clinics lost funding and had to pass some of the cost of services on to patients, raising new confidentiality concerns and creating new burdens on staff to carry out financial counselling with patients. Other sites had to grapple with restrictions on the pregnancy options counselling that they could provide, concentrate counselling on fertility awareness-based methods, and increase efforts to include parents/guardians in the care of adolescent patients. State and federal policies impact how publicly supported family planning care is provided, and compromise efforts to provide patient-centred care.

Physician Awareness of Fertility Awareness-Based Methods

Physician Awareness of Fertility Awareness-Based Methods

Predictors of Fertility Awareness–Based Method Use Among Women Trying to Conceive and Women Contemplating Pregnancy

Fertility awareness–based methods have been linked to shorter time to conception and, thus, may serve as an initial intervention for the primary prevention of infertility. Little is known about the predictors of fertility awareness–based method used among women who are, or will soon be, trying to conceive. The objective of this research was to identify predictors of fertility awareness–based method use among women who are trying to conceive or contemplating pregnancy within the next year.

O-091 From Family Planning to Fertility Planning - ‘FertPlan’ awareness amongst contraceptive healthcare providers and users

Abstract Study question Are women and healthcare professionals seeking or providing contraception aware of age-related decline in female fertility and information support regarding fertility awareness? Summary answer 89.9% of contraceptive users and 71% of providers stated lack of awareness regarding age and fertility emphasising website as the preferred information resource. What is known already The last 50 years has seen an upward trend in the age at which women are giving birth. The birth rate for women aged 35 to 39 has trebled since 1980 and is now at its highest ever level. Delaying childbearing may mean that some women will inevitably leave it too late and become childless involuntarily. Women are also seeking fertility treatment at older ages, however, success rates decrease dramatically with age. It is not clear whether women who delay their fertility are aware of the decline in fertility with age, and whether healthcare professionals discuss fertility planning with women. Study design, size, duration We conducted two independent anonymous questionnaire surveys of reproductive age women seeking contraception and healthcare professionals(HCP) providing contraception in the UK following research ethics approval, to determine their awareness of the age-related decline in fertility, information resource and potential barriers to provision of information. . This was a prospective study design conducted over a year period using an online questionnaire. A total of 249 participants completed the survey. Participants/materials, setting, methods 138 reproductive age women on contraception consented and participated in the study by completing the online questionnaire. Of these, 96.4% were of white origin,1.4% mixed ethnicity, 1.4% Asian origin and 0.7% Black. 111 HCP providing contraceptive advice in family planning clinics or in General practice completed the survey. Of these, 6 were allied healthcare professionals ie specialist nurses. Data was collated and analysed using percentages and descriptive statistics. Main results and the role of chance Of the total 138 female contraceptive users, 87 were aged 30-39 years whilst 35 were 40-45 years. 51.4% of women indicated no concern about their future fertility, whilst the remainder gave roughly uniformly distributed ratings of concern from unconcerned to highly concerned. However, one third of all women (31.1%) believed that age-related fertility decline occurred after 40 years. 89.9% of women felt fertility awareness and education is important. Of the total 111 HCP, ∼one in 10 HCP (11.7%) misconstrued the female age-related decline to begin from 40 years onwards. The contraceptive providers also were misinformed regarding age related decline in IVF success rate with 45% of them citing 40 years or over to be the age that contributed to decline in IVF success. Despite these figures, majority (71.2%) of HCP agreed there was lack of fertility awareness and 33.3% felt fertility education should be commenced as early as school age. 27% HCP always discussed future fertility whilst 33.3% discussed most of the times. The most commonly-stated barriers to providing information were lack of time, self-perceived lack of knowledge, and women not asking. 73.2% of reproductive age contraceptive users and 85.6% HCPs expressed website to be the most preferred option for information resource. Limitations, reasons for caution To the best of our knowledge, this is one of the first studies seeking fertility awareness amongst those practising family planning. As this was not a qualitative interview based study, the findings are open to interpretation and one must exercise caution. Wider implications of the findings This study highlights clear need for fertility education and awareness amongst contraceptive providers and users. By providing resources to inform, we may increase awareness and confidence amongst both groups thereby empowering women to make informed choices about their future fertility by integrating Fertility planning within Family Planning. Trial registration number Not applicable (IRAS 248991 and R&amp;D Ref 8999)

O-112 Fertility awareness: Educating the teenagers in europe

Abstract The term fertility awareness has been long associated with specific methods of family planning. Within the context of reproductive health and fertility issues, fertility awareness is a level of knowledge of the society on the topics of human reproduction system, fertility life cycle, possible threats to reproductive health and the ways of its protection. Moreover, as the birth rates have been continuously falling throughout Europe and the number of European citizens with fertility issues has increased during the last 50 years, fertility and infertility have been put into the spotlight for scientists, policy-makers, non-government organizations and other stakeholders. Therefore, the level of fertility awareness should be increased among all society groups. The main objective of the Fertility Awareness Project is to digitally reach teenagers aged 15-18 in various European countries in order to check their knowledge of fertility and to raise their awareness level. Fertility Awareness Project will follow a knowledge-based, holistic, systemic approach built on two pillars: collecting information and providing information. For this purpose, a digital tool will be developed to measure/increase fertility awareness and this tool will be disseminated in 4 selected European countries among teenagers aged 15-18, aiming to reach as many respondents as possible. After the data collection, a large effort will be devoted to evaluate the results based on the application usage by the target group. Thus, the Fertility Awareness Project will provide reliable information on the levels of fertility awareness among young people in Europe and the outcome of the project will help us to advocate for actions to promote fertility education on EU and national levels.

P-489 The ABC of fertility intentions: a mixed-methods study exploring the spectrum of attitudes towards family building

Abstract Study question What are the intentions of men and women of reproductive age in the UK regarding fertility and family building? Summary answer We identified six main categories of people; Avoiders, Betweeners, Completers, Desirers, Expectants and Flexers, for whom fertility-education strategies should be tailored differently to suit intentions. What is known already Several studies have highlighted poor fertility awareness across men and women of reproductive age. As the average age of first-time parents continues to rise, there has been a concerted effort from educators, healthcare professionals, charities, reproductive health groups and government policy makers, to improve fertility awareness. In order to ensure that these messages are effective and to deploy the best strategies, it is important to understand people’s reproductive health needs. This study therefore aimed to explore the different family building intentions in order to aid tailoring of information to help individuals and couples achieve their family building intentions. Study design, size, duration Mixed method research was conducted via a UK-wide cross-sectional survey and semi-structed interviews. Results were obtained from 1,082 survey respondents and in-depth interviews with 15 men and 20 women. Interviewees were purposively sampled to include men and women from the reproductive age range (18-45 years) and of varying ethnic and educational backgrounds. Participants/materials, setting, methods Survey participants were recruited nationwide via online newspaper and social media adverts and of those who agreed to a follow-up interview, 35 were included this study. Interviews lasted an hour on average. Data was transcribed and analysed via thematic framework analysis. Favourable ethical opinion was given by University College London Research Ethics Committee. Main results and the role of chance From the survey and interviews, we identified six key categories of people, grouped alphabetically, in a user-friendly manner to highlight a spectrum of fertility intentions: Avoiders describe respondents who have no children and do not want to have children in the future; Betweeners describe those who already have child(ren) and want more in the future but are not actively trying to conceive; Completers describe those who have child(ren) but do not want more; Desirers describe those who are actively trying to conceive; Expectants describe those who were pregnant at the time of the study and Flexers describe those who may or may not already have and are unsure but open to having child(ren) in the future. A majority of the survey population were trying to get pregnant; were pregnant; or planning to have a child in the future - whether actively, passively or simply open to the idea, with interviews providing deep insights into their family building decision-making. Limitations, reasons for caution Due to the online recruitment method, there may be a bias toward more educated respondents. Wider implications of the findings We developed a user-friendly, alphabetical categorisation of fertility intentions, which can be used by individuals, healthcare professionals, educators, special interest groups, charities, and policymakers to support and enable individuals and couples in making informed choices to achieve their desired intentions, if and when they choose to start a family. Trial registration number not applicable

O-111 The International Fertility Education Initiative

Abstract Awareness Raising. The International Fertility Education Initiative Jacques de Mouzon, Joyce Harper, Karin Hammarberg, and the IFEI group Clearly, from the international reports on Assisted reproductive technology, more and more patients go to be treated by ART everywhere in the World, even in the richest countries where access is not limited by economic constraints. At the same time, there is a large tendency of maternal age increase at conception and birth, whereas it is well known that there is a fertility decline both with women’s and men’s age. It clearly appears that one driver concerns the lack of awareness of people of reproductive age on the factors affecting the chance of conceiving and of getting a healthy baby. Thus, to improve fertility awareness in the public, a group of 45 specialists in infertility from about twenty countries met in 2020 and decided to launch an initiative, together with patients’ associations, the International Fertility Education initiative (IFEI). The group includes experts of various scientific fields: clinicians, nurses / midwifes, scientists, psychologists, ethicists, public health, patients. The chair is Pr. Joyce Harper, who was at the initiative of this initiative The IFEI objectives and creation were published in Human Reproduction open in 2021. Objectives include research and actions to improve fertility awareness. The mission can be summarized as follows: To increase fertility awareness using the life course approach, in order to improve reproductive health and facilitate decision-making in family planning among adolescents, people of reproductive age, primary healthcare, education professionals, and policymakers through development, evaluation and dissemination of inclusive educational resources. Four strategic goals have been identified 5 working groups have been designed to cover the mission and strategic goals: IFEI has regular meetings where each group progresses are discussed. The groups advancements will be presented at the ESHRE annual meeting in Milano, during the special session entitled “Awareness Raising”. In 2021, IFEI has established links with ESHRE, under the umbrella of the special interest group Global and Socio-cultural Aspects of Infertility. In 2022, links are being established also with IFFS and FIGO, to develop a consistent action. In conclusion, IFEI is rapidly progressing towards its objectives and several countries has already developed specific national action plans that are consistent with the general aim on fertility awareness Trial registration number

P-490 Patient Care Guidance: Development of a unique tool for fertility clinics based on best practice evidence

Abstract Study question How can fertility clinics be encouraged to implement evidence-based person-centred care? Summary answer To help fertility clinics provide holistic care to their patients a multidisciplinary team developed a user-friendly, evidence based practical guidance. What is known already Despite wide evidence about the benefits of person-centred care for patients seeking fertility treatment, this is not systematically implemented in most fertility clinics. Study design, size, duration The aim was to develop evidence-based practical guidance on person-centred care for fertility clinics. A multidisciplinary team collaborated to developed person-centred care guidance for fertility clinics over a 12-month period. Participants/materials, setting, methods A group of 18 stakeholders, including:15 fertility experts, 2 patient associations and 1 quality manager reviewed and summarised evidence relating to the needs of fertility patients to guide the implementation of person-centred care in fertility clinics. It was specially designed to fulfil the needs of different countries’ legislation and cultural contexts. Main results and the role of chance This collaboration resulted in a unique and practical evidence-based tool to help fertility clinics implement best practice in person-centred care. It includes a range of topics such as: the importance of a patient care system in ART; benefits of patient-centered care for patients, staff, and the clinic; ways to communicate information to patients; informing about fertility treatment options; fertility awareness; men’s needs; emotional support; benefits of a mentor program; how to support to staff; exit strategies; needs of patients seeking cross-border care; the fertility clinic’ online communication; engaging patients in good and safe choices; and also how to care about patients undergoing a gamete donation treatment. Limitations, reasons for caution Despite the large number of topics required to support on fertility clinics, high impact topics were prioritised in the first phase of the guidance document – which will be updated periodically. Wider implications of the findings This guidance offers added value to fertility clinics and patients. The authors were able to adapt scientific evidence into a practical and user-friendly guidance that allows all staff to understand the concept of patient-centred care, the roles, responsibilities, actions that can be taken to improve patient experience, outcome and care. Trial registration number NO

P-500 How do we talk to teenagers and young adults about fertility? A qualitative study on young peoples’ thoughts about fertility

Abstract Study question What are teenagers and young adults’ attitudes towards learning about fertility, and how do they want to receive fertility information? Summary answer Young people find it important to learn about fertility from professionals when they are young, and want to hear about fertility in a multifaceted way. What is known already During the past 30 years women and men in many high-income countries increasingly postpone family formation. It is estimated that 16-26% of the Danish population who want children will experience infertility at some point during their reproductive years. Several studies have shown that women and men tend to underestimate the decline in fecundity with increasing age and overestimate the success rate of medically assisted reproductive technologies. A growing body of research suggests that young people want to know more about fertility, preferably as part of their education. Study design, size, duration Semi-structured qualitative focus group interviews were conducted with teenagers (age 18-19) and young adults (age 20-26). Data collection is still ongoing. Participants/materials, setting, methods The study participants (N = 40) were single or cohabiting men and women throughout Denmark. They were between 18 to 26 years old and recruited from both vocational schools and high schools. The interviews were audiotaped, anonymized and transcribed in full. Data were analyzed using qualitative content analysis following the method by Graneheim and Lundman. Main results and the role of chance Overall the participants found it very important to learn about fertility as a mandatory part of the curriculum at their educations and they wanted to hear about it in a multifaceted way (e.g., social media, podcasts, theatre and personal stories). The participants want to learn about fertility at an early age, so they have the information they need prior to starting their family in the future. They want to feel involved and heard and have the possibility to ask questions. Knowledge should be provided by a professional other than their teacher. They prefer explanations, rather than listing facts. The participants stressed that personal stories and humor are also important when talking with young people about fertility. They feel a conflict between having a healthy lifestyle to take care of their fertility and the behaviour that they believe is a part of being young. Limitations, reasons for caution The study participants had all chosen to be a part of this study. Hence, the results may not be directly transferred to all young people in regard to attitudes towards how to talk to teenagers and young adults about fertility. Wider implications of the findings This study contributes to the understanding and implementation of future fertility awareness educational interventions and campaigns targeted to and effective among young people. These findings can be useful in the process of increasing the fertility awareness in this population. Trial registration number N/A

P-497 Men’s attitude towards two fertility education interventions and preferences for future fertility awareness initiatives

Abstract Study question What are men's preferences for communication of fertility information and how to target prevention efforts to promote men to make informed decisions regarding family formation? Summary answer Men preferred fertility education interventions to use positive language to create new knowledge, include personal stories as conversation starters, and be provided in different formats. What is known already The far majority of men in Denmark wants to become fathers; however, 20% of 50-year-old men are childless compared to 12% among women. Around 40% of men in Denmark have reduced semen quality. Previous studies have found that men have insufficient knowledge about fertility, infertility and associated risk factors, and that men want to receive more information about fertility when they are young. Only few intervention studies have been performed about how to increase men’s and women’s fertility knowledge, and even fewer studies have focused only on men. Study design, size, duration Qualitative focus group discussions with 13 men assigned into five focus groups were carried out. Two interventions were introduced; an episode from the podcast “Actually you don’t have to wait that long” about two couples who have become parents in their mid-twenties, and an informational poster developed by The International Fertility Education Initiative was shown during the group discussions. The interviews took place online over Zoom in January 2021. Interviews ranged in average 91 minutes. Participants/materials, setting, methods All participants were recruited through Facebook and social networks. The interviewed men were young, childless aged 25-32 in a committed relationship and all residents in Copenhagen, Denmark. Focus group questions were semi-structured and examined the men’s reactions to the podcast and poster and preferences for communication of fertility information. The focus group discussions were recorded, anonymized and transcribed. Data were analyzed using Graneheim and Lundman's method of qualitative content analysis. Main results and the role of chance The overall themes were: “Poster: source of information”, “Podcast: report from the lived life” and “Information targeting men”. The men’s reactions to the poster and podcast were categorized into the sub-themes benefits and critiques and suggestions. Benefits of the poster was that it included important knowledge and was relevant to a large target group. Critiques were that it had too much information and lacked the emotional aspect of family formation. They wished for more positive languaging and communication about the fertility information on the poster. The benefit of the podcast was the use of personal stories to highlight the emotional aspect of family formation which was a conversation starter for partners. Critiques were that some men found the personal stories unrelatable and believed it didn’t contribute new knowledge. They suggested to include couples with fertility problems with an expert. According to men, future interventions should focus on how information is communicated. It should be factual, include humor and not be negative or shameful. Different formats to provide fertility information including TV-programs, podcasts, and social media interventions should be used to reach the most men in different ways. They also suggested fertility information should be included in sexual education in school. Limitations, reasons for caution All men were residents of the capital city Copenhagen, and men with a short education were underrepresented. Therefore, our results may not represent the opinions of all men aged 25-32 years in Denmark. Wider implications of the findings In the future fertility awareness campaigns should be developed in cooperation with the target group together with clinicians, and concurrent intervention studies on the developed methods should be performed. In all probability, a mix of different interventions will be necessary to attain the desired effect to ensure long-lasting fertility awareness. Trial registration number Not applicable

P-496 “The plethora of information can be overwhelming…”: A mixed methods study exploring the sources of fertility information

Abstract Study question What sources are used when seeking fertility information and how informed do individuals feel about these sources? Summary answer Sources discussed with varying levels of access, reliability, and trust included: school education; healthcare-professionals; websites (general/government/medical); social-media/online-forums; family/friends; smartphone-apps; books/magazines/newspapers; fertility-products; sexual-health clinics/centres and charities. What is known already As the average age of first-time parents continues to rise, health policies have highlighted the importance of optimising reproductive health through better knowledge. There has also been a concerted effort by various reproductive health groups to improve fertility awareness. Understanding the different sources of information used by the target audience is important for disseminating and improving fertility knowledge. This mixed-methods study therefore aimed to assess the different sources used by individuals when seeking fertility information and the perceived accessibility and reliability of these sources in order to understand what’s working, what isn’t, and opportunities for improvement. Study design, size, duration Mixed method research was conducted via a UK-wide cross-sectional survey and semi-structed interviews. Results were obtained from 1,082 survey respondents and in-depth interviews with 15 men and 20 women. Interviewees were purposively sampled to include men and women from the reproductive age range (18-45 years) and of varying ethnic and educational backgrounds. Participants/materials, setting, methods Survey participants were recruited nationwide via online newspaper and social media adverts and of those who agreed to a follow-up interview, 35 were included this study. Interviews lasted an hour on average. Data was transcribed and analysed via thematic framework analysis. Favourable ethical opinion was given by University College London Research Ethics Committee. Main results and the role of chance When asked about knowledge from school education, 89.3% of survey respondents selected ‘good’/’some knowledge’ on the biology of reproduction and pregnancy-prevention, contrasting with 76.4% who reported having ‘no knowledge’/’do not recall’ of factors affecting fertility or protection of fertility. While healthcare-professionals were ranked the most trusted but not easily accessible source, the internet was the most used, due to accessibility and perceived anonymity. However, many internet sources weren’t trusted, with a respondent citing “the plethora of information can be overwhelming, you don’t know what you can trust.” Male, 27, White. Interviews highlighted family and friends as important sources, but with recurring themes around awkwardness and embarrassment discussing the topic. For example, one respondent recalled that her first discussion of sex with her mother was on her wedding night stating, “…Mum, I'm 28! And you’re just discussing this with me now?” Female, 36, Asian. Social media was seen as a useful tool for wider reach of different population groups. Mobile apps (e.g. cycle-trackers) were cited but with concerns over information reliability; while others discussed using fertility products like sperm and ovulation kits to better understand their fertility. Other sources discussed include health centres, sexual health clinics, charities and other third-party organisations. Limitations, reasons for caution A key methodological limitation of this study is that the interviewees were self-selected, which has implications for generalisability. The results necessarily reflect the views of those who were willing to participate. Additionally, the online recruitment method could result in potential bias towards respondents of higher socioeconomic status. Wider implications of the findings School education remains a consistent but sometimes inadequate source of fertility information. Ensuring better fertility information during school education may offset the impact of unreliable sources. In addition to websites, apps and products based on robust scientific evidence, there remains an important need for additional training for primary healthcare-professionals. Trial registration number N/A

Pauliina Rauhala’s Taivaslaulu as a Critique of Finnish Conservative Laestadians’ Birth Control Ban

Abstract The Finnish author Pauliina Rauhala’s award-winning debut novel, Taivaslaulu (2013; Heaven Song)—which investigates the nexus of gender, agency, and familial and religio-communal belonging—is set in the world of Conservative Laestadianism, the largest revival movement within the Evangelical Lutheran Church of Finland. This conservative pietist movement is known, among other things, for its birth control ban, which extends not only to artificial contraception but also to fertility awareness methods and, in its most extreme form, even to marital celibacy. This article argues that “continuous traumatic stress” (CTS)—a term that, unlike post-traumatic stress, focuses on chronic, ongoing trauma—and “religious trauma” together constitute a relevant conceptual lens through which to examine Rauhala’s depiction of the life of her female protagonist under the Conservative Laestadian birth control ban, a prohibition operating in the realm of religious regulation of both body and mind. More generally, this article posits that examinations of gendered and gender-specific traumas resulting from “destructive uses of religion” (psychiatrist James L. Griffith’s term; italics added) are an integral part of the interdisciplinary study of religion and gender.