GYNAECOLOGY
The Effect of Age, Ethnicity, and Level of Education on Fertility Awareness and Duration of Infertility Brenna E. Swift, MASc,1 Kimberly E. Liu, MD, FRCSC, MSL2,3 Faculty of Medicine, University of Toronto, Toronto ON
1
Department of Obstetrics and Gynaecology, University of Toronto, Toronto ON
2
Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, Toronto ON
3
Abstract Objective: An increasing number of Canadian women are delaying child-bearing, despite a decrease in fertility with age. A longer duration of infertility is associated with a significant decrease in live birth rate, reinforcing the need for prompt access to fertility treatment. This study aimed to assess the fertility awareness of women attending a fertility clinic to determine whether fertility awareness is a factor in accessing treatment. Methods: A quantitative cross-sectional survey evaluated fertility awareness and collected information about ethnicity, education level, and the duration of infertility for new patients. Fertility awareness was evaluated with questions about prevalence, causes, and treatment of infertility. Results: The mean age of participants in the study was 34 years (range 23 to 44; n = 140). The duration of infertility before new patients first sought medical advice for infertility was less than one year in 52.9%, one to two years in 28.6%, two to three years in 12.9%, and four or more years in 5.0% of study participants. Fertility awareness was calculated as the percentage of correct responses to the survey questions. The mean fertility awareness for all study participants was 49.9% and this ranged from the lowest score of 9.1% to the highest score of 90.9% correct. Women waiting for longer than two years to seek medical help had lower fertility awareness (P = 0.038). In addition, fertility awareness was greater in women who had previously sought medical help for infertility from a family doctor, a gynaecologist, or another fertility clinic (P = 0.001). Higher fertility awareness correlated with a higher level of education (linear trend P < 0.001). Finally, fertility awareness also varied with ethnicity (ANOVA P = 0.025), but the age at which women of different ethnicities sought treatment was similar (ANOVA P = 0.13).
Key Words: Fertility awareness, age, ethnicity, health literacy, duration of infertility, education Competing Interests: None declared. Received on December 15, 2013 Accepted on July 18, 2014
990 l NOVEMBER JOGC NOVEMBRE 2014
Conclusion: Fertility awareness is associated with time to seek treatment, ethnicity, and level of education among new patients seeking medical treatment. This study demonstrates the need to educate women of reproductive age and identifies particular patient populations in Canada that would most benefit from further education about infertility.
Résumé Objectif : Un nombre croissant de Canadiennes reportent la grossesse, et ce, malgré la baisse de la fertilité qui est constatée avec l’âge. La prolongation de la durée de l’infertilité est associée à une baisse marquée du taux de naissance vivante, ce qui souligne la nécessité d’assurer un accès rapide au traitement contre l’infertilité. Cette étude cherchait à évaluer les connaissances en matière de fertilité chez des femmes consultant une clinique de fertilité, en vue de déterminer si de telles connaissances constituent un facteur pour ce qui est de l’accès au traitement. Méthodes : Une enquête transversale quantitative a évalué les connaissances en matière de fertilité chez de nouvelles patientes et a recueilli des données au sujet de leur ethnicité, de leur scolarité et de la durée de leur infertilité. Les connaissances en matière de fertilité ont été évaluées par l’intermédiaire de questions portant sur la prévalence, les causes et la prise en charge de l’infertilité. Résultats : L’âge moyen des participantes à l’étude était de 34 ans (plage : 23-44; n = 140). La durée de l’infertilité avant que ces nouvelles patientes aient pour la première fois cherché à obtenir l’avis d’un médecin à ce sujet était de moins d’un an chez 52,9 % d’entre elles; d’un à deux ans, chez 28,6 %; de deux à trois ans, chez 12,9 %; et de quatre ans ou plus, chez 5,0 %. Le pourcentage de bonnes réponses aux questions de l’enquête a été utilisé pour définir les connaissances en matière de fertilité. Pour l’ensemble des participantes à l’étude, le score moyen pour ce qui est des connaissances en matière de fertilité était de 49,9 % (plage : de 9,1 % à 90,9 %). Les femmes qui avaient attendu pendant plus de deux ans avant de chercher à obtenir l’aide d’un médecin comptaient des connaissances moindres en matière de fertilité (P = 0,038). De plus, les connaissances en matière de fertilité étaient supérieures chez les femmes qui avaient déjà cherché à obtenir de l’aide pour contrer leur
The Effect of Age, Ethnicity, and Level of Education on Fertility Awareness and Duration of Infertility
infertilité auprès d’un médecin de famille, d’un gynécologue ou d’une autre clinique de fertilité (P = 0,001). Le fait de détenir des connaissances élevées en matière de fertilité était en corrélation avec une scolarité accrue (tendance linéaire P 39
Ethnicity
n (%)
Education
5 (3.6) 14 (10.0)
Median (range) Age
n (%) 11 (7.9)
34 (23 to 44)
Table 2. Fertility history of new patients at the Mount Sinai Centre for Fertility and Reproductive Health (n = 140) Pregnancy history
n (%)
Cause of infertility*
n (%)
Primary infertility
80 (57.1)
Male factor
29 (20.7)
Secondary infertility
60 (42.6)
Tubal disease
17 (12.1)
Miscarriage or therapeutic abortion
51 (36.4)
Endometriosis
Live birth
28 (20.0)
Decreased ovarian reserve
Duration of infertility before first time seeking medical help:
8 (5.7) 14 (10.0)
Donor insemination/egg donation/ gestational carrier
7 (5.0) 12 (8.6)
0 to 6 months
53 (37.9)
Uterine factors
7 to 12 months
21 (15.0)
Information seeking
> 1 to 2 years
40 (28.6)
Polycystic ovary syndrome
> 2 to 3 years
18 (12.9)
4 (2.9) 27 (19.3)
Premature ovarian insufficiency
7 (5.0)
≥ 4 years
7 (5.0)
Recurrent pregnancy loss
9 (6.4)
No answer
1 (0.7)
Unexplained primary infertility
(13.6)
Unexplained secondary infertility
9 (6.4)
Other
5 (3.6)
*Percentage total is > 100% because some patients had more than one diagnosis
RESULTS
A total of 140 women completed the survey and participated in the chart review during the study period. The median age of women seeking fertility treatment for the first time at the Mount Sinai Centre for Fertility and Reproductive Health was 34 years (range 23 to 44 years). Most had a college or university degree and self-identified as coming from a variety of ethnic backgrounds. These characteristics of the study participants are summarized in Table 1. The pregnancy history, diagnosis, and duration of infertility for the study population are summarized in Table 2. Almost 60% of participants had primary infertility. The duration of infertility before medical help was first sought ranged from less than six months to more than four years, with 52.9% of women seeking help within the first year. Several diagnoses of infertility were identified, with male factor infertility being the single most common diagnosis. 992 l NOVEMBER JOGC NOVEMBRE 2014
The survey evaluated participants’ fertility awareness using survey questions about the prevalence, causes, and treatment of infertility. The survey participant’s responses are summarized in Table 3. Fertility awareness was calculated as the percentage of correct responses to the survey questions. The mean fertility awareness for all study participants was 49.9% correct and this ranged from the lowest score of 9.1% to the highest score of 90.9% correct. The mean percentage of correct responses within each category was as follows with the range shown in brackets: prevalence 40.7% (0% to 100%), causes 54.3% (0% to 100%), treatment 45.7% (0% to 100%), and total score 49.9% (9.1% to 90.9%). The majority of participants either did not know or overestimated the prevalence of infertility, but underestimated the prevalence of infertility in women over age 40. One half of participants correctly identified the age at which women’s fertility declines significantly as 35 to 39 years old; the remaining participants either did
The Effect of Age, Ethnicity, and Level of Education on Fertility Awareness and Duration of Infertility
Table 3. Responses to fertility awareness questions (n = 140) Fertility awareness about the prevalence of infertility, n (%) What percentage of couples trying to have children experience infertility? < 10 10 to 20 21 to 30 31 to 40 > 40 Don’t know
1 (0.7) 24 (17.1) 26 (18.6) 13 (9.3) 9 (6.4) 66 (47.1)
Pregnancy is most likely at what point during the menstrual cycle? Equal chance on each day Day 1 to 10 Day 11 to 21 Day 22 to 32 Don’t know No answer
0 (0.0) 8 (5.7) 107 (76.4) 10 (7.1) 14 (10.0) 1 (0.7)
At what age does a woman’s fertility significantly decline? 30 to 34 35 to 39 40 to 44 45 to 49 > 50 No impact Don’t know
8 (5.7) 76 (54.3) 32 (22.9) 12 (8.6) 2 (1.4) 1 (0.7) 7 (5.0)
What percentage of couples, in which the woman is over the age of 40, will experience infertility? < 30 30 to 49 50 to 69 70 to 90 > 90 Don’t know
6 (4.3) 19 (13.6) 35 (25.0) 19 (13.6) 4 (2.9) 56 (40.0)
Fertility awareness about causes of infertility, n (%)
Irregular menstrual cycle (< 21 days or > 35 days) Prolonged use of hormonal birth control History of endometriosis History of ovarian cysts Vegetarian diet History of pelvic inflammatory disease History of chlamydia or gonorrhea Unprotected sexual intercourse with multiple partners Regular exercise Overweight (BMI > 25 kg/m2) Stress Smoking > 10 cigarettes per day Drinking 1 alcoholic drink per week
Decrease fertility
No impact
Increase fertility
Don’t know
No answer
104 (74.3) 60 (42.9) 87 (62.1) 96 (68.6) 8 (5.7) 80 (57.1) 85 (60.7) 33 (23.6) 0 (0.0) 110 (78.6) 134 (95.7) 124 (88.6) 29 (20.7)
12 (8.6) 37 (26.4) 2 (1.4) 8 (5.7) 71 (50.7) 1 (0.7) 5 (3.6) 45 (32.1) 29 (20.7) 13 (9.3) 1 (0.7) 5 (3.6) 85 (60.7)
1 (0.7) 2 (1.4) 2 (1.4) 1 (0.7) 10 (7.1) 1 (0.7) 0 (0.0) 18 (12.9) 90 (64.3) 2 (1.4) 0 (0.0) 0 (0.0) 0 (0.0)
23 (16.4) 41 (29.3) 48 (34.3) 35 (25.0) 50 (35.7) 57 (40.7) 50 (35.7) 43 (30.7) 19 (13.6) 15 (10.7) 4 (2.9) 11 (7.9) 26 (18.6)
0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 1 (0.7) 0 (0.0) 1 (0.7) 0 (0.0) 1 (0.7) 1 (0.7) 1 (0.7)
Fertility awareness about the treatment of infertility, n (%) What is the chance of pregnancy in the following scenarios: A 30-year-old female undergoing in vitro fertilization < 25% 26 to 50% 51 to 75% > 76% Don’t know A 40-year-old female undergoing in vitro fertilization < 25 % 26 to 50% 51 to 75% > 76% Don’t know No answer
7 (5.0) 37 (26.4) 24 (17.1) 26 (18.6) 45 (32.1)
49 (35.0) 25 (17.9) 12 (8.6) 3 (2.1) 47 (33.6) 3 (2.1)
All fertility treatment options involve hormonal drugs True False Don’t know No answer
35 (25.0) 76 (54.3) 29 (20.7) 2 (1.4)
The most common treatment for infertility is in vitro fertilization True False Don’t know No answer
31 (22.1) 64 (45.7) 44 (31.4) 2 (1.4)
A woman conceiving with fertility treatment is more likely to have twins than a woman who conceived without treatment True False Don’t know No answer
93 (66.4) 14 (10.0) 31 (22.1) 4 (2.9)
Correct answers for each question are shown in bold text.
NOVEMBER JOGC NOVEMBRE 2014 l 993
Gynaecology
Figure 1. Fertility awareness does not impact duration of infertility before seeking medical help during the first two years of infertility, but fertility awareness is significantly lower among patients waiting greater than 2 years to seek medical help (P = 0.038)
70 60
Fertility awareness, %
Fertility awareness, %
* 55 50 45 35 30 25 20 15 10 5 0
Figure 3. Fertility awareness was significantly different among patients with different levels of education (P = 0.01) and fertility awareness increased linearly with patients’ level of education (P < 0.001)
50 40 30 20 10 0
< 2 yr
> 2 yr
Duration of infertility prior to the first time seeking medical help
gh Hi
h
l oo
sc
or
s
les
lle
Co
*
du
ty rsi
ee
e re eg ld a n sio
gr
de
s
ofe
pr
ive
Un
Highest level of education completed
Figure 4. Fertility awareness was significantly different among different ethnicities (P = 0.025)
60
60
50
Fertility awareness, %
Fertility awareness, %
ive
ate
ra
yg
t rsi
Un
e
re
eg
d ad
r
rg
de
n yu
t rsi
ive
Un
Figure 2. Patients who have sought previous medical help had significantly higher fertility awareness than patients who were seeking medical help for the first time (P = 0.001).
e
re
eg
d ge
40 30 20 10 0 Yes
No
Previous medical help n = 65
n = 75
not know or believed that women’s fertility did not decline until an older age. The majority of study participants identified the causes of infertility correctly, although some mistakenly believed that regular exercise increases fertility. In addition, the majority of women overestimated the rates of pregnancy associated with IVF and approximately one half of the participants answered the other questions about fertility treatment correctly. The association between participants’ fertility awareness and the duration of infertility before first seeking medical help is shown in Figure 1. Fertility awareness was similar for women who waited for up to two years to seek medical help, but there was a significant decrease in fertility 994 l NOVEMBER JOGC NOVEMBRE 2014
50 40 30 20 10 0
Caucasian
Asian
African
Hispanic
Ethnicity
awareness in women who waited more than two years to seek medical help (P = 0.038). Participants’ age, ethnicity, and level of education did not significantly affect the duration of infertility before medical help was first sought. Women who had sought previous medical help had significantly greater fertility awareness than women who were seeking medical help for the first time (Figure 2; P = 0.001). Almost one half (46.4%) of the participants had sought medical help previously from a family doctor (44.6%), a gynaecologist (40.0%), another fertility clinic (29.2%), or other sources that included a naturopath, an endocrinologist, or an acupuncturist (6.7%). The remaining 53.6% of study participants declared no previous medical
The Effect of Age, Ethnicity, and Level of Education on Fertility Awareness and Duration of Infertility
help, although all had required a referral from a physician for their initial consultation appointment at this clinic. Although fertility awareness appeared to increase with increasing age of participants, this trend was not significant. Fertility awareness scores were significantly associated with level of education (ANOVA P = 0.007), with fertility awareness increasing linearly with increasing education (Figure 3; linear trend P
The Effect of Age, Ethnicity, and Level of Education on Fertility Awareness and Duration of Infertility Brenna E. Swift, MASc,1 Kimberly E. Liu, MD, FRCSC, MSL2,3 Faculty of Medicine, University of Toronto, Toronto ON
1
Department of Obstetrics and Gynaecology, University of Toronto, Toronto ON
2
Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, Toronto ON
3
Abstract Objective: An increasing number of Canadian women are delaying child-bearing, despite a decrease in fertility with age. A longer duration of infertility is associated with a significant decrease in live birth rate, reinforcing the need for prompt access to fertility treatment. This study aimed to assess the fertility awareness of women attending a fertility clinic to determine whether fertility awareness is a factor in accessing treatment. Methods: A quantitative cross-sectional survey evaluated fertility awareness and collected information about ethnicity, education level, and the duration of infertility for new patients. Fertility awareness was evaluated with questions about prevalence, causes, and treatment of infertility. Results: The mean age of participants in the study was 34 years (range 23 to 44; n = 140). The duration of infertility before new patients first sought medical advice for infertility was less than one year in 52.9%, one to two years in 28.6%, two to three years in 12.9%, and four or more years in 5.0% of study participants. Fertility awareness was calculated as the percentage of correct responses to the survey questions. The mean fertility awareness for all study participants was 49.9% and this ranged from the lowest score of 9.1% to the highest score of 90.9% correct. Women waiting for longer than two years to seek medical help had lower fertility awareness (P = 0.038). In addition, fertility awareness was greater in women who had previously sought medical help for infertility from a family doctor, a gynaecologist, or another fertility clinic (P = 0.001). Higher fertility awareness correlated with a higher level of education (linear trend P < 0.001). Finally, fertility awareness also varied with ethnicity (ANOVA P = 0.025), but the age at which women of different ethnicities sought treatment was similar (ANOVA P = 0.13).
Key Words: Fertility awareness, age, ethnicity, health literacy, duration of infertility, education Competing Interests: None declared. Received on December 15, 2013 Accepted on July 18, 2014
990 l NOVEMBER JOGC NOVEMBRE 2014
Conclusion: Fertility awareness is associated with time to seek treatment, ethnicity, and level of education among new patients seeking medical treatment. This study demonstrates the need to educate women of reproductive age and identifies particular patient populations in Canada that would most benefit from further education about infertility.
Résumé Objectif : Un nombre croissant de Canadiennes reportent la grossesse, et ce, malgré la baisse de la fertilité qui est constatée avec l’âge. La prolongation de la durée de l’infertilité est associée à une baisse marquée du taux de naissance vivante, ce qui souligne la nécessité d’assurer un accès rapide au traitement contre l’infertilité. Cette étude cherchait à évaluer les connaissances en matière de fertilité chez des femmes consultant une clinique de fertilité, en vue de déterminer si de telles connaissances constituent un facteur pour ce qui est de l’accès au traitement. Méthodes : Une enquête transversale quantitative a évalué les connaissances en matière de fertilité chez de nouvelles patientes et a recueilli des données au sujet de leur ethnicité, de leur scolarité et de la durée de leur infertilité. Les connaissances en matière de fertilité ont été évaluées par l’intermédiaire de questions portant sur la prévalence, les causes et la prise en charge de l’infertilité. Résultats : L’âge moyen des participantes à l’étude était de 34 ans (plage : 23-44; n = 140). La durée de l’infertilité avant que ces nouvelles patientes aient pour la première fois cherché à obtenir l’avis d’un médecin à ce sujet était de moins d’un an chez 52,9 % d’entre elles; d’un à deux ans, chez 28,6 %; de deux à trois ans, chez 12,9 %; et de quatre ans ou plus, chez 5,0 %. Le pourcentage de bonnes réponses aux questions de l’enquête a été utilisé pour définir les connaissances en matière de fertilité. Pour l’ensemble des participantes à l’étude, le score moyen pour ce qui est des connaissances en matière de fertilité était de 49,9 % (plage : de 9,1 % à 90,9 %). Les femmes qui avaient attendu pendant plus de deux ans avant de chercher à obtenir l’aide d’un médecin comptaient des connaissances moindres en matière de fertilité (P = 0,038). De plus, les connaissances en matière de fertilité étaient supérieures chez les femmes qui avaient déjà cherché à obtenir de l’aide pour contrer leur
The Effect of Age, Ethnicity, and Level of Education on Fertility Awareness and Duration of Infertility
infertilité auprès d’un médecin de famille, d’un gynécologue ou d’une autre clinique de fertilité (P = 0,001). Le fait de détenir des connaissances élevées en matière de fertilité était en corrélation avec une scolarité accrue (tendance linéaire P 39
Ethnicity
n (%)
Education
5 (3.6) 14 (10.0)
Median (range) Age
n (%) 11 (7.9)
34 (23 to 44)
Table 2. Fertility history of new patients at the Mount Sinai Centre for Fertility and Reproductive Health (n = 140) Pregnancy history
n (%)
Cause of infertility*
n (%)
Primary infertility
80 (57.1)
Male factor
29 (20.7)
Secondary infertility
60 (42.6)
Tubal disease
17 (12.1)
Miscarriage or therapeutic abortion
51 (36.4)
Endometriosis
Live birth
28 (20.0)
Decreased ovarian reserve
Duration of infertility before first time seeking medical help:
8 (5.7) 14 (10.0)
Donor insemination/egg donation/ gestational carrier
7 (5.0) 12 (8.6)
0 to 6 months
53 (37.9)
Uterine factors
7 to 12 months
21 (15.0)
Information seeking
> 1 to 2 years
40 (28.6)
Polycystic ovary syndrome
> 2 to 3 years
18 (12.9)
4 (2.9) 27 (19.3)
Premature ovarian insufficiency
7 (5.0)
≥ 4 years
7 (5.0)
Recurrent pregnancy loss
9 (6.4)
No answer
1 (0.7)
Unexplained primary infertility
(13.6)
Unexplained secondary infertility
9 (6.4)
Other
5 (3.6)
*Percentage total is > 100% because some patients had more than one diagnosis
RESULTS
A total of 140 women completed the survey and participated in the chart review during the study period. The median age of women seeking fertility treatment for the first time at the Mount Sinai Centre for Fertility and Reproductive Health was 34 years (range 23 to 44 years). Most had a college or university degree and self-identified as coming from a variety of ethnic backgrounds. These characteristics of the study participants are summarized in Table 1. The pregnancy history, diagnosis, and duration of infertility for the study population are summarized in Table 2. Almost 60% of participants had primary infertility. The duration of infertility before medical help was first sought ranged from less than six months to more than four years, with 52.9% of women seeking help within the first year. Several diagnoses of infertility were identified, with male factor infertility being the single most common diagnosis. 992 l NOVEMBER JOGC NOVEMBRE 2014
The survey evaluated participants’ fertility awareness using survey questions about the prevalence, causes, and treatment of infertility. The survey participant’s responses are summarized in Table 3. Fertility awareness was calculated as the percentage of correct responses to the survey questions. The mean fertility awareness for all study participants was 49.9% correct and this ranged from the lowest score of 9.1% to the highest score of 90.9% correct. The mean percentage of correct responses within each category was as follows with the range shown in brackets: prevalence 40.7% (0% to 100%), causes 54.3% (0% to 100%), treatment 45.7% (0% to 100%), and total score 49.9% (9.1% to 90.9%). The majority of participants either did not know or overestimated the prevalence of infertility, but underestimated the prevalence of infertility in women over age 40. One half of participants correctly identified the age at which women’s fertility declines significantly as 35 to 39 years old; the remaining participants either did
The Effect of Age, Ethnicity, and Level of Education on Fertility Awareness and Duration of Infertility
Table 3. Responses to fertility awareness questions (n = 140) Fertility awareness about the prevalence of infertility, n (%) What percentage of couples trying to have children experience infertility? < 10 10 to 20 21 to 30 31 to 40 > 40 Don’t know
1 (0.7) 24 (17.1) 26 (18.6) 13 (9.3) 9 (6.4) 66 (47.1)
Pregnancy is most likely at what point during the menstrual cycle? Equal chance on each day Day 1 to 10 Day 11 to 21 Day 22 to 32 Don’t know No answer
0 (0.0) 8 (5.7) 107 (76.4) 10 (7.1) 14 (10.0) 1 (0.7)
At what age does a woman’s fertility significantly decline? 30 to 34 35 to 39 40 to 44 45 to 49 > 50 No impact Don’t know
8 (5.7) 76 (54.3) 32 (22.9) 12 (8.6) 2 (1.4) 1 (0.7) 7 (5.0)
What percentage of couples, in which the woman is over the age of 40, will experience infertility? < 30 30 to 49 50 to 69 70 to 90 > 90 Don’t know
6 (4.3) 19 (13.6) 35 (25.0) 19 (13.6) 4 (2.9) 56 (40.0)
Fertility awareness about causes of infertility, n (%)
Irregular menstrual cycle (< 21 days or > 35 days) Prolonged use of hormonal birth control History of endometriosis History of ovarian cysts Vegetarian diet History of pelvic inflammatory disease History of chlamydia or gonorrhea Unprotected sexual intercourse with multiple partners Regular exercise Overweight (BMI > 25 kg/m2) Stress Smoking > 10 cigarettes per day Drinking 1 alcoholic drink per week
Decrease fertility
No impact
Increase fertility
Don’t know
No answer
104 (74.3) 60 (42.9) 87 (62.1) 96 (68.6) 8 (5.7) 80 (57.1) 85 (60.7) 33 (23.6) 0 (0.0) 110 (78.6) 134 (95.7) 124 (88.6) 29 (20.7)
12 (8.6) 37 (26.4) 2 (1.4) 8 (5.7) 71 (50.7) 1 (0.7) 5 (3.6) 45 (32.1) 29 (20.7) 13 (9.3) 1 (0.7) 5 (3.6) 85 (60.7)
1 (0.7) 2 (1.4) 2 (1.4) 1 (0.7) 10 (7.1) 1 (0.7) 0 (0.0) 18 (12.9) 90 (64.3) 2 (1.4) 0 (0.0) 0 (0.0) 0 (0.0)
23 (16.4) 41 (29.3) 48 (34.3) 35 (25.0) 50 (35.7) 57 (40.7) 50 (35.7) 43 (30.7) 19 (13.6) 15 (10.7) 4 (2.9) 11 (7.9) 26 (18.6)
0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 1 (0.7) 0 (0.0) 1 (0.7) 0 (0.0) 1 (0.7) 1 (0.7) 1 (0.7)
Fertility awareness about the treatment of infertility, n (%) What is the chance of pregnancy in the following scenarios: A 30-year-old female undergoing in vitro fertilization < 25% 26 to 50% 51 to 75% > 76% Don’t know A 40-year-old female undergoing in vitro fertilization < 25 % 26 to 50% 51 to 75% > 76% Don’t know No answer
7 (5.0) 37 (26.4) 24 (17.1) 26 (18.6) 45 (32.1)
49 (35.0) 25 (17.9) 12 (8.6) 3 (2.1) 47 (33.6) 3 (2.1)
All fertility treatment options involve hormonal drugs True False Don’t know No answer
35 (25.0) 76 (54.3) 29 (20.7) 2 (1.4)
The most common treatment for infertility is in vitro fertilization True False Don’t know No answer
31 (22.1) 64 (45.7) 44 (31.4) 2 (1.4)
A woman conceiving with fertility treatment is more likely to have twins than a woman who conceived without treatment True False Don’t know No answer
93 (66.4) 14 (10.0) 31 (22.1) 4 (2.9)
Correct answers for each question are shown in bold text.
NOVEMBER JOGC NOVEMBRE 2014 l 993
Gynaecology
Figure 1. Fertility awareness does not impact duration of infertility before seeking medical help during the first two years of infertility, but fertility awareness is significantly lower among patients waiting greater than 2 years to seek medical help (P = 0.038)
70 60
Fertility awareness, %
Fertility awareness, %
* 55 50 45 35 30 25 20 15 10 5 0
Figure 3. Fertility awareness was significantly different among patients with different levels of education (P = 0.01) and fertility awareness increased linearly with patients’ level of education (P < 0.001)
50 40 30 20 10 0
< 2 yr
> 2 yr
Duration of infertility prior to the first time seeking medical help
gh Hi
h
l oo
sc
or
s
les
lle
Co
*
du
ty rsi
ee
e re eg ld a n sio
gr
de
s
ofe
pr
ive
Un
Highest level of education completed
Figure 4. Fertility awareness was significantly different among different ethnicities (P = 0.025)
60
60
50
Fertility awareness, %
Fertility awareness, %
ive
ate
ra
yg
t rsi
Un
e
re
eg
d ad
r
rg
de
n yu
t rsi
ive
Un
Figure 2. Patients who have sought previous medical help had significantly higher fertility awareness than patients who were seeking medical help for the first time (P = 0.001).
e
re
eg
d ge
40 30 20 10 0 Yes
No
Previous medical help n = 65
n = 75
not know or believed that women’s fertility did not decline until an older age. The majority of study participants identified the causes of infertility correctly, although some mistakenly believed that regular exercise increases fertility. In addition, the majority of women overestimated the rates of pregnancy associated with IVF and approximately one half of the participants answered the other questions about fertility treatment correctly. The association between participants’ fertility awareness and the duration of infertility before first seeking medical help is shown in Figure 1. Fertility awareness was similar for women who waited for up to two years to seek medical help, but there was a significant decrease in fertility 994 l NOVEMBER JOGC NOVEMBRE 2014
50 40 30 20 10 0
Caucasian
Asian
African
Hispanic
Ethnicity
awareness in women who waited more than two years to seek medical help (P = 0.038). Participants’ age, ethnicity, and level of education did not significantly affect the duration of infertility before medical help was first sought. Women who had sought previous medical help had significantly greater fertility awareness than women who were seeking medical help for the first time (Figure 2; P = 0.001). Almost one half (46.4%) of the participants had sought medical help previously from a family doctor (44.6%), a gynaecologist (40.0%), another fertility clinic (29.2%), or other sources that included a naturopath, an endocrinologist, or an acupuncturist (6.7%). The remaining 53.6% of study participants declared no previous medical
The Effect of Age, Ethnicity, and Level of Education on Fertility Awareness and Duration of Infertility
help, although all had required a referral from a physician for their initial consultation appointment at this clinic. Although fertility awareness appeared to increase with increasing age of participants, this trend was not significant. Fertility awareness scores were significantly associated with level of education (ANOVA P = 0.007), with fertility awareness increasing linearly with increasing education (Figure 3; linear trend P
