A “Fertility Awareness” Survey on Social Media: Men Can Do Better

Abstract

Infertility affects 17% of the global population, yet fertility awareness remains low, particularly among younger individuals and men. This study assessed fertility awareness and attitudes toward infertility prevention among French adults of childbearing age, focusing on gender differences. Conducted via social media from March to May 2023, the survey included 322 participants aged 18–43 who had not consulted assisted reproduction centers. Most respondents were women (84%), under 33 (59%), from high socio-professional backgrounds (58%), in relationships (78%), and childless (59%). Significant gender differences emerged regarding desired ages for having a first (women: 30.7 ± 3.5 years vs. men: 32.8 ± 3.8 years; p = .06) and last child (women: 36.7 ± 3.6 years vs. men: 39.8 ± 4.5 years; p = .001). Only 55.8% of men correctly identified the female fertility window, compared to 64.1% of women (p = .023). Men also showed lower awareness of the timing of female fertility decline (p = .043) and underestimated the prevalence of assisted reproductive technologies among heterosexual couples (p = .001). In addition, men were less likely to discuss fertility with their doctor (15.4% vs. 35.9%; p = .004) or express interest in infertility prevention consultations (53.9% vs. 60.8%; p = .048). These findings suggest a gender gap in fertility awareness, with men generally less informed and engaged in reproductive health discussions. While the small sample size limits generalizability, the results underscore the need for targeted educational efforts to improve fertility knowledge and encourage proactive reproductive health behaviors across genders.

Introduction

Infertility is a significant public health concern resulting from various factors with medical, psychological, and socio-economic implications. This phenomenon affects 17.5% of the global adult population (Cox et al., 2022). In France, it is estimated that 24% of couples are unable to conceive after 1 year of trying (Slama et al., 2012). Annually, 1.25% of women receive infertility treatment (Messaoud et al., 2020) and 3.7% of births are achieved through assisted reproductive technologies (ART) (De la Rochebrochard, 2022).

Effective infertility management depends on identifying and understanding the risk factors within the reproductive-age population. There is evidence to suggest that modifying environmental and lifestyle factors can reduce the incidence of infertility (Barron et al., 2022).

Despite its importance, fertility awareness—defined by the American Society of Reproductive Medicine as the “understanding of reproduction, fertility, fecundability, and related risk factors”—remains notably deficient, particularly among younger (Boivin et al., 2019; Ren et al., 2023) and men (Hammarberg et al., 2017; Hviid Malling et al., 2022). To date, no studies have been conducted on this topic in France. As part of the national infertility plan launched in 2022, we aimed to assess the knowledge of the French population of childbearing age on this subject, with a focus on comparing the responses of men and women to enhance the prevention of infertility risk factors.

Methods

The study was conducted as a survey distributed on social media platforms (LinkedIn, Twitter, Instagram, and Facebook) by the hospital’s communications department between March 7 and May 3, 2023. Inclusion criteria for participation in the questionnaire were living in France and being between 18 and 43 years old. Participants who had previously consulted an assisted reproduction center were excluded. The questionnaire was translated into English (Supplemental Appendix 1), adapted from existing research models (Jurkowski et al., 2021), and updated with recent scientific insights (Rossin, 2020).

The objective was to collect demographic data and evaluate gender differences in fertility, knowledge, ART, and interest in infertility prevention counseling. Approval for the study was obtained from the Institutional Review Board of Suresnes, in September 2022 (IRB number ID-RCB N: 00012437)

Data analysis involved Chi-squared and Student’s or Wilcoxon tests to determine significant gender-based differences, with statistical significance set at a p-value < .05.

Results

A total of 322 individuals participated in the survey. Demographic characteristics and questionnaire results are provided in Supplemental Appendix 2.

Most participants were women (n = 270; 84%) under the age of 33 (n = 191; 59%), in relationships (n = 252; 78%) without children (n = 191; 59%), residing in the Paris region (n = 246; 76%), and from high socio-professional backgrounds (n = 187; 58%). More men were from high socio-professional backgrounds than women (p = .001).

Regardless of gender, most childless participants expressed intentions to have children in the future (n = 163; 86%) and desired multiple children (mean: 2.38 ± 0.84). Professional career (35%) and financial stability (31%) were identified as primary barriers to planning a pregnancy.

Significant gender differences were observed regarding the desired age for having both a first child (women: 30.7 ± 3.5 years vs. men: 32.8 ± 3.8 years; p = .06) and a last child (women: 36.7 ± 3.6 years, vs. men 39.8 ± 4.5 years; p = .001).

The three main sources of information on fertility were Media and the Internet (n = 177; 55%), health professionals (n = 166; 51.6%), and the entourage (n = 154; 47.8%) for both sexes. Significantly more men than women cited school as a source of information (21.2% vs. 9.6%, respectively; p = .017).

Tobacco was identified as the most important non-medical risk factor of infertility, and more so among men (84.6% vs. 70.7% for women; p = .039).

Participants responded correctly to questions regarding the probability of pregnancy per cycle as influenced by the age of the woman (before 30, at 35, and 40).

Concerning the time of the female cycle when a woman is most fertile, the majority of participants answered correctly (between the 12th and 16th day of the cycle), but significantly less so for men (55.8% vs. 64.1% for women), and more men than women indicated that they were unsure (9.6% vs. 2.6%, respectively; p = .023) (Figure 1(A)).

Figure 1.

Histograms: (A) Women’s and Men’s Responses on the Time of the Female Cycle When Women are Most Fertile; (B) Women’s and Men’s Responses on the Age at Which Women’s Fertility Begins to Decline; (C) Women’s and Men’s Responses Regarding the Prevalence of Heterosexual Couples Consulting an ART Center at Least Once in Their Lives; and (D) Women’s and Men’s Responses Regarding the Proportion of Children Conceived by ART Each Year in France

Gender disparities were also observed in the timing of fertility decline in women; 17.3% of men believed it occurred at 30, 46.2% at 35, and 21.2% at 40, compared with 29.4%, 39%, and 13% respectively for women (p = .043) (Figure 1(B)).

Men generally underestimated the use of ART procedures, compared to women. 50.6% of men estimated that 10% or fewer heterosexual couples consulted an assisted reproduction center at least once in their lifetime, compared to 31.6% of women (p = .001) (Figure 1(C)). 53.8% of men estimated that 1 in 50 or fewer children are born through ART, compared to 35.5% of women (Figure 1(D)).

In addition, men were less likely than women to discuss fertility with their doctor (35.9% vs. 15.4%, respectively; p = .004) and were less inclined to consider infertility advice offered by their doctor as beneficial (60.8% vs. 53.9%, respectively; p = .048).

A total of 82.6% of participants were aware of gamete cryopreservation for social reasons, with 35.4% showing interest in this option with no differences between genders.

Discussion

This study revealed a reasonable level of fertility awareness among participants, though significant gaps persisted, particularly among men. Men’s lower engagement and interest in fertility issues are concerning, particularly given the prevalence of male infertility, which accounts for 40% to 50% of cases where a cause is identified (De Jonge et al., 2022; Mannucci et al., 2022).

Culturally, infertility is often seen as a female issue (Thoma et al., 2021) and, for men, an affront to their masculinity (Hanna & Gough, 2020). This perception may lead some men to avoid addressing the problem or to simply lack interest in the subject.

As the study results demonstrate, men are generally reluctant to discuss fertility with their doctors or to seek information about it. This reluctance is particularly detrimental to efforts aimed at addressing modifiable risk factors for male infertility, such as sexually transmitted infections, smoking, substance abuse, exposure to environmental pollutants, and endocrine disruptors (Daumler et al., 2016).

These deficiencies may also be attributed to men’s fewer opportunities compared to women to discuss fertility in medical contexts. In France, men visit general practitioners and specialists less frequently than women. In addition, women benefit from annual gynecological check-ups, during which they can discuss fertility and pregnancy planning (INSEE, 2022).

While the lower response rate from men compared to women in our survey may limit the generalizability of our findings, it also underscores that men may be less concerned about fertility issues than women.

The findings of this study align with previous research on the subject (Hammarberg et al., 2017; Hviid Malling et al., 2022). Despite a consistent desire for parenthood, men are generally less concerned about fertility than women. This is partly due to their reduced exposure to fertility-related discussions within the healthcare system, which negatively impacts their knowledge and delays both the prevention of risk factors and timely screening.

Men tend to perform less well than women in responding to fertility-related questions and are more likely to underestimate the impact of age on fertility.

However, these results should be interpreted with caution, as the small sample size may limit the generalizability of the conclusions. Furthermore, since the survey was distributed via the hospital’s communications department on social media platforms, it may have reached only a limited and potentially biased audience. We also note that the men who responded to the questionnaires largely expressed a desire to have children and belong to a high social category, which could have influenced the level of fertility awareness positively.

Collectively, these results highlight the necessity for increased awareness and targeted educational campaigns to bridge this knowledge gap and increase men’s engagement with fertility issues.