What do we know about our fertility in the UK and why should we care? 

Over the past two decades, high-income countries have seen a significant increase in the number of individuals opting for childbearing at advanced maternal and paternal age. Data from the UK Office for National Statistics shows that the fertility rate for women under 30 years has reached an all-time low, while rates for women aged 40-44 years have more than quadrupled. This trend is mirrored in other high-income countries. This shift towards delayed family building has prompted a concerted effort by educators, healthcare professionals, reproductive health societies, charities, and policymakers to improve fertility education.

Factors influencing delayed childbearing

Several factors contribute to delayed childbearing, including economic reasons such as employment and career progression, changing social norms about the ideal age for parenthood, education, the availability of contraception, and assisted reproductive technologies. Research indicates that delayed childbearing is not always a conscious choice, but rather a complex interplay of factors, including financial and emotional stability, relationship status, health, and fertility status.

Impact on public health

The demographic shift towards delayed family building is of growing public health and clinical concern due to elevated risks of poor maternal and fetal outcomes. For those women experiencing difficulty conceiving naturally, poor outcomes increase rapidly once over the age of 35. Therefore, improving fertility knowledge remains an essential part of public health initiatives for preventing involuntary childlessness and helping individuals achieve their desired family-building intentions.

Understanding reproductive cycles and fertility is essential for both pregnancy prevention and pregnancy planning. Education should enable men and women to understand how their individual fertility may decline with age based on a combination of genetic and lifestyle factors. Rapid advances in assisted reproductive technologies highlight the emphasis placed on potential solutions rather than the root causes, which include poor knowledge about fertility.

Assessing fertility knowledge in the UK

Since most studies designed to assess the level of knowledge of fertility and reproductive health have been conducted in student population groups or those visiting fertility clinics, we conducted a study with the aim of assessing fertility knowledge among different population groups in the UK including men, women, and healthcare professionals. The survey covered questions on fertility and reproductive health topics including male and female reproductive biology, such as asking what ovulation was, how long it might take a couple to conceive, and at what age fertility starts to decline. The inclusion of men and healthcare professionals filled an important gap in the literature as there is a paucity of studies on this topic for both groups. Results were obtained from 1082 survey respondents which included men, women, women trying to conceive and healthcare professionals. Thirty-five of those who agreed to participate were invited for follow-up interviews.

What did we find?

First – men are difficult to recruit! The study duration had to be extended twice due to the difficulty recruiting men. Although male readership was higher, national newspaper adverts which delivered the required study sample size of women in less than a three-month period did not yield a similar number of men in six months. Additional adverts in sporting sections of online newspapers, adverts targeting gyms, sporting centres and a construction centre were placed to attract more men. Recruitment of male participants took nine months in total versus two and a half for women.

Men in our study on average, scored lower than women and healthcare professionals in the survey, but women trying to conceive scored higher than all other groups. Although healthcare professionals were cited as the most trusted and used sources by all population groups, they did not necessarily demonstrate higher knowledge than lay population groups in this study and their role did appear to affect knowledge.

When we asked healthcare professionals to tell us where responsibility lies for providing accurate information on fertility awareness, most HCPs (79.9 percent) selected 'HCPs' (that is other HCPs). There were inconsistencies regarding where responsibility lies for providing the right information and support. Suggestions ranged from primary to secondary care to government policies, further highlighting a lack of clarity on where responsibility lies.

The importance of wider determinants

Although fertility awareness remains crucial when helping individuals achieve their desired family size, it is of crucial importance to acknowledge the impact of broader determinants on family-building decisions. Recent studies have shown that even with appropriate fertility knowledge, circumstances such as financial stability, relationship status, and health can significantly influence an individual's decision to start a family. People have different needs at different life stages, my study published in Human Reproduction in 2022 showed, so interventions will need to be tailored accordingly and we must continue to work on getting the language right, as I showed in a paper published in Human Reproduction in April 2023.

A further study published in Human Reproduction on women who became pregnant after the age of 40 found that nearly half of those who underwent in vitro fertilisation admitted that, even if they had the necessary knowledge their circumstances when younger would not have allowed a pregnancy. Similarly, research published in Sociological Perspectives has shown that factors such as financial stability, relationship status, and health can affect decision-making. Fertility awareness campaigns should, therefore, consider these wider determinants as a critical aspect of health policies. It is also critical to continue to engage men in these discussions, as our paper in Human Reproduction explained.

Conclusion

The trend towards delayed childbearing is a complex issue, influenced by a range of factors, including economic, social, and health-related considerations. Improving fertility education is crucial for enabling individuals to make informed decisions about family planning and preventing involuntary childlessness. However, it is of uttermost importance to emphasise the impact of wider determinants when developing policies and awareness campaigns. By taking a holistic approach, we can help individuals make informed decisions about their family building.

You can read more about our study: 'Exploring fertility knowledge among healthcare professional and lay population groups in the UK: a mixed methods study' here in Human Fertility. You can also find out more about the work of the International Reproductive Health Education Collaboration (IRHEC) here on the ESHRE website.