title: The effect of age, ethnicity, and level of education on fertility awareness and duration of infertility.
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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Faculty of Medicine, University of Toronto, Toronto ON.
authors.forename: Brenna E
authors.initials: BE
authors.lastname: Swift
authors.affiliation: Department of Obstetrics and Gynaecology, University of Toronto, Toronto ON; Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, Toronto ON.
authors.forename: Kimberly E
authors.initials: KE
authors.lastname: Liu
mesh_terms: D000328:Adult; D000367:Age Factors; D003430:Cross-Sectional Studies; D004522:Educational Status; D005260:Female; D005298:Fertility / Q000502:physiology*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007247:Infertility, Female / Q000209:etiology / Q000628:therapy; D044469:Racial Groups; D011795:Surveys and Questionnaires; D013997:Time Factors; D055815:Young Adult
keywords: age; duration of infertility; education; ethnicity; fertility awareness; health literacy