{"paper_id":"2a2951ce-c56e-416c-ab3d-c05d284a150a","body_text":"A Cross-sectional Survey of Fertility Knowledge in House Officers and Clinical Medical Students in a Low Resource Setting | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article A Cross-sectional Survey of Fertility Knowledge in House Officers and Clinical Medical Students in a Low Resource Setting Abigail St. Onge, Joshua Nyaah, Seth Amponsah-Tabi, John Jude Kweku Annan This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8961255/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 7 You are reading this latest preprint version Abstract Background: Infertility rates in the general population are around 12.5% and up to 40% in West Africa. In Ghana, a pronatalist society, infertility carries significant implications. It is imperative for new doctors to be knowledgeable about fertility and infertility to counsel women. This study aimed to understand the knowledge of house officers and clinical medical students in Kumasi, Ghana to provide insight into knowledge gaps and misconceptions and inform medical education efforts. Methods: This cross-sectional study utilized a validated, 29-question survey, the Fertility and Infertility Treatment Knowledge Score, to assess the knowledge of house officers and clinical medical students at Kwame Nkrumah University of Science and Technology in Kumasi, Ghana. The primary outcome was score. Permission to use the survey was obtained and approval was granted by university CHRPE. Participants gave consent in the survey. Statistical analysis was performed in R using appropriate tests with significance set at p < 0.05. Results: 231 respondents completed the survey (54% female, 46% male). Most were senior clinical students: 13% year four, 44% year five, 28% year 6, and 16% house officers. The average score overall was 64% (SD = 11%). There was no significant difference in score based on sex (p = 0.193). House officers averaged the highest score (66%, SD = 11%); fourth years averaged the lowest (56%, SD = 11%). Scores increased significantly with level of training, from fourth years to fifth years (p < 0.001), sixth years (p = 0.016), and house officers (p = 0.002). Frequently missed topics included age-related fertility decline, natural fertility, and IVF efficacy. Scores were high on mechanisms of conception and infertility treatments. Knowledge of factors influencing fertility, including contraceptive use and male age, was variable. Conclusions: Students’ knowledge improves in clinical training, but critical misconceptions persist. Only level of training predicts score, not demographic differences. These findings reflect the efficacy of the current curriculum at one university, but may not generalize nationally. Addressing and correcting misconceptions through enhancements in curriculum is essential to improve counseling and prevent perpetuating stereotypes surrounding infertility in Ghanaian society. Medical education Fertility Infertility Infertility treatment Medical knowledge Assisted reproductive technology In-vitro fertilization Figures Figure 1 Background Infertility is a commonly experienced condition across the world, but it is often not well understood in the general population. High rates of infertility exist worldwide, and in West-Africa in particular. Infertility rates in the general population are around 12.5% 1 , with about 30–40% being due to female factors and 20–40% remaining idiopathic 2 . In West Africa, rates of infertility may be up to 40% 3 . Furthermore, an important part of routine gynecological care is counseling on family planning and natural fertility. Up to 65% of gynecological consultations are due to infertility, so it is critical for women and couples who desire children to have access to knowledgeable physicians to counsel them on that topic 4 . The knowledge a physician has could significantly influence whether or not this counseling is provided to patients as well as the accuracy of the information given. As age-related fertility decline can play a significant role in future infertility, counseling early on at routine visits could play a crucial role in whether or not women experience infertility in the future and their success in getting pregnant once infertility has been diagnosed. In order to provide the best care to their patients, physicians must be equipped with accurate and up-to-date knowledge on a variety of topics relating to fertility and infertility. In most low resource centers, new doctors are the first point of call for couples seeking fertility treatment. Since there are few specialists in obstetrics and gynecology, many cases at the gynecological units, including the tertiary institutions, comprehensively involve newly qualified doctors called house officers. The knowledge base of the new and upcoming doctors will help in proper evaluation of the infertile couple and referrals to appropriate consultants or specialized clinics for further management. Their level of understanding and evaluation of these patients is based on the knowledge they acquired during their recent medical training. Having adequate knowledge about fertility management as a medical student prior to graduation and new house officer is essential in quality of care for the infertile couple. Therefore, it is imperative to ascertain the level of fertility knowledge of house officers and clinical medical students. However, no study has been conducted to assess the knowledge of house officers and medical students on these topics of fertility and infertility in a low resource setting like Ghana. This cross-sectional study aims to evaluate the knowledge of current house officers who graduated from the School of Medical Sciences (SMS), Kwame Nkrumah University of Science and Technology (KNUST) and the current clinical medical students of SMS, KNUST in the topics of fertility and infertility, including but not limited to age-related fertility decline, natural fertility, and assistive reproductive technologies. Understanding these gaps in knowledge is crucial for medical education in order to design curriculum that best supports students and enhances the care they provide for their patients. The findings will inform program directors of knowledge gaps and misconceptions in fertility and infertility knowledge among house officers and clinical medical students. This information will help trainers address any significant areas of weakness during training of these house officers and clinical medical students to best equip them to counsel their future patients. Komfo Anokye Teaching Hospital (KATH) is located in Kumasi, the capital city of the Ashanti region which is the second most populous region in Ghana. Kumasi is in the middle zone of Ghana and is an important geographical and cultural link between the less developed north and more developed south. It is a hub of the country’s culture where infertility is considered a curse and every married woman is expected to deliver within a year or two of marriage. Giving birth within a year or two of marriage is an indication of divine approval of the union. KATH is the second largest tertiary institution in the country. The hospital has many subspecialties in the directorate of Obstetrics and Gynecology; one of these is the Reproductive Endocrinology and Infertility (REI) unit. This unit currently has trained consultants for in vitro fertilization (IVF) and is a training center designated for REI training. It currently collaborates with private health facilities in conducting IVF cases as it is yet to be fully equipped by the government to be fully operational. KATH serves as the main site for the clinical training of medical students of SMS KNUST. The hospital oversees the clinical training of the students during the fourth, fifth, and sixth years of the clinical training. A similar study has been conducted in the United States to understand the knowledge of residents in various obstetrics and gynecology (OBGYN) programs across the country 1 . That study was conducted in a high resource setting on physicians in residency training. This current study is aimed at understanding the knowledge of a group of house officers and clinical medical students in Kumasi, Ghana, a low resource setting. Additionally, 91% of new OBGYN graduates in Ghana as of 2017 were male 4 , as opposed to the 91% of female respondents in the study conducted in the United States 1 . Significant differences in demographics and resources between the United States and Ghana provide convincing reasons to conduct a new study in Ghana in a representative population of house officers and clinical medical students. This study will provide insight into the knowledge gaps in fertility and infertility knowledge that exist among house officers and clinical medical students in Ghana in order to better inform program directors how to address any significant areas of weakness or misconceptions. Materials and Methods This was a cross sectional study that was carried out among KNUST students and house officers training at KATH. The study population was all current house officers and all current clinical medical students at SMS, KNUST. The study population was contacted via WhatsApp and reminders were sent over the course of two months. The study was conducted in June and July, in the middle of the academic year. Before the commencement of the study, ethical approval was obtained from the Committee on Human Research Publications & Ethics (CHRPE) of KNUST, Kumasi, Ghana. Consent was obtained from each participant in the web-based survey prior to completion. A validated survey called the Fertility and Infertility Treatment Knowledge Score (FIT-KS) was used to assess knowledge of fertility and infertility in each house officer and clinical medical student 5 . The web-based survey was sent out in the form of a Google Form. FIT-KS is a web-based survey, with 29 multiple-choice items. It assesses knowledge of natural fertility (21 questions) and knowledge of infertility treatment (8 questions) as well as demographic fill-in questions. Questions were updated with data specific to Ghana, or West Africa, when applicable and readily available. Demographic information collected included the following: age, year in training, gender, current number of children, number of children desired, ideal age to have children, and what options would be utilized if the respondent were to experience infertility. The entire survey is included as an additional file (see Additional File 1). Only surveys in which every question was complete were included; any incomplete surveys were excluded. The data was compiled into a spreadsheet and de-identified. The data was accessible only to the investigators. No participant identifiable information was documented. For ambiguously submitted answers, a system was in place to quantify all answers. For the desired number of children, when an age range, as opposed to a single number, was submitted, the average age of the range was used. For age at having children, the youngest age in a range was used, presumed to represent the age at which the respondent would have their first of multiple children. In terms of age, “late” was quantified as 8, meaning “late 20s” was quantified as 28. Similarly, “mid” was quantified as 5 and “early” was quantified as 2, so that “mid-20s” was 25 and “early 20s” was 22. Statistical analysis was performed using either an analysis of variance (ANOVA) or Welch’s F-test, two-sample t tests, or Chi-square or Fisher’s exact test as appropriate for the data set. Bartlett’s test was used to verify that variances are equal across the samples, in cases where ANOVA was used, such as whether knowledge differed by year of medical training. All statistical analysis was performed in Excel and R. Studio version 4.5.1 with the level of significance set at less than 0.05 (p < 0.05). Results 231 respondents completed the survey, 124 female (53.7%) and 107 male (46.3%). Most respondents were between the ages of 18 and 25 (91.8%). 12.55% of respondents were in year four, 43.72% in year five, 27.71% in year six, and 16.0% house officers (Table 1 ). The average score overall was 63.6% (18.43 out of 29) (Fig. 1 ). The average score on the fertility questions (66.4%) was higher than infertility questions (55.6%). Table 1 Demographic data Category Frequency Percentage Gender Female 124 53.68 Male 107 46.32 Age 18–25 212 91.77 26–30 17 7.36 31–35 1 0.43 36–40 1 0.43 41–45 0 0.00 Level Year 4 29 12.55 Year 5 101 43.72 Year 6 64 27.71 House Officer 37 16.02 Specialty OBGYN 21 9.09 Other 210 90.91 Totals 231 100.00 Demographic data of respondents. There was no significant relationship between gender and score (p = 0.1927); females averaged a score of 64.4% whereas males averaged a score of 62.6% (Fig. 1 ). Scores similarly were not significantly related to age (p = 0.2396) or whether or not someone planned to specialize in obstetrics and gynecology in the future (p = 0.4404) (Fig. 1 ). Level of training did have a significant relationship with score, with higher scores associated with higher levels of training. There was a significant difference between the scores of respondents in year four compared with each other level. The average score was 55.8% in year four compared to 65.0% in year five, 63.3% in year six, and 66.0% in house officers (Fig. 1 ). There were no significant differences between the scores of respondents in year five, year six, and house officers. Average score by gender, age, level of training, and intended future speciality. Error bars represent the standard error of the mean. Commonly missed questions included topics such as age-related fertility decline and natural fertility. 53.5% of respondents incorrectly answered that the age at which women’s ability to get pregnant declines most precipitously is between the ages of 40 and 45, whereas only 40.3% chose the correct answer of ages 35 to 39. Respondents only correctly identified the chance of a woman getting pregnant over the course of 1 month at a rate of 26.8% in women age 30 and 32.9% in women age 40, with the majority of respondents choosing a higher value than has been observed. Respondents also tended to underestimate the chance of miscarriage, with only 23.4% answering correctly (Table 2 ). Respondents frequently answered incorrectly regarding IVF efficacy. Only 29.9% of respondents correctly identified the efficacy of undergoing IVF in women under the age of 35, with the majority underestimating the success. 35.1% correctly identified the success of IVF in women over 44, but 64.9% overestimated the success rate. Overall, only 22.5% were able to identify the live birth rate per thawed egg, with more respondents choosing a higher success rate than reality. Respondents also frequently overestimated the prevalence of twins in IVF pregnancies, with just over one third answering correctly (Table 2 ). Table 2 Most Frequently Missed Questions Topic Subtopic(s) Question % Correct Answer Most Common Incorrect Answer % Choosing Most Common Incorrect Answer Fertility Age-Related Fertility Decline Over which age range does a woman’s ability to get pregnant decline most precipitously? 40% 35–39 40–45 53% Over the course of 1 month, what is the percent chance that a 30yo woman who is trying to get pregnant will get pregnant? 27% 20% 30% 32% Over the course of 1 month, what is the percent chance that a 40yo woman who is trying to get pregnant will get pregnant? 33% <=5% 6–10% 36% Natural Fertility On average, for a woman in her peak reproductive years, what is the percent chance that a pregnancy (recognized or unrecognized) will end in a miscarriage? 23% 15–25% <=5% 36% Factors Affecting Fertility A man’s age is a factor that affects a couple’s fertility. 43% TRUE FALSE 57% Prior use of oral contraceptive pills decreases a woman's chances of fertility. 49% FALSE TRUE 51% Use of certain sexual lubricants decreases a woman's chances of fertility. 45% TRUE FALSE 55% Infertility Treatment IVF Efficacy For a woman under 35 years old, undergoing IVF with her own eggs, what is the pregnancy rate per cycle? 30% 41–60% 6–20% 25% For a woman over 44 years old, undergoing IVF with her own eggs, what is the pregnancy rate per cycle? 35% <=5% 6–20% 39% IVF Risks In women who are undergoing IVF, what is the percent of pregnancies that result in twins? 35% 21–35% 36–45% 33% Egg Freezing and IVF Efficacy As per the largest published studies, when using frozen eggs from women less than 37 years old, what is the live birth rate per thawed egg? 23% <=10% 11–15% 33% This table shows the most frequently missed questions alongside the most frequently selected incorrect answer. Respondents showed strong knowledge in areas related to mechanisms of conception and types of fertility treatments. Over 90% of respondents correctly answered regarding the location of fertilization and number of eggs released per cycle. Over 85% of respondents correctly identified descriptions of IVF, intrauterine insemination (IUI), and egg cryopreservation procedures. Knowledge was variable in factors affecting fertility. Respondents tended to correctly answer regarding the effects of smoking, obesity, and prior gonorrhea or chlamydia infection on fertility. They also consistently demonstrated understanding that both men and women contribute to fertility. On the other hand, less than half of respondents answered that a man’s age does in fact affect a couple’s fertility (42.3%). Over half of respondents incorrectly answered that prior use of contraception does affect fertility (50.6%) while less than half believed that use of sexual lubricants can affect fertility (45.0%). Respondents were also asked about their comfort discussing fertility with patients and whether or not they counsel patients. 79.7% answered that they do feel comfortable answering patients’ questions about fertility. However, only 39.8% reported that they actively discuss fertility with their patients. Significantly higher scores were noted in respondents who are comfortable counseling patients (p = 0.042) and in those who do discuss fertility with their patients (p = 0.029). Discussion This study highlighted strengths of the current OBGYN curriculum at one school in Ghana, and simultaneously identified areas of weakness and common misconceptions that are important to address and correct. Overall, students show improvement throughout their clinical years, with higher scores in older students compared with those in their fourth year at the beginning of their clinical training. Level of training was the only factor significantly associated with score; factors such as gender, age, or intended specialty were not significantly associated. This highlights the importance of the curriculum in shaping the knowledge of these students and doctors. The most important year in shaping the knowledge of fertility and infertility seems to be in fourth year and early fifth year, as there was a significant difference between the scores of fourth years and more senior students and house officers, but not amongst the scores of students in fifth year and beyond. Students in this study overwhelmingly reported feeling comfortable discussing fertility with their patients. While fewer students report actually counseling patients, it is crucial that those who do are equipped with the proper knowledge. Very often, women seeking gynecological or infertility specific care come into contact with young doctors first. Therefore, in order to ensure they receive the most accurate information and are made aware of all of their options, it is essential to ensuring that young doctors counseling them are knowledgeable on these topics. Finally, addressing many of the common misconceptions is important to prevent the perpetuation of stereotypes in society. Infertility holds a large stigma, in Africa and Ghana in particular. Misconceptions such as the effects of contraception on fertility or the role of the man, not just the woman, can be detrimental to many involved should they not be corrected. Women tend to be blamed for infertility much more than men are. This results in social and psychological consequences for any women deemed as infertile. It is essential that the doctors counseling young couples, the very people who are supposed to be experts, do not spread false information, and rather actively seek to change the narrative in society. Only by spreading correct information will these stigmas slowly fade. Strengths of this study are that it utilized a validated survey tool, updated with statistics relevant to Ghana when possible, that had been previously used in a similar study in the United States. The survey was sent to every fourth, fifth, and sixth year student as well as house officers to avoid selection bias. Limitations of this study stem from the response rate to the survey that was sent out. Of all of the fourth, fifth, and sixth year students and house officers, less than 25% filled it out. Therefore, it is possible that this sample is not fully representative of the general student and house officer population. Those who filled it out may feel more confident in their knowledge on the topic or may have more interest in the topic. Furthermore, fifth year students made up a larger proportion of respondents, and many happened to be on their OBGYN rotation during this time. It is possible that these factors together could have skewed the data upwards slightly. However, despite fifth year students being actively engaged in OBGYN, there was no significant difference between their scores and those of sixth years and house officers, indicating that the gains made in fourth and early fifth year are more significant than any recency effects of studying that topic at the moment. Additionally, there were some questions in which statistics specific to Ghana were not available due to lack of research in this up and coming field, necessitating the use of US based statistics which may or may not be the same in Ghana. The goal is for the sample to be as representative as possible of house officers and medical students in Ghana; however, only students from Kwame Nkrumah University of Science and Technology were sampled, so generalization should be done with caution. Attitudes on fertility and infertility vary across regions in Ghana and West Africa. The implications of this cannot be downplayed in the analysis of this data. This study identifies actions that can be taken by medical education leaders to improve medical education. Areas of weakness can be addressed both through didactic teaching as well as clinical experiences. As the prevalence of infertility treatment and access expands in Ghana, it is important to ensure students are exposed to these visits and procedures. Most infertility treatments remain in private hospitals and clinics, where many students do not rotate. Therefore, exploring ways for students to get directly involved in the clinical application of this knowledge is crucial. Scores improving between fourth year and beyond indicate the effectiveness of the current didactic curriculum during fourth year and early fifth year. The plateau in improvement after fourth year highlights the opportunity for improvement in clinical teaching in later stages of education, including fifth year, sixth year, and house officer training, as students do not continue to make significant gains in their knowledge of fertility and infertility when they are in these peak times on the wards. Therefore, this highlights an opportunity to improve continuing education opportunities. Increasing clinical exposure to fertility and infertility counseling and procedures could help ensure continuing gains in older students. Future directions of this research would be to create and implement curriculum requirement recommendations and targeted educational training for medical students and house officers, specific to their level of training, to teach and reinforce these principles. This should include both traditional didactic activities as well as required clinical experiences. Many programs require a certain number of experiences across different topics. Including fertility and infertility counseling and treatments in these requirements, as well as supporting these objectives with implementable training, would be an important next step. Conclusions Students’ knowledge improves throughout clinical training as trainees advance in level, but critical misconceptions persist. Only level of training predicts score; fourth years had significantly lower scores than fifth years, sixth years, and house officers. Neither demographic differences, including age and gender, nor clinical interest was significantly associated with score. These findings reflect the efficacy of the current curriculum at one university in Ghana, but may not be generalizable nationally. Addressing and correcting misconceptions through enhancements in curriculum is essential to improve counseling and prevent perpetuating stereotypes surrounding infertility in Ghanaian society. Abbreviations SMS School of Medical Sciences KNUST Kwame Nkrumah University of Science and Technology KATH Komfo Anokye Teaching Hospital REI Reproductive Endocrinology and Infertility IVF in vitro fertilization OBGYN obstetrics and gynecology CHRPE Committee on Human Research Publications & Ethics FIT KS-Fertility and Infertility Treatment Knowledge Score ANOVA Analysis of Variance IUI intrauterine insemination Declarations Ethics approval and consent to participate Before the commencement of the study, ethical approval was obtained from the Committee on Human Research Publications & Ethics (CHRPE) of KNUST, Kumasi, Ghana. Informed consent was obtained from each participant in the web-based survey prior to completion. This study adhered to the principles in the Declaration of Helsinki. Consent for publication Not applicable Availability of data and materials The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. The questionnaire used in this study is available in the supplemental materials. Competing interests The authors declare that they have no competing interests Funding There was no external funding. The authors self-funded the study. Authors' contributions AS contributed to the design of the study, acquisition, analysis, and interpretation of the data, and wrote the manuscript. JA contributed to the conception and design of the study, acquisition and interpretation of the data, and substantively revised the manuscript. SA contributed to the conception and design of the study and the acquisition of the data. JN contributed to the conception and design of the study and the acquisition of the data. All authors read and approved the final manuscript. Acknowledgements Not applicable Authors' information Dr. John Jude Kweku Annan is an Obstetrician Gynecologist and Associate Professor at SMS, KNUST in the Department of Obstetrics and Gynecology as well as an Honorary Consultant in Reproductive Endocrinology and Infertility. Abigail St. Onge is a student at NYU Grossman School of Medicine, who worked with Dr. Annan and his team in Kumasi, Ghana over the summer. Dr. Seth Amponsah-Tabi is an Obstetrician Gynecologist at Suntreso Government Hospital, a district hospital in Ghana. He graduated from SMS, KNUST. Dr. Joshua Nyaah is a House Officer at KNUST. He also graduated from SMS, KNUST. References Roberts, L.M., Kudesia, R., Zhao, H. et al. A cross-sectional survey of fertility knowledge in obstetrics and gynecology residents. Fertil Res and Pract 6, 22 (2020). https://doi.org/10.1186/s40738-020-00091-2 Hamilton, M. (2012) Infertility. In: Edmonds, K.D., Ed., Dewhurst’s Textbook of Obstetrics and Gynaecology. 8th Edition, John Wiley & Sons, London, 567-579. https://doi.org/10.1002/9781119979449.ch45 Olajubu, F.A., Mope, D.-A., Osinupebi, O.A. and Jagun, O.E. (2013) Seminal Fluid Characteristics of Men Attending Infertility Clinic of a Teaching Hospital. Open Journal of Medical Microbiology, 3, 1-4. https://doi.org/10.4236/ojmm.2013.31001 Kekulawala M, Samba A, Braunschweig Y, Plange- Rhule J, Turpin C, Johnson TR, et al. Obstetric capacity strengthening in Ghana results in wide geographic distribution and retention of certified Obstetrician/Gynaecologists: A quantitative analysis. BJOG. 2022;129:1757–1761. https://doi.org/10.1111/1471-0528.17121 Kudesia R, Chernyak E, McAvey B. Low fertility awareness in United States reproductive-aged women and medical trainees: creation and validation of the Fertility & Infertility Treatment Knowledge Score (FIT-KS). Fertil Steril. 2017;108(4):711–7. https://doi.org/10.1016/j.fertnstert.2017.07.1158 Additional Declarations No competing interests reported. Supplementary Files AdditionalFile1.pdf Additional File 1: Additional File 1.pdf Title of data: FIT-KS survey Description: This is the FIT-KS survey that was sent to and completed by all participants in the study. Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 30 Mar, 2026 Reviewers agreed at journal 28 Mar, 2026 Reviewers invited by journal 25 Mar, 2026 Editor assigned by journal 23 Mar, 2026 Editor invited by journal 02 Mar, 2026 Submission checks completed at journal 01 Mar, 2026 First submitted to journal 01 Mar, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {\"props\":{\"pageProps\":{\"initialData\":{\"identity\":\"rs-8961255\",\"acceptedTermsAndConditions\":true,\"allowDirectSubmit\":false,\"archivedVersions\":[],\"articleType\":\"Research Article\",\"associatedPublications\":[],\"authors\":[{\"id\":611977937,\"identity\":\"4a83ce13-e2f6-4116-9385-65b1333eb0af\",\"order_by\":0,\"name\":\"Abigail St. Onge\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"New York University\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Abigail\",\"middleName\":\"St.\",\"lastName\":\"Onge\",\"suffix\":\"\"},{\"id\":611977939,\"identity\":\"6b824d28-a296-47e7-92dd-82687ea714de\",\"order_by\":1,\"name\":\"Joshua Nyaah\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Komfo Anokye Teaching Hospital\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Joshua\",\"middleName\":\"\",\"lastName\":\"Nyaah\",\"suffix\":\"\"},{\"id\":611977941,\"identity\":\"46b74c4f-aafd-4117-a06e-a8278362a835\",\"order_by\":2,\"name\":\"Seth Amponsah-Tabi\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Suntreso Government Hospital\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Seth\",\"middleName\":\"\",\"lastName\":\"Amponsah-Tabi\",\"suffix\":\"\"},{\"id\":611977943,\"identity\":\"403d8a45-4e67-4d2b-888b-e18dc10038af\",\"order_by\":3,\"name\":\"John Jude Kweku Annan\",\"email\":\"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA6klEQVRIiWNgGAWjYBACxgYGAwYeBgY5Nmb2gw+AAjx8xGox5mfvSTYAaWEjwiKwlsSZPQfMJEBcglqYZyRvfPCmwo5xw42EtMqvOXYybAzMDx/dwOewGWnFhnPOJDMb3Eg8dlt2WzLQYWzGxjl4teSYSfO2HWAzANpyW3IbM1ALD5s0AS3mv4FaeIBazIolt9UTpcWMGahFQhLofcaP2w4ToaXnWbEk0C8GoECWZtx2nIeNmYBfDNuTN34Ahlh9GzAqP/7cVm3Pz9788DFeLQ1IHGYeMIlHOQjIo7jyBwHVo2AUjIJRMDIBAMnLRye91j/+AAAAAElFTkSuQmCC\",\"orcid\":\"\",\"institution\":\"Kwame Nkrumah University of Science and Technology\",\"correspondingAuthor\":true,\"prefix\":\"\",\"firstName\":\"John\",\"middleName\":\"Jude Kweku\",\"lastName\":\"Annan\",\"suffix\":\"\"}],\"badges\":[],\"createdAt\":\"2026-02-24 21:53:42\",\"currentVersionCode\":1,\"declarations\":\"\",\"doi\":\"10.21203/rs.3.rs-8961255/v1\",\"doiUrl\":\"https://doi.org/10.21203/rs.3.rs-8961255/v1\",\"draftVersion\":[],\"editorialEvents\":[],\"editorialNote\":\"\",\"failedWorkflow\":false,\"files\":[{\"id\":105575289,\"identity\":\"e3d564ae-ad32-4079-96a5-2577245f5a67\",\"added_by\":\"auto\",\"created_at\":\"2026-03-27 13:37:57\",\"extension\":\"png\",\"order_by\":1,\"title\":\"Figure 1\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":73610,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eScore by Demographic Category\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"1.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-8961255/v1/91477d7738b68c1fd7db411e.png\"},{\"id\":105575585,\"identity\":\"7c45163a-2da9-4c5b-a85b-1e2c4b5622de\",\"added_by\":\"auto\",\"created_at\":\"2026-03-27 13:40:14\",\"extension\":\"pdf\",\"order_by\":0,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"manuscript-pdf\",\"size\":718751,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"manuscript.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-8961255/v1/7703f894-150f-4b69-bdd0-443e090bfa0a.pdf\"},{\"id\":105574871,\"identity\":\"59419569-0f60-4581-b61d-728c4cb8b19b\",\"added_by\":\"auto\",\"created_at\":\"2026-03-27 13:36:32\",\"extension\":\"pdf\",\"order_by\":1,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"supplement\",\"size\":49745,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003e\\u003cu\\u003eAdditional File 1:\\u003c/u\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eAdditional File 1.pdf\\u003c/p\\u003e\\n\\u003cp\\u003eTitle of data: FIT-KS survey\\u003c/p\\u003e\\n\\u003cp\\u003eDescription: This is the FIT-KS survey that was sent to and completed by all participants in the study.\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"AdditionalFile1.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-8961255/v1/79604ae462084bcbfa7d4a85.pdf\"}],\"financialInterests\":\"No competing interests reported.\",\"formattedTitle\":\"\\u003cp\\u003eA Cross-sectional Survey of Fertility Knowledge in House Officers and Clinical Medical Students in a Low Resource Setting\\u003c/p\\u003e\",\"fulltext\":[{\"header\":\"Background\",\"content\":\"\\u003cp\\u003eInfertility is a commonly experienced condition across the world, but it is often not well understood in the general population. High rates of infertility exist worldwide, and in West-Africa in particular. Infertility rates in the general population are around 12.5%\\u003csup\\u003e1\\u003c/sup\\u003e, with about 30\\u0026ndash;40% being due to female factors and 20\\u0026ndash;40% remaining idiopathic\\u003csup\\u003e\\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e\\u003c/sup\\u003e. In West Africa, rates of infertility may be up to 40%\\u003csup\\u003e3\\u003c/sup\\u003e.\\u003c/p\\u003e \\u003cp\\u003eFurthermore, an important part of routine gynecological care is counseling on family planning and natural fertility. Up to 65% of gynecological consultations are due to infertility, so it is critical for women and couples who desire children to have access to knowledgeable physicians to counsel them on that topic\\u003csup\\u003e\\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e\\u003c/sup\\u003e. The knowledge a physician has could significantly influence whether or not this counseling is provided to patients as well as the accuracy of the information given. As age-related fertility decline can play a significant role in future infertility, counseling early on at routine visits could play a crucial role in whether or not women experience infertility in the future and their success in getting pregnant once infertility has been diagnosed. In order to provide the best care to their patients, physicians must be equipped with accurate and up-to-date knowledge on a variety of topics relating to fertility and infertility.\\u003c/p\\u003e \\u003cp\\u003eIn most low resource centers, new doctors are the first point of call for couples seeking fertility treatment. Since there are few specialists in obstetrics and gynecology, many cases at the gynecological units, including the tertiary institutions, comprehensively involve newly qualified doctors called house officers. The knowledge base of the new and upcoming doctors will help in proper evaluation of the infertile couple and referrals to appropriate consultants or specialized clinics for further management. Their level of understanding and evaluation of these patients is based on the knowledge they acquired during their recent medical training. Having adequate knowledge about fertility management as a medical student prior to graduation and new house officer is essential in quality of care for the infertile couple. Therefore, it is imperative to ascertain the level of fertility knowledge of house officers and clinical medical students.\\u003c/p\\u003e \\u003cp\\u003eHowever, no study has been conducted to assess the knowledge of house officers and medical students on these topics of fertility and infertility in a low resource setting like Ghana. This cross-sectional study aims to evaluate the knowledge of current house officers who graduated from the School of Medical Sciences (SMS), Kwame Nkrumah University of Science and Technology (KNUST) and the current clinical medical students of SMS, KNUST in the topics of fertility and infertility, including but not limited to age-related fertility decline, natural fertility, and assistive reproductive technologies. Understanding these gaps in knowledge is crucial for medical education in order to design curriculum that best supports students and enhances the care they provide for their patients. The findings will inform program directors of knowledge gaps and misconceptions in fertility and infertility knowledge among house officers and clinical medical students. This information will help trainers address any significant areas of weakness during training of these house officers and clinical medical students to best equip them to counsel their future patients.\\u003c/p\\u003e \\u003cp\\u003eKomfo Anokye Teaching Hospital (KATH) is located in Kumasi, the capital city of the Ashanti region which is the second most populous region in Ghana. Kumasi is in the middle zone of Ghana and is an important geographical and cultural link between the less developed north and more developed south. It is a hub of the country\\u0026rsquo;s culture where infertility is considered a curse and every married woman is expected to deliver within a year or two of marriage. Giving birth within a year or two of marriage is an indication of divine approval of the union. KATH is the second largest tertiary institution in the country. The hospital has many subspecialties in the directorate of Obstetrics and Gynecology; one of these is the Reproductive Endocrinology and Infertility (REI) unit. This unit currently has trained consultants for in vitro fertilization (IVF) and is a training center designated for REI training. It currently collaborates with private health facilities in conducting IVF cases as it is yet to be fully equipped by the government to be fully operational. KATH serves as the main site for the clinical training of medical students of SMS KNUST. The hospital oversees the clinical training of the students during the fourth, fifth, and sixth years of the clinical training.\\u003c/p\\u003e \\u003cp\\u003eA similar study has been conducted in the United States to understand the knowledge of residents in various obstetrics and gynecology (OBGYN) programs across the country\\u003csup\\u003e\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e\\u003c/sup\\u003e. That study was conducted in a high resource setting on physicians in residency training. This current study is aimed at understanding the knowledge of a group of house officers and clinical medical students in Kumasi, Ghana, a low resource setting. Additionally, 91% of new OBGYN graduates in Ghana as of 2017 were male\\u003csup\\u003e\\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e\\u003c/sup\\u003e, as opposed to the 91% of female respondents in the study conducted in the United States\\u003csup\\u003e\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e\\u003c/sup\\u003e. Significant differences in demographics and resources between the United States and Ghana provide convincing reasons to conduct a new study in Ghana in a representative population of house officers and clinical medical students. This study will provide insight into the knowledge gaps in fertility and infertility knowledge that exist among house officers and clinical medical students in Ghana in order to better inform program directors how to address any significant areas of weakness or misconceptions.\\u003c/p\\u003e\"},{\"header\":\"Materials and Methods\",\"content\":\"\\u003cp\\u003eThis was a cross sectional study that was carried out among KNUST students and house officers training at KATH. The study population was all current house officers and all current clinical medical students at SMS, KNUST. The study population was contacted via WhatsApp and reminders were sent over the course of two months. The study was conducted in June and July, in the middle of the academic year. Before the commencement of the study, ethical approval was obtained from the Committee on Human Research Publications \\u0026amp; Ethics (CHRPE) of KNUST, Kumasi, Ghana. Consent was obtained from each participant in the web-based survey prior to completion.\\u003c/p\\u003e \\u003cp\\u003eA validated survey called the Fertility and Infertility Treatment Knowledge Score (FIT-KS) was used to assess knowledge of fertility and infertility in each house officer and clinical medical student\\u003csup\\u003e\\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e\\u003c/sup\\u003e. The web-based survey was sent out in the form of a Google Form. FIT-KS is a web-based survey, with 29 multiple-choice items. It assesses knowledge of natural fertility (21 questions) and knowledge of infertility treatment (8 questions) as well as demographic fill-in questions. Questions were updated with data specific to Ghana, or West Africa, when applicable and readily available. Demographic information collected included the following: age, year in training, gender, current number of children, number of children desired, ideal age to have children, and what options would be utilized if the respondent were to experience infertility. The entire survey is included as an additional file (see Additional File 1). Only surveys in which every question was complete were included; any incomplete surveys were excluded. The data was compiled into a spreadsheet and de-identified. The data was accessible only to the investigators. No participant identifiable information was documented.\\u003c/p\\u003e \\u003cp\\u003eFor ambiguously submitted answers, a system was in place to quantify all answers. For the desired number of children, when an age range, as opposed to a single number, was submitted, the average age of the range was used. For age at having children, the youngest age in a range was used, presumed to represent the age at which the respondent would have their first of multiple children. In terms of age, \\u0026ldquo;late\\u0026rdquo; was quantified as 8, meaning \\u0026ldquo;late 20s\\u0026rdquo; was quantified as 28. Similarly, \\u0026ldquo;mid\\u0026rdquo; was quantified as 5 and \\u0026ldquo;early\\u0026rdquo; was quantified as 2, so that \\u0026ldquo;mid-20s\\u0026rdquo; was 25 and \\u0026ldquo;early 20s\\u0026rdquo; was 22.\\u003c/p\\u003e \\u003cp\\u003eStatistical analysis was performed using either an analysis of variance (ANOVA) or Welch\\u0026rsquo;s F-test, two-sample t tests, or Chi-square or Fisher\\u0026rsquo;s exact test as appropriate for the data set. Bartlett\\u0026rsquo;s test was used to verify that variances are equal across the samples, in cases where ANOVA was used, such as whether knowledge differed by year of medical training. All statistical analysis was performed in Excel and R. Studio version 4.5.1 with the level of significance set at less than 0.05 (p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05).\\u003c/p\\u003e\"},{\"header\":\"Results\",\"content\":\"\\u003cp\\u003e231 respondents completed the survey, 124 female (53.7%) and 107 male (46.3%). Most respondents were between the ages of 18 and 25 (91.8%). 12.55% of respondents were in year four, 43.72% in year five, 27.71% in year six, and 16.0% house officers (Table\\u0026nbsp;\\u003cspan refid=\\\"Tab1\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e). The average score overall was 63.6% (18.43 out of 29) (Fig.\\u0026nbsp;\\u003cspan refid=\\\"Fig1\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e). The average score on the fertility questions (66.4%) was higher than infertility questions (55.6%).\\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab1\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 1\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003eDemographic data\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"4\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003eCategory\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eFrequency\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003ePercentage\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eGender\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eFemale\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e124\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e53.68\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eMale\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e107\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e46.32\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"4\\\" rowspan=\\\"5\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eAge\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003e18\\u0026ndash;25\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e212\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e91.77\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003e26\\u0026ndash;30\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e17\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e7.36\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003e31\\u0026ndash;35\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e1\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.43\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003e36\\u0026ndash;40\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e1\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.43\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003e41\\u0026ndash;45\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e0\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.00\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"3\\\" rowspan=\\\"4\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eLevel\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eYear 4\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e29\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e12.55\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eYear 5\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e101\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e43.72\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eYear 6\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e64\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e27.71\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eHouse Officer\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e37\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e16.02\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eSpecialty\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eOBGYN\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e21\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e9.09\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eOther\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e210\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e90.91\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eTotals\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e231\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e100.00\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e \\u003cp\\u003eDemographic data of respondents.\\u003c/p\\u003e \\u003cp\\u003eThere was no significant relationship between gender and score (p\\u0026thinsp;=\\u0026thinsp;0.1927); females averaged a score of 64.4% whereas males averaged a score of 62.6% (Fig.\\u0026nbsp;\\u003cspan refid=\\\"Fig1\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e). Scores similarly were not significantly related to age (p\\u0026thinsp;=\\u0026thinsp;0.2396) or whether or not someone planned to specialize in obstetrics and gynecology in the future (p\\u0026thinsp;=\\u0026thinsp;0.4404) (Fig.\\u0026nbsp;\\u003cspan refid=\\\"Fig1\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e).\\u003c/p\\u003e \\u003cp\\u003eLevel of training did have a significant relationship with score, with higher scores associated with higher levels of training. There was a significant difference between the scores of respondents in year four compared with each other level. The average score was 55.8% in year four compared to 65.0% in year five, 63.3% in year six, and 66.0% in house officers (Fig.\\u0026nbsp;\\u003cspan refid=\\\"Fig1\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e). There were no significant differences between the scores of respondents in year five, year six, and house officers.\\u003c/p\\u003e \\u003cp\\u003e \\u003c/p\\u003e \\u003cp\\u003eAverage score by gender, age, level of training, and intended future speciality. Error bars represent the standard error of the mean.\\u003c/p\\u003e \\u003cp\\u003eCommonly missed questions included topics such as age-related fertility decline and natural fertility. 53.5% of respondents incorrectly answered that the age at which women\\u0026rsquo;s ability to get pregnant declines most precipitously is between the ages of 40 and 45, whereas only 40.3% chose the correct answer of ages 35 to 39. Respondents only correctly identified the chance of a woman getting pregnant over the course of 1 month at a rate of 26.8% in women age 30 and 32.9% in women age 40, with the majority of respondents choosing a higher value than has been observed. Respondents also tended to underestimate the chance of miscarriage, with only 23.4% answering correctly (Table\\u0026nbsp;\\u003cspan refid=\\\"Tab2\\\" class=\\\"InternalRef\\\"\\u003e2\\u003c/span\\u003e).\\u003c/p\\u003e \\u003cp\\u003eRespondents frequently answered incorrectly regarding IVF efficacy. Only 29.9% of respondents correctly identified the efficacy of undergoing IVF in women under the age of 35, with the majority underestimating the success. 35.1% correctly identified the success of IVF in women over 44, but 64.9% overestimated the success rate. Overall, only 22.5% were able to identify the live birth rate per thawed egg, with more respondents choosing a higher success rate than reality. Respondents also frequently overestimated the prevalence of twins in IVF pregnancies, with just over one third answering correctly (Table\\u0026nbsp;\\u003cspan refid=\\\"Tab2\\\" class=\\\"InternalRef\\\"\\u003e2\\u003c/span\\u003e).\\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab2\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 2\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003eMost Frequently Missed Questions\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"7\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c5\\\" colnum=\\\"5\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c6\\\" colnum=\\\"6\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c7\\\" colnum=\\\"7\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eTopic\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eSubtopic(s)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eQuestion\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e% Correct\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eAnswer\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003eMost Common Incorrect Answer\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e% Choosing Most Common Incorrect Answer\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"6\\\" rowspan=\\\"7\\\"\\u003e \\u003cp\\u003eFertility\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\" morerows=\\\"2\\\" rowspan=\\\"3\\\"\\u003e \\u003cp\\u003eAge-Related Fertility Decline\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eOver which age range does a woman\\u0026rsquo;s ability to get pregnant decline most precipitously?\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e40%\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e35\\u0026ndash;39\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e40\\u0026ndash;45\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e53%\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eOver the course of 1 month, what is the percent chance that a 30yo woman who is trying to get pregnant will get pregnant?\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e27%\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e20%\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e30%\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e32%\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eOver the course of 1 month, what is the percent chance that a 40yo woman who is trying to get pregnant will get pregnant?\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e33%\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e\\u0026lt;=5%\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e6\\u0026ndash;10%\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e36%\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eNatural Fertility\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eOn average, for a woman in her peak reproductive years, what is the percent chance that a pregnancy (recognized or unrecognized) will end in a miscarriage?\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e23%\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e15\\u0026ndash;25%\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e\\u0026lt;=5%\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e36%\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\" morerows=\\\"2\\\" rowspan=\\\"3\\\"\\u003e \\u003cp\\u003eFactors Affecting Fertility\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eA man\\u0026rsquo;s age is a factor that affects a couple\\u0026rsquo;s fertility.\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e43%\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eTRUE\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003eFALSE\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e57%\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003ePrior use of oral contraceptive pills decreases a woman's chances of fertility.\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e49%\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eFALSE\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003eTRUE\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e51%\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eUse of certain sexual lubricants decreases a woman's chances of fertility.\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e45%\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eTRUE\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003eFALSE\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e55%\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"3\\\" rowspan=\\\"4\\\"\\u003e \\u003cp\\u003eInfertility Treatment\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eIVF Efficacy\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eFor a woman under 35 years old, undergoing IVF with her own eggs, what is the pregnancy rate per cycle?\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e30%\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e41\\u0026ndash;60%\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e6\\u0026ndash;20%\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e25%\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eFor a woman over 44 years old, undergoing IVF with her own eggs, what is the pregnancy rate per cycle?\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e35%\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e\\u0026lt;=5%\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e6\\u0026ndash;20%\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e39%\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eIVF Risks\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eIn women who are undergoing IVF, what is the percent of pregnancies that result in twins?\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e35%\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e21\\u0026ndash;35%\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e36\\u0026ndash;45%\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e33%\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eEgg Freezing and IVF Efficacy\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eAs per the largest published studies, when using frozen eggs from women less than 37 years old, what is the live birth rate per thawed egg?\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e23%\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e\\u0026lt;=10%\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e11\\u0026ndash;15%\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e33%\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e \\u003cp\\u003eThis table shows the most frequently missed questions alongside the most frequently selected incorrect answer.\\u003c/p\\u003e \\u003cp\\u003eRespondents showed strong knowledge in areas related to mechanisms of conception and types of fertility treatments. Over 90% of respondents correctly answered regarding the location of fertilization and number of eggs released per cycle. Over 85% of respondents correctly identified descriptions of IVF, intrauterine insemination (IUI), and egg cryopreservation procedures.\\u003c/p\\u003e \\u003cp\\u003eKnowledge was variable in factors affecting fertility. Respondents tended to correctly answer regarding the effects of smoking, obesity, and prior gonorrhea or chlamydia infection on fertility. They also consistently demonstrated understanding that both men and women contribute to fertility. On the other hand, less than half of respondents answered that a man\\u0026rsquo;s age does in fact affect a couple\\u0026rsquo;s fertility (42.3%). Over half of respondents incorrectly answered that prior use of contraception does affect fertility (50.6%) while less than half believed that use of sexual lubricants can affect fertility (45.0%).\\u003c/p\\u003e \\u003cp\\u003eRespondents were also asked about their comfort discussing fertility with patients and whether or not they counsel patients. 79.7% answered that they do feel comfortable answering patients\\u0026rsquo; questions about fertility. However, only 39.8% reported that they actively discuss fertility with their patients. Significantly higher scores were noted in respondents who are comfortable counseling patients (p\\u0026thinsp;=\\u0026thinsp;0.042) and in those who do discuss fertility with their patients (p\\u0026thinsp;=\\u0026thinsp;0.029).\\u003c/p\\u003e\"},{\"header\":\"Discussion\",\"content\":\"\\u003cp\\u003eThis study highlighted strengths of the current OBGYN curriculum at one school in Ghana, and simultaneously identified areas of weakness and common misconceptions that are important to address and correct. Overall, students show improvement throughout their clinical years, with higher scores in older students compared with those in their fourth year at the beginning of their clinical training. Level of training was the only factor significantly associated with score; factors such as gender, age, or intended specialty were not significantly associated. This highlights the importance of the curriculum in shaping the knowledge of these students and doctors. The most important year in shaping the knowledge of fertility and infertility seems to be in fourth year and early fifth year, as there was a significant difference between the scores of fourth years and more senior students and house officers, but not amongst the scores of students in fifth year and beyond.\\u003c/p\\u003e \\u003cp\\u003eStudents in this study overwhelmingly reported feeling comfortable discussing fertility with their patients. While fewer students report actually counseling patients, it is crucial that those who do are equipped with the proper knowledge. Very often, women seeking gynecological or infertility specific care come into contact with young doctors first. Therefore, in order to ensure they receive the most accurate information and are made aware of all of their options, it is essential to ensuring that young doctors counseling them are knowledgeable on these topics.\\u003c/p\\u003e \\u003cp\\u003eFinally, addressing many of the common misconceptions is important to prevent the perpetuation of stereotypes in society. Infertility holds a large stigma, in Africa and Ghana in particular. Misconceptions such as the effects of contraception on fertility or the role of the man, not just the woman, can be detrimental to many involved should they not be corrected. Women tend to be blamed for infertility much more than men are. This results in social and psychological consequences for any women deemed as infertile. It is essential that the doctors counseling young couples, the very people who are supposed to be experts, do not spread false information, and rather actively seek to change the narrative in society. Only by spreading correct information will these stigmas slowly fade.\\u003c/p\\u003e \\u003cp\\u003eStrengths of this study are that it utilized a validated survey tool, updated with statistics relevant to Ghana when possible, that had been previously used in a similar study in the United States. The survey was sent to every fourth, fifth, and sixth year student as well as house officers to avoid selection bias.\\u003c/p\\u003e \\u003cp\\u003eLimitations of this study stem from the response rate to the survey that was sent out. Of all of the fourth, fifth, and sixth year students and house officers, less than 25% filled it out. Therefore, it is possible that this sample is not fully representative of the general student and house officer population. Those who filled it out may feel more confident in their knowledge on the topic or may have more interest in the topic. Furthermore, fifth year students made up a larger proportion of respondents, and many happened to be on their OBGYN rotation during this time. It is possible that these factors together could have skewed the data upwards slightly. However, despite fifth year students being actively engaged in OBGYN, there was no significant difference between their scores and those of sixth years and house officers, indicating that the gains made in fourth and early fifth year are more significant than any recency effects of studying that topic at the moment. Additionally, there were some questions in which statistics specific to Ghana were not available due to lack of research in this up and coming field, necessitating the use of US based statistics which may or may not be the same in Ghana.\\u003c/p\\u003e \\u003cp\\u003eThe goal is for the sample to be as representative as possible of house officers and medical students in Ghana; however, only students from Kwame Nkrumah University of Science and Technology were sampled, so generalization should be done with caution. Attitudes on fertility and infertility vary across regions in Ghana and West Africa. The implications of this cannot be downplayed in the analysis of this data.\\u003c/p\\u003e \\u003cp\\u003eThis study identifies actions that can be taken by medical education leaders to improve medical education. Areas of weakness can be addressed both through didactic teaching as well as clinical experiences. As the prevalence of infertility treatment and access expands in Ghana, it is important to ensure students are exposed to these visits and procedures. Most infertility treatments remain in private hospitals and clinics, where many students do not rotate. Therefore, exploring ways for students to get directly involved in the clinical application of this knowledge is crucial.\\u003c/p\\u003e \\u003cp\\u003eScores improving between fourth year and beyond indicate the effectiveness of the current didactic curriculum during fourth year and early fifth year. The plateau in improvement after fourth year highlights the opportunity for improvement in clinical teaching in later stages of education, including fifth year, sixth year, and house officer training, as students do not continue to make significant gains in their knowledge of fertility and infertility when they are in these peak times on the wards. Therefore, this highlights an opportunity to improve continuing education opportunities. Increasing clinical exposure to fertility and infertility counseling and procedures could help ensure continuing gains in older students.\\u003c/p\\u003e \\u003cp\\u003eFuture directions of this research would be to create and implement curriculum requirement recommendations and targeted educational training for medical students and house officers, specific to their level of training, to teach and reinforce these principles. This should include both traditional didactic activities as well as required clinical experiences. Many programs require a certain number of experiences across different topics. Including fertility and infertility counseling and treatments in these requirements, as well as supporting these objectives with implementable training, would be an important next step.\\u003c/p\\u003e\"},{\"header\":\"Conclusions\",\"content\":\"\\u003cp\\u003eStudents\\u0026rsquo; knowledge improves throughout clinical training as trainees advance in level, but critical misconceptions persist. Only level of training predicts score; fourth years had significantly lower scores than fifth years, sixth years, and house officers. Neither demographic differences, including age and gender, nor clinical interest was significantly associated with score. These findings reflect the efficacy of the current curriculum at one university in Ghana, but may not be generalizable nationally. Addressing and correcting misconceptions through enhancements in curriculum is essential to improve counseling and prevent perpetuating stereotypes surrounding infertility in Ghanaian society.\\u003c/p\\u003e\"},{\"header\":\"Abbreviations\",\"content\":\"\\u003cdiv class=\\\"DefinitionList\\\"\\u003e \\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e \\u003cdiv class=\\\"Term\\\"\\u003eSMS\\u003c/div\\u003e \\u003cdiv class=\\\"Description\\\"\\u003e \\u003cp\\u003eSchool of Medical Sciences\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/div\\u003e \\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e \\u003cdiv class=\\\"Term\\\"\\u003eKNUST\\u003c/div\\u003e \\u003cdiv class=\\\"Description\\\"\\u003e \\u003cp\\u003eKwame Nkrumah University of Science and Technology\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/div\\u003e \\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e \\u003cdiv class=\\\"Term\\\"\\u003eKATH\\u003c/div\\u003e \\u003cdiv class=\\\"Description\\\"\\u003e \\u003cp\\u003eKomfo Anokye Teaching Hospital\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/div\\u003e \\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e \\u003cdiv class=\\\"Term\\\"\\u003eREI\\u003c/div\\u003e \\u003cdiv class=\\\"Description\\\"\\u003e \\u003cp\\u003eReproductive Endocrinology and Infertility\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/div\\u003e \\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e \\u003cdiv class=\\\"Term\\\"\\u003eIVF\\u003c/div\\u003e \\u003cdiv class=\\\"Description\\\"\\u003e \\u003cp\\u003ein vitro fertilization\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/div\\u003e \\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e \\u003cdiv class=\\\"Term\\\"\\u003eOBGYN\\u003c/div\\u003e \\u003cdiv class=\\\"Description\\\"\\u003e \\u003cp\\u003eobstetrics and gynecology\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/div\\u003e \\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e \\u003cdiv class=\\\"Term\\\"\\u003eCHRPE\\u003c/div\\u003e \\u003cdiv class=\\\"Description\\\"\\u003e \\u003cp\\u003eCommittee on Human Research Publications \\u0026amp; Ethics\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/div\\u003e \\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e \\u003cdiv class=\\\"Term\\\"\\u003eFIT\\u003c/div\\u003e \\u003cdiv class=\\\"Description\\\"\\u003e \\u003cp\\u003eKS-Fertility and Infertility Treatment Knowledge Score\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/div\\u003e \\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e \\u003cdiv class=\\\"Term\\\"\\u003eANOVA\\u003c/div\\u003e \\u003cdiv class=\\\"Description\\\"\\u003e \\u003cp\\u003eAnalysis of Variance\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/div\\u003e \\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e \\u003cdiv class=\\\"Term\\\"\\u003eIUI\\u003c/div\\u003e \\u003cdiv class=\\\"Description\\\"\\u003e \\u003cp\\u003eintrauterine insemination\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/div\\u003e \\u003c/div\\u003e\"},{\"header\":\"Declarations\",\"content\":\"\\u003ch4\\u003e\\u003cu\\u003eEthics approval and consent to participate\\u003c/u\\u003e\\u003c/h4\\u003e\\n\\u003cp\\u003eBefore the commencement of the study, ethical approval was obtained from the Committee on Human Research Publications \\u0026amp; Ethics (CHRPE) of KNUST, Kumasi, Ghana. Informed consent was obtained from each participant in the web-based survey prior to completion. This study adhered to the principles in the Declaration of Helsinki.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003ch4\\u003e\\u003cu\\u003eConsent for publication\\u003c/u\\u003e\\u003c/h4\\u003e\\n\\u003cp\\u003eNot applicable\\u003c/p\\u003e\\n\\u003ch4\\u003e\\u003cu\\u003eAvailability of data and materials\\u003c/u\\u003e\\u003c/h4\\u003e\\n\\u003cp\\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. The questionnaire used in this study is available in the supplemental materials.\\u003c/p\\u003e\\n\\u003ch4\\u003e\\u003cu\\u003eCompeting interests\\u003c/u\\u003e\\u003c/h4\\u003e\\n\\u003cp\\u003eThe authors declare that they have no competing interests\\u003c/p\\u003e\\n\\u003ch4\\u003e\\u003cu\\u003eFunding\\u003c/u\\u003e\\u003c/h4\\u003e\\n\\u003cp\\u003eThere was no external funding. The authors self-funded the study.\\u003c/p\\u003e\\n\\u003ch4\\u003e\\u003cu\\u003eAuthors' contributions\\u003c/u\\u003e\\u003c/h4\\u003e\\n\\u003cp\\u003eAS contributed to the design of the study, acquisition, analysis, and interpretation of the data, and wrote the manuscript.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eJA contributed to the conception and design of the study, acquisition and interpretation of the data, and substantively revised the manuscript.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eSA contributed to the conception and design of the study and the acquisition of the data.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eJN contributed to the conception and design of the study and the acquisition of the data.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eAll authors read and approved the final manuscript.\\u003c/p\\u003e\\n\\u003ch4\\u003e\\u003cu\\u003eAcknowledgements\\u003c/u\\u003e\\u003c/h4\\u003e\\n\\u003cp\\u003eNot applicable\\u003c/p\\u003e\\n\\u003ch4\\u003e\\u003cu\\u003eAuthors' information\\u003c/u\\u003e\\u003c/h4\\u003e\\n\\u003cp\\u003eDr. John Jude Kweku Annan is an Obstetrician Gynecologist and Associate Professor at SMS, KNUST in the Department of Obstetrics and Gynecology as well as an Honorary Consultant in Reproductive Endocrinology and Infertility.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eAbigail St. Onge is a student at NYU Grossman School of Medicine, who worked with Dr. Annan and his team in Kumasi, Ghana over the summer.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eDr. Seth Amponsah-Tabi is an Obstetrician Gynecologist at Suntreso Government Hospital, a district hospital in Ghana. He graduated from SMS, KNUST.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eDr. Joshua Nyaah is a House Officer at KNUST. He also graduated from SMS, KNUST.\\u0026nbsp;\\u003c/p\\u003e\"},{\"header\":\"References\",\"content\":\"\\u003col\\u003e\\n\\u003cli\\u003eRoberts, L.M., Kudesia, R., Zhao, H. et al. A cross-sectional survey of fertility knowledge in obstetrics and gynecology residents. Fertil Res and Pract 6, 22 (2020). https://doi.org/10.1186/s40738-020-00091-2\\u003c/li\\u003e\\n\\u003cli\\u003eHamilton, M. (2012) Infertility. In: Edmonds, K.D., Ed., Dewhurst\\u0026rsquo;s Textbook of Obstetrics and Gynaecology. 8th Edition, John Wiley \\u0026amp; Sons, London, 567-579. https://doi.org/10.1002/9781119979449.ch45\\u003c/li\\u003e\\n\\u003cli\\u003eOlajubu, F.A., Mope, D.-A., Osinupebi, O.A. and Jagun, O.E. (2013) Seminal Fluid Characteristics of Men Attending Infertility Clinic of a Teaching Hospital. Open Journal of Medical Microbiology, 3, 1-4. https://doi.org/10.4236/ojmm.2013.31001\\u003c/li\\u003e\\n\\u003cli\\u003eKekulawala M, Samba A, Braunschweig Y, Plange- Rhule J, Turpin C, Johnson TR, et al. Obstetric capacity strengthening in Ghana results in wide geographic distribution and retention of certified Obstetrician/Gynaecologists: A quantitative analysis. BJOG. 2022;129:1757\\u0026ndash;1761. https://doi.org/10.1111/1471-0528.17121\\u003c/li\\u003e\\n\\u003cli\\u003eKudesia R, Chernyak E, McAvey B. Low fertility awareness in United States reproductive-aged women and medical trainees: creation and validation of the Fertility \\u0026amp; Infertility Treatment Knowledge Score (FIT-KS). Fertil Steril. 2017;108(4):711\\u0026ndash;7. https://doi.org/10.1016/j.fertnstert.2017.07.1158\\u003c/li\\u003e\\n\\u003c/ol\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":true,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":false,\"hideJournal\":false,\"highlight\":\"\",\"institution\":\"\",\"isAcceptedByJournal\":false,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"bmc-medical-education\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"meed\",\"sideBox\":\"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)\",\"snPcode\":\"\",\"submissionUrl\":\"https://www.editorialmanager.com/meed/default.aspx\",\"title\":\"BMC Medical Education\",\"twitterHandle\":\"BMC_series\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"em\",\"reportingPortfolio\":\"BMC Series\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":true},\"keywords\":\"Medical education, Fertility, Infertility, Infertility treatment, Medical knowledge, Assisted reproductive technology, In-vitro fertilization \",\"lastPublishedDoi\":\"10.21203/rs.3.rs-8961255/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-8961255/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003cp\\u003e\\u003cb\\u003eBackground:\\u003c/b\\u003e\\u003c/p\\u003e \\u003cp\\u003eInfertility rates in the general population are around 12.5% and up to 40% in West Africa. In Ghana, a pronatalist society, infertility carries significant implications. It is imperative for new doctors to be knowledgeable about fertility and infertility to counsel women. This study aimed to understand the knowledge of house officers and clinical medical students in Kumasi, Ghana to provide insight into knowledge gaps and misconceptions and inform medical education efforts.\\u003c/p\\u003e\\u003cp\\u003e\\u003cb\\u003eMethods:\\u003c/b\\u003e\\u003c/p\\u003e \\u003cp\\u003eThis cross-sectional study utilized a validated, 29-question survey, the Fertility and Infertility Treatment Knowledge Score, to assess the knowledge of house officers and clinical medical students at Kwame Nkrumah University of Science and Technology in Kumasi, Ghana. The primary outcome was score. Permission to use the survey was obtained and approval was granted by university CHRPE. Participants gave consent in the survey. Statistical analysis was performed in R using appropriate tests with significance set at p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05.\\u003c/p\\u003e\\u003cp\\u003e\\u003cb\\u003eResults:\\u003c/b\\u003e\\u003c/p\\u003e \\u003cp\\u003e231 respondents completed the survey (54% female, 46% male). Most were senior clinical students: 13% year four, 44% year five, 28% year 6, and 16% house officers. The average score overall was 64% (SD\\u0026thinsp;=\\u0026thinsp;11%). There was no significant difference in score based on sex (p\\u0026thinsp;=\\u0026thinsp;0.193). House officers averaged the highest score (66%, SD\\u0026thinsp;=\\u0026thinsp;11%); fourth years averaged the lowest (56%, SD\\u0026thinsp;=\\u0026thinsp;11%). Scores increased significantly with level of training, from fourth years to fifth years (p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001), sixth years (p\\u0026thinsp;=\\u0026thinsp;0.016), and house officers (p\\u0026thinsp;=\\u0026thinsp;0.002). Frequently missed topics included age-related fertility decline, natural fertility, and IVF efficacy. Scores were high on mechanisms of conception and infertility treatments. Knowledge of factors influencing fertility, including contraceptive use and male age, was variable.\\u003c/p\\u003e\\u003cp\\u003e\\u003cb\\u003eConclusions:\\u003c/b\\u003e\\u003c/p\\u003e \\u003cp\\u003eStudents\\u0026rsquo; knowledge improves in clinical training, but critical misconceptions persist. Only level of training predicts score, not demographic differences. These findings reflect the efficacy of the current curriculum at one university, but may not generalize nationally. Addressing and correcting misconceptions through enhancements in curriculum is essential to improve counseling and prevent perpetuating stereotypes surrounding infertility in Ghanaian society.\\u003c/p\\u003e\",\"manuscriptTitle\":\"A Cross-sectional Survey of Fertility Knowledge in House Officers and Clinical Medical Students in a Low Resource Setting\",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2026-03-27 13:08:07\",\"doi\":\"10.21203/rs.3.rs-8961255/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0},{\"type\":\"editorInvitedReview\",\"content\":\"\",\"date\":\"2026-03-30T18:38:14+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"34551324778299961400983117473995156438\",\"date\":\"2026-03-29T01:19:12+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewersInvited\",\"content\":\"\",\"date\":\"2026-03-25T09:09:52+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorAssigned\",\"content\":\"\",\"date\":\"2026-03-23T09:49:19+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorInvited\",\"content\":\"\",\"date\":\"2026-03-02T13:04:29+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"checksComplete\",\"content\":\"\",\"date\":\"2026-03-01T11:48:57+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"submitted\",\"content\":\"BMC Medical Education\",\"date\":\"2026-03-01T11:43:56+00:00\",\"index\":\"\",\"fulltext\":\"\"}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"bmc-medical-education\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"meed\",\"sideBox\":\"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)\",\"snPcode\":\"\",\"submissionUrl\":\"https://www.editorialmanager.com/meed/default.aspx\",\"title\":\"BMC Medical Education\",\"twitterHandle\":\"BMC_series\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"em\",\"reportingPortfolio\":\"BMC Series\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":true}}],\"origin\":\"\",\"ownerIdentity\":\"4745fd6c-1543-4347-a139-255fb324652d\",\"owner\":[],\"postedDate\":\"March 27th, 2026\",\"published\":true,\"recentEditorialEvents\":[],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"under-review\",\"subjectAreas\":[],\"tags\":[],\"updatedAt\":\"2026-03-27T13:08:08+00:00\",\"versionOfRecord\":[],\"versionCreatedAt\":\"2026-03-27 13:08:07\",\"video\":\"\",\"vorDoi\":\"\",\"vorDoiUrl\":\"\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-8961255\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-8961255\",\"identity\":\"rs-8961255\",\"version\":[\"v1\"]},\"buildId\":\"XKTyCvWXoU3ODBz1xrDgd\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC-BY-4.0","license_restricted":false}