{"paper_id":"47a712cd-7607-490d-95cd-a667c72ba4a6","body_text":"Infertility rates have been rising, and according to the World Health Organization\n(WHO), it affects one in every six people worldwide ( WHO, 2023 ), while global fertility rates are declining, raising concerns\nabout the consequences of underpopulation ( Fauser\n et al. , 2025 ). Since access to diagnosis and\ntreatment is available to only a few fortunate individuals ( Njagi  et al. , 2023 ;  Norman & Fauser, 2024 ), many people on the infertility\njourney turn to online resources for information ( Broughton  et al. , 2018 ). In fact, social media has\nbecome a major source of health-related information for many seeking fertility care,\nand the numbers have increased in recent years. People search social media for\nhealth-related information for various reasons, which may include: learning about a\nspecific disease or physician/hospital, obtaining guidance or a second opinion, and\neven sharing experiences and connecting with others facing the same condition ( Farsi  et al. , 2022 ).\nStudies have shown that individuals facing infertility often turn to social media\nplatforms like Instagram and Facebook to seek information, find fertility clinics,\nshare experiences, and even get second opinions ( Sormunen  et al ., 2020 ;  Peyser  et al ., 2021 ). The COVID-19 pandemic may have\nenhanced the role of social media as a source of information for fertility-related\nissues ( Perone  et al .,\n2020 ). Unfortunately, in the fertility space on social media, physicians and\nacademic societies are the minority and less influential than patients, support\ngroups, and the so-called influencers, who comprise the majority according to  Blakemore  et al.  (2020) .\nBrazilians are particularly keen on using social media for health information. Sadly,\nthe quality and accuracy of the daily content posted are controversial and need to\nbe assessed. Recent published research shows social media is increasingly used not\nonly for information and education but also for emotional and social support, as\nwell as searching for fertility clinics and doctors ( Perone  et al. , 2021 ;  Carneiro  et al. , 2024 ). Since fertility care\ninformation is limited and infertility rates are rising, social media may serve as\nan alternative for those seeking care and information. Therefore, we aimed to\ndetermine the prevalence, authorship, and reliability of educational\nfertility-related information shared on Instagram in Brazil using the DISCERN\ninstrument according to ( Logullo  et\nal. , 2019 ).\n\nThis cross-sectional study examined publicly available posts related to infertility\nhashtags on Brazilian Instagram, the most popular social media platform among\nreproductive-aged people in Brazil ( Bianchi,\n2025 ).\nA list of 11 hashtags related to fertility terms commonly used on Instagram was\nselected based on ( TagsFinder.com, 2025 ):\n#infertility, #ivf, #endometriosis, #tryingotconceive, #maternity,\n#humanreproduction, #pregnancy, #invitrofertilization, #assistedreproduction,\n#pregnant, #difficulttogetpregnant. To minimize the influence of the platform’s\nalgorithm, a new Instagram account (@resmedgob) was created. Authorship was\ncategorized as either healthcare professionals (HCP) or laypeople (LP). Posts were\ncollected in March 2021, with the 20 most recent ones included in the analysis. Only\neducational posts written in Portuguese were evaluated, while video and commercial\nposts were excluded. Educational posts included those providing education or\ninformation on fertility topics such as infertility diagnosis or workup,\nendometriosis, and other conditions. Two authors used the DISCERN ( Logullo  et al. , 2019 ) tool to\nassess the quality and reliability of the posts, and any disagreements were\nreconciled. The DISCERN instrument consists of 16 questions divided into three\nsections: reliability (1-8), quality of information on treatment choices (9-15), and\noverall rating (16). Each question was scored from 1 to 5, with 1 indicating no\nagreement and 5 indicating the highest agreement. A score of five was assigned when\nthe quality criterion was fully met, while scores of 2, 3, or 4 indicated partial\nfulfillment of the criterion. A score of 1 was used when the criterion was not met\nat all.\nFor this study, questions 1 to 8 were used to assess the reliability of the shared\ninformation: (1) Are the aims clear? (2) Does it achieve its aims? (3) Is it\nrelevant? (4) Is it clear what sources of information were used to compile the\npublication (other than the author or producer)? (5) Is it clear when the\ninformation used or reported in the publication was produced? (6) Is it balanced and\nunbiased? (7) Does it provide details of additional sources of support and\ninformation? (8) Does it refer to areas of uncertainty?\nThree specific questions focus on key aspects for the evaluation: question 4\naddresses the ability to verify the information; question 6 is used to identify bias\nin the post, and question 7 pertains to the connection with additional sources.\nDISCERN reliability scores can be interpreted as follows: 1-2.9 = poor reliability;\n3-4 = moderate reliability; and >4 = high reliability.\nThis study does not require approval from an Ethics Committee because it used\npublicly available information and did not involve any interaction or intervention\nwith human subjects, in accordance with local regulations ( Ministério da Saúde - Conselho Nacional de Saúde,\n2016 ).\n\nThirty-seven posts met the inclusion criteria and were analyzed. Most were authored\nby healthcare professionals (n=33; 89.2%). The authors included 24 medical doctors,\nfive fertility clinics, four allied healthcare professionals, one magazine, and\nthree laypeople. The majority of posts (n=15) focused on fertility treatments; other\ntopics covered diseases such as endometriosis, exams, and diagnoses. Mean Discern\nanalysis for each question is shown in  Table\n1 .\nMean Discern Analysis.\n\nOur results show that the majority of the posts were authored by healthcare\nprofessionals, with medical doctors responsible for the majority of educational\ninfertility-related content on Instagram. Unfortunately, the reliability of these\nposts, as measured by the DISCERN instrument, was poor when questions 4 to 8 were\nconsidered. Although the posts clearly stated their aim and relevance, they lacked\nimportant details such as the sources of information used, additional sources of\nsupport, and other relevant details. The analyzed posts also failed to be balanced\nand unbiased, and most importantly, they did not address areas of uncertainty even\nthough they were primarily authored by physicians.\nPeople on the fertility journey often use social media to share their experiences and\nseek support, but healthcare professionals, including physicians, are increasingly\nusing it as a low-cost educational platform ( Peyser\n et al. , 2021 ). In Brazil, Instagram is a common\nsource for health-related information and may provide a great opportunity to educate\npatients and their families about infertility ( Carneiro  et al. , 2024 ). I analyzed infertility posts on\nX and Instagram using various tools, including an adaptation of DISCERN, and found\nthat these posts often lack accuracy, credibility, and reliability. Since social\nmedia platforms are important sources of information on a complex issue like\nfertility, there is a need to focus on the quality and trustworthiness of these\nposts ( Perone  et al. , 2021 ;\n Dhanoya  et al. ,\n2025 ).\nSince the information available on these platforms can influence how people make\ndecisions about health and disease, ensuring this material is reliable is of utmost\nimportance. Therefore, individuals should recognize that, given the vast amount of\ncontent posted by nearly anyone, much of it should be questioned since most posts\nare not verified ( Carneiro, 2022 ). In fact,\nbecause so many posts are published daily, verifying accuracy is nearly impossible\n( Quaas, 2020 ;  Carneiro, 2022 ). Additionally, people need to be aware of the\nrisks posed by misinformation and commercial bias present in many so-called\neducational and scientific posts on social media, as well as the influence of\nso-called influencers who may have their own agenda ( Quaas, 2020 ;  Dhanoya  et\nal. , 2025 ).\nUnfortunately, there is a paucity of studies on the quality and reliability of\ninfertility information shared on social media.  Dhanoya  et al.  (2025)  used Twitter/X and Instagram to\nexamine the quality, credibility, accuracy, and readability of fertility-related\nposts. Most (74%) of these posts failed to cite scientific references, and\nunfortunately, 45% contained incorrect data while only 11% were considered reliable.\nAdditionally, readability analysis showed that the majority (80%) were difficult to\nunderstand.\nInstagram has approximately 122.9 million users in Brazil, with 42.39% males and\n57.61% females ( Bianchi, 2025 ). There is no\ndenying the significant educational potential Instagram offers, as it can reach a\nlarge audience at low cost. Since more people are increasingly using social media as\na source of health information and many may not have access to proper fertility\ncare, they might base their decisions on the posts that are readily available, there\nis an urgent need to ensure these posts and profiles share clear, reliable content\n( Dhanoya  et al. , 2025 ).\nThus more studies are needed to understand and improve how Instagram is used in\nfertility/infertility care.\nThe DISCERN instrument was chosen because it is easy to use and has been validated in\nPortuguese ( Logullo  et al. ,\n2019 ). Unfortunately, there is a shortage of tools that have been\nproperly validated to evaluate the quality of information available online ( Alhlayl & Alzghaibi, 2025 ). It should be\nnoted that the DISCERN tool cannot be used to assess the scientific quality or\naccuracy of the evidence on which a publication is based, as this would require\nsearching and verifying other sources. However, it can assess the reliability of the\nshared information and evaluate whether the sources used are accurate. As social\nmedia use is rapidly increasing, the need for clear, accessible, and scientifically\nbased information shared on social media cannot be overstated. The use of 11 common\nhashtags chosen according to ( https://www.tagsfinder.com/ )\nallowed for a comprehensive search on Instagram and the selection of relevant\neducational posts, providing a significant overview of fertility-related content\nshared on Brazilian Instagram. Since our aim was to evaluate the reliability of the\nshared information, we focused on questions 1 to 8.\nTo the best of our knowledge, this is the first time the accuracy and reliability of\nfertility-related Instagram posts have been analyzed in Brazil. Our analysis was\nlimited to Portuguese and the number of posts included, but it may serve as a\nstarting point for understanding the social media fertility landscape and improving\nthe quality of information shared. More studies on the accuracy and reliability of\ninfertility-related content posted on social media platforms like Instagram are\nneeded.","source_license":"public-domain-us","license_restricted":false}