Effectiveness of a 1-h Reproductive Health Lecture on Enhancing Fertility Knowledge Among Japanese Female Undergraduates.

Natsuki Miyake: visualization, writing – review and editing. Isao Ohsawa: project administration, methodology. Maki Goto: data curation, investigation, funding acquisition. Tomomi Seki: writing – original draft, writing – review and editing, visualization, formal analysis, validation. Tomoko Uno: methodology, project administration. Akira Iwase: conceptualization, methodology, project administration, supervision, funding acquisition. Takashi Tonoike: methodology, project administration. Keiko Nukaya: data curation, project administration, investigation. Kazuo Tsuzuki: project administration, methodology. Satoko Osuka: writing – review and editing. Hiroaki Kajiyama: supervision.

This study was approved by the ethics committees of the participating universities and our institute (approval number: 2013‐0263).

This work was supported by Japan Society for the Promotion of Science, 20K11508; Pfizer Health Research Foundation.

This study was conducted among female students aged 20–29 years who attended 60‐min lectures on fertility between 2014 and 2018 at two non‐medical universities in Aichi Prefecture, Japan. Participation in the questionnaire was voluntary and anonymous. The lecture was delivered by the same physician certified in reproductive medicine, using the same slide materials to ensure consistency in the educational content. The lecture covered basic reproductive physiology and fertility awareness, including the biological differences in gamete production between men and women, age‐related fertility decline, and lifestyle factors that affect fertility such as smoking. Female fertility declines with age, particularly after approximately 35 years, whereas male fertility may be affected by aging to a lesser extent. The lecture primarily focused on the natural and basic concepts of infertility and age‐related fertility decline. Assisted reproductive technologies such as donor egg treatment were not specifically discussed. The lecture also emphasized the importance of paying attention to one's own menstrual cycle and recommended that individuals experiencing irregular menstruation, menstrual difficulties, ejaculation, or sexual dysfunction consult medical professionals. Anonymous multiple‐choice questionnaires with identical content were administered immediately before and after the lecture to assess changes in knowledge and attitudes toward fertility. The questionnaire was based on previously published fertility awareness surveys. Specifically, the items were adapted from a questionnaire used in a previous study on fertility awareness [ 15 ], which was later referenced in a related educational intervention study [ 16 ]. The original instrument was developed based on earlier research and the professional experience of the authors and was pilot tested in several student populations to assess its validity and reliability. In the present study, the selected items were modified to fit the educational content of the lecture and reviewed by physicians specializing in reproductive medicine prior to implementation. The questionnaire included items that covered the following four themes: awareness of fertility decline with age, knowledge about fertility and infertility, attitudes toward childbearing, and perceptions regarding ovarian reserve. The questionnaire included items that assessed both factual knowledge and perceptions regarding reproductive health. Questions categorized as “knowledge about fertility and infertility” were treated as knowledge‐based items with predefined answers based on established medical evidence. The proportion of correct responses before and after the lecture was compared with the expected responses for each item, as shown in Table  1 . The remaining items assessed students' perceptions of or attitudes toward reproductive health (e.g., awareness of fertility decline with age, attitudes toward childbearing, and perceptions regarding ovarian reserve). For these items, no predefined correct answers were assigned and changes in the distribution of responses before and after the lecture were analyzed. The educational outcomes of the lecture were evaluated by comparing the distribution of responses and proportion of expected responses before and after the lecture. The questionnaire items and answer choices are presented in Table  1 . Questionnaire items included in the Anonymous Pre‐ and Post‐Lecture Surveys. Note: This table summarizes the questionnaire items included in the anonymous pre‐ and post‐class surveys completed by the students. Items under “Knowledge about fertility and infertility” were treated as knowledge‐based questions with predefined correct responses. The remaining items assessed students' perceptions of or attitudes toward reproductive health, and therefore no predefined correct answers were assigned. Statistical analyses were performed using GraphPad Prism software (version 9.4.1; GraphPad Software, San Diego, CA, USA). As most questionnaire responses were based on ordinal Likert‐type scales, the differences between the pre‐ and post‐lecture responses were analyzed using the Wilcoxon signed‐rank test. Statistical significance was set at p <  0.05.

A total of 726 students aged 20–29 years completed the questionnaire. After excluding 14 responses owing to age discrepancies or incomplete questionnaires, 712 responses were included in the final analysis. The median age of the participants was 20 years (interquartile range: 20–21 years). First, the students were asked the following question: At what age do you think women become unable to conceive? This question was intended to assess students' perceptions of the upper age limit of female fertility, rather than to imply that conception becomes absolutely impossible at a specific age. Students were informed that female fertility declines substantially after the age of 40. Students' responses showed a more accurate distribution after the lecture, reflecting an improved understanding of age‐related fertility decline. The students' estimated ages significantly decreased, and the number of students selecting “≥ 55 years” declined (the number of respondents who selected “≥ 55 years” age group decreased from 334 (46.9%) to 192 (27.0%), p  < 0.01, Wilcoxon signed‐rank test; Figure  1 ). Changes in students' attitudes toward pregnancy and age. Students were asked to fill in a questionnaire before and after the lecture about the age at which it becomes impossible to become pregnant. Students selected their age from options in 5‐year increments (e.g., 20–24, 25–29, 30–34 years etc.). p values were calculated by Wilcoxon signed‐rank test. Next, students were asked to answer nine questions to test their knowledge about fertility and infertility. Students' understanding of fertility improved significantly after the lecture. Specifically, awareness of factors affecting infertility, including sexually transmitted diseases (STDs), being overweight or underweight, smoking, alcohol consumption, and lack of exercise, showed statistically significant improvements following the intervention. The number of respondents who selected “strongly agree” or “agree” increased from 532 (74.7%) to 639 (89.7%) for STDs, 365 (51.3%) to 671 (94.2%) for overweight, 625 (87.8%) to 686 (96.3%) for underweight, 574 (80.6%) to 688 (96.6%) for smoking, 499 (70.1%) to 613 (86.1%) for alcohol consumption, and 235 (33.0%) to 390 (54.8%) for lack of exercise ( p  < 0.01 for all comparisons, Wilcoxon signed‐rank test; Figure  2A–F ). The number of students who answered “neither” to the question “Do you think infertility can always be treated?” increased from 189 (26.5%) to 246 (34.6%) (Figure  2G ). Moreover, misconceptions, such as “infertility occurs only in women,” were significantly reduced after the lecture (the number of respondents who selected “not so much” and “not at all” increased from 426 [59.8%] to 543 [76.3%], p  < 0.01, Wilcoxon signed‐rank test; Figure  2H ). Likewise, the number of students who answered “not at all” to the question “infertility occurs only in older adults” significantly increased after the lecture (from 322 [45.2%] to 393 [55.2%], p  < 0.01, Wilcoxon signed‐rank test; Figure  2I ). Students' understanding of infertility has changed following the classes. Students were asked to answer nine questions about knowledge related to infertility before and after the lecture. Numbers in the graphs represent the number of students who answered each question. “Before” and “After” indicate responses before and after the lecture, respectively. ** p  < 0.01 according to the Wilcoxon signed‐rank test. In terms of attitudes toward childbearing, no statistically significant changes were observed in students' desire to have children (Figure  3A ) or in the number of children they desired after the lecture (Figure  3B ). Students' desired ages to start and finish having children became significantly younger following the lecture ( p  < 0.01, Wilcoxon signed‐rank test; Figure  3C,D ). Changes in students' perception about raising children. Before and after the class, students were asked about their desire to have children (A), and if so, the number of children they desired (B). (C, D) Distribution of students' responses regarding the age at which they wish to begin having children (C) and the age at which they hope to complete childbearing (D), based on pre‐ and post‐anonymous questionnaires. “Before” and “After” indicate responses before and after the lecture, respectively. n.s .: not significant. The Wilcoxon signed‐rank test was used for statistical analysis. Finally, we examined changes in students' understanding of ovarian reserve. Significant improvements were observed in students' awareness that ovarian reserve declines with age, and in their interest in knowing their own ovarian reserve status. The number of students who responded “well known” to the question “Do you know the term ‘ovarian reserve’?” increased from 4 (0.6%) to 444 (62.4%) ( p  < 0.01, Wilcoxon signed‐rank test; Figure  4A ). Similarly, those who answered “decreases with age” to the question “Do you think ovarian reserve changes with age?” increased from 83 (11.7%) to 559 (78.5%) ( p  < 0.01, Wilcoxon signed‐rank test; Figure  4B ). Interest in personal ovarian reserve also increased, with students who selected “strongly agree” or “agree” to the question “Would you like to know your own ovarian reserve?” increasing from 92 (12.9%) to 544 (76.4%) ( p  < 0.01, Wilcoxon signed‐rank test; Figure  4C ). Additionally, more students expressed interest in gamete cryopreservation if needed, increasing from 88 (12.4%) to 292 (41.0%) ( p  < 0.01, Wilcoxon signed‐rank test; Figure  4D ). Furthermore, after the lecture, approximately half of the students believed that medical interventions might improve ovarian function or reproductive potential ( p  < 0.05, Wilcoxon signed‐rank test; Figure  4E ). Change in attitude about ovarian reserve. Students were asked about “ovarian reserve.” The numbers in the graph represent the number of students answering each question. “Before” and “After” indicate responses before and after the lecture, respectively. * p  < 0.05 and ** p  < 0.01 according to the Wilcoxon signed‐rank test.

Our results revealed that a single 60‐min fertility education lecture significantly improved the fertility‐related knowledge of non‐medical university students on key reproductive topics, particularly fertility, infertility, and ovarian reserve. Several studies have examined the effects of reproductive education on women of reproductive age [ 17 ]. However, relatively few studies have evaluated fertility education among Japanese female non‐medical students. The present findings contribute to the growing evidence supporting the educational value of fertility awareness programs in this population. Misconceptions such as infertility affecting only women or older individuals were notably reduced, which is consistent with previous reports [ 4 , 5 , 6 , 7 ]. Furthermore, awareness of age‐related fertility decline increased, consistent with prior studies highlighting the value of early reproductive education in enhancing fertility literacy [ 17 ]. Additionally, students showed increased awareness of the impact of lifestyle factors, such as smoking, body weight, and sexually transmitted infections, on fertility. Improving awareness of these factors may have broader public health implications, because greater fertility literacy may encourage healthier lifestyle choices and earlier engagement with reproductive health services. The lack of significant change in attitudes toward childbearing may be explained by several factors. First, the baseline preferred age for childbearing among participants was already relatively young, which may have limited the extent of change observed after the lecture. Second, although the lecture presented information on age‐related fertility decline, it did not aim to promote early childbearing. Individual reproductive decisions should be made based on individual values and life circumstances, including career development and personal preferences. Therefore, the findings may reflect that the lecture increased knowledge without substantially influencing personal attitudes toward the timing of childbearing. A particularly important finding is the increased interest in ovarian reserve assessment and fertility preservation, including elective oocyte cryopreservation. Although cryopreservation is becoming more widely recognized for social reasons, its utilization rates remain low and overall pregnancy success is limited. A recent systematic review reported that approximately 11% of women who underwent planned elective oocyte cryopreservation eventually used their stored oocytes, with a live birth rate of 28% per patient. Success rates were notably higher when eggs were frozen before the age of 35 years (52%) than among those aged ≥ 40 years (19%) [ 18 ]. In countries such as the United States, where elective oocyte cryopreservation is relatively common, there are no age limits or storage restrictions; however, the financial burden is substantial, typically between 7000 and 20 000 USD [ 19 ]. These biological and financial limitations must be communicated clearly. Therefore, providing realistic expectations and accurate medical information is essential. Reproductive education that incorporates contemporary medical advances can help individuals make informed decisions regarding their reproductive futures. Based on these findings, future educational programs may consider incorporating information about ovarian reserve biomarkers, such as anti‐Müllerian hormone (AMH), in conjunction with annual health checkups. Since AMH can be measured independently of the menstrual cycle and may help identify conditions such as polycystic ovary syndrome (PCOS) or primary ovarian insufficiency at an earlier stage, it may provide an opportunity to raise awareness of reproductive health among young women [ 20 , 21 ]. Previous studies have also suggested that AMH measurements during annual health check‐ups may have educational value in preconception care settings [ 22 , 23 , 24 ]. Expanding the educational content to include common gynecological conditions, such as PCOS, endometriosis, and uterine fibroids, may further encourage early gynecological consultations and engagement in preconception care. Ultimately, fostering fertility literacy among young adults, regardless of their immediate reproductive intentions, is an important step toward informed self‐care and reproductive autonomy. This study has several limitations. First, the study was limited to non‐medical students from two universities in a single prefecture, which may have affected the generalizability of the findings. Second, the study evaluated the immediate knowledge changes after the lecture, while long‐term knowledge retention and actual behavioral changes were not assessed. Future studies should consider longitudinal follow‐up and examine the impact of reproductive education in diverse populations. Third, lectures were conducted between 2014 and 2018, before the introduction of public insurance coverage for infertility treatment in Japan and before the expansion of subsidy programs for elective oocyte cryopreservation. Since then, social awareness of fertility and reproductive technologies may have changed due to policy developments and the increased dissemination of information through social media. Therefore, the baseline level of fertility knowledge among current students may differ from that observed in this study. Future studies conducted under the current social context would allow for a comparison of baseline fertility knowledge. Fourth, the questionnaire included both knowledge‐based items with predefined correct answers, and perception‐based items without predefined correct responses. Therefore, changes observed in perception‐based items should be interpreted as shifts in students' understanding or attitudes rather than improvements in factual knowledge. In addition, for some knowledge‐based items, such as the question regarding whether infertility can always be treated, the lecture content may have introduced future perspectives (e.g., regenerative approaches), which could have influenced students' responses and should be considered when interpreting the results. In conclusion, this educational intervention improved university students' knowledge of fertility, particularly regarding ovarian reserve, age‐related fertility decline, and their interest in fertility preservation. Fertility education during early adulthood may contribute to improving fertility literacy and increasing awareness of reproductive decision‐making. Providing accurate and accessible reproductive health information may help empower young adults to make informed choices about their reproductive future. Further studies evaluating long‐term knowledge retention and behavioral outcomes will be important to determine the sustained impact of fertility education on young adults.

Informed consent was obtained from all participants.

In recent years, public attention toward fertility preservation has increased in Japan; this is driven by factors such as expanded insurance coverage for infertility treatments and local government subsidies for oocyte cryopreservation for social reasons (e.g., Tokyo) [ 1 ]. Despite this trend, Japan continues to face one of the lowest fertility rates globally (total fertility rate of 1.4 in 2024), contributing to a rapid population decline [ 2 , 3 ]. Similar to other developed countries, studies from Australia [ 4 ], Sweden [ 5 ], and the United States [ 6 ] have revealed limited fertility knowledge among individuals of reproductive age [ 7 ]. However, little is known about fertility awareness among Japanese non‐medical university students. This knowledge gap hinders the development of targeted educational interventions to improve reproductive health literacy. Globally, delayed childbearing is associated with higher education, career priorities, and social changes [ 8 ], as the biologically optimal reproductive period often overlaps with these factors. Although age‐related fertility decline is relatively well recognized [ 9 ], other contributing factors, such as smoking, obesity, excessive caffeine or alcohol intake, and stress, remain unclear [ 10 , 11 ]. Understanding fertility at a young age is critical, as it shapes life planning and future family building decisions. Ovarian reserve, defined as the quantity and quality of the remaining oocytes, decreases naturally with age. Fertility preservation techniques, including oocyte and ovarian tissue cryopreservation, are used in Japan for medical and social purposes [ 12 ]. These methods have shown promising results in terms of pregnancy and live birth rates, which is supported by evidence [ 13 ]. Despite the availability of these technologies, the awareness and acceptance of fertility preservation vary across different populations. Educational interventions improve understanding of reproductive aging and preservation options [ 13 , 14 ], highlighting the need for early and accurate information to support informed reproductive choices. Although fertility education is increasingly being recognized as an important component of reproductive health promotion, fertility awareness among young adults remains limited in many countries. In Japan, opportunities for structured reproductive education after secondary school are limited, particularly for non‐medical university students. Therefore, improving fertility literacy during early adulthood may help individuals make informed reproductive decisions. In this study, we aimed to evaluate the educational impact of a fertility lecture, including information on ovarian reserve, on fertility‐related knowledge and awareness among non‐medical university students using pre‐ and post‐lecture questionnaires.

The authors declare no conflicts of interest.