Kerry Hampton Danielle Mazza Department of General Practice, School of Primary Health Care, Monash University

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1 Fertility-awareness knowledge, attitudes and practices of infertile women seeking fertility assistance at two assisted reproductive technology services in metropolitan Melbourne Kerry Hampton Danielle Mazza Department of General Practice, School of Primary Health Care, Monash University

2 Background Infertility is when a couple fails to conceive after having regular unprotected sex for 12 or more months, and affects up to 1 in 6 couples. 1,2,3 Around 50% of infertile couples in developed countries seek fertility assistance at ART services Blake et al, Stanford et al, Hunault et al, Boivin et al,2007.

3 Background Natural family planning researchers advocate fertilityawareness education in the primary care of women having difficulty conceiving. 1,2 National Institute for Clinical Excellence (NICE) guidelines states that People who are concerned about their fertility should be informed that sexual intercourse every 2 to 3 days optimizes the chance of pregnancy. Timing intercourse to coincide with ovulation causes stress and is not recommended 3 1. Gnoth et al, Stanford et al, NICE Guidelines (2004).

4 Background Fertility-awareness is a woman s ability to recognize the signs of the fertile days in the menstrual cycle 1 There are 3 methods of fertility-awareness: rhythm method, temperature method mucus method. 1,2 76% of infertile women seeking fertility assistance have insufficient fertility-awareness to maximize the chance of natural conception. 1 women s utilization of fertility-awareness methods is low and knowledge of fertility-awareness is also poor. 1,3,4,5 1. Blake et al, Gnoth et al, Sievert et al, Sinai et al, Dyer et al, 2002

5 Background There are an average six fertile days in the menstrual cycle 1, but the timing of these days is highly variable. 2,3 Pregnancy is only a possibility with intercourse in the fertile days and that chance increases from 8% five days before ovulation to 33% on the day of ovulation. 1 For the chance of pregnancy to be maximized, intercourse needs to occur in the fertile window over a minimum of six menstrual cycles. 4,5 1. Wilcox et al, Dunson et al, Keulers, et al, Gnoth et al Colombo et al, 2000

6 Aim To determine the fertility-awareness knowledge, attitudes and practices of infertile women seeking fertility assistance at two Assisted Reproductive Technology services in metropolitan Melbourne.

7 Methods Cross-sectional design A self-administered questionnaire of women on entry to two different ART services Survey based on Blake 1997 measuring: demographic characteristics of the study sample knowledge and practice of fertility-awareness methods utilization of the fertile period attitudes to fertility-awareness Exclusion criteria women who could not read English no menstruation in previous 6/12

8 Measuring fertility-awareness knowledge and practice no fertilityawareness poor fertilityawareness moderate fertilityawareness high fertilityawareness no knowledge of fertile symptoms in the menstrual cycle a rhythm approach to fertility-awareness or when the mucus symptom of fertility is poorly understood or observed only sometimes in the menstrual cycle the mucus symptom of fertility is accurately understood and observed in most menstrual cycles the mucus symptom of fertility or the temperature method is accurately understood and three or more menstrual cycles have been documented with either method

9 Knowledge and practice of the mucus method Cervical mucus secretion changes Number (%) Often aware 58 (28) Sometimes aware 93 (46) Never aware 30 (12) Knew the mucus type that indicates the fertile time 48 (24) Could describe the mucus change that indicates the beginning of the fertile time Could describe the mucus change that indicates the end of the fertile time 44 (21) 26 (13) Had documented 3 or more menstrual cycles with mucus changes 26 (13)

10 Knowledge and practice of the temperature method Number (%) Understood how the temperature method indicates the occurrence of ovulation 11 (5) Understood how the temperature method indicates the peak fertile time in the menstrual cycle 17 (7) Had documented 3 or more menstrual cycles with the temperature method 50 (24)

11 Grading of fertility-awareness in infertile women seeking fertility assistance

12 Attitudes to fertility awareness 94% agree that a woman should receive fertility-awareness education when she first reports to her doctor difficulty in conceiving 76% agree that timed intercourse in the fertile window can help some infertile couples to conceive 87% actively tried to improve their fertility-awareness from one or more source only 18% sought the information from their general practitioner, most sought it from the internet and books

13 Conclusions the majority of women seeking fertility assistance have insufficient fertility-awareness to optimize natural conception most women having difficulty conceiving believe fertilityawareness may help them, and actively try to improve their knowledge despite their efforts women did not attain high fertilityawareness raising questions about the quality and accuracy of information they source

14 Implications Our findings challenge the current NICE (2004) guideline that fail to support women to attain high fertility-awareness when they first report to their doctor difficulty in conceiving. Fertility-awareness education should be a fundamental part of preconception care, and the primary care of couples when they first report difficulty conceiving.

15 Acknowledgments Christopher Anderson Karin Hammarberg Wendy Lee Monash IVF nurses and receptionists at Epworth Health Care and Monash Surgical Private Hospitals Australian Commonwealth Government Department of Health and Aging

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