CROSSMARK_Color_Square https://doi.org/10.35845/kmuj.2024.23374                                   ORIGINAL ARTICLE

Awareness and attitude towards fertility and parenthood: a comparative study among medical students in Saudi Arabia

Fehmida Tehsin 1 Description: Description: Description: C:\Users\Asghars\Downloads\email corrspondence.gif, Sayed Ibrahim Ali 2, Ghadah Al Qarni 3

1: Department of Obstetrics & Gynecology, College of Medicine, King Faisal University, Al Ahsa, Kingdom of Saudi Arabia.

2: Department of FAMCO, College of Medicine, King Faisal University, Al Ahsa, Kingdom of Saudi Arabia.

3: Student, College of Medicine, King Faisal University, Al Ahsa, Kingdom of Saudi Arabia.

 

Email Description: Description: Description: C:\Users\Asghars\Downloads\email corrspondence.gif: fehmidatehsin123@gmail.com

Contact #: +966-0538269202

 

Date Submitted: July 09, 2023

Date Revised: February 12, 2024

Date Accepted: March 09, 2024

THIS ARTICLE MAY BE CITED AS: Tehsin F, Ali SI, Qarni GA. Awareness and attitude towards fertility and parenthood: a comparative study among medical students in Saudi Arabia. Khyber Med Univ J 2024;16(1):16-24. https://doi.org/10.35845/kmuj.2024.23374

ABSTRACT

OBJECTIVES: To compare the awareness, attitudes towards fertility, and intentions for parenthood between preclinical and clinical medical students.

METHODS:  An online cross-sectional study was conducted among preclinical and clinical medical students of King Faisal University, Al Ahsa, Saudi Arabia. The study was conducted during the first semester of the academic year of a medical bachelor's degree program, utilizing a convenience sampling technique. A total of 225 students, comprising 148 from the 3rd year and 77 from the 4th year blocks, voluntarily completed self-reported questionnaires. Data analysis was performed using IBM SPSS version-26.

RESULTS: The mean age of participants was 21.56±1.55 years, with a slightly higher representation of females (54.2%) compared to males (45.8%). Among the participants, 45.8% were married, and only 11.1% had children, while the majority expressed a desire to have children (73.8%) within the age range of 25-29 years. A significant proportion (44.9%) indicated a preference for 2-3 children. In terms of childcare, most participants agreed to its necessity. Interestingly, females across both academic years showed similar responses regarding the possibility of combining work/study, with almost equal numbers agreeing or remaining undecided. Clinical students exhibited greater fertility knowledge compared to preclinical students, with no significant differences observed based on gender. Furthermore, participants with a family history of infertility were more inclined to consider both IVF and adoption (p-value = 0.0001).

CONCLUSION: Clinical-year medical students showed improved understanding of female fertility decline and infertility causes, coupled with positive attitudes towards parenthood at a suitable reproductive age, preferring smaller families.

KEYWORDS: Fertility (MeSH); Awareness (MeSH); Parenthood (Non-MeSH); Parents (MeSH); Saudi Arabia (Non-MeSH); Students, Medical (MeSH).

INTRODUCTION

Fertility diminishes with age, particularly in females, due to the finite store of eggs acquired since birth, with no replenishment throughout reproductive life—a phenomenon not observed in males. Advanced female age serves as a key indicator for fertility challenges, encompassing childlessness, miscarriage, and chromosomal abnormalities, attributed to declining egg count and quality.1 The desire for parenthood ranks among the foremost aspirations for married couples. Primary infertility is defined as the inability to achieve pregnancy within 12 months of unprotected sexual intercourse, regardless of outcome. Female anovulation and tubal blockage constitute 45% of cases, while male factors such as abnormal semen parameters, premature ejaculation, and erectile dysfunction contribute 30%, with 25% remaining unexplained.2 Both partners undergo infertility evaluation to identify underlying causes and explore management options, including ovulation induction, intrauterine insemination, and assisted reproductive techniques like in vitro fertilization, intracytoplasmic sperm injection, surrogacy, or adoption.3 Studies have investigated risk factors, psychological ramifications, and counseling's role in infertility.4-7 Lifestyle and environmental factors may also influence infertility through metabolic disturbances.8

In the contemporary era, self-imposed infertility is becoming increasingly prevalent as individuals intentionally postpone pregnancy to pursue career advancement, address employment challenges, cope with childcare limitations, or overcome financial constraints.9,10 Recent research focusing on undergraduates' fertility and parenthood intentions has uncovered significant gaps in knowledge. It reveals that students often overestimate the age at which fertility declines and the success rates of fertility treatments.11 Studies intriguing undergraduates’ intentions toward parenthood and fertility awareness have revealed misconceptions and gaps in fertility knowledge and emphasized the necessity for a thorough education on fertility matters, as students frequently harbor misconceptions about fertility and the potential challenges of parenthood. Collectively, these studies underscore the crucial need to provide accurate and comprehensive information regarding fertility and parenthood to undergraduates.12-14.

Our study aimed to evaluate fertility awareness among medical undergraduates, taking into account the extended duration required for bachelor's degree completion and further specialization in the competitive medical field. Given the potential vulnerability to fertility issues, particularly among females marrying later in life, our focus was on assessing intentions towards parenthood, knowledge regarding female age, ovarian reserve, and risk factors for both male and female infertility. Additionally, we aimed to compare awareness levels between clinical-year and preclinical medical students. Furthermore, the study sought to evaluate participants' attitudes towards abnormal fertility investigation results, particularly in special circumstances.

METHODS

This cross sectional study was conducted in the College of Medicine, King Faisal University, Al Ahsa, Saudi Arabia, in the first semester of the academic year, September 2022–December 2022.  Preclinical (3rd year) and clinical (4th year) medical students were the target participants of the study. The MBBS program curriculum is conducted in four blocks per academic year. A sample size of 225 students was retrieved through an online sample size calculator with a 5% margin of error and 95% confidence interval according to the total number of students in the first-semester 4th-year obstetrics/gynecology and a preclinical 3rd-year block. The three blocks (medicine, surgery, and movement) of the fourth year and one third-year block (development and reproduction) were excluded from the study. A validated English questionnaire was adopted from a German-published study15 after obtaining permission and was tailored to the culture and needs of the Saudi Arabian students, as was done in a study conducted at King Saud Bin Abdul-Aziz University for Health Science published in 2019.16 The English Questionnaire was distributed online to the students after the completion of a teaching session by study researchers. Students were briefed about the study aim before attempting the study questionnaire; verbal informed consent was retrieved, and voluntary participation was ensured. Through convenience sampling, 225 students voluntarily submitted responses. (148 from the 3rd year and 77 from the 4th year obstetrics/gynecology block).

The questionnaire comprised two main sections. Section A focused on general personal information, while section B contained the following components: i) 5 items assessing intentions of having children, ii) 5 statements regarding important circumstances influencing the decision to have children using a Likert scale, iii) 19 knowledge questions/statements, with 5 having one best answer and 16 offering true/false options, all requiring selection of true answers, and iv) 6 attitude statements regarding infertility, rated on a 1-5 Likert scale from "strongly agree" to "strongly disagree."

Ethical permission was obtained from KFU Research Deanship (ETHICS378). Students' voluntary participation was ensured and respected.

The extracted data were analyzed using the statistical software IBM SPSS version 26 (SPSS, Inc., Chicago, IL). All statistical analyses were conducted using two-tailed tests, with a significance level set at p < 0.05. Descriptive analysis, including frequency and percent distribution, was performed for all variables. Cross-tabulation was utilized to assess factors associated with categorical variables. Relationships were evaluated using Pearson's chi-square test.

RESULTS

The mean age of the sample was 21.56±1.55 years. The response rate was 100% as all reached students answered the questionnaire. The age ranged from 20 to 26 years. The gender distribution of the sample is slightly skewed towards females, with 54.2% females and 45.8% males. The majority of the sample (65.8%) was from the preclinical third year of study, while 34.2% were in their fourth year of clinical study. About 45.8% of the participants were married. In terms of family history of infertility, 11.6% reported a positive family history of infertility. Of those who were married, only 11.1% reported having children. Regarding the anticipated age for the birth of their first child, the majority of participants (73.8%) indicated an age range of 25–29. The majority of participants (44.9%) expressed a desire to have 2-3 children [Table I].

Table 1: Demographic characteristics and intentions to have children

Variables

Frequency (n=225)

Percentage

Gender

Male

103

45.8

Female

122

54.2

Academic Year

Preclinical third year

148

65.8

4th year clinical

77

34.2

Family History of Infertility

yes

26

11.6

no

199

88.4

Are you married?

yes

103

45.8

no

122

54.2

Do you have children?

yes

25

11.1

no

78

34.7

How many children do you have?

0

78

34.7

1

10

4.4

2

7

3.1

3

8

3.6

At what age do you think the first child be born?"

20-24 years

29

12.9

25-29 years

166

73.8

30-40 years

30

13.3

Number of desired children

1-2

35

15.6

2-3

101

44.9

3-4

44

19.6

more than 4

45

20.0

In assessing decisions to have children using a five-point Likert scale ranging from strongly disagree to strongly agree, a higher proportion of female students, compared to male students, indicated agreement with the desire to have a stable financial situation, complete studies, and prepare for parenthood, across both academic years. The majority of students agreed on the importance of childcare. However, the notion that work/study can be combined with having children was more commonly selected by female students, with a mix of agreement and indecision, whereas male students showed a more balanced distribution between agreement and indecision (Table II).

Table II: Important circumstances for the decision to have children (n=225)

        Statements 

Gender and

academic year

Strongly disagree

Disagree

Undecided

Agree

Strongly agree

I want to have a stable financial situation, e.g., a regular income

Male

1

2

6

16

78

Female

1

2

7

12

100

3rd year

1

4

7

20

116

4th year

1

0

6

8

62

First I want to complete my studies

Male

1

0

21

25

56

Female

1

0

16

21

84

3rd year

0

0

25

28

95

4th year

2

0

12

18

45

I want my work/study can be combined with having children

Male

6

9

32

32

24

Female

10

9

41

28

34

3rd year

12

15

51

32

38

4th year

4

3

22

28

20

I must have access to childcare

Male

0

6

19

48

30

Female

1

1

16

35

69

3rd year

0

5

29

58

56

4th year

1

2

6

25

43

I have to feel prepared

Male

1

2

11

29

60

Female

1

1

5

27

88

3rd year

1

2

12

30

103

4th year

1

1

4

26

45

 

The Table III presents the results of knowledge questions among clinical and preclinical medical students regarding fertility-related topics. The analysis of knowledge awareness revealed that 4th year clinical students (n=77) exhibited a higher level of awareness compared to 3rd year students (n=148). Overall, there appears to be variability in understanding among students. While a majority correctly identified the duration for considering infertility in married couples and the age range for peak female fertility, knowledge gaps were evident in areas such as the timing of peak fertility within the menstrual cycle and the success rates of in vitro fertilization (IVF) treatment. Additionally, there were misconceptions observed, such as the belief that women are born with a fixed number of eggs that do not decrease over time. These findings underscore the importance of targeted education on fertility-related topics for medical students to ensure accurate understanding and informed decision-making in future medical practice.

Table III:  Knowledge questions (MCQS and True/False) and the correct answers of both clinical and preclinical students (n=225)

Knowledge items

 One best answer options 

Correct answers

Correct answers per academic year

 

1-After how much period a married couple is considered to have infertility while living together and not observing contraception?

6 months

 

  N (f)

9 month

 

 

  N (f)

12 months

 

  N (f)

12 months

 

 N (f)

3rd year (n=148)

 

  N (f) 

 4th year

 (n=77)

 

  N (f) 

18 (8)

6 (2.66)

188 (83.5)

188 (83.55)

118 (79%)            

70 (90%)

2-At what age woman is most fertile?

20-26

27-39

40-45

20-26

 

132 (58.66)

35 (15.55)

33 (14.66)

132 (58.66)

86 (58%)

46 (59%)

3-When is the most fertile time in a woman’s menstrual cycle?

Throughout Cycle

Mid Cycle

Late Cycle

Mid Cycle

 

11(4.8)

39

(17.33)

167

(74.2)

39

(17.33)

27 (18%)

12 (15%)

4-At what age is there a marked decrease in women's ability to become pregnant?

30-34

35-39

40-44

30-34

 

 

72(32)

79

(35.11)

50

(22.22)

72

(32)

47 (31.7%)

25(32%)

5-What are the chances on average of achieving a child from IVF treatment?

20-29%

30-39%

40-59%

20-29%

 

19

(8.44)

109

(48.44)

49

(21.78)

19

(8.44)

15 (10%)

4(5%)

Close-ended items

                  Selected choices

      True answers

               False [n (f)] 

True  [n (f)]     

3rd year [n (f)]

4th year [n(f)]

6-Do you know the concept of oocyte freezing?

85(37.8)

 

 140(62.22)

78 (52.7%)

62 (80.5%)

7- A female is born with eggs which will never decrease in number.

202(89.7)

 

 23(10.22)

14 (9.4%)

9(11%)

8-At birth women have the maximum number of oocytes.

124(55.1)

 

 101(44.88)

46 (31%)

55(71%)

9-IVF allows a woman to conceive even with reduced egg stores.

138(61.4)

 

 87(38.66)

50 (33.7%)

37 (48%)

10-If a woman undergoes cancer treatment she can consider freezing eggs beforehand.

87(38.6)

 

 138(61.33)

73 (49%)

 

65(84.4%)

 

11- The ovarian reserve can be determined?

165(73.4)

 

 60(26.66)

31(21%)

29 (37.6%)

12-Anovulation can be treated with medicines/drugs.

140(62.3)

 

 85(37.77)

33 (22.2%)

52 (67.5%)

13-Menstrual cycle irregularity can result in infertility.

104(46.2)

 

 121(53.77)

61 (41.2%)

60 (77.9%)

14-Genital tract infections in males and females can cause infertility

77(34.2)

 

 148(65.77)

87 (58.7%)

61(79%)

15-Smoking can reduce fertility.

            54(24)

 

            171(76)

107(72.2%)

64 (83%)

16-Psychological stress can affect fertility.

52(23.2)

 

 173(76.88)

109(73%)

64(83%)

17-Some drugs can result in male and female infertility

28(12.4)

 

 197(87.55)

130(87%)

67(87%)

18-Diabetes and cystic fibrosis can cause infertility in males.

         15(55.6)

 

 100(44.44)

48 (32%)

52(67%)

19-Alcohol consumption can affect fertility

         97(43.2)

 

         128(56.8)   

65(43%)

63(81%)

IVF: In vitro fertilization

Table IV shows the relationship of students’ fertility knowledge (five multiple choice & fourteen close-ended true/false questions) with their gender, academic year, and family history of infertility. Correctly chosen one best answer showed statistical significance with clinical-year (4th-year) medical students and family history of infertility while no significant relationship was found with student’s gender. Regarding gender differences, disparities are noticeable across academic years. For instance, in the 3rd preclinical year (item 1), no significant gender difference is observed (p-value = 0.214). However, in subsequent clinical years (e.g., items 4, 8, 12), p-values consistently fall below 0.05, suggesting significant gender-based variations. Furthermore, academic year trends within each gender group are apparent. For example, within the male group (e.g., item 12), there are significant variations across academic years (p-value = 0.0001), implying that academic progression may impact measured outcomes for male students.

Students with a family history of infertility exhibited a higher level of knowledge compared to those without such familial experiences, suggesting the potential influence of family background on understanding infertility. Across both male and female groups, the majority of p-values were consistently below the threshold of 0.05, indicating a statistically significant impact of family history on the measured outcome. These findings highlight the importance of considering familial experiences when assessing infertility knowledge among students, highlighting the potential role of shared experiences in shaping understanding in this area.

Table IV: Analysis of infertility knowledge among clinical and preclinical medical students: gender, academic year, and family history

Knowledge

Items (19)

Gender

Academic year

Family history

Male

Female

P Value

3rd preclinical

4th clinical

P Value

Yes

No

P Value

1

85

102

0.214

118 (79.7%)

70 (90%)

0.0001

21

167

0.0001

2

56

76

0.308

86 (58%)

46 (59.7%)

0.0001

13

19

0.0001

3

18

21

0.333

27 (18%)

12 (15%)

0.011

5

34

0.0001

4

34

38

0.409

47 (31.7%)

25 (32%)

0.0001

10

62

0.0001

5

11

8

0.415

15 (10%)

4 (5%)

0.018

4

15

0.014

6

52

88

0.0001

78 (52.7%)

62 (80.5%)

0.258

20

10

0.0001

7

9

14

0.299

14 (9.4%)

9 (11%)

0.357

4

19

0.0001

8

38

63

0.018

46 (31%)

55 (71%)

0.358

15

86

0.0001

9

40

47

0.338

50 (33.7%)

37 (48%)

0.152

12

75

0.0001

10

52

86

0.0001

73 (49%)

65 (84.4%)

0.522

20

118

0.0001

11

23

37

0.422

31 (21%)

29 (37.6%)

0.297

10

50

0.0001

12

22

63

0.0001

33 (22.2%)

52 (67.5%)

0.019

17

68

0.0001

13

41

80

0.0001

61 (41.2%)

60 (77.9%)

0.951

18

103

0.0001

14

68

80

0.521

87 (58.7%)

61 (79%)

0.021

22

126

0.0001

15

81

90

0.851

107 (72.2%)

64 (83%)

0.0001

23

148

0.0001

16

72

101

0.014

109 (73%)

64 (83%)

0.0001

22

151

0.0001

17

89

108

0.125

130 (87%)

67 (87%)

0.0001

24

173

0.0001

18

37

63

0.0001

48 (32%)

52 (67%)

0.425

19

81

0.0001

19

52

76

0.024

65 (43%)

63 (81%)

0.319

19

109

0.0001

 

Table V shows the analysis of students' attitudes toward infertility reveals significant influences of gender, academic year, and family history on their perspectives and choices. Notably, gender differences are evident in the willingness to postpone studies or work for infertility treatment, with 30 male and 51 female students showing a readiness to prioritize treatment, suggesting a gender-specific approach to managing infertility (p-value = 0.017).

The impact of academic advancement was evident in attitudes towards in IVF, with 27 students in the 3rd preclinical year considering it compared to only 10 students in the 4th clinical year. This observation suggests a shift in attitudes as students’ progress through their medical education (p-value = 0.004).

The influence of a family history of infertility on attitudes was pronounced, with individuals having such a familial background significantly more inclined to consider both in IVF and adoption. Specifically, 4 individuals with a family history of infertility expressed willingness to consider IVF compared to 33 individuals without such a history (p-value = 0.0001). This points to the profound impact of personal and familial experiences on students' inclinations towards fertility treatments.

Table V: Association of students’ attitudes with gender, academic year, and family history of infertility in the event of infertility

 

Statements

Gender

Academic year

Family history

Male

Female

3rdpreclinical

4rth clinical

Male

Female

I would consider in vitro fertilization

85

102

118 (79.7%)

I would consider in vitro fertilization

85

102

p-value

0.214

0.0001

0.0001

I would postpone my study/quit my job to seek treatment.

56

76

86 (58%)

I would postpone my study/quit my job to seek treatment.

56

76

p-value

0.308

0.0001

0.0001

I would continue my job/ work/study.

18

21

27 (18%)

I would continue my job/ work/study.

18

21

p-value

0.333

0.011

0.0001

I would consider the adoption

34

38

47 (31.7%)

I would consider the adoption

34

38

p-value

0.409

0.0001

0.0001

I would drop my desire for children

11

8

15 (10%)

I would drop my desire for children

11

8

p-value

0.415

0.018

0.014

I would be very upset and depressed

52

88

78 (52.7%)

I would be very upset and depressed

52

88

p-value

0.0001

0.258

0.0001

 

DISCUSSION

Recognizing the limitations of female fertility holds significant implications for family planning and aligning personal aspirations with the competitive demands of higher education. This awareness becomes particularly integral within the context of medical education, a path that typically spans five to six years for a bachelor’s degree, followed by additional years of residency for specialization and, subsequently, a fellowship for a subspecialty program. The extended duration of medical training underscores the importance of informed family planning decisions, as individuals navigate the pursuit of academic excellence in a world characterized by relentless competition across diverse fields of higher education. The correlation between fertility awareness and the prolonged timeline of medical education accentuates the need for strategic and proactive considerations in balancing professional and personal aspirations.

The current study has assessed the awareness and attitude towards female fertility and parenthood among medical students. Female students were slightly more than male, less than half were found married, a small proportion of married students had children and one-quarter of them had a family history of infertility. The majority of the students wanted to have their first baby by 25-29 years of age where a good number desired two to three children while only one quarter thought of more than four. Clinical year students as was earlier speculated, had far better awareness regarding fertility issues than preclinical students. In the event of infertility issues female students were more concerned about dropping and postponing their studies/job to seek treatment, considering adoption as an option, dropping their desire for children, and feeling upset and depressed about infertility while students of clinical year were more inclined to consider IVF treatment than the preclinical third-year students.

A similar German study15 stated that female non-medical students planned to have children at an earlier age than male non-medical and medical students, majority knew about oocyte freezing while less number of students were aware of ovarian reserve which is similar to our study results. Their study identified deficient knowledge concerning the most fertile female age which is opposite to our results. We did not include circumstances or statements for choosing these ovarian technologies aspects but generally inquired about the ovarian reserve or oocyte freezing.

 A study in Qassim16, city of Saudi Arabia, assessed different colleges of King Saud Bin Abdulaziz University, where participants considered having 3 children at 27 years’ age for the first child almost similar to our study findings. They showed a lack of awareness about female fertility decline by age and our participants being medical students were well aware of age-related female fertility decline. In Iraq17 a study found non-medical students had more desire for parenthood and wanted to have a first child between 21-24 years of age while medical students decided to have one at 25-27 years. Risk factors of infertility were better identified by medical students who opted for IVF than non-medical students. Regarding medical students’ findings, these are almost consistent with ours. A Ukranian study18 on medical students found a low level of female age-related infertility awareness and more than half thought a deep decline after 45 years, some males and females did not want children which is contrary to our findings. However, it's noteworthy that both studies aligned in terms of the age selected for the first baby, with participants in both studies commonly choosing ages 24 and 26. In another similar study in Nigeria19 university undergraduates did not pick properly the slight and maximum decline in fertility for female age. Interestingly, a majority of participants expressed a desire for three children, and females were notably more determined to have children at a younger age compared to males. These findings provide further insight into the perceptions and preferences regarding fertility among young adults in different cultural contexts.

A Serbian study20  has assessed fourth-year medical students for parenthood intentions and fertility awareness. Almost all desired for children a maximum of up to 3, and both genders agreed on the importance of children, female chose IVF and adoption in the diagnosed case of infertility which is similar to our study findings. All students wanted their first baby to be born before 35 years of age which is contrary to our results where the majority wanted to have it by 25-29 years of age, females considered children after completion of study and availability of child care facilities which is similar to current study results. They showed low awareness of age-related woman fertility while the majority of our fourth-year medical students knew about the age-related decline in female fertility which is contrary to their results.

Another study 21 compared university students in Hong Kong with Western students’ results. They also lacked knowledge of female fertility decline with age as Western students were less interested in children, and did not seriously take any action in case of infertility issues which was contrary to Western students and also is dissimilar with current study findings because of the different culture of their participants. Another study in an Australian university22 revealed that students aimed to have children during their fertile years but prioritized other life goals first, demonstrating limited knowledge about female fertility decline with age. These findings emphasize cultural variations in perceptions and priorities regarding fertility. 

A comparative study23 involving medical students from Sweden, Belgium, and Greece showed satisfactory awareness of female fertility decline with age, with Belgians demonstrating higher consideration for oocyte and sperm freezing. The median age for the first child was reported to be 29 years. In contrast, a Mexican study24 comparing undergraduate and graduate university students found a low level of awareness regarding female fertility decline and IVF success rates. Males showed greater eagerness to have children at age 30, with a higher inclination towards adoption in cases of infertility. These findings differ from the current study due to variations in the educational backgrounds of the participants.

Most of the study's findings align with existing literature, there is slight dissimilarity in results related to the decline in female fertility with age, particularly studies involving medical students. These disparities underscore the importance of additional education and awareness initiatives to enhance students' knowledge and comprehension of female fertility-related matters. The findings of this study have provided valuable insights into the awareness and attitudes of medical students in Saudi Arabia toward fertility and parenthood. In Saudi Arabia, there has been a historical inclination towards maintaining large family sizes. However, with advancements in education and literacy rates, there has been a noticeable shift among the younger generation towards embracing more effective family planning practices. Education is pivotal in shaping societal norms, contributing to a more informed and empowered approach to family life.

The limitation of the current study is its single-center design, conducted exclusively at a medical college within a university in Al Ahsa, Saudi Arabia. Consequently, the findings may not be generalized to medical students of other medical colleges in the country.

CONCLUSION

Our study emphasizes the critical need for improved fertility education among medical undergraduates. Medical students, particularly clinical-year students, displayed a better grasp of female fertility decline with age and demonstrated familiarity with various infertility causes. Despite knowledge gaps, participants expressed positive intentions regarding parenthood, with many favoring smaller family sizes. Addressing these gaps and promoting proactive family planning strategies are vital for enhancing reproductive health outcomes among future healthcare professionals.

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AUTHORS' CONTRIBUTIONS

Following author have made substantial contributions to the manuscript as under:

 

NN, RK & MA: Concept and study design, acquisition of data, drafting the manuscript, critical review, approval of the final version to be published

LG, FBH & SH: Acquisition, analysis and interpretation of data, drafting the manuscript, approval of the final version to be published

 

Author agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

 

CONFLICT OF INTEREST

Authors declared no conflict of interest, whether financial or otherwise, that could influence the integrity, objectivity, or validity of their research work.

 

GRANT SUPPORT AND FINANCIAL DISCLOSURE

Authors declared no specific grant for this research from any funding agency in the public, commercial or non-profit sectors

 

DATA SHARING STATEMENT

The data that support the findings of this study are available from the corresponding author upon reasonable request

 

WhatsApp Image 2018-07-28 at 12.46.19 PMThis is an Open Access article distributed under the terms of the Creative Commons Attribution-Non-Commercial 2.0 Generic License.

 

KMUJ web address: www.kmuj.kmu.edu.pk

Email address: kmuj@kmu.edu.pk