# A "Fertility Awareness" Survey on Social Media: Men Can Do Better

Hubert Bettinger, Marie Carbonnel, Alexandre Vallée, Catherine Racowsky,

Henri-Corto Stoekle, Jean-Marc Ayoubi

► To cite this version:

Hubert Bettinger, Marie Carbonnel, Alexandre Vallée, Catherine Racowsky, Henri-Corto Stoekle, et al. A "Fertility Awareness" Survey on Social Media: Men Can Do Better. American Journal of Men's Health, 2025, 19 (3), 10.1177/15579883251325513. hal-05299975

HAL Id: hal-05299975

https://hal.science/hal-05299975v1

Submitted on 14 Oct 2025

HAL is a multi-disciplinary open access
archive for the deposit and dissemination of sci-
entific research documents, whether they are pub-
lished or not. The documents may come from
teaching and research institutions in France or
abroad, or from public or private research centers.

L'archive ouverte pluridisciplinaire HAL, est
destinée au dépôt et à la diffusion de documents
scientifiques de niveau recherche, publiés ou non,
émanant des établissements d'enseignement et de
recherche français ou étrangers, des laboratoires
publics ou privés.

<figure><img src="image_1.png" /></figure>

Distributed under a Creative Commons Attribution 4.0 International License
<figure><img src="image_2.png" /></figure>

# A "Fertility Awareness" Survey on Social Media: Men Can Do Better

American Journal of Men's Health

May-June 1-5

© The Author(s) 2025

Article reuse guidelines:
sagepub.com/journals-permissions

DOI: 10.1177/15579883251325513

journals.sagepub.com/home/jmh

<figure><img src="image_3.png" /></figure>

Sage

Hubert Bettinger<fnref n="1" />,<fnref n="2" />, Marie Carbonnel<fnref n="1" />,<fnref n="2" /> ID,
Alexandre Vallée<fnref n="3" />, Catherine Racowsky<fnref n="1" />,<fnref n="2" />,
Henri-Corto Stoekle<fnref n="4" />, and Jean-Marc Ayoubi<fnref n="1" />,<fnref n="2" />,<fnref n="3" />

## Abstract

Infertility affects 17% of the global population, yet fertility awareness remains low, particularly among younger individuals and men. This study assessed fertility awareness and attitudes toward infertility prevention among French adults of childbearing age, focusing on gender differences. Conducted via social media from March to May 2023, the survey included 322 participants aged 18–43 who had not consulted assisted reproduction centers. Most respondents were women (84%), under 33 (59%), from high socio-professional backgrounds (58%), in relationships (78%), and childless (59%). Significant gender differences emerged regarding desired ages for having a first (women: 30.7 ± 3.5 years vs. men: 32.8 ± 3.8 years; *p* = .06) and last child (women: 36.7 ± 3.6 years vs. men: 39.8 ± 4.5 years; *p* = .001). Only 55.8% of men correctly identified the female fertility window, compared to 64.1% of women (*p* = .023). Men also showed lower awareness of the timing of female fertility decline (*p* = .043) and underestimated the prevalence of assisted reproductive technologies among heterosexual couples (*p* = .001). In addition, men were less likely to discuss fertility with their doctor (15.4% vs. 35.9%; *p* = .004) or express interest in infertility prevention consultations (53.9% vs. 60.8%; *p* = .048). These findings suggest a gender gap in fertility awareness, with men generally less informed and engaged in reproductive health discussions. While the small sample size limits generalizability, the results underscore the need for targeted educational efforts to improve fertility knowledge and encourage proactive reproductive health behaviors across genders.

## Keywords

infertility, fertility awareness, prevention, public health, gender equality

Received November 11, 2024; revised February 13, 2025; accepted February 18, 2025

## Introduction

Infertility is a significant public health concern resulting from various factors with medical, psychological, and socio-economic implications. This phenomenon affects 17.5% of the global adult population (Cox et al., 2022). In France, it is estimated that 24% of

couples are unable to conceive after 1 year of trying (Slama et al., 2012). Annually, 1.25% of women receive infertility treatment (Messaoud et al., 2020) and 3.7% of births are achieved through assisted reproductive technologies (ART) (De la Rochebrochard, 2022).

## Corresponding Author

Marie Carbonnel, Department of Obstetrics, Gynecology and Reproductive Medicine, Foch Hospital, 40 Worth Street, Suresnes 92150, France.

Email: m.carbonnel@hopital-foch.com

<figure><img src="image_4.png" /></figure>

<footnote n="1">¹Department of Obstetrics, Gynecology and Reproductive Medicine, Foch Hospital, Suresnes, France</footnote>

<footnote n="2">²UFR Simone Veil, University Versailles, Saint-Quentin-en-Yvelines, France</footnote>

<footnote n="3">³Department of Epidemiology and Public Health, Foch Hospital, Suresnes, France</footnote>

<footnote n="4">⁴Department of Ethics and Scientific Integrity, Foch Hospital, Suresnes, France</footnote>
Effective infertility management depends on identi-
fying and understanding the risk factors within the
reproductive-age population. There is evidence to sug-
gest that modifying environmental and lifestyle factors
can reduce the incidence of infertility (Barron et al.,
2022).

Despite its importance, fertility awareness—defined
by the American Society of Reproductive Medicine as
the “understanding of reproduction, fertility, fecund-
ability, and related risk factors”—remains notably
deficient, particularly among younger (Boivin et al.,
2019; Ren et al., 2023) and men (Hammarberg et al.,
2017; Hviid Malling et al., 2022). To date, no studies
have been conducted on this topic in France. As part
of the national infertility plan launched in 2022, we
aimed to assess the knowledge of the French popula-
tion of childbearing age on this subject, with a focus
on comparing the responses of men and women to
enhance the prevention of infertility risk factors.

## Methods

The study was conducted as a survey distributed on
social media platforms (LinkedIn, Twitter, Instagram,
and Facebook) by the hospital's communications
department between March 7 and May 3, 2023.
Inclusion criteria for participation in the questionnaire
were living in France and being between 18 and
43 years old. Participants who had previously con-
sulted an assisted reproduction center were excluded.
The questionnaire was translated into English
(Supplemental Appendix 1), adapted from existing
research models (Jurkowski et al., 2021), and updated
with recent scientific insights (Rossin, 2020).

The objective was to collect demographic data and
evaluate gender differences in fertility, knowledge,
ART, and interest in infertility prevention counseling.
Approval for the study was obtained from the
Institutional Review Board of Suresnes, in September
2022 (IRB number ID-RCB N: 00012437)

Data analysis involved Chi-squared and Student's
or Wilcoxon tests to determine significant gender-
based differences, with statistical significance set at a
p-value < .05.

## Results

A total of 322 individuals participated in the survey.
Demographic characteristics and questionnaire results
are provided in Supplemental Appendix 2.

Most participants were women (n = 270; 84%) under the age of 33 (n = 191; 59%), in relationships (n = 252; 78%) without children (n = 191; 59%),

residing in the Paris region (n = 246; 76%), and from
high socio-professional backgrounds (n = 187; 58%).
More men were from high socio-professional back-
grounds than women (p = .001).

Regardless of gender, most childless participants expressed intentions to have children in the future (n = 163; 86%) and desired multiple children (mean: 2.38 ± 0.84). Professional career (35%) and financial stability (31%) were identified as primary barriers to planning a pregnancy.

Significant gender differences were observed regarding the desired age for having both a first child (women: 30.7 ± 3.5 years vs. men: 32.8 ± 3.8 years; p = .06) and a last child (women: 36.7 ± 3.6 years, vs. men 39.8 ± 4.5 years; p = .001).

The three main sources of information on fertility
were Media and the Internet (n = 177; 55%), health
professionals (n = 166; 51.6%), and the entourage
(n = 154; 47.8%) for both sexes. Significantly more
men than women cited school as a source of informa-
tion (21.2% vs. 9.6%, respectively; p = .017).

Tobacco was identified as the most important non-
medical risk factor of infertility, and more so among
men (84.6% vs. 70.7% for women; p = .039).

Participants responded correctly to questions regarding the probability of pregnancy per cycle as influenced by the age of the woman (before 30, at 35, and 40).

Concerning the time of the female cycle when a
woman is most fertile, the majority of participants
answered correctly (between the 12th and 16th day of
the cycle), but significantly less so for men (55.8% vs.
64.1% for women), and more men than women indi-
cated that they were unsure (9.6% vs. 2.6%, respec-
tively; p = .023) (Figure 1(A)).

Gender disparities were also observed in the timing
of fertility decline in women; 17.3% of men believed it
occurred at 30, 46.2% at 35, and 21.2% at 40, com-
pared with 29.4%, 39%, and 13% respectively for
women (p = .043) (Figure 1(B)).

Men generally underestimated the use of ART pro-
cedures, compared to women. 50.6% of men esti-
mated that 10% or fewer heterosexual couples
consulted an assisted reproduction center at least once
in their lifetime, compared to 31.6% of women
(p = .001) (Figure 1(C)). 53.8% of men estimated that
1 in 50 or fewer children are born through ART, com-
pared to 35.5% of women (Figure 1(D)).

In addition, men were less likely than women to dis-
cuss fertility with their doctor (35.9% vs. 15.4%,
respectively; p = .004) and were less inclined to con-
sider infertility advice offered by their doctor as bene-
ficial (60.8% vs. 53.9%, respectively; p = .048).
<figure><img src="image_5.png" /><figcaption>**Figure 1.** Histograms: (A) Women's and Men's Responses on the Time of the Female Cycle When Women are Most Fertile; (B) Women's and Men's Responses on the Age at Which Women's Fertility Begins to Decline; (C) Women's and Men's Responses Regarding the Prevalence of Heterosexual Couples Consulting an ART Center at Least Once in Their Lives; and (D) Women's and Men's Responses Regarding the Proportion of Children Conceived by ART Each Year in France</figcaption></figure>

A total of 82.6% of participants were aware of gamete cryopreservation for social reasons, with 35.4% showing interest in this option with no differences between genders.

## Discussion

This study revealed a reasonable level of fertility awareness among participants, though significant gaps persisted, particularly among men. Men's lower engagement and interest in fertility issues are concerning, particularly given the prevalence of male infertility, which accounts for 40% to 50% of cases where a cause is identified (De Jonge et al., 2022; Mannucci et al., 2022).

Culturally, infertility is often seen as a female issue (Thoma et al., 2021) and, for men, an affront to their masculinity (Hanna & Gough, 2020). This perception may lead some men to avoid addressing the problem or to simply lack interest in the subject.

As the study results demonstrate, men are generally reluctant to discuss fertility with their doctors or to seek information about it. This reluctance is particularly detrimental to efforts aimed at addressing modifiable risk factors for male infertility, such as sexually transmitted infections, smoking, substance abuse, exposure to environmental pollutants, and endocrine disruptors (Daumler et al., 2016).

These deficiencies may also be attributed to men's fewer opportunities compared to women to discuss
fertility in medical contexts. In France, men visit general practitioners and specialists less frequently than women. In addition, women benefit from annual gynecological check-ups, during which they can discuss fertility and pregnancy planning (INSEE, 2022).

While the lower response rate from men compared to women in our survey may limit the generalizability of our findings, it also underscores that men may be less concerned about fertility issues than women.

The findings of this study align with previous research on the subject (Hammarberg et al., 2017; Hviid Malling et al., 2022). Despite a consistent desire for parenthood, men are generally less concerned about fertility than women. This is partly due to their reduced exposure to fertility-related discussions within the healthcare system, which negatively impacts their knowledge and delays both the prevention of risk factors and timely screening.

Men tend to perform less well than women in responding to fertility-related questions and are more likely to underestimate the impact of age on fertility.

However, these results should be interpreted with caution, as the small sample size may limit the generalizability of the conclusions. Furthermore, since the survey was distributed via the hospital's communications department on social media platforms, it may have reached only a limited and potentially biased audience. We also note that the men who responded to the questionnaires largely expressed a desire to have children and belong to a high social category, which could have influenced the level of fertility awareness positively.

Collectively, these results highlight the necessity for increased awareness and targeted educational campaigns to bridge this knowledge gap and increase men's engagement with fertility issues.

## Acknowledgments

The authors would like to thank Pr Christian Herve for his methodological advice and Dr Fay for her revision of our questionnaire

## Author Contribution Statements

H.B., M.C., A.V., and H.-C.S. conceptualized the study; H.B. and M.C. drafted the original manuscript; H.B., A.V., H.-C.S., C.R., and J.-M.A. contributed to reviewing and editing the manuscript; A.V. conducted the formal analysis; J.-M.A. provided validation. All authors reviewed the final manuscript and approved the submission.

## Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

## Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

## Ethical Statement

Registration: The survey was reviewed and approved by the institutional review boards of Suresnes, France in September 2022: IRB00012437.

## ORCID iD

Marie Carbonnel https://orcid.org/0000-0001-9935-1203

## Supplemental Material

Supplemental material for this article is available online.

## References

Barron, M. L., Lithgow, D., Wade, G. H., & Mueller Luckey, G. (2022). Fertility health knowledge in U.S. adults: Men narrowing the knowledge gap. *American Journal of Men's Health, 16*(5), 15579883221117915. https://doi.org/10.1177/15579883221117915

Boivin, J., Sandhu, A., Brian, K., & Harrison, C. (2019). Fertility-related knowledge and perceptions of fertility education among adolescents and emerging adults: A qualitative study. *Human Fertility, 22*(4), 291-299. https://doi.org/10.1080/14647273.2018.1486514

Cox, C. M., Thoma, M. E., Tchangalova, N., Mburu, G., Bornstein, M. J., Johnson, C. L., & Kiarie, J. (2022). Infertility prevalence and the methods of estimation from 1990 to 2021: A systematic review and meta-analysis. *Human Reproduction Open, 2022*(4), hoac051. https://doi.org/10.1093/hropen/hoac051

Daumler, D., Chan, P., Lo, K. C., Takefman, J., & Zelkowitz, P. (2016). Men's knowledge of their own fertility: A population-based survey examining the awareness of factors that are associated with male infertility. *Human Reproduction, 31*(12), 2781-2790. https://doi.org/10.1093/humrep/dew265

De Jonge, C. J., Gellatly, S. A., Vazquez-Levin, M. H., Barratt, C. L. R., & Rautakallio-Hokkanen, S. (2022). Male attitudes towards infertility: Results from a global questionnaire. *World Journal of Men's Health, 40*, 204. https://doi.org/10.5534/wjmh.220099

De la Rochebrochard, E. (2022). 40 ans après la naissance du premier "bébé éprouvette" français, plus de 400000 enfants conçus par FIV [40 years after the birth of France's first "test-tube baby"], over 400,000 children have been conceived by IVF]. *The Conversation*.

Hammarberg, K., Collins, V., Holden, C., Young, K., & McLachlan, R. (2017). Men's knowledge, attitudes and behaviours relating to fertility. *Human Reproduction Update, 23*(4), 458-480. https://doi.org/10.1093/humupd/dmx005

Hanna, E., & Gough, B. (2020). The social construction of male infertility: A qualitative questionnaire study of men
with a male factor infertility diagnosis. *Sociology of Health and Illness*, 42(3), 465–480. https://doi.org/10.1111/1467-9566.13038

Hviid Malling, G. M., Schmidt, L., Pitsillos, T., Hammarberg, K., Tydén, T., Friberg, B., Jensen, I., & Ziebe, S. (2022). Taking fertility for granted—a qualitative exploration of fertility awareness among young, childless men in Denmark and Sweden. *Human Fertility*, 25(2), 337–348. https://doi.org/10.1080/14647273.2020.1798516

INSEE. (2022). *Femmes et hommes, l'égalité en question* [Women and men, equality in question]. www.insee.fr

Jurkowski, L., Manubens, R., Ryberg, J. O., & Rossi, M. (2021). Fertility awareness, attitudes towards parenting, and knowledge about assisted reproductive technology among university students in Argentina. *Jornal Brasileiro de Reprodução Assistida*, 25(3), 453–458. https://doi.org/10.5935/1518-0557.20210019

Mannucci, A., Argento, F. R., Fini, E., Coccia, M. E., Taddei, N., Becatti, M., & Fiorillo, C. (2022). The impact of oxidative stress in male infertility. *Frontiers in Molecular Biosciences*, 8, 799294. https://doi.org/10.3389/fmolb.2021.799294

Messaoud, K. B., Bouyer, J., & de la Rochebrochard, E. (2020). Infertility treatment in France, 2008–2017: A

challenge of growing treatment needs at older ages. *American Journal of Public Health*, 110(9), 1418–1420. https://doi.org/10.2105/AJPH.2020.305781

Ren, Y., Xie, Y., Xu, Q., Long, M., Zheng, Y., Li, L., & Niu, C. (2023). University students' fertility awareness and its influencing factors: A systematic review. *Reproductive Health*, 20(1), 85. https://doi.org/10.1186/s12978-023-01628-6

Rossin, B. (2020). The epidemiology of fertility; the great revolutions of this half-century. *Sexologies*, 29(1), 12–20. https://doi.org/10.1016/j.sexol.2020.01.005

Slama, R., Hansen, O. K. H., Ducot, B., Bohet, A., Sorensen, D., Giorgis Allemand, L., Eijkemans, M. J. C., Rosetta, L., Thalabard, J. C., Keiding, N., & Bouyer, J. (2012). Estimation of the frequency of involuntary infertility on a nation-wide basis. *Human Reproduction*, 27(5), 1489–1498. https://doi.org/10.1093/humrep/des070

Thoma, M., Fledderjohann, J., Cox, C., & Kantum Adageba, R. (2021). *Biological and social aspects of human infertility: A global perspective*. Oxford Research Encyclopedia of Global Public Health. Retrieved February 25, 2025, from https://oxfordre.com/publichealth/view/10.1093/acrefore/9780190632366.001.0001/acrefore-9780190632366-e-184