Fertility Awareness, Knowledge, and Understanding in the United Kingdom: A Systematic Review

Abstract

Introduction:Globally, the average age at first childbirth continues to rise. In England and Wales in 2020, the mean age at first conception was 30.7 years for women and 33.7 years for men  record highs. Evidence from international studies consistently demonstrates that people of reproductive age harbour significant knowledge deficits regarding infertility risk factors and the consequences of delayed childbearing. Fertility awareness (FA) encompassing knowledge of reproductive biology, recognition of infertility risk factors, and understanding of assisted reproductive technologies (ART) is therefore a crucial public health concern.Objective:To review and synthesise existing UK-based literature examining fertility awareness, knowledge, and understanding across diverse population subgroups.Methods:A systematic search of electronic databases (PubMed, EMBASE, CINAHL, MEDLINE, Scopus, Cochrane CENTRAL, Web of Science, and others) was performed for literature published up to September 2022. Searches combined MeSH terms and free-text keywords related to fertility awareness, infertility knowledge, ART, and the United Kingdom. Two independent reviewers applied predefined eligibility criteria; a narrative synthesis was performed on included publications.Results:Twenty-three publications met the eligibility criteria. Overall fertility awareness in UK adults was low to moderate. Men demonstrated consistently lower levels of FA than women and were rarely included in fertility-focused discourse. Higher education and prior experience of fertility treatment correlated with greater awareness. Age-related fertility decline was poorly understood across all subgroups, and an unfounded belief that ART can fully compensate for ageing was prevalent. Young people possessed adequate biological knowledge of reproduction but could not apply it to their own reproductive timelines. Engagement with fertility preservation was minimal among optimally aged women. General practitioners felt underprepared to counsel patients on fertility matters.Conclusions: Targeted fertility awareness interventions are urgently needed in the United Kingdom. School-based programmes should be strengthened to bridge the gap between biological knowledge and practical reproductive decision-making. Male-directed information should be delivered through healthcare settings and online platforms. Culturally sensitive resources for minority populations, improved GP training, and a reconsideration of national curricula are all warranted. Further high-quality, representative research is required to strengthen the evidence base.