Low awareness of fertility preservation among medical students in Hong Kong

Medical students in Hong Kong have limited awareness and knowledge of fertility preservation (FP), according to a study by the Chinese University of Hong Kong (CUHK). 

“Appropriate and timely education on FP ought to be provided to medical students across the world. In Hong Kong, FP service utilization could be increased with greater involvement of the public sector, enhanced service provision and financial subsidization,” the researchers suggested. [Hong Kong Med J 2020, doi: 10.12809/hkmj208390]

In the cross-sectional study, data were collected from approximately 700 Chinese medical students (female, 57.6 percent; mean age, 21.59 years) who were able to communicate in English, through a self-administered online survey. The accuracy and clarity of the survey’s content were validated by physicians in the Department of Obstetrics and Gynaecology, and assessed by doctors and medical students in a pilot study.

Despite an overall (71.2 percent) awareness of FP strategies, 77.8 percent of the medical students (particularly junior students; p<0.001) were unfamiliar with its service provision across clinics and specialists, and 86.8 percent were unaware of the regulations related to FP.

Of note, 88.1 percent of the students underestimated female infertility at the age of 45 years, while 89.8 percent overestimated the age of male fertility decline.

Female students demonstrated significantly higher awareness of FP methods with gamete and embryo freezing compared with male students (p<0.003). Willingness to discuss the treatment option of FP with patients increased from 71.2 percent to 95.5 percent if the risk of infertility increased from <30 percent to ≥70 percent.

Female students also had significantly higher understanding of the age range in which fertility significantly declines  (45.7 percent vs 38.8 percent for male students; p<0.05).

Electronic media (58.4 percent), medical school (57.6 percent), and medical professionals (38.7 percent) were the main sources of knowledge acquisition, with school education and medical professionals being the main sources particularly for senior students (both, p<0.0001).

Most students (86.4 percent) expressed a wish to enhance knowledge of FP, whilst 80.7 percent agreed with the need to incorporate education on FP into the medical curriculum.

A vast majority (94.2 percent) of respondents agreed with the establishment of one or two dedicated clinics or centres for FP counselling, with a significantly higher proportion of male students expressing a need of having two dedicated centres (75.0 percent vs 68.2 percent; p=0.021).

More senior vs junior students agreed that FP should be provided solely as a public service (89.1 percent vs 71.9 percent; p=0.001). Most (97.9 percent) respondents agreed that practice guidelines for FP should be required, whilst 59.7 percent agreed that an age limit should be set for FP (65.7 percent vs 51.5 percent for female vs male students; p=0.025). The most common basis for recommending FP to patients was the desire to have children (51.0 percent), followed by prognosis of cancer or medical condition (23.5 percent), and time available before gonadotoxic treatment (7.4 percent).

Most respondents indicated that the government should subsidize 30–50 percent of the cost of sperm freezing (79.8 percent), egg freezing (80.2 percent) and in vitro fertilization (IVF) (67.9 percent). More senior vs junior students (p<0.02) indicated that the government should support >70 percent of the cost.

Compared with female students, significantly more male students agreed with FP provision due to lack of a suitable partner (34.0 percent vs 22.1 percent; p<0.05), and were determined not to delay their family planning (16.5 percent vs 7.9 percent; p=0.037).