Journal of Environmental Treatment Techniques  
2019, Volume 7, Issue 1, Pages: 171-178  
J. Environ. Treat. Tech.  
ISSN: 2309-1185  
Journal web link: http://www.jett.dormaj.com  
Infertility Knowledge, Attitudes, and Beliefs  
among Iranian College Students  
1
2
3
4
Sanaz Alaee , Elham Yousefian *, Amirreza Talaiekhozani , Gholam Reza Ziaee , Hamideh  
Homayoon5  
1- Department of Reproductive Biology, School of Advanced Medical Sciences and Technologies, Shiraz University of Medical  
Sciences, Shiraz, Iran  
2
- Department of Obstetrics and Gynecology, Isfahan University of Medical Sciences, Isfahan, Iran  
- Department of Civil Engineering, Jami Institute of Technology, Isfahan, Iran  
- Department of Accounting, Jami Institute of Technology, Isfahan, Iran  
- Department of Obstetrics and Gynecology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran  
3
4
5
Received: 20/01/2019  
Accepted: 28/02/2019  
Published: 01/06/2019  
Abstract  
The knowledge, attitudes and beliefs of college students about infertility was assessed. A questionnaire was designed. The target  
population was students attending a college located in Fooladshahr, Isfahan, Iran. The main research outcome measures for this  
study were to determine the infertility knowledge, attitudes and beliefs among these students. Our results demonstrated that there  
are differences in knowledge, attitudes and beliefs of students based on gender. A greater proportion of female students answered  
more questions correctly in comparison to their male counterparts. Also the majority of students knew about some of the biological  
and lifestyle factors related to infertility, including that infertility is a problem for both men and women, and the effects of genetics,  
abnormal sperm production and/or function, blocked fallopian tube and environmental factors on fertility. However, there were  
notable gaps in fertility knowledge in some areas, such as the most fertile time in a woman’s menstrual cycle, the age range with a  
marked decrease in a woman’s ability to become pregnant, negative effects of advanced age on men’s fertility, and negative effects  
of genital tract infection, being underweight or overweight, smoking, alcohol, psychological stress and sexually transmitted  
infection. In Conclusion the awareness of female students in some cases is significantly more than that of males. It also appears that  
there is an overall perception that women are more likely to become infertile due to any number of causes that are, in fact, of equal  
risk to both men and women.  
Keywords: Infertility, Knowledge, Students, Attitude  
1
among the important factors that cause infertility or  
1
Introduction  
infertility-related problems (7-13). Some studies have shown  
that students are not aware of many basic concepts, such as  
a woman’s fertility window and the age at which fertility  
begins to decline. They also do not know the preventable  
factors of infertility (3, 5, 7-9). It has been shown that  
sexually transmitted diseases, which can affect fertility  
potential, especially in girls, are becoming increasingly  
prevalent among teenagers (14-15). It is known that  
knowledge about infertility is inadequate, and even if  
present, there are numerous misconceptions regarding  
infertility in many parts of the world (3, 5, 9, 16-17).  
Nowadays, infertility is an important public health  
problem worldwide that affects many couples and leads to a  
vast range of social, personal, familial and emotional  
problems (1-2). Infertility is one of the major concerns of  
fertility specialists. It is suggested that a high rate of  
infertility is mainly related to a wide gap in peoples’  
awareness about infertility risk factors and the causes of  
infertility (3-4). Awareness of married and even single  
people about infertility as a medical issue will help them to  
know the causes of infertility and prevent its occurrence; it  
will also help infertility specialists to diagnose it precisely  
for its treatment (5). It is determined that beliefs about  
infertility differ significantly among people and are related  
to age, marital status, gender and educational level (3, 6-7).  
Studies show that increasing age, sexually transmitted  
disease, incorrect lifestyle and environmental pollutions are  
A global survey of almost 17,500 women (mostly of  
childbearing age) from 10 countries revealed that knowledge  
regarding fertility and the biology of reproduction is poor  
(
18). Amazingly, many women have little awareness about  
the period of the month in which the occurrence of  
*
Corresponding author: Elham Yousefian, Assistant Professor, Department of Obstetrics and Gynecology, Isfahan University of  
Medical Sciences, Isfahan, Iran. Email: Elham.yousefian@med.mui.ac.ir.  
71  
1
Journal of Environmental Treatment Techniques  
2019, Volume 7, Issue 1, Pages: 171-178  
conception is high. Additionally, they are unaware of when  
should they seek infertility treatment (9, 19).  
collection, the survey was administered by a single  
coordinator who was also aware of the questions and could  
explain all of them.  
In Iran, it is shown that currently the mean age of the  
first-time mothers is relatively high (20) and the incidence  
and prevalence of sexually transmitted diseases (STIs) are  
much higher than the registered data suggest (21-22).  
Furthermore, studies have demonstrated that the knowledge  
of students and people about infertility risk factors is low (3,  
2.4 Data Analyses  
Since previous studies have shown that there are  
differences between males’ and females’ awareness about  
the causes of infertility and beliefs (6-8), results were  
analyzed by gender. Data were analyzed using SPSS 16  
software (IBM Corporation, Armonk, NY). The comparison  
process was conducted using the Mann-Whitney  
nonparametric test.  
2
3). In Iran, as in many other countries, there exist no  
comprehensive surveys with regard to infertility and  
attitudes among students in Iran. Most studies have focused  
on sexual health knowledge and practice (14, 24). Thereby,  
evaluating students’ knowledge and then providing  
knowledge about infertility and its risk factors to young  
people is a necessity for preventing and decreasing the  
incidence of infertility. Although there are many studies  
related to these factors, it seems that the awareness of young  
people and their attitudes about infertility have not yet been  
comprehensively evaluated. The purpose of this study was to  
achieve a better understanding of the level of awareness,  
attitudes and beliefs about infertility among Iranian college  
students and to examine the effects of gender on responses.  
3
Results and Discussion  
A total of 170 surveys were returned (111 male and 59  
female students). The average age of female and male  
students was 26.6 and 25.8, respectively. According to Table  
1
, 67.57% of males and 62.71% of females correctly knew  
the description of infertility. Only 21.9% of males and  
2.14% of female students correctly knew that the most  
3
fertile time in a woman’s menstrual cycle occurs in the  
middle of her cycle. 57.29% of male and 63.16% of female  
students knew the age at which women are most fertile. Most  
students overestimated that female fertility decreases  
between ages 40-44, while 27.81% of males and 36.21% of  
females correctly answered. Most students believed that  
infertility is a disease (males: 58.18%; females: 61.02%).  
Males were significantly more aware than females about  
the negative effects of advanced age on men’s fertility  
(males: 47.66%; females: 28.81%; p=0.006). The majority of  
students, however, knew that both males and females could  
be responsible for infertility (males: 94.55%; females:  
94.92%). Females were significantly more aware about the  
relation between men’s (male students: 59.81%; female  
students: 81.03%, p=0.008) and women’s (male: 59.43%;  
females; 31%) genetics with infertility (p=0.024  
respectively). Females were significantly more aware about  
the relationship between men’s (male students: 49.07%;  
female students: 65.52%, p=0.045) and women’s (males:  
53.21%; females: 84.48%, p=0.000).genital tract infection  
with infertility. Female awareness about the relationship  
between an irregular menstrual cycle and infertility was  
significantly higher than that of males (male students:  
34.58%; female students: 68.97%; p=0.000). Female  
students were more aware about the negative effects of  
underweight or overweight in men (males: 15.24%; females:  
2
Materials and Methods  
2
.1 Participants  
For this study, the students of Jami Institute of  
Technology served as the target population.  
2.2 Survey Questionnaire Items  
A pretest questionnaire was designed after a through  
literature review and using questions adapted from other  
studies (7-9), as well as several questions developed  
specifically for this study population. The questionnaire  
contained demographic information including gender, age,  
questions about participants’ beliefs and knowledge about  
infertility, with a multiple choice answer or three answer  
choices, “Yes,” “No,” and “I don’t know,” with only one  
right answer among the available choices (Table 1) and also  
questions about basic infertility knowledge and participants’  
views and questions about which approach(s) are the best to  
improve college students’ knowledge in this area. It should  
be mentioned that the questionnaire’s reliability and validity  
was checked by pre-sampling of 15 students. In this  
introductory step, the sample of size n=15 was chosen  
randomly and Cronbach’s alpha was calculated. The value of  
Cronbach’s alpha was about 0.8.  
24.14%) and women (males: 19.44%; females: 63.16%) on  
2
.3 Data Collection Protocol  
Students who were attending classes in any of the  
fertility, and in the case of women’s weight, female  
awareness was significantly higher than males (p=0.000).  
Females were more aware about the negative effects of  
alcohol consumption by men (males: 33.03%; females:  
37.93%) and women (males: 35.78%; females: 52.54%) on  
fertility, and females awareness about this issue in males was  
significant (p=0.000). Additionally, females possessed  
significantly more awareness about secondary infertility  
(males: 43.12%; females: 61.02%; p=0.031). The awareness  
of students about the negative effects of smoking on men’s  
(males: 33.64%; females: 33.9%) and women’s fertility  
(males: 41.28%; females: 55.17%) showed no significant  
difference (p>0.05).  
courses of the mentioned college during were sampled. The  
number of participants in this study was 170 (111 men and  
59 women) who were chosen from the aforementioned areas  
with no regard to marital status, number of children or other  
criteria. A simple random sampling (SRS) method was  
utilized for sampling. The questionnaire was then distributed  
among participants. The students filled out the two-page  
questionnaire during their free periods between classes. Once  
completed, each questionnaire was immediately checked by  
the coordinator to ensure that all questions had been  
answered. The participants were also informed of the  
confidentiality of their information. For consistency in data  
172  
Journal of Environmental Treatment Techniques  
2019, Volume 7, Issue 1, Pages: 171-178  
Table 1: Students’ knowledge and beliefs about infertility  
*
Correct answer  
Question  
Male  
Responses n  
Female  
Responses  
n (%)  
Male  
Mean  
Rank  
Female  
Mean  
Rank  
P
Responses  
Value  
(%)  
Infertility Knowledge  
A woman’s  
failure to  
conceive after  
experiencing  
intercourse for a  
year without  
use of  
contraception*  
A woman’s  
failure to  
What is the correct description of  
infertility?  
7
5 (67.57)  
37 (62.71)  
2 (3.39)  
84.50  
80.15  
0.493  
conceive after  
the first  
1 (0.9)  
intercourse  
I do not know  
32 (28.83)  
16 (15.24)  
18 (30.51)  
2 (3.57)  
When is the most fertile time in a  
woman’s menstrual cycle?  
Beginning  
Mid-cycle *  
End of cycle  
Throughout the  
cycle  
23 (21.9)  
18 (32.14)  
18 (32.14)  
79.43  
79.27  
83.95  
84.08  
0.532  
0.464  
14 (13.33)  
6
(5.71)  
0 (0.00)  
I do not know  
46 (43.81)  
7 (7.29)  
18 (32.14)  
At what age does a woman have the  
greatest fertility potential?  
15-24  
0 (0.00)  
2
2
3
0-24 *  
5-29  
0-44  
55 (57.29)  
34 (35.42)  
0 (0.00)  
36 (63.16)  
21 (36.84)  
0 (0.00)  
At all ages  
6 (6.25)  
2 (3.51)  
In what age range is there a marked  
decrease in a woman’s ability to  
become pregnant?  
25-34  
5 (4.81)  
3 (5.17)  
3
4
5-39 *  
0-44  
29 (27.88)  
64 (61.54)  
6 (5.77)  
64 (58.18)  
39 (35.45)  
7 (6.36)  
21 (36.21)  
33 (56.90)  
1(1.72)  
36 (61.02)  
20 (33.90)  
3 (5.08)  
79.09  
82.23  
85.83  
79.95  
0.273  
0.741  
In all ages  
Yes *  
No  
Do you think infertility is a disease?  
I do not know  
Infertility beliefs  
Advanced age has negative effects on  
men’s fertility  
Yes *  
51 (47.66)  
17 (28.81)  
90.57  
84.31  
70.69  
82.00  
0.006  
0.202  
No  
35 (32.71)  
21 (19.63)  
1 (0.92)  
106 (97.25)  
2(1.83)  
32 (54.24)  
10 (16.95)  
0 (0.00)  
58 (100.00)  
0 (0.00)  
I do not know  
Yes  
No *  
Infertility is a problem only for men  
I do not know  
Infertility is a problem only for  
women  
Yes  
1 (0.91)  
2 (3.39)  
No *  
I do not know  
107 (97.27)  
2 (1.82)  
57 (96.61)  
0 (0.00)  
84.79  
84.90  
85.40  
85.18  
0.792  
0.929  
Infertility is a problem for both men  
and women  
Yes *  
104 (94.55)  
56 (94.92)  
No  
3 (2.73)  
3 (2.73)  
2 (3.39)  
1 (1.69)  
I do not know  
173  
Journal of Environmental Treatment Techniques  
2019, Volume 7, Issue 1, Pages: 171-178  
Male  
Responses n  
Female  
Responses  
n (%)  
Male  
Mean  
Rank  
Female  
Mean  
Rank  
P
Question  
Responses  
Value  
(%)  
Infertility risk factors  
Genetics (men)  
Yes *  
No  
I do not know  
Yes *  
No  
I do not know  
Yes *  
No  
I do not know  
Yes *  
No  
64 (59.81)  
21 (19.63)  
22 (20.56)  
63 (59.43)  
21 (19.81)  
22 (20.75)  
53 (49.07)  
15 (13.89)  
40 (37.04)  
58 (53.21)  
12 (11.01)  
39 (35.78)  
37 (34.58)  
26 (24.30)  
44 (41.12)  
47 (81.03)  
6 (10.34)  
5 (8.62)  
46 (79.31)  
7 (12.07)  
5 (8.62)  
38 (65.52)  
5 (8.62)  
15 (25.86)  
49 (84.48)  
3 (5.17)  
76.97  
76.35  
78.62  
79.14  
74.11  
94.12  
90.73  
92.59  
100.66  
99.40  
0.008  
0.024  
0.045  
0.000  
0.000  
Genetics (women)  
Genital tract infection (men)  
Genital tract infection (women)  
Irregular menstrual cycle  
Being underweight or overweight  
I do not know  
Yes *  
No  
6 (10.34)  
40 (68.97)  
10 (17.24)  
8 (13.79)  
I do not know  
Yes *  
16 (15.24)  
14 (24.14)  
78.27  
71.54  
88.75  
0.141  
0.000  
(
men)  
No  
52 (49.52)  
37 (35.24)  
23 (39.66)  
21 (36.21)  
I do not know  
Being underweight or overweight  
women)  
Yes *  
21 (19.44)  
36 (63.16)  
104.71  
(
No  
48 (44.44)  
39 (36.11)  
36 (33.64)  
48 (44.86)  
23 (21.50)  
45 (41.28)  
34 (31.19)  
30 (27.52)  
36 (33.03)  
41 (37.61)  
32 (29.36)  
39 (35.78)  
35 (32.11)  
35 (32.11)  
9 (15.79)  
I do not know  
Yes *  
No  
I do not know  
Yes *  
No  
I do not know  
Yes *  
No  
I do not know  
Yes *  
No  
12 (21.05)  
20 (33.90)  
26 (44.07)  
13 (22.03)  
32 (55.17)  
14 (24.14)  
12 (20.69)  
22 (37.93)  
19 (32.76)  
17 (29.31)  
31 (52.54)  
15 (25.42)  
13 (22.03)  
Smoking (men)  
Smoking (women)  
Alcohol (men)  
86.95  
80.03  
74.06  
79.88  
77.25  
91.47  
102.68  
93.04  
0.187  
0.117  
0.000  
0.074  
Alcohol (women)  
I do not know  
A couple who have a child may have  
difficulty conceiving again  
Yes *  
47 (43.12)  
36 (61.02)  
79.01  
94.64  
0.031  
No  
37 (33.94)  
25 (22.94)  
13 (22.03)  
10 (16.95)  
I do not know  
Abnormal sperm production and/or  
function  
Yes *  
88 (80.73)  
49 (83.05)  
83.82  
78.33  
81.07  
85.75  
83.63  
88.02  
0.715  
0.302  
0.234  
No  
2 (1.83)  
1 (1.69)  
9 (15.25)  
53 (89.83)  
3 (5.08)  
3 (5.08)  
I do not know  
Yes *  
No  
19 (17.43)  
88 (80.73)  
5 (4.59)  
Blocked fallopian tube  
I do not know  
16 (14.68)  
Environmental factors (lead,  
radiation)  
Yes *  
79 (73.15)  
47 (81.03)  
No  
8 (7.41)  
2 (3.45)  
I do not know  
21 (19.44)  
9 (15.52)  
Psychological stress  
Yes *  
No  
I do not know  
43 (39.81)  
23 (21.30)  
42 (38.89)  
23 (38.98)  
15 (25.42)  
21 (35.59)  
84.93  
82.31  
0.720  
Sexually transmitted infection (men)  
174  
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2019, Volume 7, Issue 1, Pages: 171-178  
Male  
Responses n  
Female  
Responses  
n (%)  
28 (48.28)  
7 (12.07)  
23 (39.66)  
Male  
Mean  
Rank  
80.55  
Female  
Mean  
Rank  
87.53  
P
Question  
Responses  
Value  
(%)  
Yes *  
No  
I do not know  
42 (39.25)  
14 (13.08)  
51 (47.66)  
0.326  
Sexually transmitted infection  
(
women)  
Yes *  
No  
I do not know  
Yes  
No *  
39 (36.45)  
15 (14.02)  
53 (49.53)  
18 (16.67)  
57 (52.78)  
33 (30.56)  
37 (62.71)  
2 (3.39)  
20 (33.90)  
10 (17.86)  
36 (64.29)  
10 (17.86)  
73.62  
99.17  
0.000  
Infertility is 100% curable  
84.61  
86.54  
78.43  
79.47  
0.376  
0.059  
I do not know  
Preservation of fertility and  
childbearing is important for me  
Yes  
No  
101(94.39)  
6 (5.61)  
52 (88.14)  
7 (11.86)  
I am concerned about my ability to  
have children  
Yes  
No  
45 (42.86)  
60 (57.14)  
82 (76.64)  
25 (23.36)  
38 (35.19)  
70 (64.81)  
34 (57.63)  
25 (42.37)  
51 (87.93)  
7 (12.07)  
78.14  
77.07  
72.54  
90.25  
90.11  
79.80  
0.070  
0.012  
0.276  
If I discovered that I was infertile, I  
would be upset  
Yes  
No  
I ashamed to ask questions about  
infertility  
Yes  
No  
18 (30.51)  
41 (69.49)  
I would like to have more knowledge  
about fertility preservation and  
infertility risk factors  
Yes  
103 (95.37)  
53 (89.83)  
94.22  
70.14  
91.29  
87.6  
0.371  
0.031  
No  
5 (4.63)  
6 (10.17)  
To whom would you prefer to go first  
for treatment?  
Gynecologist  
Others  
75 (68.18)  
51 (86.44)  
Moreover, no significant difference was discerned about  
the relationship between abnormal sperm production and/or  
function (males: 33.64%; females: 83.05%), or blocked  
fallopian tube (males: 80.73%; females: 89.83%),  
environmental factors (males: 73.15%; females: 81.03%)  
and psychological stress between males and females (males:  
preferred to consult a gynecologist for the initial treatment of  
infertility if they had a problem in conceiving a baby.  
Most of the students (males: 38.88%; females: 25%)  
stated that they have received their knowledge about  
infertility through the Internet and then friends (23.14%),  
books (16.66%), family (14.81%), university (6.47%) and  
media (5.54%) in male students. For females, other preferred  
sources were family and media (19.44% and 19.44%), book  
and friends (13.8% and 13.8%) and the university (8.28%).  
54.8% of male and 52.54% of female students suggested that  
courses or seminars about infertility and its causes are the  
best way for receiving knowledge, following by other  
methods, such as media and the Internet.  
39.81%; females: 38.98%; p>0.05). Females were more  
aware about the negative effects of sexually transmitted  
diseases on men’s (males: 39.25%; females: 48.28%) and  
women’s (males: 36.45%; females: 62.71%) fertility. In  
regard to female sexually transmitted infection (STI), the  
difference was significant (p=0.000).  
52.78% of males and 64.29% of females knew that  
infertility is not 100% curable. Preservation of fertility was  
important for a high number of males and females (males:  
Determining students’ knowledge, attitudes and beliefs  
about infertility contributes strongly to the design of  
educational programs associated with prevention of  
infertility, and also is highly beneficial to students’  
successful childbearing and quality of life. According to the  
current study, 65.14% of students knew the description of  
infertility, which is less than the results from the Quach et al.  
study (79.48%) (7); but their overall knowledge about the  
most fertile time in a woman’s menstrual cycle was low  
(27.02%). 67.86% of female students did not know the most  
fertile time in a woman’s menstrual cycle, which shows that  
female students are not sufficiently aware about the best time  
for intercourse in order to become pregnant. In a study by  
9
4.39%; females: 88.14%). Females were slightly more  
concerned about their ability to have children (males:  
2.86%; females: 57.63%), and women also said that if they  
4
found out that they were infertile, they would be upset,  
significantly more than males (males: 76.64%; females:  
87.93%; p=0.012). A high percentage of male and females  
said that they would be ashamed to ask questions about  
infertility (males: 64.81%; females: 69.49%). 95.37% of  
males and 89.83% of females would have liked to have had  
more knowledge about fertility preservation and infertility  
risk factors. 68.18% of male and 86.64% of female students  
175  
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2019, Volume 7, Issue 1, Pages: 171-178  
Rouchou and Forde (8), students were more aware about the  
most fertile time in a women’s menstrual cycle (43.7%), in  
comparison to our results (27.02%) (8). 60.2% of their  
participants knew the age of highest fertility potential in  
women.  
Overall 32% of students were aware about the age range  
of females in which fertility decreased but in another study  
the awareness of students about this subject was 11.9% (8).  
In our study, 59.6% of students knew that infertility is a  
disease, but in a study in Pakistan, 43.5% of the participants  
had the opinion that infertility is not a disease (9). Rouchou  
and Forde (8) found that only 6% of students know that  
infertility is a disease. The awareness of male students about  
the negative effect of advanced age on men’s fertility was  
significantly higher than that of females. The low knowledge  
about this factor may be related to the misconception that age  
does not affect fertility in men.  
The majority of students (94.74%) knew that both men  
and women could be responsible for infertility, which is  
consistent with the results of Rouchou and Forde (87.5%) (8)  
and the Quach et al. study (80%) (7). Ali et al. showed that  
only 50% of people correctly identified that both male and  
female are equally responsible for infertility and in the event  
of infertility, both should be examined (9). The difference  
between results may be due to different populations selected  
for study. Similar to our study, the Rouchou and Forde and  
Quach et al. studies (7-8) were of students, but in Ali’s study  
the population was people, not students. Therefore, it seems  
that students have higher knowledge or less prejudice about  
which partner is responsible for infertility.  
Female students were significantly more aware about the  
relationship between men’s and women’s genetics and  
infertility; but a study found no significant change regarding  
this awareness between males and females (8). Females were  
significantly more aware about the relationship between  
men’s and women’s genital tract infections and infertility.  
The overall awareness of students about men’s and women’s  
genital tract infection (63%) was similar to that of the  
Rouchou and Forde study (59%) (8). The overall awareness  
of male students about the relationship between irregular  
menstrual cycle and infertility was 51.77%, and female  
awareness was significantly higher than that of males. In a  
study, the awareness of males was higher than in our study  
secondary infertility, but in the Rouchou and Forde study  
there was no significant difference regarding secondary  
infertility (8). The awareness of students about the negative  
effects of smoking on women’s fertility (48.33%) was more  
than that of men’s (33.77%). This suggests that there is a  
perception among Iranian students that women are more  
susceptible to infertility than men. Despite the high amount  
of information through social media about the negative  
effects of smoking, students’ awareness is low, and it shows  
the inadequacy of students’ knowledge about such an  
important factor that directly affects fertility.  
More than 80% of students of our study were aware that  
abnormal sperm production and/or function and blocked  
fallopian tube lead to infertility. A similar finding was  
achieved in a study by Rouchou and Forde (8), but the  
awareness of our students about the effect of environmental  
factors on fertility was more than that in the Rouchou and  
Forde study (77% vs. 60%) (6). A study showed that Iranian  
college students do not have high awareness about the effect  
of environmental factors on fertility, and women’s awareness  
was higher than men’s (3). 60% of students had no  
knowledge about the negative effects of psychological stress  
on men’s and women’s fertility, and no difference was  
observed between male and female students, but in a study  
on Iranian students, female students had significantly more  
awareness about the negative effects of stress on fertility (3).  
Similar to other studies (7-8), almost half of the students in  
the present study did not know that STI could cause  
infertility in men. Female awareness about the effects of STI  
on women’s fertility was significantly higher than that of  
males. 58.5% of students knew that infertility is not 100%  
curable, which is higher than the results of Quach et al. study  
(40%) (7). 91.25% of students expressed that preservation of  
fertility was important to them. In the study by Quach et al.  
this percentage was lower, 69.7% (7).  
Females were more concerned about their ability to have  
children and significantly more upset if they found out that  
they are infertile, consistent with the results of the Quach et  
al. study (7). 67% of students expressed that they are  
ashamed to ask questions about infertility, but in the Quach  
study this was about 7% (7). This may be associated with a  
difference in cultural and social features.  
77.41% of students preferred to initially consult a  
gynecologist for the treatment of infertility, which is similar  
to the result of Ali et al. study (72%) (9). Results  
demonstrated that students receive their knowledge about  
infertility mostly through the Internet and most of them  
suggested that having courses or seminars about infertility  
and its causes is the best way to receive knowledge, which  
emphasizes the need to have university courses related to this  
topic. Our study demonstrated that there are gender-based  
differences in students’ knowledge, attitudes and beliefs.  
This may be related to the perception among Iranian students  
that women are more susceptible to infertility than men.  
Our results also revealed that the majority of students  
knew about some of the biological and lifestyle factors  
related to fertility, including that infertility is a problem for  
both men and women, the effects of genetics, abnormal  
sperm production and/or function, blocked fallopian tube and  
environmental factors. However, in some cases there are  
notable gaps in knowledge about fertility, such as the most  
(
58% vs. 34%), and there was no significant difference  
between male and females (8). Ali et al. showed that this  
awareness was 85% among the population they chose, which  
is higher than our results (9). Women were significantly  
more aware about the negative effects of underweight or  
overweight in women, which may be associated with their  
higher sensitivity to being balanced. About 80% of males  
were unaware about the negative effects of underweight or  
overweight on fertility in men and women. In the Quach et  
al. study, the awareness of male and female students about  
the negative effects of being underweight or overweight on  
fertility showed no significant difference (7).  
Females were significantly more aware of the negative  
effects of alcohol consumption by men on fertility, but in a  
study by Rouchou and Forde there was no significant  
difference between females and males regarding their  
awareness about the negative effects of alcohol consumption  
on fertility (8). Females were significantly more aware about  
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2019, Volume 7, Issue 1, Pages: 171-178  
fertile time in a women’s menstrual cycle, the age range with  
a marked decrease in a woman’s ability to become pregnant,  
and negative effects of a range of factors, including advanced  
age on men’s fertility, negative effects of genital tract  
infection, underweight or overweight, smoking, alcohol,  
psychological stress and sexually transmitted infection. The  
gaps in the knowledge of youth about infertility is also  
demonstrated in other studies (5-8, 25). Lack of adequate  
knowledge about prevention of infertility and reasons for  
infertility renders university students unable to adequately  
protect their fertility.  
Consequently, university students must be educated  
about infertility, thereby empowering their awareness about  
protecting their fertility. Doing so would be helpful to  
society, because most are young people in their childbearing  
years, who would transfer their knowledge to others. It  
would be beneficial to have a teaching module inserted into  
universities’ educational curricula that specifically addresses  
the topic of infertility. Effective education on infertility  
prevention can be accomplished through the media, schools,  
health care workers and government.  
4
Conclusion  
It is essential to manage educational programs and  
design new strategies regarding fertility protection in  
universities.  
Acknowledgments  
The authors would like to express their outmost gratitude  
for the financial support provided by Jami Institute of  
Technology for the culmination of this paper.  
Ethical issue  
Authors are aware of, and have complied with the best  
practice in publication ethics specifically with regard to  
authorship, dual submission, and manipulation of figures,  
competing interests and compliance with policies on  
research ethics. Authors have adhered to publication  
requirements that this submitted work is original and has not  
been published elsewhere in any form of language.  
Competing interests  
The authors wish to declare that there is no conflict of  
interest in this research work.  
The findings of this study could form the basis of further  
training for public health educators, health care professionals  
and government policymakers to manage educational  
programs and for investigators to design new strategies  
regarding fertility protection into future studies. These  
educational opportunities would not only increase the  
knowledge and awareness of people, but would also decrease  
the stigma attached to childlessness.  
Authors’ contribution  
All the authors of this study have completely contributed  
to the data collection, data analyses and manuscript writing.  
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