Young adult's views on using a poster to learn about fertility: redesigning the fertility education poster.

Fertility awareness should be taught to everyone. The International Reproductive Health Education Collaboration (IRHEC) designed a fertility poster in 2019 but did not have a specific target group in mind. Studies have been conducted in Denmark and Sweden to determine how the poster can be redesigned. In this study, we carried out focus groups with young adults in the UK to ask their views of the poster, with the aim of redesigning it. Six focus groups were undertaken with twenty seven, 18-25 year olds. Five questions were asked: 1. What are your thoughts, feelings, and reactions to the poster? 2. Did you learn anything from the poster? 3. How has reading the poster impacted your opinions or thoughts about having children? 4. What are your opinions about using a poster format to inform and start reflections regarding family building? 5. Reading through each point are there any changes to be made? Content analysis was performed. Themes identified revealed the information on the poster gave the participants some anxiety and apprehension, especially regarding the effect of age on fertility, perceptions of IVF, and gaps in knowledge. The fertility education poster is a good resource for education, but other resources should be developed.

Parenthood intentions of 16-18-year-olds in England: a survey of school students.

There is a need to understand teenagers' views towards having children to better tailor sexuality and reproductive health education. We conducted a survey of parenthood intentions for 16-18-year-old students. The survey was anonymous, contained open-ended and multiple-choice questions and was live from 10 May 2021 to 18 July 2022. The sample size was n = 931. Quantitative data were analysed descriptively and using chi-squared tests; qualitative data were analysed thematically. The majority of students (64%) indicated they wanted to have children in the future, with 49% desiring to have two children. Students who opted against having children cited the turbulent state of the world, concerns about parenthood, and, for many females, negative associations to pregnancy and childbirth. Many students felt concern about the possibility of having children in the future (45%), expressing concerns about their ability to have healthy children and worries about the lives their children might lead. Six themes were identified in their responses to the question 'What are your concerns about the possibility of having children in the future?': Fears; Self-doubt; Health and wellbeing; Big investment; Hinderance to personal aspirations; and Non-inclusive LGBTQ+ education. We conclude by making recommendations as to how school reproductive health and sex education might be improved.

Experiences of users of period tracking apps: which app, frequency of use, data input and output and attitudes.

RESEARCH QUESTION: What are the experiences of users of period tracking apps in relation to which apps they use, their frequency of use, the type of data and their attitudes to period tracking apps? DESIGN: This was an observational mixed-methods study using an online survey designed using Qualtrics XM. The survey included 50 open-ended and multiple choice questions, but only specific questions were analysed in this study. The survey was promoted via social media for 22 days between 30 June and 21 July 2021. RESULTS: Of the 375 total participants, 326 responses were complete and included in analysis. In the results section further down, this is explained as 330 complete responses, with 4 additional responses excluded due to data inconsistencies. The participants' age range was 14-54 years, with a mean of 26.0 (±7.81) years. Most participants (61.9%) had been using a period tracking app for 2 years or longer. Of these 85.6% entered more data when on their period, 31% at a frequency of once a day. There were approximately equivalent proportions of participants who felt that entering data into their app was either 'part of their normal routine' (43.3%) or 'not a priority' (38.0%). Thematic analysis of the participants' experiences of using period-tracking apps revealed five main themes: symptom tracking and understanding general health; concerns with period start date predictions; the problems with fertility tracking; concerns about cost; and concerns about data privacy. CONCLUSIONS: The infrequency of data inputting and the wide range of symptoms tracked reflects the differing needs of participants from their period-tracking apps. This highlights the need for increased education and research into understanding the realities of variations in using apps.

How do women feel cold water swimming affects their menstrual and perimenopausal symptoms?

OBJECTIVE: This study aimed to determine how women felt cold water swimming affected their menstrual and perimenopausal symptoms. STUDY DESIGN: An online survey that asked women who regularly swim in cold water about their experiences. The survey was advertised for 2 months on social media. Questions related to cold water swimming habits and menstrual and perimenopausal symptoms were analysed. MAIN OUTCOME MEASURES: Quantitative and qualitative data including; frequency of menstrual and menopause symptoms, the effect of cold water swimming on these symptoms. RESULTS: 1114 women completed the survey. Women reported that cold water swimming reduced their menstrual symptoms, notably psychological symptoms such as anxiety (46.7%), mood swings (37.7%) and irritability (37.6%). Perimenopausal women reported a significant improvement in anxiety (46.9%), mood swings (34.5%), low mood (31.1%) and hot flushes (30.3%). The majority of women with symptoms swam specifically to reduce these symptoms (56.4% for period and 63.3% for perimenopause symptoms). Women said they felt it was the physical and mental effects of the cold water that helped their symptoms. For the free text question, five themes were identified: the calming and mood-boosting effect of the water, companionship and community, period improvements, an improvement in hot flushes and an overall health improvement. CONCLUSION: Women felt that cold water swimming had a positive overall effect on menstrual and perimenopause symptoms. Studies on other forms of exercise to relieve menstrual and perimenopause symptoms may show similar findings.

Perimenopausal women's voices: How does their period at the end of reproductive life affect wellbeing?

OBJECTIVE: To explore perimenopausal women's feelings towards their periods, the impact on their wellbeing and how we can support them. STUDY DESIGN: Participants were recruited for focus groups through social media advertisements. In 6 online focus groups, 31 perimenopausal women aged 40-55 living in the UK were asked 5 questions relating to periods and perimenopause, support and education. MAIN OUTCOME MEASURES: Content analysis. RESULTS: When asked How do you feel about having a period? The participants often related back to the stress of menarche and said their period negatively impacted their wellbeing their whole lives. During perimenopause, their periods had become unpredictable, heavy, and a debilitating disruption to their lives. The women desired support at work through policy, and from family and friends. They believed that educating girls and boys during school was the best place to start, but that education through work and community groups was also needed. They felt healthcare professionals should have mandatory training regarding women's health issues and menopause. CONCLUSION: The study highlights the impact of menstrual experiences on the wellbeing of perimenopausal women, emphasising the need for improved menstrual education from an early age. Comprehensive menstrual education in schools involving both genders to enable informed decision-making and improved training for healthcare professionals are recommended. Support networks for perimenopausal women will promote better quality of life for women as they go through their perimenopause journey.

Women's knowledge and attitudes to the menopause: a comparison of women over 40 who were in the perimenopause, post menopause and those not in the peri or post menopause.

OBJECTIVES: To evaluate women's knowledge and attitudes towards the menopause by comparing three groups of women: perimenopause, post menopause and those women not in either the peri or post menopause (other). METHODS: A 35 question online survey was advertised on social media to evaluate women's attitudes and knowledge of the menopause. Three groups of women were compared: perimenopause, post menopause and those women not in either the peri or post menopause (other). RESULTS: Most women were completely uninformed or only had some knowledge of the menopause before the age of 40. Most women thought that the menopause should be taught at school, but over 80% had received no menopause education at school themselves. The most popular sources of menopause information were independent websites and friends. Perimenopausal women were significantly more likely than postmenopausal women to use online resources for menopause information. The perimenopausal and postmenopausal groups had more positive attitudes towards the menopause than the other group. 57.5% of postmenopausal women found the menopause difficult or very difficult. Most women were happy about no longer menstruating, although some expressed sadness regarding fertility loss. CONCLUSIONS: Most women had limited knowledge and negative attitudes towards the menopause, leaving them unprepared to cope with the physical and psychological changes associated with this stage of life. Improved menopause education is required to improve quality of life during the menopausal transition and a most positive narrative of life postmenopause.

An online survey of postmenopausal women to determine their attitudes and knowledge of the menopause.

OBJECTIVE: To explore postmenopausal women's attitudes and knowledge of the menopause. STUDY DESIGN: An online survey to evaluate women's attitudes and knowledge of the menopause, promoted via social media. In this study, only the data from 829 women who identified as postmenopausal were analysed. MAIN OUTCOME MEASURES: Quantitative and qualitative data. RESULTS: Regarding women's attitudes towards the menopause before they went through it, 18.0% were accepting of it, 15.8% were dreading it and 5.1% were looking forward to it. 38.1% of women felt that the menopause was difficult, 24.6% felt it was very difficult and 20.7% felt it was fine. 94.1% of women had never been taught about the menopause at school, and 49.0% did not feel informed at all about the menopause. More than 60% started looking for information regarding menopause as their symptoms started. The qualitative thematic analysis of the participants' responses produced six themes: the need for education, knowledge and understanding of symptoms, why is getting treatment so difficult, feelings and attitudes towards the menopause, the impact of menopause on a woman's life, the importance of the media - are they getting it right. CONCLUSION: Women's lack of education and their healthcare professionals' lack of adequate training on the menopause means that women enter this critical life stage uneducated and unsupported. It is vital that everyone is taught about the menopause and that general practitioners receive proper training. The negative narrative of menopause needs to be re-addressed to normalise the menopause and give postmenopause women hope.

Menopause knowledge and education in women under 40: Results from an online survey.

BACKGROUND: All women experience the menopause, yet education around the topic is limited. Studies conducted in women aged over 40 show that women have limited knowledge about the menopause. OBJECTIVES: This study aims to understand what women under 40 know about the menopause, how they have acquired this knowledge and where they think menopause education should be taught. This data will help to determine how to effectively deliver menopause education. DESIGN: A survey was designed that asked women under 40 what they know of, and their attitudes to, the menopause, using Qualtrics XM software. METHODS: The survey was advertised for 5 weeks on social media. Six questions related to menopause education were analysed. Responses between age groups under 20, 21-30 and over 30 were compared using a chi-square test. A thematic-style analysis was also conducted on a free-text question where answers referred to education. RESULTS: A total of 738 women's responses were included in the analysis; over 80% had no knowledge or just some knowledge of the menopause. Women over 30 used official websites (p = 0.017) and scientific literature (p = 0.047) significantly more than other age groups to learn about the menopause, while women under 20 were more likely to learn from family members (p = 0.002). These women felt education should start in schools. CONCLUSION: Many women under 40 have limited education of the menopause. Women under 20 are more passive in their approach to learning about the menopause compared with those over 30, who are more proactive. Menopause education strategies must start at school and extend beyond schools adopting a multifaceted approach; it is recommended that the workplace, social media and public health campaigns are used to deliver menopause education moving forward.

An online survey of UK women's attitudes to having children, the age they want children and the effect of the COVID-19 pandemic.

STUDY QUESTION: What are women's views on having children, including the age they want to have them and other influences such as the coronavirus disease 2019 (COVID-19) pandemic? SUMMARY ANSWER: Women's views on having children, at their preferred age of 30 years, included their maternal urge and concerns about their biological clock and stability, while 19% said COVID-19 had affected their views. WHAT IS KNOWN ALREADY: Women globally are delaying the birth of their first child, with the average age of first birth approaching 32 years in some countries. The average age women have their first child in the UK is 30.7 years and over 50% of women aged 30 years are childless. The fertility rate stands at 1.3 in several European Union countries. Some people are not having their desired family size or are childless by circumstance. It is essential to understand people's attitudes to having children in different countries to identify trends so we can develop educational resources in an age-appropriate manner. STUDY DESIGN, SIZE, DURATION: We conducted an anonymous, online survey of multiple choice and open-ended questions. The survey was live for 32 days from 15 May 2020 to 16 June 2020 and was promoted using social media. PARTICIPANTS/MATERIALS, SETTING, METHODS: A total of 887 women from 44 countries participated in the survey. After filtering out women who did not consent, gave blank or incomplete responses, and those not in the UK, 411 responses remained. From the data, three areas of questioning were analysed: their views on having children, the ideal age they want to have children and the effects of the COVID-19 pandemic. Qualitative data were analysed by thematic analysis. MAIN RESULTS AND THE ROLE OF CHANCE: The average age (±SD) of the women who completed the survey was 32.2 years (±5.9), and they were mainly heterosexual (90.8%) and 84.8% had a university education. One-third of women were married/in a civil partnership (37.7%) and 36.0% were cohabitating. In relation to their views on having children, the main themes identified were: the maternal urge, the ticking of the biological clock, why did no one teach us this?, the need for stability and balance in their life, pressure to start a family and considering other ways to have a family. When asked 'In an ideal world, at what age approximately would you like to have had or have children?' a normal distribution was observed with a mean age of 29.9 (±3.3) years. When asked 'What factors have led you to decide on that particular age?' the most frequent choice was 'I am developing my career'. Three themes emerged from the qualitative question on why they chose that age: the need for stability and balance in their life, the importance of finding the right time and life experiences. The majority of women felt that the COVID-19 pandemic had not affected their decision to have children (72.3%), but 19.1% said it had. The qualitative comments showed they had concerns about instability in their life, such as finances and careers, and delays in fertility treatment. LIMITATIONS, REASONS FOR CAUTION: The survey was promoted on social media only and the women who answered the survey were highly educated. WIDER IMPLICATIONS OF THE FINDINGS: The women surveyed ideally want children at age 30 years but there are obstacles in their way, such as the need to develop their career. Global tailored fertility education is essential to ensure people make informed reproductive choices. In addition, it is essential for supportive working environments and affordable childcare to be in place in every country. STUDY FUNDING/COMPETING INTEREST(S): J.C.H. is founder of www.globalwomenconnected.com and Reproductive Health at Work, and author of the book Your Fertile Years. This project was funded by the Institute for Women's Health, UCL. TRIAL REGISTRATION NUMBER: N/A.

An online survey of perimenopausal women to determine their attitudes and knowledge of the menopause.

INTRODUCTION: Women are not usually taught about the menopause formally, and many general practitioners have relatively little training. The aim of this study was to explore perimenopausal women's attitudes and knowledge of the menopause. METHOD: An online survey was designed to evaluate attitudes and knowledge of the menopause in women older than 40 years. The survey was generated with Qualtrics XM® and promoted via social media. In all, 3150 women started the survey. In this study, data from 947 perimenopausal women were analysed. RESULTS: Regarding women's attitudes to the menopause, 38.8% were accepting of it but more than 30% were dreading it. The women had experienced a number of menopause symptoms including mood swings (68.9%), brain fog (68.3%), and fatigue (66.8%). More than 90% of women had never been taught about the menopause at school, and more than 60% did not feel informed at all about the menopause. School was thought to be the best place for menopause education to start (83.6%). In all, 68.2% of women had only looked for information about the menopause as their symptoms started and they had talked to friends and used a variety of websites to look for information. When asked for their free-text views on the menopause, thematic analysis produced four themes: the overarching knowledge gap, the onset and impact of symptoms, perimenopause: the hidden phenomenon, and managing symptoms: differing schools of thought. CONCLUSION: Lack of education for women and their general practitioners is causing perimenopausal women to go through this important stage in their lives with a lack of knowledge and appropriate medical care. It is essential that women are taught about the menopause, from school onwards and that we offer health professionals appropriate training starting from the medical school curriculum.

Passion, pressure and pragmatism: how fertility clinic medical directors view IVF add-ons.

RESEARCH QUESTION: What are the views of the medical directors of fertility clinics on IVF add-ons? DESIGN: A total of 93 UK clinics were emailed with an invitation for their medical director to participate. Ten IVF clinic medical directors were interviewed to discuss their views on the use of IVF add-ons. Some of the interviewees were medical directors of an IVF clinic with multiple branches across the UK, meaning the total number of clinics accounted for in this study was 35 out of the 93 contacted. Thematic analysis was used to analyse the data. RESULTS: The participants consisted of seven males and three females, with six from solely private clinics and four with NHS and private patients. Four themes were identified: clinical decision-making and the patient-doctor relationship; regulations and the add-on traffic light system; research and evidence; and commercialization and financialization of the IVF sector. CONCLUSIONS: UK IVF medical directors had a wide variety of views and experienced different pressures to offer IVF add-ons. The add-on discussion touches on core aspects of professional identity and the meaning of medical practice. The add-on debate points to broader changes in the organization of the IVF sector, which affect key aspects of practising (reproductive) medicine, including the patient-doctor relationship and responsibility for clinical decision-making, and the relationship between regulator and IVF clinic and between scientific evidence and clinical practice.

A survey of women's experiences of using period tracker applications: Attitudes, ovulation prediction and how the accuracy of the app in predicting period start dates affects their feelings and behaviours.

INTRODUCTION: Using an online survey, the aim of this study was to ask women about their real-life experiences of using period tracker apps, their attitudes towards using their app, the information the app provided regarding ovulation and how the accuracy of the app in predicting period start dates affects their feelings and behaviours if their period comes earlier or later than predicted. METHODS: This mixed-methods observational study was conducted by an online survey of 50 multiple-choice and open-ended questions. The survey was generated with Qualtrics XM® and promoted via social media. It was open to any person who had used a period tracker. RESULTS: From 375 total responses, 330 complete responses were obtained, giving a completion rate of 88.0%. Respondents were aged between 14 and 54, with a mean age of 26.0 (±7.81). When asked what was the best thing about using the app, 29.7% (98/330) of respondents selected 'To know when I'm ovulating'. Respondents were asked if their period ever started earlier than the app predicted; 54.9% (189/330) said it had and 72.1% (238/330) said it had started later than predicted. When asked how they felt if their period arrived earlier or later than expected, thematic analysis of periods starting earlier revealed four themes: feeling unaffected, being frustrated/unprepared, feeling anxious/stressed and feeling confused/intrigued. Thematic analysis when their period arrived later revealed six themes: anxious/concerned about pregnancy, disappointed about pregnancy, seeking advice/informing healthcare professionals, thoughts about menopause, feeling unaffected and being better prepared. CONCLUSION: Period trackers need to be clearer on their intended use and reliability, especially for period due date and ovulation. Qualitative analysis shows the impact of inaccurate predictions on aspects of the users' health. This study calls for period tracker app companies to update their apps to provide transparency to their users about their intended use and capabilities.

Telling donor-conceived children about their conception: Evaluation of the use of the Donor Conception Network children's books.

If parents have used donated gametes, it is a personal choice whether they disclose to their children. For those that do, there is, however, little advice on how to tell their children. The Donor Conception Network (DCN) has made a series of books to help parents disclose. This study evaluated parents' experience of using these books. An online survey with both quantitative and qualitative questions was used. The DCN membership and social media were used to publicize the survey, and 108 responses were analysed. At the time of conception, the parents' family types were mainly mother and father (56.5%) and solo mothers (36.1%). The method of conception was mainly donor spermatozoa (55.6%) followed by donor egg (38.0%), double donation (8.3%) and one case of surrogacy. Most parents had read the book to their children before 2 years of age (76.9%). Before reading the books, some of the parents had some confidence in telling (43.5%) or were very confident in telling (30.6%). After reading the books, 60.2% reported having much more confidence in telling. Most parents felt their children had no understanding (76.8%) or only some understanding (22.3%) of donor conception before reading the books. After reading the books most parents felt their children's understanding had increased (71.3%). Most parents felt that reading the books had given them more confidence in using donor conception language (90.7%). The use of books to tell children about their conception may be a useful resource for parents wishing to be open with their children.

Period tracker applications: What menstrual cycle information are they giving women?

BACKGROUND: Period tracking applications (apps) allow women to track their menstrual cycles and receive a prediction for their period dates. The majority of apps also provide predictions of ovulation day and the fertile window. Research indicates apps are basing predictions on assuming women undergo a textbook 28-day cycle with ovulation occurring on day 14 and a fertile window between days 10 and 16. OBJECTIVE: To determine how the information period tracker apps give women on their period dates, ovulation day and fertile window compares to expected results from big data. METHODS: Five women's profiles for 6 menstrual cycles were created and entered into 10 apps. Cycle length and ovulation day for the sixth cycle were Woman 1-Constant 28 day cycle length, ovulation day 16; Woman 2-Average 23 day cycle length, ovulation day 13; Woman 3-Average 28 day cycle length, ovulation day 17; Woman 4-Average 33 day cycle length, ovulation day 20; and Woman 5-Irregular, average 31 day cycle length, ovulation day 14. RESULTS: The 10 period tracker apps examined gave conflicting information on period dates, ovulation day and the fertile window. For cycle length, the apps all predicted woman 1's cycles correctly but for women 2-5, the apps predicted 0 to 8 days shorter or longer than expected. For day of ovulation, for women 1-4, of the 36 predictions, 3 (8%) were exactly correct, 9 predicted 1 day too early (25%) and 67% of predictions were 2-9 days early. For woman 5, most of the apps predicted a later day of ovulation. CONCLUSION: Period tracker apps should ensure they only give women accurate information, especially for the day of ovulation and the fertile window which can only be predicted if using a marker of ovulation, such as basal body temperature, ovulation sticks or cervical mucus.

Analysis of fertility clinic marketing of complementary therapy add-ons.

Complementary therapies are often used during in-vitro fertilization (IVF) treatment. The aim of this study was to determine how UK fertility clinic websites are advertising complementary therapy add-ons. The Human Fertilisation and Embryology Authority's (HFEA) 'Choose a Fertility Clinic' website was used to identify fertility clinics and their websites. Acupuncture, reflexology, nutritional advice and miscellaneous complementary therapies were examined to determine treatment provision and costs. Treatment claims for acupuncture and reflexology were analysed using an inductive coding approach, and categorized depending on whether they pertained to holistic benefits, physiological benefits or improvements to IVF treatment outcome. At least one complementary therapy was advertised by 17 of 66 (26%) websites. Acupuncture was the most commonly advertised complementary therapy (16/66 clinic websites, 24%), followed by nutritionist services (11/66, 17%), reflexology (10/66, 15%) and other miscellaneous complementary therapies (9/66, 14%). Treatment costs were found to range from less than £50 for individual appointments to hundreds of pounds for treatment packages. Treatments were not always offered in-house at the fertility clinic, but rather patients were referred to an affiliated practitioner. Analysing claims relating to the complementary therapies highlighted that there were differences in the extent to which clinics claimed that complementary therapies benefited IVF, and that information occasionally acknowledged scientific research evidence but did not always present resources in an unbiased manner. Fertility clinic websites should provide accurate information for patients for complementary therapy add-ons. HFEA should add acupuncture and reflexology to their traffic-light system with amber and red ratings, respectively.

The use of expanded carrier screening of gamete donors.

STUDY QUESTION: What are the sperm and egg donor rejection rates after expanded carrier screening (ECS)? SUMMARY ANSWER: Using an ECS panel looking at 46/47 genes, 17.6% of donors were rejected. WHAT IS KNOWN ALREADY: The use of ECS is becoming commonplace in assisted reproductive technology, including testing of egg and sperm donors. Most national guidelines recommend rejection of donors if they are carriers of a genetic disease. If the use of ECS increases, there will be a decline in the number of donors available. STUDY DESIGN, SIZE, DURATION: A review of the current preconception ECS panels available to donors was carried out through an online search. The genetic testing results of donors from Cryos International were analysed to determine how many were rejected on the basis of the ECS. PARTICIPANTS/MATERIALS, SETTING, METHODS: Data on gamete donors and their carrier status was provided by Cryos International, who screen donors using their own bespoke ECS panel. The ECS panels identified through the review were compared to the Cryos International panel and data. MAIN RESULTS AND THE ROLE OF CHANCE: A total of 16 companies and 42 associated ECS panels were reviewed. There were a total of 2673 unique disorders covered by the panels examined, with a mean of 329 disorders screened. None of these disorders were common to all panels. Cryos International screen 46 disorders in males and 47 in females. From 883 candidate donors, 17.6% (155/883) were rejected based on their ECS result. Carriers of alpha-thalassaemia represented the largest proportion of those rejected (19.4%, 30/155), then spinal muscular atrophy (15.5%, 24/155) and cystic fibrosis (14.8%, 23/155). LIMITATIONS, REASONS FOR CAUTION: Panel information was found on company websites and may not have been accurate. WIDER IMPLICATIONS OF THE FINDINGS: This study highlights the need for consistent EU regulations and guidelines that allow genetic matching of gamete donors to their recipients, preventing the need to reject donors who are known carriers. A larger ECS panel would be most beneficial; however, this would not be viable without matching of donors and recipients. STUDY FUNDING/COMPETING INTEREST(S): No specific funding was obtained. J.C.H. is the founder of Global Women Connected, a platform to discuss women's health issues and the Embryology and PGD Academy, who deliver education in clinical embryology. She has been paid to give a lecture by Cryos in 2019. A-B.S. is an employee of Cryos International. TRIAL REGISTRATION NUMBER: N/A.

Childless by circumstance - Using an online survey to explore the experiences of childless women who had wanted children.

Childlessness is increasing globally. This study aimed to explore the experiences of childless women who had wanted children. An online survey study was promoted through social media to recruit women aged ≥46 years who were childless by circumstance. The survey remained open for 15 days. In total, 303 survey responses were collected, 176 of which were complete surveys. In total, 15.3% (27/176) of women who had wanted children reported that they had not tried to have children, most commonly due to the lack of a partner (40.7%, 11/27). Of the 139 women who had tried to have children, 70.5% (98/139) had used calendar-based menstrual cycle tracking methods to identify their fertile window, and many had undergone fertility checks including hormone tests (75.5%, 105/139) and ultrasound scans (71.2%, 99/139). A significant proportion of women had experienced a miscarriage (40.2%, 56/139). Many women had decided not to have any fertility treatment (43.2%, 60/139). For those who did, the majority had tried in-vitro fertilization (74.6%, 59/79). The most common reason that women gave for stopping fertility treatment was due to emotional reasons (74.7%, 59/79). When asked how women felt now about their childlessness, the most common issues identified were unhappiness (85/158, 54%), acceptance (43/158, 27%) and happiness (30/158, 19%). There should be more support for unsuccessful fertility patients and other childless women, and more emphasis should be placed upon fertility education in order to ensure that women are better informed about fertility issues.

Feasibility and acceptability of theatrical and visual art to deliver fertility education to young adults.

The Fertility Education Initiative was established in 2016 to provide education on fertility, modern families and reproductive science for young adults, teachers, health professionals, parents and adults. We report on our study to determine the feasibility and acceptability of using the arts to delivery fertility education in schools. The evaluation was mixed methods: (i) two focus groups with young people aged 14-16 and 16-18 were conducted to investigate attitudes to fertility awareness; and (ii) seventeen 16-22 year olds were divided into two groups and each undertook a day of art workshops that consisted of two visual and two theatrical workshops and then completed questionnaires at the end of each workshop and at the end of the day. The artists were interviewed using a semi-structured interview. Young adults confirmed they were interested in learning about fertility, but current understanding varied. The majority thought that fertility education should be delivered in schools at ages 16-18. During the art workshops they learnt some facts but asked for more science and discussion. They felt using art was powerful and they wanted to hear the artists personal stories. Tools using a number of platforms need to be developed that can be taken into schools nationally and evaluated for their engagement.

Do fertility tracking applications offer women useful information about their fertile window?

RESEARCH QUESTION: To characterize mobile fertility tracking applications (apps) to determine the use of such apps for women trying to conceive by identifying the fertile window. DESIGN: An exploratory cross-sectional audit study was conducted of fertility tracking applications. Ninety out of a possible total 200 apps were included for full review. The main outcome measures were the underlying app method for predicting ovulation, the fertile window, or both, price to download and use the app, disclaimers and cautions, information and features provided and tracked, and app marketing strategies. RESULTS: All the apps except one monitored the women's menstrual cycle dates. Most apps only tracked menstrual cycle dates (n = 49 [54.4%]). The remainder tracked at least one fertility-based awareness method (basal body temperature, cervical mucus, LH) (n = 41 [45.6%]). Twenty-five apps measured dates, basal body temperature, LH and cervical mucus (27.8%). Seventy-six per cent of apps were free to download with free apps having more desirable features, tracking more measures and having more and better quality educational insights than paid apps. Seventy per cent of apps were classified as feminine apps, 41% of which were pink in colour. CONCLUSIONS: Mobile fertility tracking apps are heterogenous in their underlying methods of predicting fertile days, the price to obtain full app functionality, and in content and design. Unreliable calendar apps remain the most commonly available fertility apps on the market. The unregulated nature of fertility apps is a concern that could be addressed by app regulating bodies. The possible benefit of using fertility apps to reduce time to pregnancy needs to be evaluated.