***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE To estimate the probability of medical consultation for infertility  during the course of a pregnancy attempt and to study its determinants . DESIGN Pregnancy-based retrospective telephone survey analyzed with a discrete time Cox model . SETTING Two rural counties in Brittany and Norm and y , France . PATIENT(S ) A r and om sample of 901 women from the general population aged 18 - 60 years reporting 1,460 pregnancy attempts result ing in a live birth between 1985 and 2000 ( participation rate , 73 % ) . INTERVENTION(S ) None . MAIN OUTCOME MEASURE(S ) Probability of medical consultation for involuntary infertility cumulated over time . RESULT ( S ) The cumulative probability of medical consultation for involuntary infertility among nulligravid women was 45 % after 12 months of involuntary infertility and 75 % after 24 months . The probability of medical consultation  at any time was half that for parous women ( odds ratio 0.4 , 95 % confidence interval 0.2 - 0.6 ) . More highly educated women were more likely to have sought medical help for infertility . Only 45 % of women who had sought medical advice received infertility treatment . CONCLUSION ( S ) Our survival approach provides a description of infertility service use during the course of a pregnancy attempt , and confirms that parity and educational level are strong predictors of medical help-seeking behaviors BACKGROUND Women age 35 and older account for an increasing proportion of births and are at increased risk of having difficulties conceiving and of delivering a multiple birth , low birth weight infant , and /or preterm infant . Little is known about men 's and women 's underst and ing of the maternal age related risks to pregnancy . OBJECTIVES 1 ) To determine the factors influencing the timing of childbearing for  non-parenting men and women , 2 ) to determine knowledge among non-parenting men and women about maternal age-related reproductive risks , the consequences of low birth weight and multiple birth , and issues related to infertility , and 3 ) to determine characteristics associated with limited knowledge of these reproductive risks . METHODS An age-stratified r and om sample of individuals , aged 20 - 45 years and without children , completed a computer-assisted telephone interview from two urban regions of Alberta , Canada ( 1006 women and 500 men ) . RESULTS Factors that influenced timing of childbearing for both men and women included : financial security ( 85.8 % ) and partner suitability to parent ( 80.2 % ) . Over 70 % of men and women recognized the direct relationship between older maternal age and conception difficulties . Less than half knew that advanced maternal age increased the risk of stillbirth , caesarean delivery , multiple birth and preterm delivery . CONCLUSIONS Poor underst and ing of the links between childbearing after age 35 , pregnancy complications and increased risk of adverse infant outcomes limits adults ' ability to make informed decisions about timing of childbearing Women of reproductive age have insufficient fertility knowledge and awareness . Reproductive lifespan and assisted reproduction are the primary areas in which awareness is lacking . Relatively simple interventions can be used to increase knowledge among university students ; however , no intervention has been tested to date in a population with more varied education levels . The aim of this study was to evaluate which intervention most improved fertility knowledge in women attending a fertility centre for oocyte donation . A r and omized controlled trial was conducted with three intervention groups : tailored , untailored and control . A question naire was administered on the day of the first consultation , and again at the oocyte retrieval . Two hundred and one women were enrolled and completed the pre-test , 109 started the cycle and 90 completed the post-test . The effect of the intervention was measured as the difference between the groups in their score from the pre-test to the post test . Only the tailored group showed a significant increase ( + 2.5 ; 95 % CI [ 1.8 , 3.3 ] ; P = 0.001 ) . Information relating to a woman 's most fertile age and limits for childbearing were the most useful . Tailored oral education , therefore , increases fertility knowledge in young women , particularly in relation to their fertility lifespan Objective Fertility declines as women age . Advancing maternal age increases pregnancy risks such as diabetes or hypertension . Studies suggest women are not aware of the risks of aging on fertility and pregnancy . The study objective was to assess women 's knowledge of fertility and reproductive outcomes affected by aging . Methods Prospect i ve IRB approved survey of women ( n=94 ) attending an obstetrics and gynecology ( OB/GYN ) clinic . Data collected included demographics , pregnancy history , and knowledge of age-related fertility decline and pregnancy risks . Statistical analysis performed using JMP Pro11.0 . Results Ages ranged from 18 to 67 . One third ( 30.5 % ) were aware fertility begins to decline at age 35 , however this varied among groups depending on prior history of infertility or requiring fertility treatment . Nulliparous women were more unaware of the health risks of pregnancy over age 35 ( 1.4 % vs 13.6 % , P 0.02 ) . African Americans ( AA ) women were less likely to think obesity ( 76 % Caucasian vs 47.8 % AA vs 66.7 % other , P < 0.05 ) and older age ( 88 % Caucasian vs 60.9 % AA vs 82.7 % other , P 0.02 ) affected fertility . Conclusion Knowledge regarding fertility and reproduction related to aging was variable and differed by age and race . Difficulty conceiving appears to be associated with higher knowledge levels . Public education will increase awareness of age-related fertility declines . Increased contact during pregnancy is an excellent opportunity to educate women in a nondirective way STUDY QUESTION What are the effects of fertility education on knowledge , childbearing desires and anxiety ? SUMMARY ANSWER Providing fertility information contributed to greater knowledge , but increased anxiety . WHAT IS KNOWN ALREADY Past studies have found that exposure to educational material improved fertility awareness and changed desires toward childbearing and its timing . Existing educational websites with evidence -based medical information provided in a non-judgmental manner have received favorable responses from reproductive-aged men and women . STUDY DESIGN , SIZE , DURATION This three-armed ( one intervention and two control groups ) , r and omized controlled trial was conducted using online social research panels ( SRPs ) in Japan in January 2015 . PARTICIPANTS / MATERIAL S , SETTING , METHODS A total of 1455 participants ( 726 men and 729 women ) between 20 and 39 years of age who hoped to have ( more ) children in the future were block-r and omized and exposed to one of three information brochures : fertility education ( intervention group ) , intake of folic acid during pregnancy ( control group 1 ) or governmental financial support for pregnancy and childbirth ( control group 2 ) . Fertility knowledge was measured with the Japanese version of the Cardiff Fertility Knowledge Scale ( CFKS-J ) . Knowledge , child-number and child-timing desires , subjective anxiety ( i.e. whether participants felt anxiety [ primary outcome ] ) , and scores on the State-Trait Anxiety Inventory were assessed immediately after exposure . Non-inferiority comparisons were performed on subjective anxiety with non-inferiority declared if the upper limit of the two-sided 95 % confidence interval ( CI ) for risk difference did not exceed a margin of 0.15 . This test for non-inferiority was only performed for subjective anxiety ; all the other variables were tests of superiority . MAIN RESULTS AND THE ROLE OF CHANCE Posttest scores on the CFKS-J ( mean , SD ) were higher in the intervention group than that of the control groups : intervention versus Control 1 and versus Control 2 : 52.8 ( 28.8 ) versus 40.9 ( 26.2 ) ( P < 0.001 ) versus 45.1 ( 27.1 ) ( P = 0.003 ) among men and 64.6 ( 26.0 ) versus 50.8 ( 26.9 ) ( P < 0.001 ) versus 53.0 ( 26.4 ) ( P < 0.001 ) among women . The percentage of participants who felt subjective anxiety after exposure to the intervention brochure was significantly higher than that of the control groups : intervention versus Control 1 and versus Control 2 : 32.6 versus 17.8 % ( risk difference [ RD ] = 0.149 , 95 % CI : 0.073–0.225 ) versus 14.5 % ( RD = 0.182 , 95 % CI : 0.108–0.256 ) among men , and 50.2 versus 26.3 % ( RD = 0.239 , 95 % CI : 0.155–0.322 ) versus 14.0 % ( RD = 0.362 , 95 % CI : 0.286–0.439 ) among women . Non-inferiority of the intervention was inconclusive ( i.e. the CI included 0.15 ) among men whereas inferiority was declared among women . The incidence of anxiety was higher in the intervention group than that of the control groups especially among men aged 30 and older and among women aged 25 and older . No difference existed in childbearing desires between groups after exposure . LIMITATIONS , REASONS FOR CAUTION The possibility of selection bias associated with the use of SRPs ( higher socioeconomic status and education ) and volunteer bias toward those more interested in fertility may limit the generalizability of these findings . WIDER IMPLICATION S OF THE FINDINGS In addition to education targeting a younger generation , psychological approaches are needed to alleviate possible anxiety caused by fertility information . STUDY FUNDING /COMPETING INTEREST(S ) This study was funded by National Center for Child Health and Development , Seiiku Medical Study Grant ( 24 - 6 ) , the Daiwa Foundation Small Grants and Grant-in-Aid for JSPS Fellows ( 26 - 1591 ) . No competing interest declared . TRIAL REGISTRATION NUMBER UMIN Clinical Trials Registry . Trial registration number , 000016168 . TRIAL REGISTRATION DATE 13 January 2015 . DATE OF FIRST PATIENT 'S ENROLMENT 15 January 2015 Abstract Background : An emerging pattern of increasing median age at first birth among women has been well documented in Western countries . A similar but less remarkable trend is being experienced in sub-Saharan Africa . There is a paucity of information in Sub-Saharan Africa about awareness of age-related fertility decline . The aim of this study was to assess the perception of fertility , childbirth intentions and parenting attitudes among university students . Material s and methods : A cross-sectional survey of 231 female and 158 male students r and omly selected university undergraduates in Nigeria using a self-reported question naire . Results : The respondents overestimated the ages of slight ( 92.1 % ) and marked decline ( 89.4 % ) in female fertility . The chance of pregnancy after unprotected sex during ovulation was overestimated by 93.1 % of the respondents . Over three-quarters of them overestimated the success rate of in-vitro fertilization . The sources of information regarding fertility issues were mainly school ( 40.1 % ) , the media ( 20.6 % ) and family members ( 18.8 % ) . About 98.7 % of the childless respondents reported an intention to have children in the future . The mean number of children desired was 3.29±1.14 . Females desire to have their first and last children earlier than males ( p=0.000 ) . The perceived potential obstacles to having the desired children were the pursuit of career aspirations ( 35.5 % ) and the pursuit of personal interests ( 20.8 % ) . Conclusions : Misconceptions about fertility issues have grave implication s for involuntary childlessness and secondary infertility . Comprehensive family planning education that will address the misconceptions about female fecundity and parenting issues are required OBJECTIVE To assess knowledge and attitudes about infertility through a survey . DESIGN Descriptive study with stratified r and om sampling . SETTING Eighteen high schools were selected in Toronto , Ontario , Canada . PATIENT(S ) Seven hundred seventy-two students participated in the study . The mean age of students was 17.5 + /- 0.98 years . Females were 49.02 % ( n = 377 ) of the sample . The sample was ethnically diverse , consisting of > 13 groups . INTERVENTION(S ) None . MAIN OUTCOME MEASURE(S ) The main outcome was infertility knowledge and attitudes . Secondary analysis compared gender and socioeconomic status . RESULT ( S ) The majority ( 608 ; 79 % ) of high school students were familiar with the term infertility ( 95 % confidence interval : 76 % , 82 % ) . More than 94 % did not know that chlamydia or gonorrhea could lead to infertility . Seventy percent felt that protecting their fertility was important to them , with significantly more females feeling this way . There was a higher proportion of students from schools with low socioeconomic status who gave incorrect answers to knowledge-related questions and were unaware of the association between sexually transmitted infections and infertility . CONCLUSION ( S ) Although the majority of students value their fertility , knowledge about prevent 
    Output:
    
The main results showed that participants report low-to-moderate FA .
Higher levels of FA were shown by women , highly educated individuals , people who reported difficulties with conceiving , and those who had planned their pregnancies .
Having or desiring to have children was not related to FA level .