A nationwide cross-sectional study evaluating fertility knowledge, attitudes and parenting aspirations among undergraduate medical students in Pakistan.

Introduction: According to the WHO, infertility affects 17.5% of the global population. The trend of delaying parenthood, especially among highly educated individuals, has contributed to reduced fertility and a higher risk of pregnancy complications. Medical students, due to prolonged education and demanding careers, are at a higher risk of struggling to have children. Despite this, little research has been conducted on their fertility awareness. This study aims to assess fertility knowledge, attitudes, and parenting aspirations - such as goals and plans for future parenthood - among medical students across Pakistan, while also addressing the often-overlooked aspect of male fertility awareness, including factors like age-related fertility decline. Materials and methods: This descriptive cross-sectional study was conducted from July to December 2023, targeting medical students from various colleges across Pakistan. A sample size of 383 participants was determined using Raosoft software. Data was collected via an online questionnaire adapted from the validated Swedish Fertility Awareness Questionnaire. Results: The study included 384 participants from 63 medical institutes across Pakistan, comprising 145 men and 239 women enrolled in undergraduate medical programs. A high proportion of participants (93.1% males, 90.8% females) intend to have children, with 31% of men and 39.3% of women planning for three children. Approximately one-third (33.1%) of male participants preferred having their last child between 35 to 39 years, while about half (53.6%) of women preferred having their last child between 30 to 34 years. Many participants (98.6% men, 97.9% women) incorrectly perceive the age at which female fertility begins to decline as being later than it actually is. Knowledge about assisted reproductive technologies is limited, with only 10.3% of males and 20.5% of females understanding in-vitro fertilization. Factors influencing decisions to have children include partner support, stable relationships, and financial security. Conclusion: This study sheds light on fertility knowledge and aspirations among Pakistani medical students, revealing strong desires for parenthood and larger families. However, it exposes misconceptions about fertility and highlights the need for improved education and access to fertility services.