Assessment of fertility knowledge and attitudes towards parenthood and fertility preservation among tertiary-educated youths in Singapore

BACKGROUND: Total fertility rates (TFRs) are declining globally, with Singapore among the lowest at 0.87 in 2025. To develop effective strategies that promote informed reproductive choices and improve fertility outcomes, it is essential to understand the evolving perspectives of tertiary-educated youths, who play a pivotal role in shaping the nation's future demographic trends. METHODS: A cross-sectional online survey was conducted among university undergraduates aged 18-25 in Singapore between August 3 and 17, 2023. The 45-item questionnaire assessed attitudes toward childbearing (3 items), fertility knowledge (22 items), and perceptions towards fertility assessment, treatment and preservation (11 items). Internal consistency of the questionnaire was good (Cronbach's alpha 0.87). Categorical variables were compared using chi-square or Fisher's exact tests, and continuous variables using independent t-tests. Multiple linear regression analyses were conducted to examine the association between demographic factors and desire for childbearing and fertility knowledge scores. RESULTS: Among 220 respondents (50.0% female), 62.3% desired biological children, with 52.6% preferring to conceive between ages 26-30. Childbearing considerations varied by age: education (75.0%) was prioritised at ages 21-25, career satisfaction (33.3%) at 26-30, and financial stability (50.0%) at 36-40. Demographic factors were not significantly associated with desire for childbearing. Although 62.7% reported confidence in their fertility knowledge, substantial misconceptions were observed regarding the impact of metabolic health on fertility (94.5%), age of fertility decline (71.8%), conception probabilities (74.5%), and the fertile window (54.1%). Although 74.1% were aware of elective egg freezing (EEF), 73.2% did not know how to access it. Students from healthcare-related faculties had higher fertility knowledge scores than those from non-healthcare faculties (β = 0.17, 95% CI: 0.28, 3.72). While 51.3% considered EEF, only 36.4% were open to in-vitro fertilisation (IVF). In a hypothetical subfertility scenario, 82.7% indicated they would seek help, primarily medical attention (68.6%), although 68.2% would not consider earlier childbearing. Interest in fertility testing (54.5%) and fertility interventions (60.0%) were high. CONCLUSIONS: Our study revealed a notable discrepancy between reproductive intentions, fertility knowledge, and prospective behaviours. Enhancing fertility education and access to assessments and preservation methods empowers individuals to make informed reproductive choices aligned with biological realities, thereby supporting long-term fertility outcomes.