Perceptions of female-factor infertility risks among young adults in Ontario: a quantitative study

Perceptions of female factor infertility (FFI) risks may influence health-related awareness and behaviors, including timely recognition of fertility concerns and healthcare engagement. Although it is well-established that health risk perception is shaped by gender, age and race, FFI risk perception is less understood. The objective of this descriptive cross-sectional study was to evaluate Ontario post-secondary students’ perceptions across 16 FFI risk scenarios, and to identify sociodemographic characteristics and experiences independently associated with higher perceived risk. Ontario post-secondary students responded to a cross-sectional, online survey, informed by Sex and Gender-Based Analysis (SGBA+), between May and October 2022. In preliminary bivariate analyses, associations between sociodemographic characteristics and high FFI risk perceptions were evaluated across 16 scenarios. Sociodemographic characteristics significantly associated with high FFI risk perceptions, along with gender, were included as covariates in multiple linear regression models to further evaluate perceptions for selected well-established FFI factors. A gender- and sexually diverse sample ( n = 575) included 451 cis women, 52 cis men, 23 trans men, and 49 nonbinary respondents, with 21% identifying as racialized, and almost 50% as members of the Two-Spirit, lesbian, gay, bisexual, transgender, queer, intersex, and others (2SLGBTQI+) community. Respondents rated established FFI risk factors as ‘slight’ to ‘moderate’ risk, with age > 35y rated as ‘high risk’ by only 2.3% of respondents. In bivariate analyses, racialized respondents frequently rated substance use behaviors as high FFI risk, whereas 2SLGBTQI+ respondents reported lower perceived risk for age-related fertility declines and obesity. Relative to cis women, cis men rated alcohol consumption (B = 0.277, CI: 0.037, 0.518, p = 0.024) and cigarette smoking (B = 0.369, CI: 0.156, 0.582, p < 0.001) as higher FFI risks, while cis men (B=-0.279, CI: -0.505, -0.054, p = 0.015), nonbinary individuals (B=-0.245, CI: -0.473, -0.017, p = 0.035), and trans men (B=-0.413, CI: -0.727,-0.099, p = 0.01) rated untreated STI as lower FFI risk. Among the sociodemographic characteristics and experiences examined, gender, 2SLGBTQI + and racialized identities were most frequently associated with perceptions of age-related fertility declines and several established factors as FFI risks. These findings may reflect differences in reproductive health knowledge, awareness, and exposure to health risk information. Reproductive health communication strategies informed by intersectional perspectives are recommended to ensure infertility risks are conveyed in an inclusive, equitable manner.