Abstract
BACKGROUND: Medical students face unique challenges in balancing training and family planning, often delaying childbearing due to the rigorous demands of the medical curriculum. In general, female physicians have their first childbirth at an age higher than that of women in the general population, increasing their risk of fertility challenges. Despite awareness of these challenges, medical students often prioritize professional commitments hoping to rely on assisted reproductive technologies (ART) later. However, ART's success rates decline with age, and its success in older women often depends on the use of eggs harvested early and stored. A comprehensive understanding of ART will help medical students make informed decisions on childbearing. This study evaluated medical students' knowledge of ART and assessed their attitudes toward its use. METHODS: This study employed a survey research design to evaluate medical students' knowledge, awareness, and attitude toward ART. The custom-designed instrument was developed based on a review of relevant literature, informal interviews, and expert consultations and adapted from an earlier survey tool. The final questionnaire included three sections: nine demographic items, 15 knowledge items assessing understanding of various topics related to fertility and ART, and 17 attitude items evaluating views on various issues pertaining to ART. The survey also included open-ended text boxes for qualitative responses. Data were collected using an electronic survey administered through Qualtrics (Qualtrics International Inc., Seattle, WA, US) over eight weeks. Collected data were analyzed using SPSS version 30 (IBM Corp., Armonk, NY, US). Descriptive statistics summarized demographic characteristics, knowledge, and attitudes. Independent t-tests, ANOVA, and chi-squared statistics assessed differences across demographic categories. Thematic analysis of open-ended responses identified emerging themes. RESULTS: The study involved 113 medical students. The majority were first-year female students aged 25 years and older. Most participants (n = 106, 93%) did not have children but planned to have children in the future, particularly after residency. While participants demonstrated strong knowledge of ART, especially regarding the impact of age on fertility, most had an average understanding of birth control effects and the male partner's age on pregnancy outcomes. Knowledge about financial aspects, health risks, and long-term outcomes of ART-conceived children was comparatively lower. Attitudes toward ART were generally favorable, with strong support for egg and sperm donation and moderate interest in egg harvesting and freezing. There was considerable support for making in vitro fertilization (IVF) available to single women and same-sex couples, but a preference for limited federal funding for IVF and a moderate willingness to pay for it. In general, participants opposed the use of surrogate mothers by couples capable of carrying pregnancies and had divided views on the designation of frozen embryos as "children." CONCLUSIONS: Overall, this study revealed limited knowledge about ART among medical students, particularly regarding the financial and long-term implications of using ART. These results highlight the need for earlier integration of fertility and ART education into medical school curricula, which would better prepare students to make informed reproductive decisions.