Fertility awareness counseling reproductive healthcare provider practices and unmet patient needs

OBJECTIVE: To examine routine provision of fertility awareness counseling for reproductive-aged women by gynecologic healthcare providers. STUDY DESIGN: A 32-item REDCap electronic survey, disseminated through professional society listservs, assessed demographics, knowledge, attitudes, and practices relating to fertility counseling. Descriptive statistics and the Kruskal-Wallis test were utilized. RESULTS: A total of 117 physicians participated, 81.2% female, with median age 45.5 [38, 57] and 14.5 [5, 23] years in practice. The mean knowledge score (4.6±1.5 out of 10) did not vary by demographics. Respondents provide more counseling on contraception than fertility in nearly all age and relationship status groups (p<0.05), and less frequent fertility counseling to young single and lesbian women, and to lesbian women at peak reproductive age than to married heterosexual women (p<0.05). Gynecologic pathology more often prompted fertility counseling (endometrio-sis 79.5%, polycystic ovary syndrome 86.3%) than general medical issues (obesity 32.5%, cigarette use 40.2%) (p<0.05). Approximately a third (33.6%) felt uncomfortable providing fertility counseling, with time constraints being the top barrier (32.5%). CONCLUSION: We found gaps in fertility knowledge and more counseling on contraception than fertility. Patient relationship status, sexual orientation, and comorbidities influenced counseling rates, despite all women having reproductive potential. These findings suggest widespread missed opportunities for comprehensive fertility awareness counseling.