Young adults underestimate infertility risks, Ontario survey finds

Many young adults in Ontario rate well-established causes of female-factor infertility as only slight to moderate risks, according to a cross-sectional survey of 575 post-secondary students published in BMC Public Health. The most striking gap involved age: although fertility decline after the mid-thirties is a well-documented phenomenon, only 2.3 percent of respondents rated being older than 35 as a high risk for female-factor infertility. The findings suggest that reproductive health risk communication may not be reaching young adults evenly, and that how risk is perceived depends strongly on gender, sexual orientation and racialized identity.

Respondents rated 16 scenarios covering established female-factor infertility risk factors, including age-related fertility decline, obesity, untreated sexually transmitted infections, alcohol consumption and cigarette smoking. The researchers first ran bivariate analyses linking sociodemographic characteristics to high-risk perceptions across all scenarios, then built multiple linear regression models for selected well-established factors, with gender included as a covariate. The sample was notably diverse.

It included 451 cisgender women, 52 cisgender men, 23 trans men and 49 nonbinary respondents. Twenty-one percent of participants identified as racialized, and nearly half identified as members of the Two-Spirit, lesbian, gay, bisexual, transgender, queer, intersex and other (2SLGBTQI+) community. Across the board, established risk factors were rated as slight to moderate rather than high, indicating limited recognition of how strongly these factors can affect fertility.

The regression models revealed systematic group differences. Relative to cisgender women, cisgender men rated alcohol consumption as a higher female-factor infertility risk (B = 0.277, 95% CI: 0.037 to 0.518, p = 0.024) and cigarette smoking as a higher risk still (B = 0.369, 95% CI: 0.156 to 0.582, p < 0.001). In contrast, cisgender men (B = -0.279, 95% CI: -0.505 to -0.054, p = 0.015), nonbinary individuals (B = -0.245, 95% CI: -0.473 to -0.017, p = 0.035) and trans men (B = -0.413, 95% CI: -0.727 to -0.099, p = 0.01) all rated untreated sexually transmitted infections as a lower risk than cisgender women did.

Bivariate analyses added a second layer of pattern. Racialized respondents more frequently rated substance use behaviors as high risks for female-factor infertility, while 2SLGBTQI+ respondents reported lower perceived risk for both age-related fertility decline and obesity. Taken together, the authors conclude that gender, 2SLGBTQI+ identity and racialized identity were the characteristics most frequently associated with perceptions of age-related fertility decline and several other established risk factors.

The researchers interpret these differences cautiously, suggesting they may reflect variation in reproductive health knowledge, awareness, and exposure to health risk information rather than differences in actual risk. If some groups systematically underestimate specific risks, they may also delay seeking information or care, although the study measured perceptions and associations, not downstream clinical outcomes. As a descriptive cross-sectional survey of students at a single point in time, the study captures perceptions rather than causes, and its sample of Ontario post-secondary students may not represent young adults more broadly.

The regression coefficients describe differences in perceived risk scores between groups, not differences in biological risk. Nevertheless, the consistency of the gender and identity patterns across multiple risk scenarios provides a quantitative basis for the authors' central recommendation: reproductive health communication strategies should be designed with intersectional perspectives in mind, so that infertility risks are conveyed in an inclusive and equitable manner to the diverse young audiences who need them.

Subject of Research: Young adults' perceptions of female-factor infertility risk factors in Ontario

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

Article References: Williams, B. K., Fernando, N. G., & Phillips, K. P. (2026). Perceptions of female-factor infertility risks among young adults in Ontario: a quantitative study. BMC Public Health. https://doi.org/10.1186/s12889-026-29687-x

Image Credits: AI Generated

DOI: 10.1186/s12889-026-29687-x

Keywords: infertility, risk perception, reproductive health, cross-sectional study, gender differences, 2SLGBTQI+, racialized identity, fertility awareness, Ontario, public health, survey research, health communication