This randomized controlled trial done in Sweden assessed whether the fertility awareness counseling tool known as Reproductive Life Plan (RLP) could increase men’s fertility awareness. The authors sought to address the limited awareness many people have about the factors that affect their fertility. They noted this lack of fertility awareness was especially problematic for men, at least partly due to the general paucity of attention directed at men’s reproductive health both in terms of education and research.
The Reproductive Life Plan provides a structured format for people to consider whether or not they are interested in having children in the future. It is intended to motivate individuals to reflect on their reproductive goals and create a plan to achieve them. Additionally, it creates the setting for a conversation with a health care professional, during which patients can discuss factors that affect their fertility. RLP-based counseling has been shown to have positive results with women. However, prior to this research, it had not yet been studied in men.
This trial included 201 men ages 18-50 who visited one of two sexual health clinics in Sweden for sexually transmitted infection (STI) testing. All 201 men received the care and STI testing for which they presented to the clinic. Additionally, 101 of them (the intervention group) received oral and written RLP-based information about fertility and lifestyle factors that can affect fertility. The RLP-based counseling was carried out by nurse midwives who, in Sweden, are responsible for much of the sexual and reproductive health care for healthy young adults.
During the RLP-counseling session, the nurse midwives consulted a list of fertility facts as a guideline and checked off any topics that were discussed. Furthermore, they emphasized relevant fertility information and lifestyle recommendations based on a predetermined checklist. After the counseling session, participants were sent home with a brochure about male fertility and lifestyle.
The authors assessed any change in the men’s fertility awareness by administering a questionnaire before the intervention, and comparing the results via a telephone survey administered three months later. The initial questionnaire included general background questions, six open-ended questions about reproduction, and two open-ended questions about lifestyle factors relevant to fertility. The questions sought to assess the participants’ general knowledge about male fertility and reproduction. As an example, one question stated, “How long does sperm usually survive in the uterus/fallopian tubes after intercourse?”
The follow-up phone survey occurred three months after the RLP-counseling session, and the participants were asked the same knowledge questions as they had during the initial assessment. All the answers were given a score of 0-2 points based on a correction template, with the maximum possible total score being 12 points.
In terms of participant characteristics, many had STI’s (75% had Chlamydia), one out of three (33%) had been involved in at least one pregnancy, and most of those resulted in induced abortions. 71% of participants wanted children in the future and, for the intervention group, the number of men who stated they wanted children increased from 58% before the intervention to 76% at follow-up.
Regarding the six general fertility questions, men in the intervention group increased their average score from 4.6 to 5.5, whereas there was no improvement in the control group. Regarding the two questions about lifestyle factors, men in the intervention group increased their average number of accurate lifestyle factors listed from 3.6 to 4.4, while the control group had no improvement.
As for feedback received about the RLP-counseling, some participants suggested a mobile application would be helpful. Three out of four participants (75%) noted they would likely make a pre-conception lifestyle adjustment if planning for a pregnancy.
This research suggests RLP-based counseling targeted toward men can increase fertility awareness and ultimately help men adjust lifestyle factors that may impact their fertility. Given the fact that the recruited participants were all seeking STI testing, an important next step will be to determine if this research is reproducible with a larger, more diverse patient population.
Editor’s Note: It is encouraging to see this type of research taking place during a time when many couples are seeking healthier, safer, and more natural alternatives for family planning. The research by Bodin et al uncovered limited knowledge in the population studied concerning potential impact of age, weight, STI’s, and chemicals known to affect the endocrine system. It also identified and attempted to rectify misinformation about factors the men thought impact fertility, yet studies have shown they do not. We hope future research will incorporate more strategies to provide pre-conception counseling to educate men about modifiable lifestyle factors impacting their fertility.
[i]  Bodin M, Tydén T, Käll L, Larsson M. Can Reproductive Life Plan-based counselling increase men’s fertility awareness? Ups J Med Sci. 2018;123(4):255‐263. doi:10.1080/03009734.2018.1541948.