Form 1 Fertility Knowledge Survey

Fertility Knowledge Survey

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Fertility Knowledge Survey

OMB: 0937-0208

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ATTACHMENT B
Fertility Knowledge Survey: Female and Male Versions

This page is intentionally blank.

FEMALE & MALE VERSIONS OF THE FERTILITY KNOWLEDGE SURVEY | IRB/PRA VERSION 20 [8/13/19] | PAGE 1
FEMALE QUESTIONNAIRE

MALE QUESTIONNAIRE

INTRODUCTION

We are conducting a survey to learn what people your age (18–29 years) know
and believe about pregnancy and having children.

Some of the survey questions are about sensitive issues like sex, pregnancy, and
birth control, and may make you uncomfortable. This survey is confidential, and your
answers will be kept private. Your answers to these questions are important to the
study. You may skip any questions you do not wish to answer.

The survey should take about 20 minutes to complete. We ask you to complete
the survey in one sitting, without taking any breaks, if possible. Your input is
extremely valuable.
SCREENER QUESTIONS

S1. What is your sex? By sex we mean the sex you were assigned at birth, on your
original birth certificate.
1. Female
2. Male

SCREENING QUESTIONS
S2. Have you ever had any surgical or medical procedure that makes it
impossible for you to get pregnant and have a baby in the future?
Examples of these include having both tubes tied, cut, removed, or blocked
(tubal sterilization, ligation, or occlusion), removal of the uterus or womb
(hysterectomy), or removal of both ovaries.
1. Yes  TERMINATE
2. No

SCREENING QUESTIONS
S2. Have you ever had a vasectomy or any other surgical or medical procedure that
makes it impossible for you to get a woman pregnant in the future? A
vasectomy is a surgical procedure to cut or block both tubes that carry sperm
out of the testicles.
1. Yes  TERMINATE
2. No

SECTION A.
First, we’d like to ask some questions about you.

A1. What is your age?
ENTER ___ years
If A1 is <18 or >29 years  TERMINATE

FEMALE & MALE VERSIONS OF THE FERTILITY KNOWLEDGE SURVEY | IRB/PRA VERSION 20 [8/13/19] | PAGE 2
FEMALE QUESTIONNAIRE

MALE QUESTIONNAIRE

A2. What is the highest grade or year of school you have completed? For example, if A2. What is the highest grade or year of school you have completed? For example, if
you completed high school (Grade 12) and you are currently attending your first
you completed high school (Grade 12) and you are currently attending your first
year of college, the highest grade that you have completed is 12th grade.
year of college, the highest grade that you have completed is 12th grade.
1. Grade 8 or less
1. Grade 8 or less
2. Grade 9
2. Grade 9
3. Grade 10
3. Grade 10
4. Grade 11
4. Grade 11
5. Grade 12 or GED (High school graduate)
5. Grade 12 or GED (High school graduate)
6. Technical school
6. Technical school
7. Some college but no degree
7. Some college but no degree
8. 2‐year college degree (Associate degree)
8. 2‐year college degree (Associate degree)
9. 4‐year college degree (Bachelor’s degree)
9. 4‐year college degree (Bachelor’s degree)
10. Graduate or professional school
10. Graduate or professional school
SECTION B.
This section is about fertility.
By fertility, we mean the ability of a woman to get pregnant and the ability of a man
to get a woman pregnant.
For a woman, infertility means NOT being able to get pregnant after at least 1 year of
trying.
For a man, infertility means NOT being able to get a woman pregnant after at least 1
year of trying.

SECTION B.
This section is about fertility.
By fertility, we mean the ability of a woman to get pregnant and the ability of a man
to get a woman pregnant.
For a woman, infertility means NOT being able to get pregnant after at least 1 year of
trying.
For a man, infertility means NOT being able to get a woman pregnant after at least 1
year of trying.

[PLACE ON SEPARATE SCREEN]
In this survey, when we use the terms “woman” or “female,” we are referring to
people whose sex assigned at birth or “biological sex” is female.
Similarly, when we use the terms “man” or “male,” we are referring to people whose
sex assigned at birth or “biological sex” is male.
A person’s sex assigned at birth (and recorded on the original birth certificate) is
based on the appearance of the external and internal genitals and other biological
characteristics (e.g., hormones).

FEMALE & MALE VERSIONS OF THE FERTILITY KNOWLEDGE SURVEY | IRB/PRA VERSION 20 [8/13/19] | PAGE 3
FEMALE QUESTIONNAIRE

MALE QUESTIONNAIRE

B1.a. Before starting this survey, how much did you know about female fertility?
1. Nothing
2. A little
3. A moderate amount
4. A lot

B1.b. Before starting this survey, how much did you know about male fertility?
1. Nothing
2. A little
3. A moderate amount
4. A lot

FEMALE & MALE VERSIONS OF THE FERTILITY KNOWLEDGE SURVEY | IRB/PRA VERSION 20 [8/13/19] | PAGE 4
B2. Below are some statements about fertility. For each statement, please select
True or False. If you do not know the answer, please select Don’t know.

True

False

B2. Below are some statements about fertility. For each statement, please select
True or False. If you do not know the answer, please select Don’t know.

Don’t
Know

a. After giving birth, a woman can get pregnant again
before her menstrual period returns.

b. A woman who is breastfeeding cannot get pregnant.

c. After her mid‐30s, a woman’s chances of getting
pregnant decrease sharply.

d. A woman’s ovaries keep making new eggs from the
time she starts having periods until she stops having
periods (menopause).

e. Smoking or exposure to cigarette smoke has no effect
on women’s fertility.

A woman’s weight has no effect on her chances of
getting pregnant.

g. Use of water‐based lubricants or “lube” (K‐Y Jelly™ or
Astroglide®) during vaginal sex increase a woman’s
chances of getting pregnant. (A lubricant reduces
friction and irritation during sex.)

h. Taking birth control pills for any length of time has no
effect on a woman’s chances of getting pregnant
once she stops taking them.

Difficulty getting pregnant can be caused by problems
in the man, the woman, or both the man and the
woman.

A doctor would consider an 18 to 29‐year‐old woman
infertile if she had tried to get pregnant but could not
after 1 year of regular, unprotected sex with a man.
(Unprotected sex is when people do NOT use any
birth control method to prevent pregnancy.)

k. Having a healthy lifestyle (regular exercise and a
healthy diet) increases fertility in women and men.

Some sexually transmitted diseases (STDs) can cause
infertility in women and men.

m. A man’s age has no effect on his ability to get a
woman pregnant.

Some sexually transmitted diseases (STDs) can cause
infertility in women and men.

m. A man’s age has no effect on his ability to get a
woman pregnant.

True

False

Don’t
Know

FEMALE & MALE VERSIONS OF THE FERTILITY KNOWLEDGE SURVEY | IRB/PRA VERSION 20 [8/13/19] | PAGE 5
FEMALE QUESTIONNAIRE

MALE QUESTIONNAIRE

n. Long‐term use of steroids can decrease a man’s
ability to get a woman pregnant.

o. By frequently wearing tight pants or underwear, a
man can reduce his ability to get a woman pregnant.

p. Frequent hot tub use can increase a man’s ability to
get a woman pregnant.

B3. If a woman has sex with a man without using any birth control method, at what
point in her menstrual cycle is she most likely to get pregnant?
1. Right before her period (bleeding) starts
2. During her period
3. Right after her period ends
4. About halfway between two periods
5. It’s all the same
6. Don’t know

B4. Of the following things, which one would make it the hardest for a woman to
get pregnant and have a healthy pregnancy?
1. Being under a lot of stress
2. Being over 35 years old
3. Smoking 10 or more cigarettes per day
4. Having 3 or more alcoholic drinks per day
5. Don’t know

Section C.
The next questions are about your views on having children. It doesn’t matter
whether you have had any children.

C1. How important is it to you to have one or more children you give birth to?
1. Not at all important
2. Slightly important
3. Moderately important
4. Very important
5. Extremely important
6. I haven’t thought about it

C1. How important is it to you to have one or more children that you biologically
father? To biologically father a child means that a man has a child by getting a
woman pregnant. It does not include adopted or stepchildren.
1. Not at all important
2. Slightly important
3. Moderately important
4. Very important
5. Extremely important
6. I haven’t thought about it

FEMALE & MALE VERSIONS OF THE FERTILITY KNOWLEDGE SURVEY | IRB/PRA VERSION 20 [8/13/19] | PAGE 6
FEMALE QUESTIONNAIRE

MALE QUESTIONNAIRE

The next four questions ask your opinion on the ideal ages for women and men to
give birth to or biologically father their first and last child.
We are not asking about the medically ideal ages. Instead, we want your opinion on
the socially ideal ages for having children in today’s society. There are no right or
wrong answers to these questions.

C2. What do you think is the ideal age at which a woman should give birth to her
first child?
1. Under 20
2. 20‐24
3. 25‐29
4. 30‐34
5. 35‐39
6. 40‐44
7. 45 or over
8. There is no ideal age

C3. What do you think is the ideal age at which a woman should give birth to her
last child?
1. Under 20
2. 20‐24
3. 25‐29
4. 30‐34
5. 35‐39
6. 40‐44
7. 45 or over
8. There is no ideal age

FEMALE & MALE VERSIONS OF THE FERTILITY KNOWLEDGE SURVEY | IRB/PRA VERSION 20 [8/13/19] | PAGE 7
FEMALE QUESTIONNAIRE

MALE QUESTIONNAIRE

C4. What do you think is the ideal age at which a man should biologically father his C4. What do you think is the ideal age at which a man should biologically father his
first child? (To biologically father a child means that a man has a child by getting
first child? (To biologically father a child means that a man has a child by getting
a woman pregnant. It does not include adopted or stepchildren.)
a woman pregnant. It does not include adopted or stepchildren.)
1. Under 20
1. Under 20
2. 20‐24
2. 20‐24
3. 25‐29
3. 25‐29
4. 30‐34
4. 30‐34
5. 35‐39
5. 35‐39
6. 40‐44
6. 40‐44
7. 45 or over
7. 45 or over
8. There is no ideal age
8. There is no ideal age
C5. What do you think is the ideal age at which a man should biologically father his
last child?
1. Under 20
2. 20‐24
3. 25‐29
4. 30‐34
5. 35‐39
6. 40‐44
7. 45 or over
8. There is no ideal age

C5. What do you think is the ideal age at which a man should biologically father his
last child?
1. Under 20
2. 20‐24
3. 25‐29
4. 30‐34
5. 35‐39
6. 40‐44
7. 45 or over
8. There is no ideal age

SECTION D.
The next questions are about your experiences with menstruation, pregnancy, and
having children. Remember, the information you provide is confidential.

SECTION D.
The next questions are about your experiences with getting a woman pregnant and
having children. Remember, the information you provide is confidential.

D1. How old were you when you had your first menstrual period? If you are not
sure, a best guess is fine.
1. ENTER ____ years old
2. I haven’t had my first period yet [SKIP TO D3]

D1. FEMALE ONLY

FEMALE & MALE VERSIONS OF THE FERTILITY KNOWLEDGE SURVEY | IRB/PRA VERSION 20 [8/13/19] | PAGE 8
FEMALE QUESTIONNAIRE

MALE QUESTIONNAIRE

D2. The length of the menstrual cycle is the number of days starting from the first
day of your period (when bleeding begins) to the first day of your next period.
What is the typical length of your menstrual cycle?
1. Less than 21 days
2. 21 to 35 days
3. Longer than 35 days
4. The length varies from month to month
5. I currently do not have a period
6. Don’t know

D2. FEMALE ONLY

D3. Are you pregnant now? If you are not sure, a best guess if fine.
1. Yes
2. No

D3. Do you have a spouse, partner, or other female (like a gestational carrier or
traditional surrogate) who is pregnant with your baby now? If you don’t know
or are not sure, a best guess is fine.
(A gestational carrier/surrogate is a woman who has a fertilized egg (embryo)
that is not her own implanted in her uterus, and carries and gives birth to a
baby for the intended parent(s). The embryo is created using the egg(s) and
sperm of the intended parent(s) or donor(s). A traditional surrogate is a
woman who, using her own egg, becomes pregnant with sperm from the
intended father or a donor, and carries and gives birth to a baby for the
intended parent(s).
1.
2.

Yes
No

D4. [IF D3 = 1]: Not including your current pregnancy, how many times have you
been pregnant in your life? Please count all of your pregnancies, even if they
did not result in the birth of a baby.
D4. [IF D3 = 2]: How many times have you been pregnant in your life? Please count
all of your pregnancies, even if they did not result in the birth of a baby.
ENTER ___ number
[IF D4 = 0, SKIP TO Section E]

D4. [IF D3 = 1]: Not including the current pregnancy, how many times have you
gotten a woman pregnant in your life? Please count all of these pregnancies,
even if they did not result in the birth of a baby. A best guess is fine.
D4. [IF D3 = 2]: How many times have you gotten a woman pregnant in your life?
Please count all of these pregnancies, even if they did not result in the birth of a
baby. A best guess is fine.
ENTER ___ number
[IF D4 = 0, SKIP TO Section E]

D5. How many children have you ever given birth to? Please include only children
born alive.
ENTER ___ number

D5. How many children have you ever biologically fathered? Please include only
children born alive. (To biologically father a child means that a man has a child
by getting a woman pregnant. It does not include adopted or stepchildren.)
ENTER ___ number

FEMALE & MALE VERSIONS OF THE FERTILITY KNOWLEDGE SURVEY | IRB/PRA VERSION 20 [8/13/19] | PAGE 9
FEMALE QUESTIONNAIRE

MALE QUESTIONNAIRE

D6. Have you ever gotten pregnant when you did not intend or mean to get
pregnant? Please count all of your pregnancies, even if they did not result in
the birth of a baby.
1. Yes
2. No
3. Don’t know

D6. Have you ever gotten a woman pregnant when you did not intend or mean to?
Please count all of these pregnancies, even if they did not result in the birth of a
baby.
1. Yes
2. No
3. Don’t know

SECTION E.
In this section, we ask about your relationships.

E1. What is your current marital or cohabiting status?
1. Married
2. Cohabiting – Not married but living with a partner
3. Separated from my spouse
4. Divorced, annulled, or widowed
5. Never been married‐‐‐SKIP TO E4
E2. [IF E1 = 1 OR 3]: What sex is your spouse? Select the sex your spouse was
assigned at birth, on their original birth certificate.
E2. [IF E1 = 2]: What sex is your partner? Select the sex your partner was assigned
at birth, on their original birth certificate.
E2. [IF E1 = 4]: What sex was your (most recent) spouse? Select the sex your (most
recent) spouse was assigned at birth, on their original birth certificate.
1. Male
2. Female

E3. [IF E1 = 1 OR 3]: How old were you when you married your spouse?
E3. [IF E1 = 4]: How old were you when you married your (most recent) spouse?
E3. [IF E1 = 2]: How old were you when you started living with your partner?
ENTER ___ years old
[IF E1 = 1 OR 2, SKIP TO E7]
[IF E1 = 3 OR 4 OR 5, ASK E4]

FEMALE & MALE VERSIONS OF THE FERTILITY KNOWLEDGE SURVEY | IRB/PRA VERSION 20 [8/13/19] | PAGE 10
FEMALE QUESTIONNAIRE

MALE QUESTIONNAIRE

E4. In this survey, a serious committed relationship means that you and your
partner have agreed to see only each other and no other romantic partners.
This type of relationship may or may not include sexual activity.
Are you currently in a serious committed relationship?
1. Yes
2. No—SKIP TO SECTION F

E5. What sex is your romantic partner? Select the sex your romantic partner was
assigned at birth, on their original birth certificate.
1. Male
2. Female

E6. How old were you when your current romantic relationship began?
ENTER__ years old

E7. [If E1 = 1‐2]: How old is your current spouse or partner?
[If E4 = 1]: How old is your romantic partner?
ENTER__ years old

SECTION F.

The next questions are about your feelings and intentions, if any, about having
children that you give birth to in the future.

The next questions are about your feelings and intentions, if any, about having
children that you biologically father in the future.

Sometimes what people want and what they intend are different because they are
not able to do what they want.

Intentions refer to what you are realistically going to try to do, and not what you
want.

FEMALE & MALE VERSIONS OF THE FERTILITY KNOWLEDGE SURVEY | IRB/PRA VERSION 20 [8/13/19] | PAGE 11
FEMALE QUESTIONNAIRE
F1. [IF D3=1]: How much thought have you given to whether you want to have [IF
D5 > 0 “more”] children that you give birth to in the future, after your current
pregnancy is over)?

[IF D3=2]: How much thought have you given to whether you want to have [IF
D5 > 0 “more”] children that you give birth to in the future?

MALE QUESTIONNAIRE
F1.

[IF D3=1]: How much thought have you given to whether you want to have [IF
D5 > 0 “more”] children that you biologically father in the future, after the
current pregnancy is over)? (To biologically father means to have a child by
getting a woman pregnant. Do not include intended adoptions or stepchildren.)

[IF D3=2]: How much thought have you given to whether you want to have [IF
D5 > 0 “more”] children that you biologically father in the future? (To
biologically father means to have a child by getting a woman pregnant. Do not
include intended adoptions or stepchildren.)

1.
2.
3.
4.

Not at all
A little
A moderate amount
A lot

F2. [IF D3=1] In the future, after your current pregnancy is over, do you want to
have [IF D5 > 0 “more”] children that you give birth to?
[IF D3=2] In the future, do you want to have [IF D5 > 0 “more”] children that
you give birth to?
1. Definitely yes
2. Probably yes
3. Probably no
4. Definitely no
5. Don’t know

1.
2.
3.
4.
F2.

Not at all
A little
A moderate amount
A lot

[IF D3=1] In the future, after the current pregnancy is over, do you want to
have [IF D5 > 0 “more”] children that you biologically father?
[D3=2] In the future, do you want to have [IF D5 > 0 “more”] children that you
biologically father?

1.
2.
3.
4.
5.

Definitely yes
Probably yes
Probably no
Definitely no
Don’t know

IF F2 = 3‐5 SKIP TO F7

FEMALE & MALE VERSIONS OF THE FERTILITY KNOWLEDGE SURVEY | IRB/PRA VERSION 20 [8/13/19] | PAGE 12
FEMALE QUESTIONNAIRE

MALE QUESTIONNAIRE

F3. [IF F2=1 OR 2 AND D3=1] After your current pregnancy is over, do you
F3. [IF F2=1 OR 2 AND D3=1] After the current pregnancy is over, do you
realistically intend to biologically father any [IF D5 > 0 “more”] children in the
realistically intend to give birth to any [IF D5 > 0 “more”] children in the future?
future? (To biologically father means to have a child by getting a woman
pregnant. Do not include intended adoptions or stepchildren.)
[IF F2=1 OR 2 AND D3=2] Do you realistically intend to give birth to any [IF
D5>0 “more”] children in the future?
[IF F2=1 OR 2 AND D3=2] Do you realistically intend to biologically father any
[IF D5>0 “more”] children in the future? (To biologically father means to have a
1. Definitely yes
child by getting a woman pregnant. Do not include intended adoptions or
2. Probably yes
stepchildren.)
3. Probably no
4. Definitely no
1. Definitely yes
5. Don’t know
2. Probably yes
3. Probably no
IF F3 = 3‐5 SKIP TO F7
4. Definitely no
5. Don’t know
IF F3 = 3‐5 SKIP TO F7
F4. [IF D3=1]: Not counting your current pregnancy, how many [IF D5 > 0, “more”]
children do you realistically intend to give birth to in the future?
[IF D3 = 2]: How many [IF D5 > 0, “more”] children do you realistically intend to
give birth to in the future?
1. 1
2. 2
3. 3
4. 4 or more
5. Don’t know
IF F4 = 5 SKIP TO F7

F4. [IF D3 = 1]: Not counting the current pregnancy, how many [IF D5 > 0, “more”]
children do you realistically intend to biologically father in the future?
[IF D3 = 2]: How many [IF D5 > 0, “more”] children do you realistically intend to
biologically father in the future?
1. 1
2. 2
3. 3
4. 4 or more
5. Don’t know
IF F4 = 5 SKIP TO F7

FEMALE & MALE VERSIONS OF THE FERTILITY KNOWLEDGE SURVEY | IRB/PRA VERSION 20 [8/13/19] | PAGE 13
F5.

[IF F4=1‐4 AND D3=1] Not counting your current pregnancy and considering
everything in your life, at what age do you expect to give birth to your next
child?
[IF F4=1‐4 AND D3=2 AND D5=0] Considering everything in your life, at what
age do you expect to give birth to your first child?

[IF F4=1‐4 AND D3=2 AND D5>0] Considering everything in your life, at what
age do you expect to give birth to your next child?
Display response categories based on A1 (age)
If A1<20, show:
1. Under 20
2. 20‐24
3. 25‐29
4. 30‐34
5. 35‐39
6. 40‐44
7. 45 or over
8. Don’t know

If A1=20‐24 show:
1. Under 20
2. 20‐24
3. 25‐29
4. 30‐34
5. 35‐39
6. 40‐44
7. 45 or over
8. Don’t know
If A1=25‐29, show:
1. Under 20
2. 20‐24
3. 25‐29
4. 30‐34
5. 35‐39
6. 40‐44
7. 45 or over
8. Don’t know
[IF F4 = 1, SKIP TO F7. OTHERWISE ASK F6]

F5. [IF F4=1‐4 AND D3=1] Not counting the current pregnancy and considering
everything in your life, at what age do you expect the next child that you
biologically father to be born?
[IF F4=1‐4 AND D3=2 AND D5=0] Considering everything in your life, at what
age do you expect the first child that you biologically father to be born?
[IF F4=1‐4 AND D3=2 AND D5>0] Considering everything in your life, at what
age do you expect the next child that you biologically father to be born?
Display response categories based on A1 (age)
If A1<20, show:
1. Under 20
2. 20‐24
3. 25‐29
4. 30‐34
5. 35‐39
6. 40‐44
7. 45 or over
8. Don’t know
If A1=20‐24 show:
1. Under 20
2. 20‐24
3. 25‐29
4. 30‐34
5. 35‐39
6. 40‐44
7. 45 or over
8. Don’t know
If A1=25‐29, show:
1. Under 20
2. 20‐24
3. 25‐29
4. 30‐34
5. 35‐39
6. 40‐44
7. 45 or over
8. Don’t know

FEMALE & MALE VERSIONS OF THE FERTILITY KNOWLEDGE SURVEY | IRB/PRA VERSION 20 [8/13/19] | PAGE 14
FEMALE QUESTIONNAIRE
F6. [IF D3=1] Not counting your current pregnancy and considering everything in
your life, at what age do you expect to give birth to your last child?]
[IF D3=2] Considering everything in your life, at what age do you expect to give
birth to your last child?]
Display response categories based on A1 (age)
If A1<20, show:
1. Under 20
2. 20‐24
3. 25‐29
4. 30‐34
5. 35‐39
6. 40‐44
7. 45 or over
8. Don’t know
If A1=20‐24, show:
1. Under 20
2. 20‐24
3. 25‐29
4. 30‐34
5. 35‐39
6. 40‐44
7. 45 or over
8. Don’t know
If A1=25‐29, show:
1. Under 20
2. 20‐24
3. 25‐29
4. 30‐34
5. 35‐39
6. 40‐44
7. 45 or over
8. Don’t know
IFE1=3‐5 AND E4=2, SKIP TO SECTION G. OTHERWISE, ASK F7.

F6.

MALE QUESTIONNAIRE
[IF F4 = 1, SKIP TO F7. OTHERWISE ASK F6]
[IF D3=1] Not counting the current pregnancy and considering everything in
your life, at what age do you expect the last child that you biologically father to
be born?]
[IF D3=2] Considering everything in your life, at what age do you expect the last
child that you biologically father to be born?]

Display response categories based on A1 (age)
If A1<20, show:
1. Under 20
2. 20‐24
3. 25‐29
4. 30‐34
5. 35‐39
6. 40‐44
7. 45 or over
8. Don’t know
If A1=20‐24, show:
1. Under 20
2. 20‐24
3. 25‐29
4. 30‐34
5. 35‐39
6. 40‐44
7. 45 or over
8. Don’t know
If A1=25‐29 show:
1. Under 20
2. 20‐24
3. 25‐29
4. 30‐34
5. 35‐39
6. 40‐44
7. 45 or over
8. Don’t know
IF E1=3‐5 AND E4=2, SKIP TO SECTION G. OTHERWISE, ASK F7.

FEMALE & MALE VERSIONS OF THE FERTILITY KNOWLEDGE SURVEY | IRB/PRA VERSION 20 [8/13/19] | PAGE 15
FEMALE QUESTIONNAIRE

MALE QUESTIONNAIRE

F7. [IF E1=1‐2]: Have you ever talked with your spouse or partner about whether
they want to have any (more) children together with you in the future? Do not
include intended adoptions or stepchildren.
[IF E1=3‐5 AND E4=1]: Have you ever talked with your romantic partner about
whether they want to have any (more) children together with you in the
future? Do not include intended adoptions or stepchildren.
1. Yes
2. No—SKIP TO SECTION G
F8. [IF D3=1 AND ((E1=1‐2 AND E2=2) OR (E1=3‐5 AND E4=1 AND E5=2))]: After the
current pregnancy is over, does your spouse or partner want to give birth to
any more children that you biologically father in the future? (Do not include
intended adoptions or stepchildren.)
[IF D3=2 AND ((E1=1‐2 AND E2=2) OR (E1=3‐5 AND E4=1 AND E5=2))]:
Does your spouse or partner want to give birth to any (more) children that you
biologically father in the future? (Do not include intended adoptions or
stepchildren.)
[IF D3=1 AND ((E1=1‐2 AND E2=1) OR (E1=3‐5 AND E4=1 AND E5=1))]: After the
current pregnancy is over, does your spouse or partner want you to biologically
father any (more) children in the future? (To biologically father means to have
a child by getting a woman pregnant. Do not include intended adoptions or
stepchildren.)
[IF D3=2 AND ((E1=1‐2 AND E2=1) OR (E1=3‐5 AND E4=1 AND E5=1))]: Does
your spouse or partner want you to biologically father any (more) children in
the future? (To biologically father means to have a child by getting a woman
pregnant. Do not include intended adoptions or stepchildren.)
1. Definitely yes
2. Probably yes
3. Probably no
4. Definitely no
5. Don’t know

F8.

[IF D3=1 AND ((E1=1‐2 AND E2=1) OR (E1=3‐5 AND E4=1 AND E5=1))]:
After your current pregnancy is over, does your spouse or partner want to
biologically father any more children with you in the future? (To biologically
father means to have a child by getting a woman pregnant. Do not include
intended adoptions or stepchildren.)
[IF D3=2 AND ((E1=1‐2 AND E2=1) OR (E1=3‐5 AND E4=1 AND E5=1))]:
Does your spouse or partner want to biologically father any (more) children
with you in the future? (To biologically father means to have a child by getting
a woman pregnant. Do not include intended adoptions or stepchildren.)

[IF D3=1 AND ((E1=1‐2 AND E2=2) OR (E1=3‐5 AND E4=1 AND E5=2))]:After
your current pregnancy is over, does your spouse or partner want you to give
birth to any (more) children in the future?
[IF D3=2 AND ((E1=1‐2 AND E2=2) OR (E1=3‐5 AND E4=1 AND E5=2))]
Does your spouse or partner want you to give birth to any (more) children in
the future?
1. Definitely yes
2. Probably yes
3. Probably no
4. Definitely no
5. Don’t know
SECTION G.
Now we’d like to ask you questions about your own fertility status.

SECTION G.
Now we’d like to ask you questions about your own fertility status.

FEMALE & MALE VERSIONS OF THE FERTILITY KNOWLEDGE SURVEY | IRB/PRA VERSION 20 [8/13/19] | PAGE 16
FEMALE QUESTIONNAIRE
G1.

MALE QUESTIONNAIRE

Some people have difficulty or are unable to get pregnant. If you tried, how
likely is it that you would have difficulty or be unable to get pregnant?

G1.

Not at all likely—SKIP TO G3
Slightly likely
Moderately likely
Very likely
Extremely likely
Don’t know—SKIP TO G3

Which of the following are reasons why you think you might have difficulty
or be unable to get pregnant? For each reason, please select Yes if it applies
to you or No if it does not.

G2.

Some people have difficulty or are unable to biologically father a child. If you
tried, how likely is it that you would have difficulty or be unable to get a
woman pregnant?

1.
2.
3.
4.
5.
6.
G2.

1.
2.
3.
4.
5.
6.

Yes

Not at all likely—SKIP TO G3
Slightly likely
Moderately likely
Very likely
Extremely likely
Don’t know—SKIP TO G3
Which of the following are reasons why you think you might have difficulty
or be unable to get a woman pregnant? For each reason, please select Yes if
it applies to you or No if it does not.
Yes

A doctor has told you that you are infertile or that you might
have difficulty getting pregnant.

A doctor has told you that you are infertile or that you might
have difficulty getting a woman pregnant.

Other women in your family are infertile or have had difficulty
getting pregnant.

Other men in your family are infertile or have had difficulty
getting a woman pregnant.

You have had vaginal intercourse many times with a man
without using a birth control method and you have not gotten
pregnant.

You have had vaginal intercourse many times with a woman
without using a birth control method and you have not gotten
her pregnant.

You do not have menstrual periods, or the length of your
menstrual cycle varies from month to month.

Blank

You have had an operation or procedure that makes it
impossible for you to have a baby.

You have had an operation or procedure that makes it
impossible for you to get a woman pregnant.

[IF (E1 = 1 OR 2 AND E2 = 1) OR (E1 = 3‐5 AND E4 = 1 AND E5 =
1) SHOW: Your male spouse or partner has had an operation
that makes it impossible for him to get you pregnant.

[IF (E1 = 1 OR 2 AND E2 = 2) OR (E1 = 3‐5 AND E4 = 1 AND E5 =
2) SHOW: Your female spouse or partner has had an operation
that makes it impossible for her to get pregnant.

G3.

Have you ever spoken to a doctor, nurse, or other medical care provider
about ways to help you get pregnant?

G3.

Have you ever spoken to a doctor, nurse, or other medical care provider
about ways to help you get a woman pregnant?

1.
2.

Yes
No

1.
2.

Yes
No

FEMALE & MALE VERSIONS OF THE FERTILITY KNOWLEDGE SURVEY | IRB/PRA VERSION 20 [8/13/19] | PAGE 17
FEMALE QUESTIONNAIRE
G4.

MALE QUESTIONNAIRE

Have you, a spouse, or a partner (current or former) ever received from a
doctor, nurse, or other medical care provider any of the following services to
help you get pregnant? Please select Yes or No for each service.

Yes

G4.

Have you, a spouse, or a partner (current or former) ever received from a
doctor, nurse, or other medical care provider any of the following services to
help you get a woman pregnant? Please select Yes or No for each service.

Yes

Advice or counseling on fertility

Infertility testing

Surgery to repair damaged or blocked tubes (female or male)

Injecting sperm into your uterus (Intrauterine insemination)

Drugs to help ovulation (develop eggs and release them from
ovaries)

Injecting your sperm into a woman’s uterus (Intrauterine
insemination)

Treatment for low testosterone, low sperm count, or no sperm

Treatment for conditions of the ovaries or uterus (like
polycystic ovary syndrome, endometriosis, or uterine fibroids)

Other medical help for female infertility (like problems with
sexual intercourse or genetic conditions)

Treatment for varicocele (swollen veins inside the bag of skin
that holds the testicles [scrotum]) or hydrocele (swelling in the
scrotum caused by fluid)

Other medical help for male infertility (like treatment for
low/abnormal sperm count, varicocele, or hydrocele)

Other medical help for male infertility (like problems with
sexual intercourse or genetic conditions)

Other medical help for female infertility (like drugs to help
ovulation or treatment for polycystic ovary syndrome,
endometriosis, or uterine fibroids)

G5. How concerned are you about your ability to get pregnant in the future?
1. Not at all concerned
2. Slightly concerned
3. Moderately concerned
4. Very concerned
5. Extremely concerned
6. I haven’t thought about it
[(IF E1 = 3‐5 AND E4=2), SKIP TO G7]

G5.

How concerned are you about your ability to biologically father a child in the
future? (To biologically father a child means that a man has a child by getting
a woman pregnant.)

1. Not at all concerned
2. Slightly concerned
3. Moderately concerned
4. Very concerned
5. Extremely concerned
6. I haven’t thought about it
[(IF E1 = 3‐5 AND E4=2), SKIP TO G7]

FEMALE & MALE VERSIONS OF THE FERTILITY KNOWLEDGE SURVEY | IRB/PRA VERSION 20 [8/13/19] | PAGE 18
FEMALE QUESTIONNAIRE
G6.

MALE QUESTIONNAIRE

[IF E1=1‐2 AND E2=1]: How concerned are you about your spouse’s or
partner’s ability to biologically father a child? (To biologically father a child
means that a man has a child by getting a woman pregnant.)

G6. [If E1=1‐2 AND E2=2]: How concerned are you about your spouse’s or partner’s
ability to get pregnant?]
[IF E1=1‐2 AND E2=1]: How concerned are you about your spouse’s or partner’s
[If E1=1‐2 AND E2=2]: How concerned are you about your spouse’s or
ability to biologically father a child? (To biologically father a child means that a
partner’s ability to get pregnant?
man has a child by getting a woman pregnant.)
[If E1=3‐5 AND E4=1 AND E5=1]: How concerned are you about your
[IF E1=3‐5 AND E4=1 AND E5=2]: How concerned are you about your romantic
romantic partner’s ability to biologically father a child? (To biologically father
partner’s ability to get pregnant?]
a child means that a man has a child by getting a woman pregnant.)
[IF E1=3‐5 AND E4=1 AND E5 = 1]: How concerned are you about your romantic
[IF E1=3‐5 AND E4=1 AND E5 = 2]: How concerned are you about your
partner’s ability to biologically father a child? (To biologically father a child
romantic partner’s ability to get pregnant?]
means that a man has a child by getting a woman pregnant.)
1. Not at all concerned
1. Not at all concerned
2. Slightly concerned
2. Slightly concerned
3. Moderately concerned
3. Moderately concerned
4. Very concerned
4. Very concerned
5. Extremely concerned
5. Extremely concerned
6. I haven’t thought about it
6. I haven’t thought about it

G7. Egg freezing is a medical technique that gives a woman the chance to freeze
her eggs when they are most likely to be healthy. Later, when she is ready to
try to get pregnant, her eggs can be thawed, combined with sperm (fertilized),
and placed into her uterus.
Before reading this description, had you heard of egg freezing?
1. Yes
2. No
3. Not sure
[IF F4 = 1‐4, ASK G8. OTHERWISE, SKIP TO SECTION H.

G7. Egg freezing is a medical technique that gives a woman the chance to freeze
her eggs when they are most likely to be healthy. Later, when she is ready to
try to get pregnant, her eggs can be thawed, combined with sperm (fertilized),
and placed into her uterus.
Before reading this description, had you heard of egg freezing?
1. Yes
2. No
3. Not sure
IF F4 = 1‐4, ASK G8. OTHERWISE, SKIP TO SECTION H.

FEMALE & MALE VERSIONS OF THE FERTILITY KNOWLEDGE SURVEY | IRB/PRA VERSION 20 [8/13/19] | PAGE 19
FEMALE QUESTIONNAIRE
G8.

MALE QUESTIONNAIRE

You answered earlier that you intend to give birth to one or more children in
the future. Please imagine that you had to delay getting pregnant until an
age when you might be worried about being able to get pregnant. How likely
is it that you would consider freezing your eggs for use later?

G8.

Not at all likely
Slightly likely
Moderately likely
Very likely
Extremely likely

You answered earlier that you intend to biologically father one or more
children in the future. Please imagine that you had to delay getting your
spouse or partner pregnant until an age when you might be worried about
her ability to get pregnant. How likely is it that you would consider asking her
to freeze her eggs for use later?

1.
2.
3.
4.
5.

Not at all likely
Slightly likely
Moderately likely
Very likely
Extremely likely

SECTION H.
The next questions ask about your experience with voluntary vaginal intercourse and
birth control. Vaginal intercourse is when a man puts his penis into a woman’s vagina.
Voluntary means that you were not forced to have vaginal intercourse against your
will.

H1. At any time in your life, have you ever had vaginal intercourse with a man?
1. Yes
2. No—SKIP TO H8

H1.

H2.

The very first time you had vaginal intercourse with a man, how old were
you? A best guess is fine.
ENTER ___years old

H3a. In the past 3 months, how many men, if any, have you had vaginal
intercourse with? Please count all male sexual partners, even those you had
vaginal intercourse with only once.
0. 0
1. 1
2. 2
3. 3
4. 4‐5
5. 6‐9
6. 10 or more

At any time in your life, have you ever had vaginal intercourse with a
woman?

1.
2.

Yes
No—SKIP TO H8
The very first time you had vaginal intercourse with a woman, how old were
you? A best guess is fine.
ENTER ___years old

H3a. In the past 3 months, how many women, if any, have you had vaginal
intercourse with? Please count all female sexual partners, even those you
had vaginal intercourse with only once.
0. 0
1. 1
2. 2
3. 3
4. 4‐5
5. 6‐9
6. 10 or more

FEMALE & MALE VERSIONS OF THE FERTILITY KNOWLEDGE SURVEY | IRB/PRA VERSION 20 [8/13/19] | PAGE 20
FEMALE QUESTIONNAIRE

MALE QUESTIONNAIRE

H3b. In the past 12 months, how many men, [IF H3a=0, “if any,”] have you had
vaginal intercourse with? Please count all male sexual partners, even those
you had vaginal intercourse with only once.
0. 0
1. 1
2. 2
3. 3
4. 4‐5
5. 6‐9
6. 10 or more
IF H3b = 0, SKIP TO H8
H4. In the past 12 months, have you or any male sexual partner used any of the
birth control methods listed below to prevent pregnancy? For each method,
select Yes, No, Not Sure if Used Method, or Don’t Know Method. Please
select Yes even if you used the method only once.
Don’t
Not
Know
Yes No
Sure Method

H3b. In the past 12 months, how many women, [IF H3a=0, “if any,”] have you had
vaginal intercourse with? Please count all female sexual partners, even those
you had vaginal intercourse with only once.
0. 0
1. 1
2. 2
3. 3
4. 4‐5
5. 6‐9
6. 10 or more
IF H3b = 0, SKIP TO H8

H4.

In the past 12 months, have you or any female sexual partner used any of
the birth control methods listed below to prevent pregnancy? For each
method, select Yes, No, Not Sure if Used Method, or Don’t Know Method.
Please select Yes even if you used the method only once.
Don’t
Not Know
Yes
No
Sure Method

a. Birth control pills

Birth control pills

b. Condoms

Condoms

c. Shots or injections (Depo‐Provera®)

Shots or injections (Depo‐Provera®)

d. Patch (Xulane®) or vaginal ring (NuvaRing®)

Patch (Xulane®) or vaginal ring (NuvaRing®)

e. IUD (Paragard®, Mirena®, Skyla®, Kyleena®,
or Liletta®)

IUD (Paragard®, Mirena®, Skyla®, Kyleena®,
or Liletta®)

f. Implant (Nexplanon®)

Implant (Nexplanon®)

g. Withdrawal or pulling out

Withdrawal or pulling out

Fertility awareness method (like
calendar/rhythm, temperature, or cervical
mucus method)

Female partner’s sterilizing operation (tubal
ligation) or occlusion (Essure®)

Other method

h. Fertility awareness method (like
calendar/rhythm, temperature, or cervical
mucus method)

i. Male partner’s vasectomy (male sterilizing
operation)

j. Other method

[IF IN H4, ANY OF ITEMS A‐J WAS YES,” ASK H5. OTHERWISE, SKIP TO H6a

[IF IN H4, ANY OF ITEMS A‐J WAS YES,” ASK H5. OTHERWISE, SKIP TO H6a.

FEMALE & MALE VERSIONS OF THE FERTILITY KNOWLEDGE SURVEY | IRB/PRA VERSION 20 [8/13/19] | PAGE 21
FEMALE QUESTIONNAIRE
H5.

[IF D3=1]: Please think about all the times you had vaginal intercourse in the
past 12 months. Before your current pregnant, how much of the time did
you or any male sexual partner use a birth control method to prevent
pregnancy? Your best guess is fine
[IF D3=2]: Please think about all the times you had vaginal intercourse in the
past 12 months. How much of the time did you or any male sexual partner
use a birth control method to prevent pregnancy? Your best guess is fine.

H5.

[D3=1]: Please think about all the times you had vaginal intercourse in the
past 12 months. Before the current pregnancy, how much of the time did
you or any female sexual partner use a birth control method to prevent
pregnancy? Your best guess is fine
[IF D3=2]: Please think about all the times you had vaginal intercourse in the
past 12 months. How much of the time did you or any female sexual partner
use a birth control method to prevent pregnancy? Your best guess is fine

1.
2.
3.
4.
5.

Never or almost never
Some of the times
About half of the times
Most of the times
Every time

H6a.

MALE QUESTIONNAIRE

1.
2.
3.
4.
5.

Never or almost never
Some of the times
About half of the times
Most of the time
Every time

Please think about the last time you had vaginal intercourse with a man. Did
you or your male sexual partner use any birth control method to prevent
pregnancy?

1. Yes
2. No—SKIP TO H6c
H6b. Which birth control method(s) did you or your male sexual partner use the
last time you had vaginal intercourse? Please select all methods used.
a. Birth control pills
b. Condoms
c. Shots or injections (Depo‐Provera®)
d. Patch (Xulane®) or vaginal ring (NuvaRing®)
e. IUD (Paragard®, Mirena®, Skyla®, Kyleena®, or Liletta®)
f. Implant (Nexplanon®)
g. Withdrawal or pulling out
h. Fertility awareness method (like calendar/rhythm, temperature, or
cervical mucus method)
i. Male partner’s vasectomy (male sterilizing operation)
j. Other method
SKIP TO H7

H6a.

Please think about the last time you had vaginal intercourse with a woman.
Did you or your female sexual partner use any birth control method to
prevent pregnancy?

1. Yes
2. No—SKIP TO H6c
H6b. Which birth control method(s) did you or your female sexual partner use the
last time you had vaginal intercourse? Please select all methods used.
a. Birth control pills
b. Condoms
c. Shots or injections (Depo‐Provera®)
d. Patch (Xulane®) or vaginal ring (NuvaRing®)
e. IUD (Paragard®, Mirena®, Skyla®, Kyleena®, or Liletta®)
f. Implant (Nexplanon®)
g. Withdrawal or pulling out
h. Fertility awareness method (like calendar/rhythm, temperature, or
cervical mucus method)
i. Male partner’s vasectomy (male sterilizing operation)
j. Other method
SKIP TO H7

FEMALE & MALE VERSIONS OF THE FERTILITY KNOWLEDGE SURVEY | IRB/PRA VERSION 20 [8/13/19] | PAGE 22
FEMALE QUESTIONNAIRE
H6c.

MALE QUESTIONNAIRE

What are the reasons that you or your male sexual partner did not use any
H6c.
birth control method the last time you had vaginal intercourse to prevent
pregnancy? For each reason below, please select Yes if it applies to you or No
if it does not.

Yes

What are the reasons that you or your female sexual partner did not use any
birth control method the last time you had vaginal intercourse to prevent
pregnancy? For each reason below, please select Yes if it applies to you or
No if it does not.

Yes

I didn’t think I could get pregnant

I didn’t think I could get my partner pregnant

I didn’t think my partner could get me pregnant

I didn’t think my partner could get pregnant

I didn’t expect to have sex

I didn’t really care or mind if I got pregnant

I didn’t really care or mind if I got my partner pregnant

I was trying to get pregnant

I was trying to get my partner pregnant

My male partner did not want me to use a birth control
method

My female partner did not want me to use a birth control
method (like condoms, withdrawal, or vasectomy)

I was worried about the side effects of birth control
methods

I was worried about the side effects of birth control
methods for my partner

I was concerned that using a birth control method would
affect my ability to get pregnant in the future

I was concerned that using a birth control method would
affect my partner’s ability to get pregnant in the future

I didn’t like any of the birth control methods available

I couldn’t afford the birth control method I wanted

H7.

In the past 12 months, have you or any male sexual partner used condoms
during vaginal intercourse to prevent sexually transmitted diseases (STDs)?

H7.

In the past 12 months, have you or any female sexual partner used condoms
during vaginal intercourse to prevent sexually transmitted diseases (STDs)?

1.
2.
3.

Yes
No
Don’t know or not sure

1.
2.
3.

Yes
No
Don’t know or not sure

FEMALE & MALE VERSIONS OF THE FERTILITY KNOWLEDGE SURVEY | IRB/PRA VERSION 20 [8/13/19] | PAGE 23
FEMALE QUESTIONNAIRE
H8.

MALE QUESTIONNAIRE

Following are three statements about birth control methods and women’s
fertility. For each statement, please select True, False, or Don’t Know. Select
Don’t Know Method if you don’t know the birth control method.

a. A woman can use an IUD even if she has
never had a child. An IUD (intrauterine
device) is a small device placed into a
woman’s uterus to prevent pregnancy.

True

False

H8.

Don’t
Don’t know
know method

True

False

Don’t
Don’t know
know method

a. A woman can use an IUD even if she has
never had a child. An IUD (intrauterine
device) is a small device placed into a
woman’s uterus to prevent pregnancy.

b. Women who stop using an IUD take longer
to get pregnant than women who have
not used an IUD.

b. Women who stop using an IUD take longer
to get pregnant than women who have not
used an IUD.

c. Taking birth control pills is riskier to a
woman’s health than having a baby
(including pregnancy, labor, and delivery).

Section J.
The next questions ask about health care and your health.

J1. Is there a place where you usually go for general health care such as when you
are sick, need advice about your health, or need routine medical care?
1. Yes
2. No
J2. Is there a place where you usually go for sexual or reproductive health care
such as family planning, gynecological or breast exams, pregnancy testing,
sexually transmitted disease (STD) testing, or related counseling or
information?
1. Yes
2. No

J1. Is there a place where you usually go for general health care such as when you
are sick, need advice about your health, or need routine medical care?
1. Yes
2. No
J2. Is there a place where you usually go for sexual or reproductive health care
such as sexually transmitted disease (STD) testing, birth control, or related
counseling or information?
1. Yes
2. No

FEMALE & MALE VERSIONS OF THE FERTILITY KNOWLEDGE SURVEY | IRB/PRA VERSION 20 [8/13/19] | PAGE 24
FEMALE QUESTIONNAIRE

MALE QUESTIONNAIRE

J3. In the past 12 months, did you receive any of the following services from a
doctor, nurse, or other medical care provider? Please select Yes or No for each
service.
Yes
No

General or routine physical exam

Visit for an illness or injury

STD or HIV: Testing, treatment, information, or advice

STDs or HIV: Testing, treatment, information, or advice

Birth control: Information, advice, or a prescription,
placement/insertion, or administration of a contraceptive
device or method

Birth control: Information, advice, or method (like condoms)

Other sexual/reproductive health care (like Pap smear or
pelvic exam, pregnancy test, or prenatal or postnatal care)

Other sexual/reproductive health care (like testicular or penis
exam)

J4. In the past 12 months, was there a time that you did not have any health
insurance or coverage?
1. Yes
2. No ‐‐ SKIP TO J6
3. Unsure or Don’t know‐‐ SKIP TO J6
J5. In how many of the past 12 months were you without coverage?
ENTER _____Number of months

J6. In general, how would you describe your physical health?
1. Excellent
2. Very good
3. Good
4. Fair
5. Poor

J6.

J7. How tall are you? A best guess is fine.
ENTER _____FEET [RANGE 3‐7]
ENTER _____INCHES [RANGE 0‐11]

J8. How much do you weigh? A best guess is fine.
ENTER ____Pounds

In general, how would you describe your physical health?
1.
2.
3.
4.
5.

Excellent
Very good
Good
Fair
Poor

FEMALE & MALE VERSIONS OF THE FERTILITY KNOWLEDGE SURVEY | IRB/PRA VERSION 20 [8/13/19] | PAGE 25
FEMALE QUESTIONNAIRE

MALE QUESTIONNAIRE

The next questions ask about alcohol and tobacco use.
J9. During the past 30 days, on how many days (if any) did you have at least one
drink of any alcoholic beverage such as beer, wine, a malt beverage, or liquor?
If you do not drink alcohol or did not drink alcohol in the past 30 days, enter 0.
ENTER ____Number of DAYS [ALLOW ONLY 0‐30]
[IF J9 = 0, SKIP TO J11].

J10. During the past 30 days, on the days when you drank, about how many drinks
did you drink per day on average? One drink is equal to a 12‐ounce beer, a 5‐
ounce glass of wine, or a drink with one shot (1.5 ounces) of liquor.
ENTER_____ (Average number of drinks per day)

J11. During the past 30 days, on how many days (if any) did you smoke cigarettes? If J11. During the past 30 days, on how many days (if any) did you smoke cigarettes? If
you do not smoke cigarettes or did not smoke a cigarette in the past 30 days,
you do not smoke cigarettes or did not smoke a cigarette in the past 30 days,
enter 0.
enter 0.
ENTER ____Number of DAYS [ALLOW ONLY 0‐30]
ENTER ____Number of DAYS [ALLOW ONLY 0‐30]
[IF J11 = 0, SKIP TO J13]
[IF J11 = 0, SKIP TO J13]
J12. During the past 30 days, on the days you smoked, about how many cigarettes
did you smoke per day on average?
1. Less than 1 cigarette per day
2. 1 to 10 cigarettes per day
3. 11 to 20 cigarettes per day (1/2 to 1 pack)
4. More than 20 cigarettes per day

J12. During the past 30 days, on the days you smoked, about how many cigarettes
did you smoke per day on average?
1. Less than 1 cigarette per day
2. 1 to 10 cigarettes per day
3. 11 to 20 cigarettes per day (1/2 to 1 pack)
4. More than 20 cigarettes per day

J13. During the past 30 days, on how many days did you use e‐cigarettes?
(E‐cigarettes are battery‐powered devices that usually contain a nicotine‐based
liquid that is vaporized and inhaled.)
1. 0 days
2. 1 or 2 days
3. 3 to 5 days
4. 6 to 9 days
5. 10 to 19 days
6. 20 to 29 days
7. All 30 days

FEMALE & MALE VERSIONS OF THE FERTILITY KNOWLEDGE SURVEY | IRB/PRA VERSION 20 [8/13/19] | PAGE 26
FEMALE QUESTIONNAIRE

MALE QUESTIONNAIRE

J14. In the past 12 months, have you been told by a doctor or other medical care
provider that you had chlamydia or gonorrhea?
1. Yes
2. No
3. Don’t know or not sure

SECTION K.
Now we’d like to ask about information you have received about your fertility or your
plans and goals for having or not having children.

K1. Has a doctor, nurse, or other medical care provider ever talked with you about
the following topics? Please select Yes or No for each topic.

Yes

a. Your ability to get pregnant and give birth to a child

a. Your ability to get a woman pregnant

b. Your plans or goals for having or not having children

c. How you could improve your health before a pregnancy

c. How you could improve your health before trying to get a
woman pregnant

d. The impact of diet or lifestyle factors (like smoking, alcohol, or
drug use) on your ability to get pregnant

d. The impact of diet or lifestyle factors (like smoking, alcohol, or
drug use) on your ability to get a woman pregnant

e. The impact of sexually transmitted diseases on your ability to
get pregnant

e. The impact of sexually transmitted diseases on your ability to
get a woman pregnant

f. How your age could affect your ability to get pregnant

g. Factors affecting the ability of your spouse or partner to get
you pregnant

f. How your age could affect your ability to get a woman
pregnant

g. Factors affecting the ability of your spouse or partner to get
pregnant and have a child

h. How to get and use donor sperm

i. How to use an egg donor, gestational carrier/surrogate, or
traditional surrogate
(A gestational carrier/surrogate is a woman who has a
fertilized egg (embryo) that is not her own implanted in her
uterus, and carries and gives birth to a baby for the intended
parent(s). The embryo is created using the egg(s) and sperm of
the intended parent(s) or donor(s). A traditional surrogate is a
woman who, using her own egg, becomes pregnant with sperm
from the intended father or a donor, and carries and gives birth
to a baby for the intended parent(s).

h. How to get and use donor sperm

i. How to use an egg donor, gestational carrier/surrogate, or
traditional surrogate

FEMALE & MALE VERSIONS OF THE FERTILITY KNOWLEDGE SURVEY | IRB/PRA VERSION 20 [8/13/19] | PAGE 27
FEMALE QUESTIONNAIRE

MALE QUESTIONNAIRE

K2. Have you ever gotten information about your fertility or your plans and goals
for having or not having children from any of the following sources? For each
source, please select Yes or No.
SOURCES

Yes

a. A friend or acquaintance

b. Your spouse or partner (current or past)

Yes

a. A friend or acquaintance

b. Your spouse or partner (current or past)

c. Your mother or father

d. A brother, sister, or other relative

e. A doctor, nurse, or other medical care provider

f. A teacher or counselor

g. A religious leader

h. A U.S. government website

i. Other internet or social media

j. A fertility tracking app on your phone

k. Books, magazines, or pamphlets

l. Television or radio

FEMALE & MALE VERSIONS OF THE FERTILITY KNOWLEDGE SURVEY | IRB/PRA VERSION 20 [8/13/19] | PAGE 28
FEMALE QUESTIONNAIRE

MALE QUESTIONNAIRE

K3. From the list of information sources below, please identify the three
sources you would trust the most to give you accurate information about
your fertility or your plans and goals for having or not having children. Enter
the item letter for the first, second, and third most trusted sources.
Enter item letter
SOURCES

K3. From the list of information sources below, please identify the three sources
you would trust the most to give you accurate information about your fertility
or your plans and goals for having or not having children. Enter the item letter
for the first, second, and third most trusted sources.
Enter item letter
SOURCES

a. A friend or acquaintance

b. Your spouse or partner (current or
_____ Second most trusted source
past)
c. Your mother or father
d. A brother, sister, or other relative
_____ Third most trusted source
e. A doctor, nurse, or other medical
care provider
f. A teacher or counselor
g. A religious leader
h. A U.S. government website
i. Other internet or social media (like
Facebook or Twitter)
j. A fertility tracking app on your phone
k. Books, magazines, or pamphlets
l. Television or radio

a. A friend or acquaintance

_____ First most trusted source

b.
c.
d.
e.
f.
g.
h.
i.
j.
k.
l.

Your spouse or partner (current or past)
Your mother or father
A brother, sister, or other relative
A doctor, nurse, or other medical care
provider
A teacher or counselor
A religious leader
A U.S. government website
Other internet or social media (like
Facebook or Twitter)
A fertility tracking app on your phone
Books, magazines, or pamphlets
Television or radio

_____ First most trusted source
_____ Second most trusted source
_____ Third most trusted source

SECTION L.
Here are some final questions about you.

L1. Currently, how important is religion in your daily life?
1. Very important
2. Moderately important
3. Not important

L2. Are you Hispanic or Latino, or of Spanish origin?
1. Yes
2. No

FEMALE & MALE VERSIONS OF THE FERTILITY KNOWLEDGE SURVEY | IRB/PRA VERSION 20 [8/13/19] | PAGE 29
FEMALE QUESTIONNAIRE

MALE QUESTIONNAIRE

L3. What is your race? Select all that apply.
1. White
2. Black or African American
3. American Indian or Alaska Native
4. Asian
5. Native Hawaiian or Other Pacific Islander
6. Other, specify: __________

L4a. Which of the following best describes you?
1. Heterosexual or straight
2. Gay or lesbian
3. Bisexual
4. Don’t know or not sure

L4b.
Do you consider yourself to be transgender?
1. Yes, transgender, male to female
2. Yes, transgender, female to male
3. Yes, transgender, non‐conforming
4. No
L5. Which of the following best describes your current employment status?
1. Working full time for pay (35 hours or more per week)
2. Working part time for pay (less than 35 hours per week)
3. Working in an unpaid job such as an internship or volunteer
4. Not working—on temporary layoff from a job or looking for work
5. Not working—student
6. Not working—stay‐at‐home spouse, partner, or caregiver
7. Not working—other

L6. How much is the combined income of all members of YOUR HOUSEHOLD for the
PAST 12 MONTHS?
Please include your income PLUS the income of all members living in your household
(including cohabiting partners and armed forces members living at home). Please
count income BEFORE TAXES and from all sources (such as wages, salaries, tips, net
income from a business, interest, dividends, child support, alimony, and Social
Security, public assistance, pensions, or retirement benefits).

FEMALE & MALE VERSIONS OF THE FERTILITY KNOWLEDGE SURVEY | IRB/PRA VERSION 20 [8/13/19] | PAGE 30
FEMALE QUESTIONNAIRE

MALE QUESTIONNAIRE

1. 1 = Less than $5,000
2. $5,000 to $7,499
3. $7,500 to $9,999
4. $10,000 to $12,499
5. $12,500 to $14,999
6. $15,000 to $19,999
7. $20,000 to $24,999
8. $25,000 to $29,999
9. $30,000 to $34,999
10. $35,000 to $39,999
11. $40,000 to $49,999
12. $50,000 to $59,999
13. $60,000 to $74,999
14. $75,000 to $84,999
15. $85,000 to $99,999
16. $100,000 to $124,999
17. $125,000 to $149,999
18. $150,000 to $174,999
19. $175,000 to $199,999
20. $200,000 to $249,999
21. $250,000 or more

L7.

Including yourself, how many people are 18 years of age or older and currently
live in your household at least 50% of the time? Please include unrelated
individuals (such as roommates), and also include those now away traveling,
away at school, or in a hospital.

1. Less than $5,000
2. $5,000 to $7,499
3. $7,500 to $9,999
4. $10,000 to $12,499
5. $12,500 to $14,999
6. $15,000 to $19,999
7. $20,000 to $24,999
8. $25,000 to $29,999
9. $30,000 to $34,999
10. $35,000 to $39,999
11. $40,000 to $49,999
12. $50,000 to $59,999
13. $60,000 to $74,999
14. $75,000 to $84,999
15. $85,000 to $99,999
16. $100,000 to $124,999
17. $125,000 to $149,999
18. $150,000 to $174,999
19. $175,000 to $199,999
20. $200,000 to $249,999
21. $250,000 or more
L7.

Including yourself, how many people are 18 years of age or older and currently
live in your household at least 50% of the time?
Please include unrelated individuals (such as roommates), and also include
those now away traveling, away at school, or in a hospital.

ENTER _____Number of people 18 years of age or older who currently live in your
household at least 50% of the time

L8.

How many people are 17 years of age or younger and currently live in your
household at least 50% of the time? Include babies and small children. If none,
enter “0”.

ENTER _____Number of people 17 years of age or younger who currently live in your
household at least 50% of the time

How many people are 17 years of age or younger and currently live in your
household at least 50% of the time? Include babies and small children. If none,
enter “0”.

ENTER _____Number of people 17 years of age or younger who currently live in your
household at least 50% of the time

FEMALE & MALE VERSIONS OF THE FERTILITY KNOWLEDGE SURVEY | IRB/PRA VERSION 20 [8/13/19] | PAGE 31
FEMALE QUESTIONNAIRE
Thank you very much for taking part in this survey!
Please click here to see the correct answers to the fertility knowledge questions:
[PLACEHOLDER FOR CLIENT PROVIDED LINK WITH CORRECT ANSWERS]
For more information about reproductive health, pregnancy, infertility, or
contraception, please go to the following websites of the U.S. Department of Health
and Human Services Centers for Disease Control and Prevention (CDC):
Reproductive Health: https://www.cdc.gov/reproductivehealth/index.html
Pregnancy: https://www.cdc.gov/pregnancy/index.html
Infertility: https://www.cdc.gov/reproductivehealth/infertility/index.htm
Contraception: https://www.cdc.gov/reproductivehealth/contraception/index.htm

MALE QUESTIONNAIRE
Thank you very much for taking part in this survey!
Please click here to see the correct answers to the fertility knowledge questions:
[PLACEHOLDER FOR CLIENT PROVIDED LINK WITH CORRECT ANSWERS]
For more information about reproductive health, pregnancy, infertility, or
contraception, please go to the following websites of the U.S. Department of Health
and Human Services Centers for Disease Control and Prevention (CDC):
Reproductive Health: https://www.cdc.gov/reproductivehealth/index.html
Pregnancy: https://www.cdc.gov/pregnancy/index.html
Infertility: https://www.cdc.gov/reproductivehealth/infertility/index.htm
Contraception: https://www.cdc.gov/reproductivehealth/contraception/index.htm

File Type	application/pdf
File Title	Microsoft Word - Attach_B_FertilityKnowledgeSurvey_Version20_8-13-19_PRA_Final_Clean
Author	cfowler
File Modified	2019-10-01
File Created	2019-10-01