Thank you for taking the time to complete this survey. Your participation is completely voluntary. Any information you provide will be used only for the indicated purposes, in conformity with the B.C. Freedom of Information and Protection of Privacy Act. Your name is not required and no one can identify individual answers in this study.

Most questions will ask you to either click on a sliding scale or on a choice of categories. If there are any questions that you do not wish to answer, please feel free to go on to the next question. You also have the right to terminate the survey at any time prior to submission.

If you complete and submit this survey, it will be assumed that you have consented to participate in this study.

As a token of our appreciation for your time, only if you agree, your name will be added to a draw to win one of two, $100.00 Amazon.ca gift certificates drawn every month until the end of the study. Your name or e-mail address will not be linked with your survey responses, so if you decide to participate in the draw, your identity will still remain completely confidential.

If you have any questions about the study or the survey content, please contact the principal investigator, Dr. Judith Daniluk, Ph.D., a professor in the Department of Educational and Counselling Psychology at the University of British Columbia 604-822-5768 (collect) or at

If you have any technical questions about the survey, please contact Adam Hunter at Verita Strategy Group, the independent third party implementing the survey for UBC at

If you have any concerns about your treatment or rights as a research participant, you may contact the Research Subject Information Line in the UBC Office of Research Services at 604-822-8598 or if long distance e-mail to

When you have completed the survey, please be sure to click on the SUBMIT button, or your responses will be lost.

FERTILITY INTENTIONS

1) How many children do you hope to have?
1
10+
2) About how old do you expect to be when you become pregnant with your first child?
20
70+
3) If you intend to have more than one child, about how old do you expect to be when you give birth to your last child?
20
70+
4) About how many months do you expect it to take for you to get pregnant once you start trying?
1
36+
5) How would you feel if you were never able to bear a child?

BELIEFS ABOUT FERTILITY AND ASSISTED HUMAN REPRODUCTION (AHR)

1) What do you consider to be the ideal age for a woman to give birth to a child for the first time?
20
70+
2) What do you consider to be the ideal age for a man to father a child for the first time?
20
70+
3) What would you consider to be the latest age a woman should consider bearing a child?
20
70+
4) What would you consider to be the latest age a man should consider fathering a child?
20
70+
5) How likely is it that you would consider becoming a mother without a partner through the use of donated sperm?

a) Would you ever consider using sperm from a donor known to you?

b) How likely is it that you would consider using sperm from an anonymous sperm donor such as from a sperm bank?

6) If you had difficulties becoming pregnant, how likely is it that you would consider using in vitro fertilization (IVF (IVF) In-Vitro Fertilization:
A procedure whereby sperm and eggs are fertilized in a laboratory and three to five days later, the resulting embryo is transferred to the woman’s uterus ) – a procedure whereby the sperm and eggs are fertilized in a laboratory and a few days later the resulting embryo is transferred to your uterus?
7) If you were unable to produce a child using your own eggs, how likely is it that you would consider using the eggs of another woman, to produce an embryo that would then be transferred to your uterus?

a) How likely is it that you would consider using the eggs from a donor known to you?

b) How likely is it that you would consider using eggs from an anonymous donor?

8) If both you and your partner had fertility problems, how likely is it that you would consider pursuing a pregnancy with donated embryos - embryos created with the sperm and eggs of another couple and carried by you?

a) How likely it is that you would consider using embryos from a donor known to you?

b) How likely is it that you would consider using embryos from an anonymous donor?

9) If you were unable to carry a child in your own uterus, how likely is it that you would consider using another woman – a surrogate – to carry and give birth to your genetic child created through IVF (IVF) In-Vitro Fertilization:
A procedure whereby sperm and eggs are fertilized in a laboratory and three to five days later, the resulting embryo is transferred to the woman’s uterus ?
10) Should there be an age restriction for a woman to be assisted in becoming pregnant at a Canadian fertility clinic?

What do you believe the upper age limit should be for a woman to be assisted in becoming pregnant at a Canadian fertility clinic?

30
70+
11) Should there be an age restriction for a man to be treated at a Canadian fertility clinic?

What do you believe the upper age limit should be for a man to be treated at a Canadian fertility clinic?

30
70+
12) Who do you believe has the right in Canada to use assisted human reproduction in their attempts to produce a child?
Heterosexual Couples
Same Sex Female Couples
Same Sex Male Couples
Single Women
Single Men
13) How likely is it that you would consider buying and using home fertility tests that might give you some idea of your and/or your partner's potential fertility?
14) How likely is it that you would consider having your eggs frozen and stored at a fertility clinic so they could be used when you are ready to become a mother?

a) What would be the latest age you would consider using your frozen eggs to try to have a baby?

30
70+

Please answer the next two questions only if you currently have, or at some time in the future may have, a male partner.

16) If you and your partner were not able to produce a child using his sperm, and if your partner was willing how likely is it that as a couple, you would consider pursuing a pregnancy with donated sperm?

a) If your male partner was infertile, how likely is it that you would consider using a sperm from a donor known to you?

b) If your male partner was infertile, how likely is it that you would consider using sperm from an anonymous sperm donor such as from a sperm bank?

FERTILITY AND AHR KNOWLEDGE

Overall, how would you rate your current knowledge of women’s fertility?
Overall, how would you rate your current knowledge of Assisted Human Reproduction (AHR) procedures and fertility treatments?

Please answer the following 16 questions to the best of your knowledge. This is not a test - we are trying to determine general knowledge about these issues.

1) For women over 30, overall health and fitness level is a better indicator of fertility than age.
2) Taking birth control pills for more than 5 years negatively affects a woman's fertility.
3) A woman’s eggs are as old as she is.
4) Prior to menopause, the assisted reproductive technologies (e.g., IVF (IVF) In-Vitro Fertilization:
A procedure whereby sperm and eggs are fertilized in a laboratory and three to five days later, the resulting embryo is transferred to the woman’s uterus ) can help most women to have a baby using their own eggs.
5) The total cost of one cycle of in vitro fertilization (IVF (IVF) In-Vitro Fertilization:
A procedure whereby sperm and eggs are fertilized in a laboratory and three to five days later, the resulting embryo is transferred to the woman’s uterus ) is under $5,000.00.
6) There is a progressive decrease in a woman's ability to become pregnant after the age of 35.
7) The rates of miscarriage are significantly higher for women in their 40s than for women in their 30s, even for physically fit women in excellent health.
8) Most Canadian fertility clinics will not provide treatment to women over the age of 45.
9) Egg freezing before the age of 35 can significantly prolong a woman’s fertility.
10) Sexually transmitted diseases (e.g. Chlamydia, Gonorrhea) significantly increase the risk of later infertility.
11) The age of her male partner is an important factor in a woman’s chances of becoming pregnant.
12) The use of in vitro fertilization (IVF (IVF) In-Vitro Fertilization:
A procedure whereby sperm and eggs are fertilized in a laboratory and three to five days later, the resulting embryo is transferred to the woman’s uterus ) poses health risks for a woman.
14) The majority of fertility conditions are caused by problems with the woman’s fertility.
16) A woman's weight affects her chances of conceiving a child.

INFORMATION SOURCES: ACTUAL AND PREFERRED

1) What have been your primary sources of information on fertility, pregnancy and/or childbirth? (select all that apply)










2) In the future, how would you like to receive information about fertility, childbearing and reproductive health? (rank only your top 3 preferences with "First Choice" being most preferred)
1st Choice:
2nd Choice:
3rd Choice:
3) From whom would you like to receive this type of information? (rank only your top 3 preferences with "First Choice" being most preferred)
1st Choice:
2nd Choice:
3rd Choice:
4) At what age do you think women should ideally be provided with information about fertility, childbearing and assisted human reproductive options?
15
45+
5) At what age do you think you would be or would have been most receptive to this type of information?
15
45+

DEMOGRAPHIC INFORMATION

Please take just a couple more minutes to provide some non-identifying information about yourself so that we know the characteristics of the women who participated in this survey.

1) What year were you born?
2) In what country were you born?
3) With which racial or ethnic group do you most identify?
4 ) With what sexual orientation do you most identify?


5 ) What is your current relationship status?






If you indicated you have a partner, in what year was he/ she born?
6 ) In the last 12 months, what has been your primary occupation? (Please select only one)









7 ) If you work for pay, what is your job title?
8) What is the highest grade or level of education that you have completed?






9) What was your total gross household income from all sources in the past 12 months?
s $15000
$220000+
10) What is your current housing situation?




11) Postal Codes help us classify our answers by geographic areas and help to determine if we have connected with people across the country. Please give us the first 3 characters of your postal code or the first 5 numbers of your Zip Code.
Postal Code/ Zip Code
12 ) How did you hear about this survey?





Which one(s)
Please explain
Is there anything you would like to comment on regarding this survey or the topics being studied?

a place of mind, The University of British Columbia

Department of Educational & Counselling Psychology
UBC Faculty of Education
2125 Main Mall
Vancouver, BC Canada V6T 1Z4
Tel: 604.822.5768

Emergency Procedures | Accessibility | Contact UBC | © Copyright The University of British Columbia