Citation #	Author	Year		Study Design Data collection method	Subjects	Purpose	Results
8	Satomi Wakasugi	2014		Quantitative Nine schools Questionnaire survey	1816 high school students Male: 75 Female: 1041	Identify the degree of reproductive knowledge essential for life planning	82.5% of boys and 84.0% of girls wanted to have children in the future, and the desired age to have children was 28.1 years for boys and 26.4 years for girls. 31.1% of boys and 58.4% of girls answered that menopause occurs around age 50, and half of both sexes said women can get pregnant at any time as long as they are still menstruating. 26.3% of boys thought that a woman menstruates her entire life, and 11.4% thought that a woman can get pregnant any time in her life as long as she is menstruating.
9	Akihiro Nishio, et al.	2015		Quantitative Six schools Questionnaire survey	1866 high school students Male: 1108 Female: 727	Investigate high school students’ knowledge and awareness of marriage and childbearing and the factors that influence them, and consider what kind of educational content is necessary and effective.	72% of boys and 81% of girls wanted to marry, with the average age they wanted to marry being 23.3 for boys and 22.6 for girls. 39% of students said they wanted to have children by the age of 25 and 46% said they wanted children by the age of 30. 14% of boys and 22% of girls were well aware of the gradual decline in a woman’s fertility after the age of 30, while 36% of boys and 18% of girls didn’t know at all. On the gradual decline of a woman’s ability to conceive decreasing with age even if she is undergoing fertility treatment, about 10% of boys and girls answered that they were well aware, and 53% of boys and 33% of girls did not know about it at all.
10	Yoshihide Kimura, et al.	2016		Quantitative Three schools Questionnaire survey	731 high school students Male: 344 Female: 387	Identify high school students’ knowledge about menstruation, ejaculation, and the ages pregnancy and childbirth are possible, as well as their attitudes about marriage and having children.	When asked until what age menstruation continues, 28.6% of boys and 5.3% of girls answered “until death.” The most common answer for girls was “until the age of 50,” at 39.6%. When asked until what age it is possible to ejaculate, 40.5% of boys and 19.1% of girls answered “until death,” with the largest group being girls who answered “until 50 years old,” at 27.4%. Regarding the age limit for female fertility, 27.2% of boys and 38.1% of girls answered “until the age of 40,” and 21.6% of boys and 3.6% of girls answered “until death.” Regarding the age limit of male fertility, 33.6% of boys answered “until death” and 28.4% of girls answered “40 years old.” 85.8% of boys and 80.3% of girls wanted to have children.
11	Mika Yamagata, et al.	2016		Quantitative Questionnaire survey	350 school nurse teachers	Clarify the state of knowledge and awareness of reproductive function and reproductive medicine held by school nurses involved in adolescent health and sex education	For knowledge of reproduction and age, 27.9% of respondents answered “40 years or older” as the age at which pregnancy rates decrease, and 42.1% answered “45 years or older” as the age until which natural pregnancy is possible. Regarding education on fertility and reproductive medicine, the following were identified as items that should be learned in school: the establishment of pregnancy (98.8%), egg aging (86.1%), and the causes of infertility (84.5%). 90.5% of school nurses were able to teach about the establishment of pregnancy, but only about half were able to cover the cryopreservation and donation of sperm and eggs. 51.8% said they covered egg aging and 40.4% covered the causes of infertility. Half of the respondents answered that “the establishment of pregnancy” should be taught in elementary school, and egg againg and the causes of infertility should be taught in high school.
12	Yuri Akizuki	2017		Research Journal Documents	None	Examine the possibility of addressing fertility knowledge as part of the school curriculum	Information on fertility that we would like to incorporate into school education is 1) that women’s fertility decreases with age (decrease in the number of eggs and deterioration in egg quality); 2) that the frequency of ovulation is approximately once a month (the life span of an egg is 24 hours), but the life span of a sperm is 2 - 3 days, and there is roughly one chance per month of getting pregnant; 3) that menstruation and ejaculation are essential phenomena for the creation of new life in the future, and that it is important to maintain appropriate lifestyle habits in order to be prepared to conceive and give birth in the future; and 4) that sexually transmitted diseases (STDs) can lead to infertility. In addition, educational precautions were 1) consideration of developmental stage, 2) consideration of the relatedness to other subjects and other content already studied, 3) not to spur anxiety in the students, 4) not to give the impression that sexual intercourse always leads to pregnancy, and 5) not to give students a negative impression of sex.
13	Yoko Nakagawa, et al.	2021		Quantitative High school students who participated in an adolescent class at a hospital Questionnaire survey	258 second- year high school students Male: 83 Female: 175	Examine high school students’ degree of knowledge about fertility and the state of opportunities for them learn about fertility and use the findings as a resource for future sex education by midwives	50% of boys and 59% of girls said school lessons were their source of information on pregnancy and childbirth. Scores were compared by gender, with boys scoring an average of 8.2 points and girls 6.9 points out of 20 in the following categories: male fertility (smoking, drinking, mumps, sperm deterioration, association with masturbation), male reproductive physiology (spermatogenesis period, presence or absence of sperm in pre-ejaculate, sperm count in ejaculate, sperm fertilization ability immediately after ejaculation, sperm viability period), female fertility (smoking, body shape, egg deterioration, female age and pregnancy, egg freezing), When the knowledge of women’s reproductive physiology (number of eggs in a lifetime, maximum number of eggs, menstruation and ovulation, eggs excreted by ovulation in one month, and egg survival time). Items related to smoking, drinking, aging of sperm and eggs, and age were understood by 50% - 60% of students, but items related to male reproductive physiology were not as understood as in girls. Regarding marriage and childbirth, 46% of boys and 44% of girls said they wanted to get married by the age of 30, and 34% of boys and 44% of girls said they wanted to have children by the age of 25 - 30.
14	Mari Aoki, et al.	2021		Quantitative Three schools Questionnaire survey	478 high school students First-year: 236 Second- year: 250 Male: 223 Female: 255	Use the Japanese version of the Cardiff Fertility Knowledge Scale to determine the state of life planning and fertility knowledge among high school students	The most common age range students hoped to have children was “25 - 29 years” (69.7%), and 88.4% wished to have children by the age of 30. The average correct answer rate of the Cardiff Fertility Knowledge Scale-Japanese version (CFKS-J) was 41.9% overall. Regarding the current state of fertility knowledge among high school students, the items with the highest percentage of correct answers to each CFKS-J item were “a woman’s ability to get pregnant decreases after the age of 36” (72.6%) and “women who smoke have a reduced ability to get pregnant” (69.1%). The items with the lowest percentage of correct answers were “about 1 in 10 couples are infertile” (27.6%), “men who have had the mumps are more likely to become infertile in
							the future” (12.1%), and “women who more than 13 kg overweight may not be able to become pregnant” (10.7%). The percentage of correct answers on the CFKS-J was higher for those who used the Internet as a source of information. On the other hand, 73.7% of all respondents chose school as their source of information. 66.2% of all respondents wanted education from midwives and doctors.
15	Yuri Akizuki, et al.		2021	Quanlitative, Semi-Structured Interview Interview	3 school nurse teachers	Examine the experiences of school nurses working in high schools in teaching about sexuality and their recognition of high school students’ sexuality issues and fertility education possibilities	School nurses’ experiences and issues related to sexuality were abstracted into the following categories: “menstruation,” “pregnancy and childbirth,” “sexual victimization,” “gender dysphoria,” and “counseling on sex for male students” Experiences related to fertility education included “female students who are losing weight, students with irregular menstruation, students with eating disorders, and students who have sexual relations with an unspecified number of people.” As for the future of fertility education, “teaching knowledge of fertility while having students consider their life design for building a happy family in the future” and “the possibility of incorporating fertility at the timing of menstrual guidance before school trips” were extracted.
16	Sakiko Matsuoka, et al.		2021	Quantitative High school students who participated in an adolescent class at a hospital Questionnaire survey	148 second- year high school students Male: 75 Female: 73	Determine the level of knowledge of fertility, sexuality and sexual reproduction among high school students, and to use this knowledge in future sex education provided by midwives	76% of boys and 95% of girls answered “school lessons” for the souce of information on pregnancy and childbirth. 51% of boys and 46% of girls said they want to get married by the age of 30, and 61% of boys and 62% of girls answered that they wanted children by the age of 30. On the effects of smoking, drinking, and aging on male fertility, the correct answer rate was over 70% for both boys and girls. For male reproductive physiology, both genders had 30% correctly answer how long sperm live, while they had less than 10% correctly answer about the period of spermatogenesis. For female fertility, the correct answer rate was more than 80% for both boys and girls on the effects of smoking, drinking, and age-related changes in eggs, but only 60% - 70% answered correctly about the effects of body shape (weight) on fertility and the age limits of pregnancy. On female reproductive physiology, the understanding of conception using frozen eggs and the number of ovulations in a single menstrual cycle was more than 50% for both boys and girls, but the understanding of the number of eggs expelled over a lifetime and the lifespan of eggs was only 10% - 20%.
17	Yoko Furukawa, et al.		2021	Quantitative One school Questionnaire survey.	342 third-year high school students	Develop preconception care practices for high school students, who will lead the next generation, and build support through appreciation of preconception care	About 70 percent of the students said they wanted to have children in the future, and half said they wanted two children. The desired age for having a child was 25 - 30 years old and respondents said that they would like to have their first child before 30 - 35 years old. Following the lecture on preconception care, the percentage of correct answers increased by more than 10 points in 6 of the 11 items compared to before and after. After the lecture, 80% of the students answered that they thought about what they had learned about preconception care, their studies or future careers, and life plans. The students listed specific actions and points for improvement, such as “recognizing areas for improvement in health,” “recognizing the need to review dietary habits,” and “reviewing lifestyle habits such as ensuring adequate exercise and sleep.”