{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T17:55:12Z","timestamp":1781805312795,"version":"3.54.5"},"reference-count":43,"publisher":"Public Library of Science (PLoS)","issue":"6","license":[{"start":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T00:00:00Z","timestamp":1781740800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Infertility affects millions globally, and while assisted reproductive technology (ART) has become a cornerstone of its treatment, there is limited research on how Lebanese women perceive these services. This study aims to fill the gap by assessing each of the knowledge, attitudes, and expectations of Lebanese women experiencing difficulty conceiving towards ART.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A cross-sectional study was conducted between June and September 2024, involving 346 Lebanese women from two fertility centers in Beirut. Participants were selected by simple random sampling to complete the questionnaire through individual interviews. Descriptive and bivariate analyses were performed, and generalized linear models were used to explore the associated factors of knowledge, attitudes, and expectation scores.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The results showed that 56.4% of participants had good knowledge, 54.9% had positive attitudes, and 73.7% exhibited high expectations. The generalized linear models revealed that previous ART use (\u03b2\u2009=\u20090.151), receiving ART information from a doctor (\u03b2\u2009=\u20090.064), female age (\u03b2\u2009=\u20090.005), and physical exercise (\u03b2\u2009=\u20090.119) were linked to higher knowledge, while higher family income (\u03b2\u2009=\u2009\u22120.133), history of immunodeficiency (\u03b2\u2009=\u2009\u22120.275), living in centers (\u03b2\u2009=\u2009\u22120.066), were linked to lower knowledge. For attitudes, residing in South Lebanon (\u03b2\u2009=\u20096.136), having a history of ovarian cyst removal (\u03b2\u2009=\u20092.065), receiving ART information from a doctor (\u03b2\u2009=\u20091.151) and female age (\u03b2\u2009=\u20090.120) were linked to positive attitudes, while living in centers (\u03b2\u2009=\u2009\u22121.835), having a regular menstrual period (\u03b2\u2009=\u2009\u22121.521) were linked to lower attitudes. For the expectations, female hormonal disorder (\u03b2\u2009=\u20092.758) was significantly associated with higher expectations, while advanced female age (\u03b2\u2009=\u2009\u22120.768) was associated with lower expectations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This study identifies associated factors influencing knowledge, attitudes, and expectations toward ART. To optimize these aspects, interventions should focus on effective education, personalized treatments, reducing barriers, and providing psychological support to improve women\u2019s reproductive health. Further research is needed to explore these factors in the broader population.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0331989","type":"journal-article","created":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T17:32:12Z","timestamp":1781803932000},"page":"e0331989","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Analysis of status and influencing factors of knowledge, attitudes, and expectations towards assisted reproductive technology among infertile women in Lebanon: A cross-sectional study"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1792-7761","authenticated-orcid":true,"given":"Reva","family":"Mosleh","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiba","family":"Assi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jana","family":"Kassir","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hassan","family":"Ajami","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph","family":"Azoury","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roula","family":"Ajrouche","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amal","family":"Al-Hajje","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,6,18]]},"reference":[{"issue":"1","key":"pone.0331989.ref001","article-title":"WHO fact sheet on infertility","volume":"6","year":"2021","journal-title":"Global Reproductive Health"},{"key":"pone.0331989.ref002","unstructured":"Lebanon Fertility Rate 1950-2025. 2025. https:\/\/www.macrotrends.net\/global-metrics\/countries\/lbn\/lebanon\/fertility-rate"},{"key":"pone.0331989.ref003","unstructured":"Puscheck EE. Practice Essentials, Overview, Etiology of Infertility. 2024. https:\/\/emedicine.medscape.com\/article\/274143-overview#a1"},{"issue":"11","key":"pone.0331989.ref004","doi-asserted-by":"crossref","first-page":"2683","DOI":"10.1093\/humrep\/dep343","article-title":"The International Committee for Monitoring Assisted Reproductive Technology (ICMART) and the World Health Organization (WHO) Revised Glossary on ART Terminology, 2009","volume":"24","author":"F Zegers-Hochschild","year":"2009","journal-title":"Hum Reprod"},{"key":"pone.0331989.ref005","article-title":"Assisted reproductive technology (ART) techniques","volume-title":"StatPearls","author":"M Jain","year":"2023"},{"issue":"4","key":"pone.0331989.ref006","first-page":"179","article-title":"Access to Infertility Services in Middle East","volume":"16","author":"MR Sadeghi","year":"2015","journal-title":"J Reprod Infertil"},{"issue":"2","key":"pone.0331989.ref007","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1093\/humupd\/dmaa047","article-title":"IVF and other ART in low- and middle-income countries: a systematic landscape analysis","volume":"27","author":"TM Chiware","year":"2021","journal-title":"Hum Reprod Update"},{"issue":"1","key":"pone.0331989.ref008","doi-asserted-by":"crossref","DOI":"10.1186\/s43043-019-0011-0","article-title":"Review of assisted reproduction techniques, laws, and regulations in Muslim countries","volume":"24","author":"C Kooli","year":"2019","journal-title":"Middle East Fertil Soc J"},{"issue":"5","key":"pone.0331989.ref009","doi-asserted-by":"crossref","first-page":"1044","DOI":"10.1016\/j.fertnstert.2012.02.015","article-title":"A persistent misperception: assisted reproductive technology can reverse the \u201caged biological clock\u201d","volume":"97","author":"N Wyndham","year":"2012","journal-title":"Fertil Steril"},{"key":"pone.0331989.ref010","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1016\/j.rbms.2017.03.002","article-title":"The need to improve fertility awareness","volume":"4","author":"J Harper","year":"2017","journal-title":"Reprod Biomed Soc Online"},{"key":"pone.0331989.ref011","unstructured":"Eladle SAM, Aboraiah MIH, Mohamed HES. Knowledge, attitude and acceptability of assisted reproductive technology among infertile women. 2019;6(1)."},{"issue":"1","key":"pone.0331989.ref012","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1111\/aogs.12781","article-title":"Attitudes towards new assisted reproductive technologies in Sweden: a survey in women 30-39 years of age","volume":"95","author":"A-L Wennberg","year":"2016","journal-title":"Acta Obstet Gynecol Scand"},{"issue":"5","key":"pone.0331989.ref013","doi-asserted-by":"crossref","DOI":"10.21543\/DEE.2019.2","article-title":"What shapes public attitudes towards assisted reproduction technologies in Europe?","volume":"62","author":"I Szalma","year":"2019","journal-title":"Demogr\u00e1fia"},{"issue":"3","key":"pone.0331989.ref014","doi-asserted-by":"crossref","DOI":"10.1016\/j.fertnstert.2017.07.892","article-title":"Expectations towards in vitro fertilization (IVF): results in Brazil","volume":"108","author":"L Leis","year":"2017","journal-title":"Fertil Steril"},{"issue":"1","key":"pone.0331989.ref015","article-title":"Infertility within the Lebanese population: beliefs and realities","volume":"25","author":"J-PKK Sahakian","year":"2020","journal-title":"Middle East Fertil Soc J"},{"key":"pone.0331989.ref016","article-title":"Exploring the Impact of In Vitro Fertilization (IVF) on the Quality of Life of Lebanese Women and Unraveling the Determinants: A FertiQoL Questionnaire Validation","author":"S Silva","year":"2023","journal-title":"In Review"},{"key":"pone.0331989.ref017","unstructured":"Centers for Disease Control and Prevention. Epi InfoTM version 7.2.6. 2023. https:\/\/www.cdc.gov\/epiinfo\/pc.html"},{"key":"pone.0331989.ref018","unstructured":"Lebanon Demographics Population, Population of Lebanon. 2024. http:\/\/srv1.worldometers.info\/demographics\/lebanon-demographics\/"},{"issue":"2","key":"pone.0331989.ref019","doi-asserted-by":"crossref","first-page":"934","DOI":"10.1080\/09603123.2023.2190084","article-title":"Factors associated with infertility among the Lebanese population: a cross-sectional study","volume":"34","author":"N Dia","year":"2024","journal-title":"Int J Environ Health Res"},{"key":"pone.0331989.ref020","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1186\/1477-7827-11-66","article-title":"Lifestyle factors and reproductive health: taking control of your fertility","volume":"11","author":"R Sharma","year":"2013","journal-title":"Reprod Biol Endocrinol"},{"key":"pone.0331989.ref021","article-title":"Female infertility","volume-title":"StatPearls","author":"MH Walker","year":"2023"},{"key":"pone.0331989.ref022","article-title":"Male Infertility","volume-title":"StatPearls","author":"SW Leslie","year":"2023"},{"issue":"3","key":"pone.0331989.ref023","doi-asserted-by":"crossref","first-page":"393","DOI":"10.1016\/j.fertnstert.2017.06.005","article-title":"The International Glossary on Infertility and Fertility Care, 2017","volume":"108","author":"F Zegers-Hochschild","year":"2017","journal-title":"Fertil Steril"},{"issue":"1","key":"pone.0331989.ref024","doi-asserted-by":"crossref","first-page":"236","DOI":"10.1186\/s12884-022-04498-1","article-title":"Pregnancy planning health information and service needs of women with chronic non-communicable conditions: a systematic review and narrative synthesis","volume":"22","author":"K Hammarberg","year":"2022","journal-title":"BMC Pregnancy Childbirth"},{"issue":"3","key":"pone.0331989.ref025","doi-asserted-by":"crossref","first-page":"204","DOI":"10.1080\/14647273.2017.1285057","article-title":"Assisted reproductive technologies and the Iranian community attitude towards infertility","volume":"20","author":"A Ahmadi","year":"2017","journal-title":"Hum Fertil"},{"key":"pone.0331989.ref026","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1016\/j.rbms.2021.06.005","article-title":"Knowledge and attitudes about assisted reproductive technology: Findings from a Hungarian online survey","volume":"13","author":"I Szalma","year":"2021","journal-title":"Reprod Biomed Soc Online"},{"key":"pone.0331989.ref027","doi-asserted-by":"crossref","first-page":"5129199","DOI":"10.1155\/2022\/5129199","article-title":"Knowledge, Attitude, and Perceptions about In Vitro Fertilization (IVF) among Women of Childbearing Age in Cape Coast, Ghana","volume":"2022","author":"SK Arhin","year":"2022","journal-title":"Obstet Gynecol Int"},{"key":"pone.0331989.ref028","article-title":"Knowledge and attitude of infertile people toward assisted reproductive techniques in Hamadan, Iran","author":"N Rabiei","year":"2022","journal-title":"Med J Islam Repub Iran"},{"issue":"2","key":"pone.0331989.ref029","doi-asserted-by":"crossref","DOI":"10.54729\/KTPE9512","article-title":"Normality testing methods and the importance of skewness and kurtosis in statistical analysis","volume":"3","author":"G Hatem","year":"2022","journal-title":"BAU J - 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A silent grief and failed care and support","volume":"37","author":"S Assaysh-\u00d6berg","year":"2023","journal-title":"Sex Reprod Healthc"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0331989","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T17:32:22Z","timestamp":1781803942000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0331989"}},"subtitle":[],"editor":[{"given":"Iwaho","family":"Kikuchi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,6,18]]},"references-count":43,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2026,6,18]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0331989","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,18]]}}}