L26/O-090 Bridging the knowledge-to-action gap: formal training as the primary driver of fertility preservation referrals. Across-sectional study

Abstract Study question What are the levels of knowledge and guideline awareness regarding fertility preservation among Israeli gynecologists, and how do these factors influence referral behaviour? Summary answer Formal training, rather than professional seniority, is the primary driver of objective knowledge, counselling confidence, and patient referral rates for fertility preservation services. What is known already Fertility preservation is a standard of care for medical and elective indications, yet timely referral remains a global challenge. International data suggest that clinician knowledge gaps and a lack of clear care pathways are significant barriers to implementation. Israel offers a unique landscape with extensive public funding for fertility preservation, but utilization remains variable. It remains unclear how national funding policies translate into clinical action at the frontline of obstetric and gynecological care, particularly among non-fertility specialists who serve as the primary screening point for eligible patients. Study design, size, duration A nationwide, cross-sectional study was conducted in the first half of 2025. The study targeted the national workforce of board-certified obstetrician–gynecologists, residents, and fertility specialists practicing in hospital and community settings across Israel. A total of 330 eligible clinicians completed a validated 16-item questionnaire assessing guideline awareness, objective knowledge, and clinical practices. Participants/materials, setting, methods Participants were assessed using an objective “composite knowledge score” (0–100%) based on four key Ministry of Health fertility preservation funding criteria. Referral frequency and counselling confidence were evaluated. Statistical analyses utilized Kruskal–Wallis for knowledge scores across professional roles and chi-square tests to identify predictors of referral behaviour. The study compared fertility specialists, general specialists, and residents. Main results and the role of chance Overall, 58.1% of clinicians reported awareness of funding criteria, yet only 46.0% had ever referred a patient for fertility preservation. The mean objective composite knowledge score was 54.8% (SD 46.2). Knowledge varied significantly by role (p < 0.001): fertility specialists scored highest (mean 84.6%), while no significant difference existed between residents (mean 45.5%) and general specialists (mean 47.8%). Formal training was the most critical determinant of clinical behaviour. Clinicians with formal fertility preservation training were dramatically more likely to have referred eligible patients (77.8% vs. 13.1%, p < 0.001) and reported higher counselling confidence (82.1% vs. 11.3%, p < 0.001). Regional disparities were observed, with lower knowledge scores in peripheral regions compared to central regions (p = 0.001). Despite these gaps, 72.0% of respondents expressed a strong interest in additional structured training. Limitations, reasons for caution The cross-sectional design precludes establishing definitive causality. Self-reported referral rates may be subject to recall or response bias. Findings are contextualized within Israel’s unique publicly funded system, which may limit generalizability to private-payer healthcare models. Wider implications of the findings Financial accessibility alone is insufficient to ensure equitable fertility preservation care. Integrating standardized education into residency training, alongside targeted continuing education for senior gynecologists, is essential to bridge the “knowledge-to-action” gap. These findings offer a model for optimizing fertility preservation delivery through clinician-focused interventions across healthcare systems. Trial registration number No