en عمومى General پژوهشي Research <div style="text-align: justify;"><strong>Background:</strong> Fertility awareness, including knowledge of ovulation, contraception, age-related fertility decline, STIs, and abortion, is a key aspect of reproductive health literacy. Limited awareness may delay seeking medical care and affect family planning decisions. This study aimed to develop a validated questionnaire and assess reproductive health knowledge among couples attending premarital counseling centers in Tehran, Iran.<br> <strong>Methods:</strong> In this cross-sectional study (Nov 2015&ndash;Apr 2016), 300 couples completed a structured questionnaire covering demographics, childbearing preferences, and fertility awareness. The fertility awareness section included 25 items on fertility at different ages, chances of conception, assisted reproductive technologies, ovulation, contraception, STIs, and abortion. Correct answers were scored, with higher scores indicating greater awareness. Data were analyzed using t-tests, paired tests, and chi-square tests (p < 0.05).<br> <strong>Results:</strong> Men were older than women (30.6&plusmn;6.4 vs. 26.9&plusmn;6.0 years). Most participants preferred two children. Women were more likely than men to choose assisted reproductive technologies if infertile (77.5% vs. 64.6%; p < 0.001). Awareness of peak female fertility was low (men 5%, women 3.5%), while men more often recognized male fertility decline (53.7% vs. 35.6%; p = 0.000). Women had higher knowledge of contraception and abortion, whereas men were more aware of condom use and permanent contraceptive methods. Total reproductive health awareness did not differ significantly between sexes (men 11.76&plusmn;4.35 vs. women 11.47&plusmn;4.19; p = 0.538).<br> <strong>Conclusion:</strong> Fertility awareness among couples in Tehran is generally low. Targeted educational programs are needed to improve knowledge on fertility, contraception, and reproductive health, supporting informed family planning decisions.</div> Fertility awareness, Reproductive health, Childbearing, Premarital counseling, Contraception, Iran 33 39 http://icml.ir/browse.php?a_code=A-10-667-2&slc_lang=en&sid=1 Maryam Mohammadi maryammohammadi8766@gmail.com 1050031947532846005640 1050031947532846005640 No Department of Basic and Population Based Studies in NCD, Reproductive Epidemiology Research Centre, Royan Institute, ACECR, Tehran, Iran. Shima Abbasihormozi shima.abbasihormozii@gmail.com 1050031947532846005641 1050031947532846005641 No Department of Basic and Population Based Studies in NCD, Reproductive Epidemiology Research Centre, Royan Institute, ACECR, Tehran, Iran. Behnaz Navid behnaz_navid@yahoo.com 1050031947532846005642 1050031947532846005642 No Department of Psychology, Payame Noor University, Tehran, Iran Samira Vesali 1050031947532846005644 1050031947532846005644 No Department of Psychology, Payame Noor University, Tehran, Iran Reza Omani-samani r.samani@gmail.com 1050031947532846005643 1050031947532846005643 Yes Department of Medical Ethics and Law, Reproductive Biomedicine Research center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran,Iran