Infertility is defined as the inability to achieve a clinical pregnancy after 12 months of regular unprotected intercourse (1). Approximately 17% of women of childbearing age worldwide are affected by infertility, which is more prevalent in developing countries (2). This condition elevates psychological and social stress in couples, creates financial strain for families, and even increases marital dissolution risk (3–5). Ovarian reserve serves as a key biomarker of female reproductive potential (6). Diminished ovarian reserve (DOR) refers to a reduction in the number or quality of oocytes, leading to the loss of normal reproductive potential in the ovaries and affecting female fertility, making it one of the primary causes of infertility (7).

Recently, socioeconomic development and shifting reproductive attitudes have increased the prevalence of delayed childbearing. Growing numbers of women prioritize career advancement and income stability over reproduction, electing to delay childbirth (8, 9). However, ovarian reserve function declines progressively with advancing female age. As women enter their mid-30s, the depletion of oocytes accelerates, accompanied by a decline in quality, which can easily lead to unintentional childlessness (10). Leridon’s model estimates that 14% of women will remain childless if they delay starting to try to conceive until the age of 35 and 34.8% if they delay until age 40 (11). Moreover, ovarian reserve function is closely related to environmental and lifestyle factors (12, 13). Therefore, early identification of modifiable ovarian reserve determinants, implementation of ovarian preservation strategies, and timely fertility planning are critical.

The knowledge, attitude, and practice (KAP) theory is a widely recognized behavioral intervention theory that can be used to explain health behaviors (14). It posits that women must first acquire knowledge of DOR and its modifiable determinants, and then form a positive attitude based on this understanding to promote behavioral change. Current research primarily focuses on ovarian reserve testing (anti-Mullerian hormone levels, antral follicle count, etc.) and fertility preservation (e.g., oocyte cryopreservation) (15–17), neglecting the gaps in women’s knowledge of ovarian reserve and their willingness to protect ovarian reserve function. Insufficient attention has been given to KAP status regarding ovarian reserve function in women of reproductive age. Although a prior cross-sectional study assessed ovarian reserve KAP among reproductive-age women in the Chongqing area of China (18), it directly judged levels based on scale scores, overlooking individual heterogeneity across demographic strata and failing to analyze population typologies underpinning KAP variations.

Latent Profile Analysis (LPA) is a human-centered method that categorizes research subjects into different latent categories by analyzing differences in their responses to overt items, thereby identifying heterogeneity within groups (19). This method aims to minimize individual differences within the same category while maximizing differences between categories, thereby improving classification accuracy and effectively capturing the typical characteristics of each subgroup (20). Therefore, this study employed LPA to explore the latent characteristics of ovarian reserve function in women of reproductive age and further analyzed the influencing factors of each subgroup, providing a reference basis for developing targeted intervention measures.

This study showed that the total score of ovarian reserve function KAP was 55.24 ± 6.92 points, at a medium level. The knowledge and attitude dimensions were relatively high, exceeding the findings of Yuan et al. (18). This indicates that women have good understanding and positive attitudes toward ovarian reserve protection. Specifically, 83.2% of participants prioritized preventing reserve depletion, 85.6% valued regular monitoring, and 45.7% expressed testing cost willingness. O’Brien et al. (21) conducted a study on KAP regarding ovarian reserve testing among the general population of women of reproductive age and also found that 64.8% of the population held a positive attitude toward it, particularly younger women.

In contrast, practice competencies were deficient, particularly regarding lifestyle regulation. The item “I avoid staying up late in daily life” scored only 2.84 ± 1.07, with 36.63% of the participants frequently staying up late. Therefore, it is necessary to change their understanding of the close association between lifestyle and ovarian reserve function to improve their self-management levels. The item with the lowest success rate in the knowledge dimension was “Oral contraceptives do not cause a decrease of ovarian reserve function in women.” The use of hormonal contraceptives leads to a significant decrease in ovarian reserve parameters defined by anti-Mullerian hormone (AMH), antral follicle count (AFC), and ovarian volume (22, 23). Although some studies have found that this decline is reversible, with ovarian reserve markers returning to normal within 2 months of discontinuing the medication (24), women of reproductive age should be aware of the association between hormonal contraceptives and ovarian reserve function indicators. They should have their ovarian reserve function assessed before using hormonal contraceptives to identify early ovarian insufficiency (25). Healthcare professionals should prioritize personalized risk assessment and ovarian reserve screening for women using hormonal contraceptives to determine whether they have an increased risk of reduced reproductive lifespan.

Our study used latent profile analysis to divide reproductive-age women’s ovarian reserve function KAP into three latent profiles, indicating the presence of population heterogeneity. Among these, 22.22% of women were classified into the “low knowledge–low attitude–low practice type,” which was characterized by insufficient knowledge, negative attitudes, and inadequate protective practices. Women without regular employment were identified as being at significant risk of belonging to this profile. They may lack stable income and social security, facing significant economic and social pressures, which lead to insufficient attention to their reproductive health. Consistent with previous studies, women without regular employment demonstrated significantly lower knowledge scores regarding ovarian reserve function (18). Since knowledge forms the foundation for fostering positive attitudes and correct behaviors, insufficient knowledge may lead to more negative attitudes toward ovarian reserve protection and subsequently hinder the adoption of preventive practices. Therefore, policymakers and healthcare professionals should strengthen support for this group, including disseminating targeted ovarian health knowledge, improving access to reproductive health services, and promoting enhanced social security policies to alleviate their financial burdens.

Production history significantly influences the profile of ovarian reserve function KAP. Women with a history of childbirth exhibited a significantly elevated risk of belonging to the “low knowledge-low attitude-low practice” profile. This may occur because entering the post-reproductive phase leads them to deprioritize the maintenance of fertility and ovarian reserve, as they perceive their core reproductive goals as achieved (26). Importantly, ovarian reserve function decline not only compromises fertility but also associates with metabolic dysregulation, elevated cardiovascular risk, and premature perimenopause (27, 28), adversely impacting physical and psychological well-being. Consequently, establishing a comprehensive lifetime reproductive health management framework for parous women is imperative. Healthcare providers must integrate ovarian preservation into continuity care models, facilitating women’s transition from reproductive completion to lifelong health maintenance.

Interestingly, our study identified a distinct profile characterized by “high knowledge-moderate attitude- moderate practice.” This profile encompasses 38.74% of women, predominantly young women aged 18–24 years. The women in this age group are at the early stages of their academic or professional trajectories, during which educational and career advancement often takes priority (29). Although these women possess adequate knowledge of ovarian reserve function, their attitudes and practices remain underdeveloped. This discrepancy may stem from developmental needs and the perception that declining fertility rates represent a distant threat, leading to relatively weaker risk awareness of reproductive health (30). Previous studies have found that many women only initiate health behavior changes and reproductive choices after detecting abnormal clinical indicators of ovarian reserve function (31, 32). Furthermore, studies suggest that younger women may overestimate the efficacy of assisted reproductive technologies (ART) in overcoming future infertility, thereby underestimating the urgency of proactive ovarian health preservation (33). This mismatch between knowledge, attitude, and behavioral enactment illustrates a critical gap in health literacy. Therefore, clinical healthcare providers should prioritize bridging this gap by using feedback of clinical indicators to reinforce risk perception, correcting over-optimism regarding ART, and promoting the early adoption of protective behaviors among younger women.

The limitations of this study include its cross-sectional design, the restriction of participants to the Hangzhou area of China, and the distribution of questionnaires primarily in hospitals and universities. These factors may skew the results toward women with higher health literacy, thereby limiting the generalizability of the findings. Future studies should consider expanding the sample size to include women of reproductive age from diverse geographical and cultural backgrounds, conducting multi-center, large-scale studies to further validate the findings, and implementing longitudinal tracking to dynamically observe changes in women’s KAP regarding ovarian reserve function.

Women of reproductive age can be categorized into three latent profiles based on their ovarian reserve function KAP: high knowledge-high attitude-high practice type, high knowledge-moderate attitude-moderate practice type, and low knowledge-low attitude-low practice type. These profiles exhibit significant heterogeneity. Relevant educators and healthcare professionals should tailor interventions and support for women of reproductive age based on the characteristics and influencing factors of each profile to enhance their KAP regarding ovarian reserve function.