title: Family intentions and personal considerations on postponing childbearing in childless cohabiting and single women aged 35-43 seeking fertility assessment and counselling.
abstract: OBJECTIVE
  What characterizes childless women aged 35 years and above seeking fertility assessment and counselling in relation to their reproduction and are there significant differences between single and cohabiting women?
  
  
  CONCLUSIONS
  Despite the women's advanced age and knowledge of the age-related decline in fecundity, 70% of the single women sought fertility assessment and counselling to gain knowledge regarding the possibility of postponing pregnancy.
  
  
  BACKGROUND
  Recent studies have indicated an increasing demand for ovarian reserve testing in women without any known fertility problem to obtain knowledge on their reproductive lifespan and pro-fertility advice. Women postpone their first pregnancy, and maternal age at first birth has increased in western societies over the past two to four decades. Postponed childbearing implies a higher rate of involuntary childlessness, smaller families than desired and declining fertility rates.
  
  
  METHODS
  Baseline data from a cross-sectional cohort study of 340 women aged 35-43 years examined at the Fertility Assessment and Counselling (FAC) Clinic at Copenhagen University Hospital from 2011 to 2014. The FAC Clinic was initiated to provide individual fertility assessment and counselling.
  
  
  METHODS
  Eligible women were childless and at least 35 years of age. All completed a web-based questionnaire before and after the consultation including socio-demographic, reproductive, medical, lifestyle and behavioural factors. Consultation by a fertility specialist included transvaginal ultrasound, full reproductive history and AMH measurement.
  
  
  RESULTS
  The study comprised 140 cohabiting and 200 single women. The majority (82%) were well-educated and in employment. Their mean age was 37.4 years. Nonetheless, the main reasons for attending were to obtain knowledge regarding the possibility of postponing pregnancy (63%) and a concern about their fecundity (52%). The majority in both groups (60%) wished for two or more children. The women listed their ideal age at birth of first child and last child as 33 (±4.7) years and 39 (±3.5) years, respectively. Of the single women, 70% would accept use of sperm donation compared with 25% of the cohabiting women (P < 0.001). In general, 45% considered oocyte vitrification for social reasons, yet only 15% were positive towards oocyte donation. The two groups were comparable regarding lifestyle factors, number of previous sexual partners, pregnancies, and ovarian reserve parameters.
  
  
  CONCLUSIONS
  The women in the present study were conscious of the risk of infertility with increasing age and attended the FAC Clinic due to a concern about their remaining reproductive lifespan, which in combination with their high educational level could impair the generalizability to the background population.
  
  
  CONCLUSIONS
  The results indicate that in general women overestimate their own reproductive capacity and underestimate the risk of future childlessness with the continuous postponement of pregnancies.
authors.affiliation: Fertility Clinic, Copenhagen University Hospital, Blegdamsvej 9, DK-2100 Copenhagen, Denmark kbirch@dadlnet.dk.
authors.forename: K
authors.initials: K
authors.lastname: Birch Petersen
authors.affiliation: Fertility Clinic, Copenhagen University Hospital, Blegdamsvej 9, DK-2100 Copenhagen, Denmark.
authors.forename: H W
authors.initials: HW
authors.lastname: Hvidman
authors.affiliation: Fertility Clinic, Copenhagen University Hospital, Blegdamsvej 9, DK-2100 Copenhagen, Denmark.
authors.forename: R
authors.initials: R
authors.lastname: Sylvest
authors.affiliation: Department of Gynaecology/Obstetrics, Copenhagen University Hospital Hvidovre Hospital, Kettegård Alle 30, DK-2650 Hvidovre, Copenhagen, Denmark.
authors.forename: A
authors.initials: A
authors.lastname: Pinborg
authors.affiliation: Fertility Clinic, Copenhagen University Hospital, Blegdamsvej 9, DK-2100 Copenhagen, Denmark.
authors.forename: E C
authors.initials: EC
authors.lastname: Larsen
authors.affiliation: Fertility Clinic, Copenhagen University Hospital, Blegdamsvej 9, DK-2100 Copenhagen, Denmark.
authors.forename: K T
authors.initials: KT
authors.lastname: Macklon
authors.affiliation: Fertility Clinic, Copenhagen University Hospital, Blegdamsvej 9, DK-2100 Copenhagen, Denmark.
authors.forename: A Nyboe
authors.initials: AN
authors.lastname: Andersen
authors.affiliation: Department of Public Health, University of Copenhagen, Oester Farimagsgade 5, PO Box 2099, DK-1071 Copenhagen K, Denmark.
authors.forename: L
authors.initials: L
authors.lastname: Schmidt
mesh_terms: D000328:Adult; D003376:Counseling / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D005193:Family Planning Services / Q000706:statistics & numerical data*; D005260:Female; D005298:Fertility / Q000502:physiology*; D006801:Humans; D017533:Marital Status
keywords: fertility assessment and counselling; oocyte donation; postponing childbearing; social egg freezing; solo-motherhood; sperm donation