Putting 'family' back in family planning.

Family planning visits are designed to help women build families in a manner most compatible with their life goals. Women's knowledge regarding age-related fertility is suboptimal, and first wanted pregnancies are now occurring at older ages. Here we review the issue of diminishing chances of a pregnancy occurring in women over 30 years of age. A debate arises over whether to perform a standard fertility assessment at an age when, for example, oocyte freezing is still practical and feasible, knowing that the proven predictors in subfertile couples may be less informative, or even inappropriate, in women without complaints about fertility. Studies have demonstrated that if women knew that their fertility was diminishing, they might alter life plans, including having children sooner or considering oocyte preservation. Therefore, we argue that physicians need to make an effort to evaluate a woman's childbearing priorities, though not necessarily their fertility, during the initial family planning visit.