Postponing parenthood is becoming increasingly more common in high-income countries, both among women and men, and the average age of a parent at the birth of their first child has been increasing. There are knowledge gaps related to fertility issues, which include the impact of age on fertility and the success rate with fertility treatment. Earlier interventions have used standardised interventions and generally there is a lack of follow-up.1-4 The negative consequences of delayed childbearing may be reduced by fertility assessment and counselling.
The Fertility Assessment and Counselling (FAC) clinic at Rigshospitalet, Copenhagen, Denmark opened in 2011; it is a personalised fertility awareness intervention for self-referred women and men. Women and men receive counselling regarding their fertility risk factors and ovarian reserve or semen quality.5 We wanted to understand the impact of attending fertility assessment and counselling sessions on fertile women’s decisions and subsequent choices regarding their childbearing 1 year after consultation. We have previously conducted a qualitative study exploring attitudes towards family formation in 20 women attending the FAC clinic.6 In this study we interviewed the same sample of women 1 year after the consultation at the FAC clinic. We conducted qualitative interviews using a semi-structured interview guide. The 20 women were aged 35–40 years and were residents in the Capital Region of Copenhagen, Denmark. The interviews took place in their own homes or at the FAC clinic. We used qualitative content analysis and Lincoln and Guba’s guidelines,7 and the consolidated criteria for reporting qualitative research (COREQ)8 were used.
We interviewed 20 different women and obtained 20 different stories. The findings highlighted the individual aspect of fertility, with every woman being a unique case. Seven women had started fertility treatment (with their partner or as a future single mother), two had left their partner, and three had delivered a baby. The overall theme was ‘knowledge increased’. After the women had attended the FAC clinic, they increased their knowledge on fertility-related issues. The subthemes were ‘Catalyst for change’, ‘Staying in limbo’, and ‘Peace of mind’. Some of the women saw the counselling as a catalyst for change; they made changes to their behaviour, relationship, or emotional state, and these changes were viewed positively. A few of the women felt that they were still in limbo as they were in doubt concerning childbearing. Being in limbo was experienced negatively. The women wanted concrete answers about their fertility status; they wanted an exact deadline and this was not given them. The rest of the women felt peace of mind regarding their decision-making about childbearing. The women felt that they were given time and felt less pressure to act immediately.
The FAC clinic focusses on each person and provides personalised fertility information and guidance. The knowledge the women gained served as a cue to action; it was a catalyst for change. The FAC clinic offers an individualised approach, which is needed given the unique nature of childbearing decisions.