Optimizing family building in women of advanced reproductive age: a Faster-Fewer-and-Finished approach

Delayed parenthood is a defining feature of contemporary reproductive medicine, fundamentally reshaping reproductive planning and increasing reliance on medically assisted reproduction (MAR). For women of advanced reproductive age (ARA), this shift exposes a potential disconnect between conventional treatment pathways and the biological constraints of ovarian ageing and a rapidly narrowing reproductive window. This risks preventable delays, cumulative treatment burden, and suboptimal outcomes in this population. Addressing these challenges requires deliberate adaptation of current clinical strategies to minimize avoidable delays in assessment and treatment, while ensuring timely, optimized, and outcome-focused care. In this Perspectives article, which is based on expert consensus opinion, we propose a hypothesis-generating framework — the Faster-Fewer-and-Finished (3F) approach — in which expedited evaluation, tailored cycle sequencing, and a patient-tailored ‘finish’ criterion are applied to maximize time-to-first-live birth or to arrive at a shared decision on how or if to continue, with treatment decisions anchored by individual age and ovarian reserve. The 3F approach prioritizes achieving a live birth or ideal family size in the shortest possible time by advocating the ‘fewest’ number of ovarian stimulation cycles necessary. While more than one cycle may be unavoidable, the emphasis is on early strategic tailoring of treatment according to age category, efficiency of intervention, and minimizing biological and emotional attrition. By aligning treatment strategies with both the realities of ovarian ageing and the wishes and life priorities of ARA patients, the 3F approach integrates established principles of MAR into a time-critical, outcome-driven theoretical framework for infertility care.