Disclaimer

This self-assessment tool is for informational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. The information provided should not be used to make decisions about your health or fertility care. Always seek the advice of your physician or another qualified healthcare provider with any questions you may have regarding your medical condition or treatment options.

By proceeding, you acknowledge and agree to this disclaimer, and consent to receive communications from us related to fertility care, services, and promotions. You may opt out at any time.

I agree to the terms of this disclaimer *

Yes

First Name *

Last Name *

Phone

Email *

Let's begin with some basic details.

Your answers will help us better understand your unique situation and needs.

6 Questions

What is your age? *

Under 35

35 - 39

40+

Which of the following best describes you? *

If applicable, what is your partner's age?

Under 35

35 - 39

40+

How long have you been trying to conceive? *

Less than 6 months

6 months to 1 year

Over 1 year

Have you been pregnant before? *

Yes, successfully carried to term

Yes, but resulted in miscarriage

No, never been pregnant

If applicable, has your partner fathered a child before?

Yes

Unsure

Let's talk about your cycle.

These questions help us assess how your menstrual and ovulation patterns might impact fertility.

3 Questions

How regular are your menstrual cycles? *

Regular (every 25 - 35 days)

Irregular (shorter than 25 days or longer than 35 days)

Absent

Do you track ovulation? *

Yes

Do you experience any of the following during your cycle? (Select all that apply) *

Painful periods (cramps that require medication or disrupt daily life)

Very heavy bleeding

Spotting between periods

None of the above

Your medical history matters.

Understanding your health and any existing conditions gives us a clearer picture of potential factors affecting your fertility.

3 Questions

Do you have any of the following conditions? (Select all that apply) *

Have you undergone any surgeries or treatments involving your reproductive system? *

Yes

Do you have a family history of infertility or related conditions? *

Yes

Unsure

Your lifestyle plays a role.

These questions help us explore how daily habits and overall health may influence fertility.

4 Questions

How often do you smoke or use tobacco products? *

Daily

Occasionally

Never

How often do you consume alcohol? *

Daily

Weekly

Rarely

Never

What is your body mass index (BMI)? *

Underweight (<18.5)

Normal weight (18.5 - 24.9)

Overweight (25 - 29.9)

Obese (30+)

How would you describe your stress levels? *

Low

Moderate

High

Your partner's health is important, too.

If applicable, answering these questions will provide additional insight into potential contributing factors.

2 Questions

Does your partner have any known health issues that may affect fertility?

Low sperm count or motility

History of testicular injury or surgery

None of the above

Unsure

Has your partner ever undergone a semen analysis?

Yes (normal results)

Yes (abnormal results)