First Name *

Last Name *

Email *

Phone *

Office Location *

Let's talk about your cycle.

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

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 partner's health is important, too.

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

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)

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Let's begin with some basic details.

Let's talk about your cycle.

Your medical history matters.

Your lifestyle plays a role.

Your partner's health is important, too.