Female Fertility Test Quiz

How old are you?
*

18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50+
1. Why do you want a personal fertility report?
*
I have problems getting pregnant
No problems. I just started trying to get pregnant
I want more information about fertility
No special reason
2. Are you more or less likely to try to get pregnant now due to Coronavirus?
*
More likely to try to get pregnant
About the same as before
Less likely to try to get pregnant
Not applicable
3. Pregnant women are at increased risk for COVID-19, do you plan to get the vaccine or have you already gotten it?
*
I’ll get it as soon as it’s offered even if not recommended to me
I’ll get it when it’s offered and recommended to me
I’m not sure I’ll get it
I will not get it
I already got it
4. What is your ethnicity/race?
*
American Indian
Asian
Black African American
Black African
Hispanic or Latino
5. How long have you been trying to get pregnant?
*
Planning soon to get pregnant
1- 6 months
7-12 months
Over 12 months
Not trying yet
6. How is your weight?
*
I’m underweight
I’m average weight
I’m overweight
7. Are you taking a daily supplement with folic acid?
*
Yes
No
8. Select all the symptoms you usually get during your period
*
Euphoria
Depression
Increased sex drive
Food cravings
Hot flashes
Ovulation pain
Sleep changes
Bloating
Constipation
Nausea
Appetite changes
Mood changes
Abdominal cramps
Muscle aches
Breast tenderness
Acne
Lower back pain
Tiredness
Decreased sex drive
Headache
Diarrhea
Joint pain
9. How often do you have sex?
*
1 – 2 times a month
1-2 times during my fertile days
3-4 times during my fertile days
1-2 times a week
3-4 times a week
10. Have you been diagnosed with infertility?
*
Yes
No
11. Have you been diagnosed with Class 1 diabetes, or glucose intolerance?
*
No
Class 1 Diabetes
Class 2 Diabetes
Impaired fasting glucose
Impaired glucose tolerance
Pre-diabetes
12. Have you been diagnosed with endometriosis or PCOS (polycystic ovary syndrome)?
*
Yes
No
13. Have you been diagnosed with PCOS (polycystic ovary syndrome)?
*
Yes
No
14. Are your fallopian tubes open?
*
Yes
No
Don’t know or not tested
15. Do you have regular menstrual cycles?
*
Yes (regular cycles every 24-32 days)
No (irregular cycles each month)
I have no cycles
I don’t know
16. How long are your menstrual cycles?
*
Every 24-32 days
Less than 24 days apart
Over 32 days apart
No bleeding/period/cycle
I don’t know
17. How heavy are your menstrual periods?
*
Normal bleeding (using tampons or pads)
Light bleeding (more spotting than bleeding)
Heavy bleeding (change pads/tampons every 1-2 hours or clots over 1 inch or bleed through clothes)
No bleeding
I don’t know
18. How long do your menstrual periods last?
*
3-7 days
Under 3 days
Over 7 days
No bleeding
I don’t know the length
19. Are you ovulating regularly?
*
Yes
No
Don’t know/not checked
20. Are your periods or is sex painful?
*
Yes
No
21. Do you have frequent vaginal or urinary tract (UTI) infections?
*
Yes
No
22. Are you under a lot of stress?
*
Yes
No
23. Are you following a healthy diet?
*
Yes
No
24. Have you ever had a sexually transmitted disease?
*
Yes
No
25. Do you smoke?
*
Yes
No
26. Do you drink alcohol?
*
Yes
No
27. Is he following a healthy diet and taking a daily supplement?
*
Yes
No
Not sure
Not applicable
28. What is his sperm count?
*
Normal
Low
Don’t know/not tested
Not applicable
29. Does he live a healthy lifestyle (no smoking, drinking, etc)?
*
Yes
No
Not sure
Not applicable
30. Has he ever had a sexually transmitted disease?
*
Yes
No
Don’t know
Not applicable
Email




If you are human, leave this field blank.


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