Who is taking this quiz?
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I am the female partner
I am the male partner
Please select your current age range
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Less than 30
30-35
36-40
Over 40
Height
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Weight
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How would you describe your menstrual cycle?
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On time each month
Usually regular
Often irregular
Amenorrhea (No period for 3 months)
Typical Menstrual Flow
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Light (1–2 pads/day
Moderate (3–4 pads/day)
Heavy (5+ pads/day or clots)
Do you experience painful periods or severe cramps?
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Yes
No
Sometimes
Have you been diagnosed with any of the following? (Select all that apply)
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PCOS
Endometriosis
Fibroids
Blocked Tubes
None
Which symptoms do you experience?
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Excess hair
Acne
Weight gain
Difficulty losing weight
None
Ever told prolactin was elevated?
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Yes
No
Confirmed and staged via laparoscopy?
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Stage I
Stage II
Stage III
Stage IV
No (clinical diagnosis)
On hormonal suppression medication?
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Yes
No
Pain severity
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Mild (1-3)
Moderate (4-6)
Severe (7-10)
Days of bleeding during period
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Less than 5
5 to 7
More than 7
Frequent lower back pain with cycle?
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Yes
No
Sometimes
Type of fibroids
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Subserosal
Intramural
Submucosal
Not sure
What is size of largest fibroid?
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Less than 3 cm
3 to 6 cm
More than 6 cm
Not sure
Do fibroid cause heavy bleeding?
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Yes
No
Had surgery for fibroid?
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Yes
No
Status of tubes
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Successful surgery
One tube blocked
Both tubes blocked
History of ectopic pregnancy or severe damage
Diagnosed with HSG (Hysterosalpingography)?
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Yes
No / Unsure
History of pelvic infection (PID)?
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Yes
No / Unsure
Chronic Health Conditions
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Diabetes
Thyroid Issues
Hypertension
Autoimmune Conditions
Hyperprolactinemia
Adrenal imbalance
None
Is this your first time trying to get pregnant?
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Yes
No
Are you currently using any method to try to conceive? (e.g., timing, ovulation kits)
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Yes
No
How long have you been trying to conceive?
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Less than 6 months
6 to 12 months
1 to 2 years
More than 2 years
Have you undergone any prior fertility treatments?
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IVF
IUI
Other
None
Partner's Height
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Partner's Weight
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Does your partner have known fertility or chronic health issues?
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Sperm issues
Chronic condition
None / Unsure
Are you willing to invest in your health to improve fertility outcomes?
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Yes, ready now
Exploring options
Unsure
Please select Your Age range
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Less than 35 years
35–40 years
Over 40 years
Heights
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Your Weight?
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Fertility Diagnosis
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Issues related to Sperm Health
Unexplained infertility
None
Latest sperm count (million/mL)
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Less than 5
5 to 15
16 to 30
More than 30
Latest sperm motility
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Less than 30%
30 to 40%
More than 40%
Sperm morphology (normal forms %)
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Less than 4%
4 to 8%
More than 8%
Diagnosed varicocele grade
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Grade III
Grade II
Grade I
None
Frequent constipation or acidity
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Yes
No
History of adult mumps
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Yes
No
Chronic Health Condition
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Diabetes
Hypertension
Thyroid Issues
Autoimmune Conditions
None
Is this the first time your partner is trying to conceive?
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Yes
No
Are you and your partner currently using any method to try to conceive?
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Yes
No
How long have you and your partner been trying to conceive?
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Less than 6 months
6 to 12 months
1 to 2 years
More than 2 years
Have you or your partner undergone any prior fertility treatments?
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Yes
No
Does your female partner have any known reproductive or chronic conditions?
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PCOS
Endometriosis
Fibroids
Blocked Tubes
Other Chronic Conditions
None / Unsure
Willingness to invest in health to improve fertility outcomes
*
Yes, ready now
Exploring options
Unsure
Enter your details for personalized results & tips.
Full Name
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Email
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Phone
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