Fertility Assessment Quiz

Welcome to the Fertility Assessment

To provide the most accurate insights, please tell us who is taking this quiz.

A I am the female partner

B I am the male partner

Please select your current age range.

A Less than 30 years

B 30 – 34 years

C 35 – 37 years

D 38 – 40 years

E Over 40 years

Do you experience any menopausal-type symptoms? (Select all that apply)

A Hot flashes

B Night sweats

C Mood swings

D Sleep disturbances

E Vaginal dryness

F None of the above

Your BMI is a key health indicator. Please provide your height and weight to auto-calculate it.

Height (cm)

Weight (kg)

How would you describe your menstrual cycle?

A On time each month (± 3 days)

B Usually regular (± 5 days)

C Often irregular (> 5 days variation)

D No period for > 3 months (Amenorrhea)

How would you describe your typical menstrual flow?

A Light (1–2 pads/day)

B Moderate (3–4 pads/day)

C Heavy (≥ 5 pads/day or clots)

Do you experience painful periods or severe cramps?

A Yes

B No

C Sometimes

Have you been diagnosed with any of the following? (Select all that apply)

A PCOS

B Endometriosis

C Fibroids

D Blocked Tubes

E None

Which of the below symptoms do you experience?

A Excess facial/body hair

B Acne or oily skin

C Weight gain around waist

D Difficulty losing weight

E None of these

Have you ever been told your prolactin was elevated?

A Yes

B No

Has endometriosis been confirmed and staged via laparoscopy?

A Yes, Stage I

B Yes, Stage II

C Yes, Stage III

D Yes, Stage IV

E No, diagnosis is clinical

Have you been on hormonal suppression medication for endometriosis in the past?

A Yes

B No

On a scale of 1-10, what is your typical pain severity?

A 1 – 3 (Mild)

B 4 – 6 (Moderate)

C 7 – 10 (Severe)

How many days of bleeding do you have during your period?

A Less than 5 days

B 5 to 7 days

C More than 7 days

Do you experience frequent lower back pain with your cycle?

A Yes

B No

C Sometimes

What type of fibroid(s) were diagnosed?

A Subserosal (outside uterine wall)

B Intramural (in uterine wall)

C Submucosal (in uterine cavity)

D Not sure

What is the size of the largest fibroid?

A Small (less than 3 cm)

B Medium (3 to 6 cm)

C Large (more than 6 cm)

D Not sure

Do your fibroids cause heavy bleeding?

A Yes

B No

Have you had surgery for your fibroids?

A Yes

B No

What is the specific status of your fallopian tubes?

A Successful Surgery

B One tube is blocked

C Both tubes are blocked

D History of Ectopic Pregnancy or Severe Damage

Was this diagnosed with an HSG (Hysterosalpingography)?

A Yes

B No / Unsure

Do you have a history of pelvic infection (e.g., PID)?

A Yes

B No / Unsure

Do you have any of these chronic health conditions? (Select all that apply)

A Diabetes

B Thyroid Issues

C Hypertension

D Autoimmune Conditions

E Hyperprolactinemia

F Adrenal imbalance

G None

Is this your first time trying to get pregnant?

A Yes

B No

Are you currently using any method to try to conceive (e.g., timing, ovulation kits)?

A Yes

B No

How long have you been trying to conceive?

A Less than 6 months

B 6 months – 1 year

C 1 – 2 years

D More than 2 years

Have you undergone any prior fertility treatments ?

A IVF

B IUI

C Other

D None

Partner's Information: BMI

Please provide your male partner's height and weight so we can calculate their BMI.

Partner's Height (cm)

Partner's Weight (kg)

Partner's Information: Health

Does he have any known fertility or chronic health issues?

A Sperm Issues

B A Chronic Condition

C None / Unsure

Are you willing to invest in your health to improve fertility outcomes?

A Yes, I'm ready to take action

B I'm exploring my options

C I'm not sure yet

Your Journey's Almost Complete!

Just one more step to unlock your personalized fertility report and discover your path forward.

Your Full Name

Your Email Address

Your Contact Number

+91

Please select your current age range.

A Less than 35 years

B 35 – 40 years

C Over 40 years

Your BMI is a key health indicator. Please provide your height and weight.

Height (cm)

Weight (kg)

Have you been diagnosed with any of the following?

A Issues related to "Sperm Health"

B Unexplained infertility

C None

What was your latest sperm count (million/mL)?

A Less than 5

B 5 to 15

C 16 to 30

D More than 30

What was your latest sperm motility percentage?

A Less than 30%

B 30% to 40%

C More than 40%

What was your sperm morphology (% normal forms)?

A Less than 4%

B 4% to 8%

C More than 8%

Do you have a diagnosed Varicocele?

A Yes, Grade III

B Yes, Grade II

C Yes, Grade I

D No

Do you suffer from frequent constipation or acidity?

A Yes

B No

Do you have a history of mumps in adulthood?

A Yes

B No

Do you have any of these chronic health conditions? (Select all that apply)

A Diabetes

B Hypertension

C Thyroid Issues

D Autoimmune Conditions

E None

Is this the first time for your partner trying to get pregnant?

A Yes

B No

Are you and your partner currently using any method to try to conceive?

A Yes

B No

How long have you and your partner been trying to conceive?

A Less than 6 months

B 6 months – 1 year

C 1 – 2 years

D More than 2 years

Have you or your partner undergone any prior fertility treatments?

A Yes

B No

Does your female partner have any known reproductive or chronic conditions?

A PCOS

B Endometriosis

C Fibroids

D Blocked Tubes

E Other Chronic Condition

F None / Unsure

Are you willing to invest in your health to improve fertility outcomes?

A Yes, I'm ready to take action

B I'm exploring my options

C I'm not sure yet

Your Journey's Almost Complete!

Just one more step to unlock your personalized fertility report and discover your path forward.

Your Full Name

Your Email Address

Your Contact Number

+91

Please complete the quiz to see your results.