j Concept Fertility Centre - Female Assessment

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  Female Assessment
   
1. Please indicate your age group.
 
   
2. How long have you been actively trying to achieve a pregnancy?
 
   
3. How many times, on average, do you and your partner have intercourse in a month?
 
   
4. Do you experience pain after or during intercourse?
  Yes    
No   
   
5. Do you have a blockage in the fallopian (uterine) tubes?
  Yes    
No   
Unknown
   
6. Have you had previous infections in the fallopian tubes?
  Yes    
No   
Unknown
   
7. Do you have any abnormalities of the uterus?
  Yes     
No  
Unknown
   
8. Do you suffer from endometriosis?
  Yes    
No   
Unknown
   
9. Do you have irregular periods?
  Yes    
No   
Unknown
   
10. Does your partner have a low sperm count?
  Yes    
No   
Unknown
   
    
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