Have you been diagnosed with any of the following:
If you are trying to conceive, when did you start actively trying:
Please list any assisted reproductive procedures starting with the most recent (ex: Egg Retrieval, FET, medicated IUI, or un-medicated IUI).
If applicable, please include the number of embryos frozen, genetically tested, and transferred under outcomes.
Age of first menstrual cycle:
Date of onset of last menstrual cycle:
Are your cycles regular:
Cycle length (number of days from the start of one cycle to the start of the next):
If you have regular cycles what day do you usually ovulate on:
How do you track ovulation (ovulation predictor kit, increased vaginal fluid):
Do you notice stretchy, clear, vaginal discharge before ovulation:
Amount of flow (Spotting, Light, Moderate Heavy) on each cycle day (ex: SLMML)
What color is your menstrual blood (ex: pink, bright red, brown, purple, black):
Do you have clots (tissue in menstrual flow).
If Yes what size (ex: almond, egg yolk):
nonemild (grain of rice size)moderate (almond size)severe (egg yolk size)
Symptoms around menses: (ex: Breast changes, Irritability, Fatigue, Bowel changes, Low back pain, Cramps). Please indicate if symptoms occur before or after the start of your flow.
Have you ever used hormonal contraception (ex: birth control, Mirena, NuvaRing, medicated IUD)?
If Yes for how many years and when did you discontinue:
Have you been pregnant before:
How long did it take to conceive:
If applicable, list pregnancies starting with the most recent:
Next: Male Reproductive History