What is your age?
< 25
25 - 40
41 - 45
> 45

What is your weight in kg?


What is your height in centimetres?
Do you smoke?
Yes
No


Do you consume more than 2 serves of alcohol per day?
Yes
No


Do you consume more than 2 cups of coffee per day?
Yes
No
Have you ever been diagnosed with Chlamydia?
Yes
No


Have you ever been diagnosed with congenital absence of the vas?
Yes
No
Have you ever taken anabolic steroids?
Yes
No


Have you ever taken recreational drugs?
Yes
No


Have you been attempting to get your partner pregnant for greater than 6 months?
Yes
No
What is your age?
< 25
25 - 30
31 - 35
36 - 40
41 - 45
> 45

What is your weight in kg?


What is your height in centimetres?
Do you smoke?
Yes
No


Do you consume more than 2 serves of alcohol per day?
Yes
No


Do you consume more than 2 cups of coffee per day?
Yes
No
Have you ever miscarried or lost a pregnancy?
Yes
No


Have you ever been diagnosed with Chlamydia?
Yes
No
Did your mother experience premature menopause <45 years of age?
Yes
No


If you answered yes, did your mother experience menopause under 35 years of age?
Yes
No


Have you been attempting to get pregnant for 6 months or more?
Yes
No