Female Fertility Assessment

What is your current age?

Under 30 30–34 35–39 40 or above

How long have you been trying to conceive?

Less than 6 months 6–12 months 12–24 months More than 2 years

Have you noticed changes in your cycle length over time?

No change, very consistent Slight changes Frequent changes Major changes or missed cycles

How regular are your menstrual cycles?

26–32 days, consistent Slight variation Often irregular Very irregular or absent

How would you describe your periods?

Manageable, mild discomfort Moderate discomfort Heavy or painful Severe pain / disruption

Have you been diagnosed with PCOS, endometriosis, fibroids, or thyroid issues?

No Suspected only Yes, well-managed Yes, unmanaged

Do you notice fertile cervical mucus before ovulation?

Yes, consistently Sometimes Rarely Never

How would you describe your current body weight?

Healthy for my height Slightly under/over Significantly under/over Very underweight or obese

Has your weight changed significantly in the last year?

Stable Minor change Large fluctuation Very unstable

Do you experience insulin resistance, diabetes, or blood sugar issues?

No Borderline Diagnosed but managed Diagnosed & unmanaged

Do you exercise in a balanced way?

Moderate & consistent Slightly inconsistent Rare or excessive Extreme over-exercise or sedentary

How is your sleep quality?

7–9 hours, restful Mild disturbances Poor or irregular Chronic insomnia

How would you rate your daily stress levels?

Well-managed Moderate High Constantly overwhelmed

Do you smoke or consume alcohol?

No Occasionally Regularly Frequently

Are you exposed to plastics, chemicals, or toxins daily?

Minimal exposure Moderate exposure High exposure Unavoidable / constant

How hydrated are you daily?

8–10 glasses (Well hydrated) 6–7 glasses (Mostly hydrated) 4–5 glasses (Often dehydrated) Less than 4 glasses (Rarely hydrated)

Have you had fertility-related tests done (AMH, hormones, ultrasound)?

Yes, recently Yes, long ago Planned Never

Are you taking fertility-supportive supplements?

High-quality, guided Basic prenatal only Unsure None

Do you experience spotting before your period starts?

Rarely or never Occasionally Frequently Almost every cycle

Have you ever been pregnant before (including chemical pregnancy or miscarriage)?

Yes, with successful outcome Yes, but pregnancy loss Unsure / early loss Never

Do you experience symptoms of hormonal imbalance? (eg. acne, hair loss, facial hair, mood swings)

Rarely Occasionally Frequently Very often

How pressured does intimacy feel during TTC?

Natural & relaxed Slightly pressured Mostly scheduled Very stressful

How often do you use electronic devices late at night?

Rarely Occasionally Most nights Every night

Have you used hormonal medications recently? (eg. birth control pills, hormonal IUD, emergency pills)

No, not in the last year Yes, stopped over 6 months ago Yes, stopped within last 6 months Currently using hormonal medication

Are you currently taking any long-term medications? (eg. thyroid meds, antidepressants, steroids, pain medications)

No Yes, short-term only Yes, long-term but monitored Yes, long-term without regular review

Question Number 1.