Skip to content

Logowithtagcolor (1)

Search

Close

Learn
- Left Column
- Right Column
  - You are not
    Alone
Get Help
- Left Column
- Right Column
  - join one of our
    
    Support Groups
Take Action
- Left Column
- Right Column
  - Volunteers help us advocate for and support people struggling to build their family.
Events
- Left Column
- Right Column
  - Every April
    National Infertility Awareness Week
About Us
- Left Column
- Right Column
  - founded in
    1974
    
    RESOLVE: The National Infertility Association is a 501(c)3, national patient advocacy organization.

×

Learn
- Left Column
- Right Column
  - You are not
    Alone
Get Help
- Left Column
- Right Column
  - join one of our
    
    Support Groups
Take Action
- Left Column
- Right Column
  - Volunteers help us advocate for and support people struggling to build their family.
Events
- Left Column
- Right Column
  - Every April
    National Infertility Awareness Week
About Us
- Left Column
- Right Column
  - founded in
    1974
    
    RESOLVE: The National Infertility Association is a 501(c)3, national patient advocacy organization.

Home
Learn
Infertility 101
Personal Assessment Tool

Share on Facebook

Share on Twitter

Share on Pinterest

Share:

Personal Assessment Tool

Welcome to the Fertility 5 Personal Assessment Tool from RESOLVE. You are taking the first steps in understanding your fertility and creating a plan for your family building journey. At the end of the survey, RESOLVE will provide you with information you need to take the next step.

1. Choose Your Gender:

Female

Male

2. Choose Your Age Range:

2. Have you ever been diagnosed with having low sperm count or low sperm quality?

Yes

No

3. Have you experienced impotence or ejaculation problems?

Yes

No

4. Have you or your partner ever been diagnosed with a sexually transmitted disease?

Yes

No

5. Do you smoke?

Yes

No

6. Have you or your partner ever been treated for cancer?

Yes

No

3. Have you been trying to conceive for more than 6 months?

Yes

No

4. Have you ever been diagnosed with a health condition that could result in abnormal hormone levels (e.g., Thyroid Disease, Polycystic Ovarian Syndrome) or impact your reproductive system (e.g., Endometriosis)?

Yes

No

5. Have you experienced two or more miscarriages in a row?

Yes

No

6. Do you have Pelvic Inflammatory Disease, painful periods, or irregular cycles?

Yes

No

7. Would you consider yourself significantly underweight, overweight, or obese? (Unsure? Search for a BMI Calculator on Google)

Yes

No

*3. Have you been trying to conceive for more than 1 year?

Yes

No

*4. Have you ever been diagnosed with a health condition that could result in abnormal hormone levels (e.g., Thyroid Disease, Polycystic Ovarian Syndrome) or impact your reproductive system (e.g., Endometriosis)?

Yes

No

*5. Have you experience two or more miscarriages in a row?

Yes

No

*6. Would you consider yourself significantly underweight, overweight, or obese? (Unsure? Search for a BMI Calculator on Google)

Yes

No

*7. Do you have Pelvic Inflammatory Disease, painful periods, or irregular cycles?

Yes

No

What is your first name?

What is your last name?

What is your email address?

Yes, I am interested in receiving emails from RESOLVE: The National Infertility Association

Yes

No

Name

This field is for validation purposes and should be left unchanged.

RESOLVE icon

stay connected

Spam Control Text: Please leave this field empty

Visit our Facebook page
Visit our Twitter page
Visit our Instagram page
Visit our Youtube page
Visit our TikTok page

RESOLVE: The National Infertility Association

1660 International Dr., Suite 600 | McLean, VA 22102
Phone: 703.556.7172 | Fax: 703.506.3266 | info@resolve.org

Privacy Policy
Contact Us

NHC SOE Cmyk

© 2024 RESOLVE: The National Infertility Association, Since 1974

Share on Facebook

Share on Twitter

Share on Pinterest

Scroll To Top