Fertility Survey

1
Do you have any of the following pre-existing medical conditions?Please select any/all pre-existing medical conditions that you have or have had in the past while pregnant.
No pre-existing conditions
Anaemia
Autoimmune disorders
Blood clotting disorders
Cancer
Diabetes
Endometriosis
Epilepsy and seizure disorders
Gastrointestinal disorders
Heart disease
Hypertension
Infectious diseases
Kidney disease
Mental health conditions or concerns
Neurological disorders
Nutritional issues
Obesity
PCOS
Pulmonary conditions
STI / STD
Thyroid disorders
Other
2
Please list any other pre-existing conditions you have.
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Small
Ok
Ok
3
Are you currently trying to get pregnant?
YESNO
4
How many months have you been trying to get pregnant?
5
What is your age?
6
How are you planning to get pregnant?
Natural Pregnancy
IVF
IUI
At home insemination
Sperm, Egg or Embryo Donor
Surrogate
Ovulation Induction
Medical Fertility Preservation
Other
7
Please list any other methods you are using to get pregnant
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Large
Normal
Small
Ok
Ok
8
Have you been taking any medication to help you get pregnant? If so please list them here.Please put in only prescribed medication here, one per line use the + button to add another line. The next question asks you about vitamins and supplements.
9
Have you been taking any supplements to help you get pregnant? If so please list them here.Please put one per line, use the + button to add another line
10
Have you been using ovulation or pregnancy tests to monitor your progress?Please swipe to see other test options.
On average how many times do you use these each month?
Ovulation Test Stick
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Ovulation Test Strips
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Pregnancy Test Stick
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Pregnancy Test Strips
Row 3, Column 0
Ovulation Test Stick
Ovulation Test Strips
Pregnancy Test Stick
Pregnancy Test Strips
On average how many times do you use these each month?
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On average how many times do you use these each month?
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On average how many times do you use these each month?
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On average how many times do you use these each month?
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11
What else have you been doing to help you get pregnant?Please select all options that are relevant to you.
Nothing different
Losing weight
Having frequent sex
Keeping a diary
Drinking fertility tea
On a fertility diet
Quit smoking
Quit drinking
No heavy exercise
Had a preconception checkup
Reduced caffeine
Exercising more frequently
Temperature monitoring
Other
12
Please list anything else you are doing to help you get pregnant
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Small
Ok
Ok
13
Do you have any resources for others trying to get pregnant that you would like to share or recommend to others?This can be books, online resources, apps, podcasts, YouTube channels, tv shows, authority figures/influencers etc.
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Large
Normal
Small
Ok
Ok
14
Are you currently pregnant?
YESNO
15
Is this your first pregnancy?Including any experiences that didn't go to term
YESNO
16
What is your age?
17
How did you fall pregnant?
Natural Pregnancy
IVF
IUI
At home insemination
Sperm, Egg or Embryo Donor
Surrogate
Ovulation Induction
Medical Fertility Preservation
Other
18
What other methods did you use to fall pregnant?
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Large
Normal
Small
Ok
Ok
19
Have you been taking any medication to help with your pregnancy? If so please list them here.Please put in only prescribed medication here, please add one per line and use the + button to add another line. The next question asks you about vitamins and supplements.
20
Have you been taking any supplements to help with your pregnancy? If so please list them here.Please add one per line and use the + button to add another line
21
How many weeks along are you?
22
Are you currently enjoying your pregnancy?Remember all experiences are different. It's normal for women to go through different experiences during pregnancy.
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23
What symptoms are you experiencing during your pregnancy?Please add in all symptoms that may be applicable.
24
Are you experiencing any complications during your pregnancy?
When did it start?
Anything else you would like to share?
High Blood Pressure
Row 0, Column 0
Row 0, Column 1
Gestatitional Diabetes
Row 1, Column 0
Row 1, Column 1
Infections
Row 2, Column 0
Row 2, Column 1
Preclampsia
Row 3, Column 0
Row 3, Column 1
Depression & Anxiety
Row 4, Column 0
Row 4, Column 1
Sever, persistent nausea and vomiting
Row 5, Column 0
Row 5, Column 1
Iron-deficiency anemia
Row 6, Column 0
Row 6, Column 1
Ectopic Pregnancy
Row 7, Column 0
Row 7, Column 1
Placental Issues
Row 8, Column 0
Row 8, Column 1
Other
Row 9, Column 0
Row 9, Column 1
High Blood Pressure
Gestatitional Diabetes
Infections
Preclampsia
Depression & Anxiety
Sever, persistent nausea and vomiting
Iron-deficiency anemia
Ectopic Pregnancy
Placental Issues
Other
When did it start?
Row 0, Column 0
Anything else you would like to share?
Row 0, Column 1
When did it start?
Row 1, Column 0
Anything else you would like to share?
Row 1, Column 1
When did it start?
Row 2, Column 0
Anything else you would like to share?
Row 2, Column 1
When did it start?
Row 3, Column 0
Anything else you would like to share?
Row 3, Column 1
When did it start?
Row 4, Column 0
Anything else you would like to share?
Row 4, Column 1
When did it start?
Row 5, Column 0
Anything else you would like to share?
Row 5, Column 1
When did it start?
Row 6, Column 0
Anything else you would like to share?
Row 6, Column 1
When did it start?
Row 7, Column 0
Anything else you would like to share?
Row 7, Column 1
When did it start?
Row 8, Column 0
Anything else you would like to share?
Row 8, Column 1
When did it start?
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Anything else you would like to share?
Row 9, Column 1
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25
Do you have any resources for others that have helped during your pregnancy that you would like to share or recommend to others?This can be books, online resources, apps, podcasts, YouTube channels, tv shows, authority figures/influencers etc.
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Ok
Ok
26
Have you been pregnant before, if so how many times have you been pregnant?Including pregnancies that didn't go to term
27
Please share an overview of your pregnancy experiences* This field is required.Every woman goes through a different experience during pregnancy. Some have twins, some have miscarriages and many have normal pregnancies. Please list all of your pregnancy experiences below in chronological order.
28
Have you experienced a pregnancy loss?The numbers are heart-breaking: approximately one in four women experience pregnancy or infant loss, it is extremely emotional and yet it's so stigmatised women struggle to share their stories. We want to create a safe space for you to share your experience, which will be used to help others going through a similar experience. If you have multiple experiences, please list details of your most recent experience.
YESNO
29
How many weeks along were you when your pregnancy loss symptoms appeared?Please enter the answer in weeks, from your previous period.
30
After you experienced pregnancy loss, when did you get your next period?Please enter the answer in weeks (from your previous period)
31
Did you have an ultrasound that showed a fetal heartbeat? If so at what week did you get the scan?
32
What symptoms did you experience?* This field is required.Please add in all symptoms that may be applicable.
33
Do you know the type of loss did you experienced?Complete miscarriage - When all the pregnancy tissue has left your uterus Missed miscarriage - a situation when there is a non-viable fetus within the uterus, without symptoms of a miscarriage Chemical Pregnancy - a very early miscarriage. It usually happens before the pregnancy reaches five weeks. Incomplete Miscarriage - when a miscarriage begins, but the pregnancy doesn't completely come away from the womb Stillbirth - is the loss of a baby before or during delivery
Complete Miscarriage
Incomplete Miscarriage
Missed Miscarriage
Septic Miscarriage
Chemical Pregnancy
Stillbirth
Late term loss
TFMR
Other
34
What other sort of loss did you experience?
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Ok
Ok
35
How did you manage your pregnancy loss?
Naturally
With Medicine
With Surgery (D&C)
Other
36
If none of the options above applied, how else did you manage your pregnancy loss?
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Ok
Ok
37
Did you go through any testing following your pregnancy loss?Please tick all the tests that you underwent.
No
Hormonal (Prolactin, thyroid and progesterone level)
Uterine Lining Endometrial Biopsy
Structural (Hysterosalpingogram)
Genetic Chromosomal Tests
Immunological Blood Test
Hysteroscopy
Laproscopy
Other
38
What other tests did you go through to understand why the pregnancy loss occured?
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Ok
Ok
39
Did you find out the cause of your pregnancy loss? If so what was the cause?
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Ok
Ok
40
The emotional part of pregnancy loss is the most difficult. How did you handle the grief and the emotions?Please share your story to help other women who have experienced or are experiencing a miscarriage.
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Small
Ok
Ok
41
Do you have any resources that you would like to share or recommend to others going through pregnancy loss?This can be books, online resources, apps, podcasts, YouTube channels, tv shows, authority figures/influencers etc.
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Large
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Small
Ok
Ok
42
Have you had a child/children?
YESNO
43
What pregnancy was this?The next few questions ask you about your pregnancy experience. So we understand what pregnancy this relates to, please let us know which pregnancy experience you are sharing information about. If it was your second child and most recent, please select both check boxes.
Most Recent
First
Second
Third or more
44
How did you fall pregnant?Please select all that apply.
Natural Pregnancy
IVF
IUI
At home insemination
Sperm, Egg or Embryo Donor
Surrogate
Ovulation Induction
Medical Fertility Preservation
Other
45
What other methods did you use to fall pregnant?
Huge
Large
Normal
Small
Ok
Ok
46
Did you take any medication to help with your pregnancy? If so please list them here.Please list only prescribed medicines, please add one per line and use the + button to add a new line. The next question asks about vitamins and supplements you have been taking.
47
Did you take any supplements to help with your pregnancy? If so please list them here.Please add one per line and use the + button to add a new line.
48
Did you enjoy your pregnancy?Remember all experiences are different. It's normal for women to go through different experiences during pregnancy.
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49
What symptoms did you experience during your pregnancy?* This field is required.Please add in all symptoms that may be applicable.
50
Did you experience any complications during your pregnancy?If you didn't experience any complications please skip to the next question. Please swipe to see the entire list.
When did it start?
Do you have anything else you would like to share?
High Blood Pressure
Row 0, Column 0
Row 0, Column 1
Gestatitional Diabetes
Row 1, Column 0
Row 1, Column 1
Infections
Row 2, Column 0
Row 2, Column 1
Preclampsia
Row 3, Column 0
Row 3, Column 1
Preterm Labour
Row 4, Column 0
Row 4, Column 1
Depression & Anxiety
Row 5, Column 0
Row 5, Column 1
Sever, persistent nausea and vomiting
Row 6, Column 0
Row 6, Column 1
Iron-deficiency anemia
Row 7, Column 0
Row 7, Column 1
Ectopic Pregnancy
Row 8, Column 0
Row 8, Column 1
Placental Issues
Row 9, Column 0
Row 9, Column 1
High Blood Pressure
Gestatitional Diabetes
Infections
Preclampsia
Preterm Labour
Depression & Anxiety
Sever, persistent nausea and vomiting
Iron-deficiency anemia
Ectopic Pregnancy
Placental Issues
When did it start?
Row 0, Column 0
Do you have anything else you would like to share?
Row 0, Column 1
When did it start?
Row 1, Column 0
Do you have anything else you would like to share?
Row 1, Column 1
When did it start?
Row 2, Column 0
Do you have anything else you would like to share?
Row 2, Column 1
When did it start?
Row 3, Column 0
Do you have anything else you would like to share?
Row 3, Column 1
When did it start?
Row 4, Column 0
Do you have anything else you would like to share?
Row 4, Column 1
When did it start?
Row 5, Column 0
Do you have anything else you would like to share?
Row 5, Column 1
When did it start?
Row 6, Column 0
Do you have anything else you would like to share?
Row 6, Column 1
When did it start?
Row 7, Column 0
Do you have anything else you would like to share?
Row 7, Column 1
When did it start?
Row 8, Column 0
Do you have anything else you would like to share?
Row 8, Column 1
When did it start?
Row 9, Column 0
Do you have anything else you would like to share?
Row 9, Column 1
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51
What sort of delivery did you have?
Unassisted Delivery without Medication
Unassisted Delivery with Medication
Assisted - Episiotomy "surgical incision"
Assisted - Amniotomy "breaking water"
Induced Labour
Assisted - Forceps Delivery
Assisted - Vacuum Extraction
Assisted - Caesarean (C-Section)
Other
52
What sort of delivery did you have?
Unassisted Delivery without Medication
Unassisted Delivery with Medication
Assisted - Episiotomy "surgical incision"
Assisted - Amniotomy "breaking water"
Induced Labour
Assisted - Forceps Delivery
Assisted - Vacuum Extraction
Assisted - Caesarean (C-Section)
Other
53
What sort of delivery did you have?
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Large
Normal
Small
Ok
Ok
54
Where did you give birth?
Home Birth
Home - Water Birth
Birth Center
Birth Center - Water Birth
Hospital
Hospital - Water Birth
On the way to the hospital
On the toilet
Other
55
Where did you give birth?
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Large
Normal
Small
Ok
Ok
56
How long were you in labour?Please list hours and minutes
How many hours
How many minutes
57
What was the weight of your baby?Please state the weight and the unit of measurement i.e. 3.5kg
58
Did your baby experience any issues following the birth?
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Large
Normal
Small
Ok
Ok
59
Did you experience any complications after your pregnancy?Please swipe to see the list of options.
When did it start, how long did it last? Share any other information about your experiences here.
Postpartum infections, (including uterine, bladder, or kidney infections)
Row 0, Column 0
Excessive bleeding after delivery
Row 1, Column 0
Pain in the perineal area (between the vagina and the rectum)
Row 2, Column 0
Vaginal discharge
Row 3, Column 0
Breast problems, such as swollen breasts, infection and clogged ducts
Row 4, Column 0
Stretch marks
Row 5, Column 0
Hemorrhoids and constipation
Row 6, Column 0
Urinary or fecal (stool) incontinence
Row 7, Column 0
Hair loss
Row 8, Column 0
Postpartum depression
Row 9, Column 0
Discomfort during sex
Row 10, Column 0
Other
Row 11, Column 0
Postpartum infections, (including uterine, bladder, or kidney infections)
Excessive bleeding after delivery
Pain in the perineal area (between the vagina and the rectum)
Vaginal discharge
Breast problems, such as swollen breasts, infection and clogged ducts
Stretch marks
Hemorrhoids and constipation
Urinary or fecal (stool) incontinence
Hair loss
Postpartum depression
Discomfort during sex
Other
When did it start, how long did it last? Share any other information about your experiences here.
Row 0, Column 0
When did it start, how long did it last? Share any other information about your experiences here.
Row 1, Column 0
When did it start, how long did it last? Share any other information about your experiences here.
Row 2, Column 0
When did it start, how long did it last? Share any other information about your experiences here.
Row 3, Column 0
When did it start, how long did it last? Share any other information about your experiences here.
Row 4, Column 0
When did it start, how long did it last? Share any other information about your experiences here.
Row 5, Column 0
When did it start, how long did it last? Share any other information about your experiences here.
Row 6, Column 0
When did it start, how long did it last? Share any other information about your experiences here.
Row 7, Column 0
When did it start, how long did it last? Share any other information about your experiences here.
Row 8, Column 0
When did it start, how long did it last? Share any other information about your experiences here.
Row 9, Column 0
When did it start, how long did it last? Share any other information about your experiences here.
Row 10, Column 0
When did it start, how long did it last? Share any other information about your experiences here.
Row 11, Column 0
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60
Do you have another pregnancy experience you would like to share?
YESNO
61
What pregnancy was this?The next few questions ask you about your pregnancy experience. So we understand what pregnancy this relates to, please let us know which pregnancy experience you are sharing information about. If it was your second child and most recent, please select both check boxes.
Most Recent
First
Second
Third or more
62
How did you fall pregnant?Please select all that apply.
Natural Pregnancy
IVF
IUI
At home insemination
Sperm, Egg or Embryo Donor
Surrogate
Ovulation Induction
Medical Fertility Preservation
Other
63
What other methods did you use to fall pregnant?
Huge
Large
Normal
Small
Ok
Ok
64
Did you take any medication to help with your pregnancy? If so please list them here.Please list only prescribed medicines, please add one per line and use the + button to add a new line. The next question asks about vitamins and supplements you have been taking.
65
Did you take any supplements to help with your pregnancy? If so please list them here.Please add one per line and use the + button to add a new line.
66
Did you enjoy your pregnancy?Remember all experiences are different. It's normal for women to go through different experiences during pregnancy.
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67
What symptoms did you experience during your pregnancy?* This field is required.Please add in all symptoms that may be applicable.
68
Did you experience any complications during your pregnancy?If you didn't experience any complications please skip to the next question. Please swipe to see the entire list.
When did it start?
Do you have anything else you would like to share?
High Blood Pressure
Row 0, Column 0
Row 0, Column 1
Gestatitional Diabetes
Row 1, Column 0
Row 1, Column 1
Infections
Row 2, Column 0
Row 2, Column 1
Preclampsia
Row 3, Column 0
Row 3, Column 1
Preterm Labour
Row 4, Column 0
Row 4, Column 1
Depression & Anxiety
Row 5, Column 0
Row 5, Column 1
Sever, persistent nausea and vomiting
Row 6, Column 0
Row 6, Column 1
Iron-deficiency anemia
Row 7, Column 0
Row 7, Column 1
Ectopic Pregnancy
Row 8, Column 0
Row 8, Column 1
Placental Issues
Row 9, Column 0
Row 9, Column 1
High Blood Pressure
Gestatitional Diabetes
Infections
Preclampsia
Preterm Labour
Depression & Anxiety
Sever, persistent nausea and vomiting
Iron-deficiency anemia
Ectopic Pregnancy
Placental Issues
When did it start?
Row 0, Column 0
Do you have anything else you would like to share?
Row 0, Column 1
When did it start?
Row 1, Column 0
Do you have anything else you would like to share?
Row 1, Column 1
When did it start?
Row 2, Column 0
Do you have anything else you would like to share?
Row 2, Column 1
When did it start?
Row 3, Column 0
Do you have anything else you would like to share?
Row 3, Column 1
When did it start?
Row 4, Column 0
Do you have anything else you would like to share?
Row 4, Column 1
When did it start?
Row 5, Column 0
Do you have anything else you would like to share?
Row 5, Column 1
When did it start?
Row 6, Column 0
Do you have anything else you would like to share?
Row 6, Column 1
When did it start?
Row 7, Column 0
Do you have anything else you would like to share?
Row 7, Column 1
When did it start?
Row 8, Column 0
Do you have anything else you would like to share?
Row 8, Column 1
When did it start?
Row 9, Column 0
Do you have anything else you would like to share?
Row 9, Column 1
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69
What sort of delivery did you have?
Unassisted Delivery without Medication
Unassisted Delivery with Medication
Assisted - Episiotomy "surgical incision"
Assisted - Amniotomy "breaking water"
Induced Labour
Assisted - Forceps Delivery
Assisted - Vacuum Extraction
Assisted - Caesarean (C-Section)
Other
70
What sort of delivery did you have?
Unassisted Delivery without Medication
Unassisted Delivery with Medication
Assisted - Episiotomy "surgical incision"
Assisted - Amniotomy "breaking water"
Induced Labour
Assisted - Forceps Delivery
Assisted - Vacuum Extraction
Assisted - Caesarean (C-Section)
Other
71
What sort of delivery did you have?
Huge
Large
Normal
Small
Ok
Ok
72
Where did you give birth?
Home Birth
Home - Water Birth
Birth Center
Birth Center - Water Birth
Hospital
Hospital - Water Birth
On the way to the hospital
On the toilet
Other
73
Where did you give birth?
Huge
Large
Normal
Small
Ok
Ok
74
How long were you in labour?Please list hours and minutes
How many hours
How many minutes
75
What was the weight of your baby?Please state the weight and the unit of measurement i.e. 3.5kg
76
Did your baby experience any issues following the birth?
Huge
Large
Normal
Small
Ok
Ok
77
Did you experience any complications after your pregnancy?Please swipe to see the list of options.
When did it start, how long did it last? Share any other information about your experiences here.
Postpartum infections, (including uterine, bladder, or kidney infections)
Row 0, Column 0
Excessive bleeding after delivery
Row 1, Column 0
Pain in the perineal area (between the vagina and the rectum)
Row 2, Column 0
Vaginal discharge
Row 3, Column 0
Breast problems, such as swollen breasts, infection and clogged ducts
Row 4, Column 0
Stretch marks
Row 5, Column 0
Hemorrhoids and constipation
Row 6, Column 0
Urinary or fecal (stool) incontinence
Row 7, Column 0
Hair loss
Row 8, Column 0
Postpartum depression
Row 9, Column 0
Discomfort during sex
Row 10, Column 0
Other
Row 11, Column 0
Postpartum infections, (including uterine, bladder, or kidney infections)
Excessive bleeding after delivery
Pain in the perineal area (between the vagina and the rectum)
Vaginal discharge
Breast problems, such as swollen breasts, infection and clogged ducts
Stretch marks
Hemorrhoids and constipation
Urinary or fecal (stool) incontinence
Hair loss
Postpartum depression
Discomfort during sex
Other
When did it start, how long did it last? Share any other information about your experiences here.
Row 0, Column 0
When did it start, how long did it last? Share any other information about your experiences here.
Row 1, Column 0
When did it start, how long did it last? Share any other information about your experiences here.
Row 2, Column 0
When did it start, how long did it last? Share any other information about your experiences here.
Row 3, Column 0
When did it start, how long did it last? Share any other information about your experiences here.
Row 4, Column 0
When did it start, how long did it last? Share any other information about your experiences here.
Row 5, Column 0
When did it start, how long did it last? Share any other information about your experiences here.
Row 6, Column 0
When did it start, how long did it last? Share any other information about your experiences here.
Row 7, Column 0
When did it start, how long did it last? Share any other information about your experiences here.
Row 8, Column 0
When did it start, how long did it last? Share any other information about your experiences here.
Row 9, Column 0
When did it start, how long did it last? Share any other information about your experiences here.
Row 10, Column 0
When did it start, how long did it last? Share any other information about your experiences here.
Row 11, Column 0
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78
Do you have any pregnancy resources that you would like to share or recommend to others?This can be books, online resources, apps, podcasts, YouTube channels, tv shows, authority figures/influencers etc.
Huge
Large
Normal
Small
Ok
Ok
79
Do you want to share any other information about your pregnancy journey with others?Please add in anything you think would help other women on the pregnancy journey e.g. highlights, lowlights, tips, feelings etc.
Huge
Large
Normal
Small
Ok
Ok
80
Share this survey with your friends who are also going through / have been through the fertility journey.If you've ever been pregnant and Googled symptoms, you know how scary it can be. You then stumble upon a forum or thread which outlines the experience of one woman, and boom suddenly you think that's exactly what's going to happen to you. We are collecting this data with experiences of real women who have been through or going through the fertility journey. Our goal is to provide you with a set of possible outcomes from a collection of women. This is by no means medical advice, but merely an aggregation of experiences from other women, just like you. Share this survey with your friends who are also going through / have been through the fertility journey.
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