Join Uterine Fibroids Research Study

Join research on uterine fibroids and infertility

Please answer all the questions to join this research study. Your answers are kept confidential and will not be shared with anyone except the research team.
1. Name*

First NameLast Name
2. Email*
example@example.com
3. Age*
Your age in years
4. Which of the following sites do you prefer to join?*

Yale University, New Haven, CT 06520Johns Hopkins University, Baltimore, MD 21218The University of Chicago, Chicago, IL 60637University of Illinois Chicago, Chicago, IL 60607
5. Are you currently pregnant?*

YesNoUnsure / Maybe
6. Are you diagnosed with uterine fibroids?*

YesNoUnsure / Maybe
7. Have you tried to conceive for a year or more unsuccessfully?

YesNoUnsure / Maybe
8. Have you tried to conceive for six months or more unsuccessfully?

YesNoUnsure / Maybe
9. Are you interested in taking a green tea extract containing EGCG (epigallocatechin gallate) to measure what impact it may have on shrinking fibroids and improving the lining of the uterus for better embryo implantation?*

YesNoUnsure / Maybe
This study tests a green tea extract to potentially improve fertility alongside an IUI fertility treatment.

EGCG stands for "Epigallocatechin Gallate." EGCG is used in many supplements, and naturally occurs in tea. EGCG might shrink fibroids, making pregnancy more likely.
10. Are you interested in undergoing an Intrauterine Insemination (IUI) to get pregnant?*

YesNoUnsure / Maybe
An IUI is a type of artificial insemination that involves washing and concentrating sperm then placing it directly in the woman’s uterus around the time of ovulation. Human chorionic gonadotropin (hCG) is part of this treatment.
11. Is your period regular?*

YesNoUnsure / Maybe
11.1 Please share more details.
12. Please fill in the following data if a professional has measured these for you. If not sure, please leave blank.

AMH (Anti-Müllerian Hormone) levelsFollicle stimulating hormone levels
AMH (Anti-Müllerian Hormone) levels
ng/mL, Nanograms per milliliter
Follicle stimulating hormone levels
IU / L, international units per liter
12c. Do you have at least one open fallopian tube?*

YesNoUnsure / Maybe
12d. Does your male partner have total motile sperm in the ejaculate of at least 5 million sperm/ml?*

YesNoUnsure / Maybe
Are you diagnosed with any of the following? Please select all that apply. If unsure, please leave blank.

A medical condition that is a contraindication to pregnancy not mentioned here.Known polycystic ovarian syndromeStage 3 or 4 endometriosisUndergone a bariatric surgery procedure within the past year.Untreated hypertensionA previous sterilization procedure (e.g., vasectomy, tubal ligation) which has been reversed.Allergy or contraindication to the treatment medications: EGCG, clomiphene citrate (CC) or hCG.Known or suspected adrenal or ovarian androgen secreting tumors.Known Cushing’s disease.History of alcohol abuseHistory of, or suspected cervical carcinoma, endometrial carcinoma or breast carcinoma.Known Renal diseaseKnown Liver diseaseKnown heart disease (New York Heart Association Class II or higher)History of deep venous thrombosis, pulmonary embolus, or cerebrovascular event.Known significant anemiaUncontrolled diabetesKnown 21-hydroxylase deficiency or other enzyme defects causing congenital adrenal hyperplasia.Suspicious ovarian mass.Undiagnosed abnormal uterine bleeding.
Result*
source
area
Phone appointment

Thank you for completing the questionnaire. You appear to pass all study criteria. As a last step, the research team would like to speak with you on the phone. You will get the opportunity to learn more about the study and ask questions before deciding to join.
Phone Number*

Area CodePhone Number
Preferred time(s) to be contacted:

9 AM10 AM11 AM12 PM1 PM2 PM3 PM4 PM5 PM
Wayturn contact email
Should be Empty:

Join research on uterine fibroids and infertility

Phone appointment