Baby Readiness Assessment (Female)

1
How would you describe your current state of health?* This field is required.
Excellent
Good
Fair
Poor
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On a scale from 1-10, how much do you think your overall health affects your ability to conceive?* This field is required.
Please Select
Please Select
1
2
3
4
5
6
7
8
9
10
3
Have you been diagnosed with any of the following?* This field is required.
Anemia
Inherited blood disorder (e.g., sickle cell, thalassemia)
None
4
Do you have any of the following symptoms?* This field is required.
Fatigue / weakness
Headache, dizziness or lightheadedness
Cold hands and feet
Pale skin
Chest pain, fast heartbeat, or shortness of breath
Brittle nails
None
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Have you been diagnosed with any of the following conditions?* This field is required.
Autoimmune disease (e.g., Crohn's, rheumatoid arthritis, MS, Celiac)
Cancer
Sexually transmitted infection(s)
Urinary tract or yeast infections
None
7
Do you experience any of the following symptoms?* This field is required.
Fatigue
Joint pain and swelling
Skin problems
Abdominal pain or digestive issues
Swollen glands
Unusual discharge from the vagina; pain when urinating
None
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Did you know...?

80% of autoimmune disease diagnoses are made in females.

And, it takes on average 7-8 years to get an autoimmune diagnosis.

Many of the symptoms on the previous page can be an sign of an underlying autoimmune condition.

If you experience any of these symptoms, or if you have a family history of autoimmune disease, it can be helpful to get screened early.

When not properly managed, autoimmune disease can be responsible for difficulty getting pregnant and sustaining a pregnancy to term.
10
Have you been diagnosed with or experienced any of the following?* This field is required.
Endometriosis or fibroids
Hypothyroid / thyroid disorder
Miscarriage
PCOS
None
Other
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Did you know...?

There are 4 different types of PCOS.

1. Insulin resistant PCOS: indicated by elevated fasting insulin levels

2. Post-pill PCOS: temporarily elevated androgen levels after coming off of birth control

3. Inflammatory PCOS: indicated elevated testosterone and elevated inflammation

4. Adrenal PCOS: indicated by elevated DHEA with normal testosterone levels

Depending on which type of PCOS you have, the suggested interventions to manage it will be different.
13
Do you experience any of the following period symptoms?* This field is required.
Acne
Bloating
Breast tenderness
Brown spotting (prior to or between periods)
Cramps
Dark red / black clots
Low libido or vaginal dryness / lack of lubrication
Migraines
Hirsutism (growth of dark or coarse hair on face, chest or back)
Sensitivity to cold
Weight gain
Constipation
None
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Did you know...?

Period symptoms are common (80%+ of females experience them),
but they are not normal (i.e. the way your body was designed to operate).

Premenstrual syndrome (PMS) is not inevitable.

It is not something you just have to "live with".

Significant PMS is an indication that things are out of balance.

The more severe your PMS symptoms are,
the more severe the dysregulation of your hormones are likely to be.

We want you to know - it doesn't have to be this way.
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Do you get a regular period (every ~25-35 days)?* This field is required.
YESNO
17
How long does your period typically last?* This field is required.
1-3 days
4-7 days
More than 8 days
18
How would you describe your menstrual bleeding?* This field is required.
Light
Medium
Heavy
Very heavy
19
Are you currently on hormonal birth control (e.g., pill, ring, IUD, shot)?* This field is required.
YESNO
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Did you know...?

Hormonal birth control use can impact your time to pregnancy.

How?

It depletes the body of key nutrients; many of these nutrients (e.g., B vitamins, vitamin E, zinc, coenzyme Q10) are critical for initiating and maintaining pregnancy.

It can alter the gut microbiome. An altered microbiome can be responsible for a number of symptoms, including headaches, yeast infections, lowered immunity and even mood disorders. A dysbiotic gut can also be transferred to your future baby, predisposing them to things like asthma and allergies.

It can impair detoxification, allowing a toxic hormonal soup to build up in your body. Excess estrogen, for example, is linked to fibroids, endometriosis and even some cancers. Moreover, any time that hormones are imbalanced (too much, too little), fertility problems ensue.

It can mask underlying hormonal imbalances. With hormonal birth control, you do not actually get a period each month; rather, it’s a chemically induced “withdrawal bleed”. Practically speaking, this means that your hormones don’t fluctuate normally and naturally; therefore, your body does not produce many of the signs of hormonal dysfunction (e.g., acne, spotting, absent periods) that it otherwise would. Basically, your body’s symptom cascade is “silenced”.

This isn’t about birth control being good or bad. As with any medication, it’s about weighing the benefits and risks. And it’s about your unique situation and priorities. It’s just important to be an informed consumer...and you can’t be informed if no one gives you all of the facts.

The big takeaway here is this:

The effects of hormonal birth control can increase barriers and therefore time to getting pregnant (e.g., through nutrient deficiencies, altered microbiome function and impaired detox). Given this, you may want to give yourself some time to transition off of birth control and ensure that your hormonal system is in good shape before trying to conceive.
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Have you been diagnosed with any of the following conditions?* This field is required.
Pre-diabetes or diabetes
Hypertension
None
23
Do you have any of the following symptoms?* This field is required.
Severe headaches
Lightheadedness / fainting
Fatigue, especially after eating
Increased thirst and/or frequent urination
None
24
Have you been diagnosed with any of the following?* This field is required.
Vitamin D deficiency
B Vitamin deficiency (e.g., folate, B12)
None
25
Do you have any of the following symptoms?* This field is required.
Fatigue
Headaches
Pale or yellow skin
Poor memory
Burning / pins-and-needles sensation in hands and feet
Dry skin
Mood swings or depression
Pain / inflammation of the mouth and tongue
None
26
How often do you have the following foods? * This field is required.
Never
Occasionally
Frequently
Daily
Coffee
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Packaged beverages (e.g. juice, soda, energy drinks)
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Packaged snacks, including sweet (e.g. cakes, cookies, candies) and savory (e.g. chips, pretzels)
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Fast food
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Alcohol
Row 4, Column 0
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Sugar in any processed form (e.g. agave, brown rice syrup, candy, fruit juice concentrate, high fructose corn syrup)
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Leafy green vegetables
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Coffee
Packaged beverages (e.g. juice, soda, energy drinks)
Packaged snacks, including sweet (e.g. cakes, cookies, candies) and savory (e.g. chips, pretzels)
Fast food
Alcohol
Sugar in any processed form (e.g. agave, brown rice syrup, candy, fruit juice concentrate, high fructose corn syrup)
Leafy green vegetables
Never
Row 0, Column 0
Occasionally
Row 0, Column 1
Frequently
Row 0, Column 2
Daily
Row 0, Column 3
Never
Row 1, Column 0
Occasionally
Row 1, Column 1
Frequently
Row 1, Column 2
Daily
Row 1, Column 3
Never
Row 2, Column 0
Occasionally
Row 2, Column 1
Frequently
Row 2, Column 2
Daily
Row 2, Column 3
Never
Row 3, Column 0
Occasionally
Row 3, Column 1
Frequently
Row 3, Column 2
Daily
Row 3, Column 3
Never
Row 4, Column 0
Occasionally
Row 4, Column 1
Frequently
Row 4, Column 2
Daily
Row 4, Column 3
Never
Row 5, Column 0
Occasionally
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Frequently
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Daily
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Never
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Occasionally
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Frequently
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Daily
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Are you currently taking a multivitamin?* This field is required.
YESNO
28
Do you follow a vegan or vegetarian diet?* This field is required.
YESNO
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Did you know...?

Vegetarians tend to have lower hormone levels than their meat-eating counterparts.

Why is this?

1. You need cholesterol to make hormones.

One of the raw materials necessary to make your sex hormones is cholesterol. Unfortunuately, plant sterols (the “cholesterol” equivalent from plants) aren't as effectively used by our bodies as cholesterol from animal products. Interestingly, your body does make its own cholesterol, but we often need to supplement with cholesterol from our diet as well to reach optimal levels.

2. You need protein to make hormones.

Protein from animal products tends to be more bioavailable than protein from plant products. There are plenty of sources of protein in a vegetarian diet (e.g., quinoa, rice and beans, lentils). However, it’s just not as quickly and easily digested and assimilated as animal protein.

3. Certain nutrients are only available in animal products, such as vitamin A (retinoids specifically), vitamin D (except maybe mushrooms!) and vitamin B12 (unless foods are fortified with these nutrients). Beyond this, the bioavailability of certain nutrients is better from animal sources than plant sources.

For example, the conversion from ALA (from plant sources) to DHA is quite poor; it’s better to get DHA directly from oily fish. Also, heme iron (from animals) is more bioavailable than nonheme iron (from plants). Zinc levels are also is also lower on vegetarian diets.
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BMI CalculatorPlease enter your weight and height
32
Have you been diagnosed with any of the following conditions?* This field is required.
Depression
Anxiety
Other mood disorder
None
33
How old are you?* This field is required.
Please Select
Please Select
15-19
20-24
25-29
30-34
35-39
40-44
45-49
50-55
55+
34
How many prescription medications do you take (not including hormonal birth control)?* This field is required.
Please Select
Please Select
0
1
2
3
4+
35
Which best describes your current estimate of when you'd like to get pregnant?* This field is required.
Please Select
Please Select
Currently trying (naturally)
Currently trying (assisted reproductive technology - IUI or IVF)
In the next 3 months
In the next 6 months
In the next 1 year
In the next couple of years
Further in the future, not sure when
Not interested in getting pregnant, just curious
36
On a scale from 1-10, how anxious are you about your ability to conceive when you're ready to (1 - not at all, 10 - extremely anxious)?* This field is required.
Please Select
Please Select
1
2
3
4
5
6
7
8
9
10
37
First Name* This field is required.
38
Email* This field is required.By providing your email, you are opting in to view your baby-readiness zone and to receive emails from 9 Months Is Not Enough
example@example.com
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