Female Fertility Worksheet

Since fertility problems are a shared concern, you and your partner should go to the first appointment together. Bring copies of your health records to your visit and have copies sent to your doctor ahead of time to avoid the hassle and expense of duplicating medical tests. Expect to be asked about your sexual history, when you first menstruated, whether you’ve ever had any sexually transmitted infections, miscarriages, or abortions, how often you make love, whether you use lubricants, and more. Not much about your private life will be private anymore, so you’ll want to feel comfortable with your doctor. (For details about what your doctor will ask your partner, see the male fertility worksheet.)

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Read this worksheet all the way through — it links to more detailed information. Then click here to print a clean worksheet you can fill out and give to your doctor.

Date of birth:
Partner’s name:
Partner’s date of birth:
Current medications:

How many months have you been actively trying to get pregnant? (Women under 35 should try for about a year before seeking help — women over 35, or those who have a chronic medical condition or a known condition that may affect fertility, should seek help after six months. Click here to see how age affects fertility.)

Have you tried charting your basal body temperature, ovulation cycle, and cervical mucus? (In addition to signaling when you’re most fertile, charting can tell you if you’re ovulating regularly. Click here to learn how to chart.)

Do you have an irregular menstrual cycle? For example, do you have your period more or less often than once a month? (An irregular cycle could simply mean you don’t ovulate regularly. But it can also indicate a thyroid problem, a prolactin problem, polycystic ovaries, or, if you’re over 40, early menopause. If you’re irregular, seek help right away because waiting to conceive naturally may be a waste of your time.)

Do you have exceptionally light or heavy periods? (It’s normal for bleeding to vary from month to month, but if your flow is consistently unpredictable, you may have an ovulation problem. And sudden heavy bleeding could mean a fibroid in the uterine lining.)

How many days long is your menstrual cycle? (To determine your cycle length, count from the first day of one period to the start of the next. A cycle of 24 to 35 days is normal.)

Do you spot between periods? Or have any unexplained bleeding?

During menstruation, do you have severe pelvic pain or cramping? (Most women feel some discomfort during their period, but severe pain could be a sign of endometriosis or pelvic adhesions.)

Did you get your first period after age 18? (This could indicate a hormonal imbalance or a reproductive endocrine disorder.)

Do you have a feeling of heaviness in your pelvis? (This can be a symptom of fibroids.)

Have you been diagnosed with endometriosis? (This can cause fertility problems in women.)

Have you been diagnosed with polycystic ovarian syndrome? (This is an ovulation disorder.)

Have you had any pelvic or abdominal surgery, such as an appendectomy? (Surgical procedures can sometimes cause scarring that affects fertility.)

Do you have a history of abnormal Pap smears? (These can lead to diagnostic procedures, such as cryotherapy or cone biopsies, that can affect your cervical mucus.)

Have you had your tubes tied (tubal ligation)? Have you had a reversal? (Reversing a sterilization procedure isn’t foolproof. Scar tissue can still prevent pregnancy or increase the chances of an ectopic pregnancy.)

Do you have a chronic illness such as diabetes, thyroid disease, or hypertension? (Chronic conditions, and some of their treatments, have been linked to fertility problems and high-risk pregnancies.)

Do you take any medications? (Steroids and other medications — including herbal medications — can affect your fertility.)

Have you ever been pregnant or given birth and had complications? (A previous pregnancy can, in rare cases, cause scarring or exacerbate a condition that can affect your fertility.)

Have you had any miscarriages? How many have you had, and did you and your doctor come to any conclusions about the cause? Did they occur in the first 12 weeks or in the second 12 weeks of pregnancy? (Repeated miscarriages are a form of fertility problem — and may mean your body needs special help carrying a pregnancy to term.)

Have you ever used an intrauterine device (IUD) as birth control? (IUDs can increase your chances of having pelvic inflammatory disease.)

Have you ever tested positive for a sexually transmitted infection? Which one? (Chlamydia and gonorrhea, for instance, have been linked to fallopian tube problems and pelvic inflammatory disease.)

Do you have pain during sex? (This can be a sign of endometriosis or pelvic adhesions due to pelvic inflammatory disease.)

Do you spot after intercourse? (Bleeding after intercourse can mean many things — from a sexually transmitted infection to uterine or cervical problems such as cervicitis, polyps, or dysplasia.)

Are you a DES daughter (did your mother take diethylstilbestrol, a synthetic estrogen given to women between 1941 and 1971 to prevent miscarriages)? (This drug has since been found to cause reproductive organ abnormalities in some women.)

Have any other members of your family had problems with genetic defects or stillbirths? (You may want to talk to any relatives — particularly childless couples or families with an only child — about their fertility history.)

(Some studies suggest that lifestyle factors may affect fertility.)

How many cups of caffeinated beverages (coffee, soda, tea) do you drink per day? (At least one study has found that the more coffee a woman drinks, the less likely she is to get pregnant. Even if it isn’t substantiated, excess caffeine isn’t believed to be good for a fetus.)

Do you drink alcohol? How many drinks per week? (Several studies suggest that women who drink alcohol — any amount — lower their chances of conceiving.)

Do you smoke? How many packs of cigarettes a week? (Some evidence shows that the nicotine in cigarettes can lower women’s estrogen levels.)

Are you under- or overweight? (Being too thin or too heavy can disrupt a woman’s ovulation cycle. Use our calculator to see if you could stand to gain or lose weight before you get pregnant.)


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