Fertility Assessment

What is your Age:

What is your weight in kg:

What is your height in cm:

Do You Smoke:

Do you consume more than 2 serves of alcohol per day?:

Do you consume more than 2 cups of coffee per day?:

Have you ever been diagnosed with Chlamydia?:

Have you ever been diagnosed with congenital absence of the vas?

Have you ever taken anabolic steroids?

Have you ever taken recreational drugs?

Have you been attempting to get your partner pregnant for greater than 6 months?