UMAY IVF CENTER

Have you been trying to conceive for at least six months with no luck?

YesNo

Do you have pain in the upper abdomen, lower abdomen or back-lumbar regions on certain days of the month?

YesNo

Do you have irregular or very heavy periods?

YesNo

Have you had a cesarean section or any other abdominal surgery?

YesNo

Have you been diagnosed with endometriosis, fibroids, or polyps in your uterus?

YesNo

Are your periods irregular?

YesNo

Have you ever had a miscarriage?

YesNo

Have you been diagnosed with polycystic ovary syndrome?

YesNo

Have you ever consulted a doctor for a diagnosis of infertility?

YesNo

Have you been diagnosed with infertility?

YesNo

Have you had IVF treatment?

YesNo

INITIAL DIAGNOSIS AND DIAGNOSIS FORM