Back to page Please enable JavaScript in your browser to complete this form. - Step 1 of 9Hello!1. What’s is your first name? *What is your surname? *What’s your email address? *Next2. What are your goals? *Curious about my fertility.I am actively trying to get pregnant.I am considering egg-freezing.Wondering if I'm near menopause.BackNext3. What is your date of birth? *DD12345678910111213141516171819202122232425262728293031/MM123456789101112/YYYY20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920(We won’t tell anyone, it stays between us.) Fertility declines with age and the rate of decline differs in everyone. BackNextHeight *FootcmFootInchescmWeight *KgStone KgStoneBMI(We won’t tell anyone, it stays between us). Your height and weight can influence your fertility. BackNext5. What type of contraception (birth control) do you use? *I am not on contraceptionThe combined oral contraceptive pillHormonal coil (mirena)The copper coil/ IUDBarrier contraception – condoms, diaphragmDepot injection or implant The progesterone only pillNatural methods (e.g. withdrawal, using tracking apps) BackNext6. What are your periods like? *I don't get periods on my form of contraception.Regular.Irregular.I'm not currently getting periods.BackNextA bit about your medical history. 7. Do you have any of these medical conditions? (Select as many as necessary) *No.PCOS.Endometriosis.Fibroids.Thyroid issues.Pelvic Inflammatory Disease.Premature Ovarian Insufficiency. In PCOS, you may have an increased AMH level therefore this test may overestimate your ovarian reserve and not be as accurate. AMH levels can fluctuate over time so feel free to take the test if you want to monitor your AMH levels over time. Just to let you know - given your diagnosis of endometriosis, your AMH levels may be lower than on average and the decline of your hormone may be quicker than others. Predicting when you will start menopause may be less accurate. Based on your history of pelvic inflammatory disease, you may have lower levels of AMH. The level will depend on the extent of your pelvic inflammatory disease and how long you have had it. You can still have the test, we are just letting you know. Given your diagnosis of premature ovarian failure/ insufficiency, AMH levels can be used to assess the extent of the disease and let you know how close you are to menopause. Option for other – type answer hereThis is just so that our doctors can give you a more custom plan.BackNext8. Are you on any regular medications? Let us know what you take. It’s all confidential. *Ps. If you are taking biotin regularly, we recommend withholding it for 4 days before you take your test. Some medications can affect your hormones. BackNext9. Anything else you want us to know? If not, write no.e.g Family history of premature ovarian failure or ovarian cancer? Are you breast feeding? Are you currently being investigated for any health problems? 9. Anything else you want us to know? If not, write no. *BackSubmit