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הסקר נערך כחלק מסקר בינלאומי שנערך ע"י ארגון ICSI - עמותות מטופלי פוריות בעולם כולו והוא נערך בעילום שם..
אנו מודים על מילוי הסקר ושיגורו חזרה אלינו
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General details
Date of birth
*
MM
/
DD
/
YYYY
What is your marital status?
*
Married
Single
Divorced/Separated
Widowed
What is the highest level of education you have completed?
*
High school or less
Some College
College
Post Graduate studies (e.g. PhD, MD, MA)
How many times have you been pregnant ?
*
1-2
3-4
5 or more
Other:
How many Children do you have ?
*
0
1-2
3-4
5 or more
Are you now or have you ever been diagnosed with infertility?
*
yes
no
In your opinion...
What proprotion of israeli couples experience infertility?
*
1 in 2
1 in 10
1 in 50
1 in 100
At what age does a woman's fertility start to measurably decline?
*
27
30
40
45
At what age does a man's fertility start to measurably decline?
*
30
40
45
50 or more
Your general health is a good indicator of your current fertility?
*
true
false
When a couple is infertile, how often is this due solely to the woman?
*
20
50
70
90
When a couple is infertile, how often is this due solely to the man?
*
10
30
50
80
When a couple is infertile, how often is this due to both the man and woman?
*
10
20
50
80
A 35 year old couple in 2000 is more likely to be infertile than a 35 year old couple in 1965?
*
true
false
Birth control pills help protect your fertility?
true
false
Clear selection
Barrier contraception (condoms and diaphragms) helps protect you fertility ?
*
true
false
Intra-uterine devices (IUDs) help protect your fertility?
true
false
Clear selection
When is a couple considered infertile (unable to concieve) ? if they are trying, but do not concieve in?
*
3 months
1 year
2.5 years
5 years
At what age will half of all couples experience infertility?
*
25
30
37
45
At what age will 90% of all couples experience infertility?
*
27
30
42
50 or more
How long will the avarage 30 year old couple take to concieve once they begin actively trying?
*
3 months
6 months
1 year
2 years
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