Request edit access
Survey
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
General details
Date of birth *
MM
/
DD
/
YYYY
What is your marital status? *
What is the highest level of education you have completed? *
How many times have you been pregnant ? *
How many Children do you have ? *
Are you now or have you ever been diagnosed with infertility? *
In your opinion...
What proprotion of israeli couples experience infertility? *
At what age does a woman's fertility start to measurably decline? *
At what age does a man's fertility start to measurably decline? *
Your general health is a good indicator of your current fertility? *
When a couple is infertile, how often is this due solely to the woman? *
When a couple is infertile, how often is this due solely to the man? *
When a couple is infertile, how often is this due to both the man and woman? *
A 35 year old couple in 2000 is more likely to be infertile than a 35 year old couple in 1965? *
Birth control pills help protect your fertility?
Clear selection
Barrier contraception (condoms and diaphragms) helps protect you fertility ? *
Intra-uterine devices (IUDs) help protect your fertility?
Clear selection
When is a couple considered infertile (unable to concieve) ? if they are trying, but do not concieve in? *
At what age will half of all couples experience infertility? *
At what age will 90% of all couples experience infertility? *
How long will the avarage 30 year old couple take to concieve once they begin actively trying? *
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of עמי חניא.
Google Forms