Help! I need Fertility Support
Please enter your responses below for an opportunity to work with Dr. Aumatma, virtually.
Email address *
First and Last Name *
Your date of birth *
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DD
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What are your latest Lab test results for AMH, FSH, LH, and estradiol? (If the tests were not done in the US, please include units of measurement) *
Average stress level?
No stress at all
Overwhelming stress
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Average energy level?
No energy at all
Energized all day
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Do you have any of the following symptoms? #1
Do you have any of the following symptoms? #2
Do you have any of the following symptoms? #3
Do you have any of the following symptoms? #4
Do you have any of the following symptoms? #5
Do you have any of the following symptoms? #6
Do you have any of the following symptoms? #7
Do you have any of the following symptoms? #8
Do you have any of the following symptoms? #9
Do you currently experience any of the following? #10
Gut-Brain: Do you currently experience any of the following?
OB/GYN: Have you ever experienced or been diagnosed with any of the following?
How often do you and your partner have intercourse? Is it planned or spontaneous?
Do you use any lubricants/ gels before or during intercourse?
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Have you used contraception in the past? If so, when and for how long?
Have you ever had a miscarriage? If so, when?
How long is your cycle on average? (# of days between day 1- start of next period)
How many days does your period last?
In what ways are you tracking your cycles? (BBTs, OPKs, beginning and end dates, etc) Please be specific.
What has your Fertility Journey been thus far? Please describe in detail. *
What have you already tried and what kind of support are you looking for? *
How much would you invest in getting the right type of support to optimize your fertility to get pregnant naturally or have a successful IVF cycle the next time you can? *
What time zone and country are you located in? *
Phone number *
Do you have any questions or comments?
A copy of your responses will be emailed to the address you provided.
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