"America's Leading Experts in Reproductive Health"
Demographic Survey
     
 

 
   
 
   
   
   
 
 
   
   
   
 
   
 
   
 
 
   
 
   
   
 
   
 
 

 


Demographic Survey

We are constantly seeking ways to better understand and serve our readership. Our demographic survey allows us to collect data such as age, ethnicity, employment, etc. This information may be used in many ways including the selection of article topics. It is also helpful in establishing the prevalence of infertility in the United States.

Individuals submitting information are not "tracked", or entered into any database. Please take a few moments to provide your information.

 

1 .Please enter your age: 2. Gender:

3. Race,Ethnicity:

4 .Education:Highest Grade Completed:

5. Are you the head of the household: Yes No

6 .Are you employed outside of the home: Yes No

7. What best describes your job:

6. What is your families average yearly income:

7. Do you have children (from a previous pregnancy)? Yes No

8. How many times have you been pregnant:

9. How many children do your have:

10. As a couple; Are you currently experiencing infertility? Yes No

11. Have you ever taken Clomid? Yes No

12. Home many cycles of Clomid have you taken?

13. Have you ever taken injectable FSH (IUI not IVF)? Yes No

14. How many FSH stimulated cycles did you undergo?

15. Have you ever undergone IVF therapy? Yes No

16. How many IVF cycles did you receive?

17. Did you find the Fertility Today informative and helpful? Yes No

18. Did you find the Web site informative and helpful? Yes No

Please add additional comments:

 

 


Copyright ©Fertility Today Magazine. All rights reserved.