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FERTILYSIS snaphot
We realize that there might be a long waiting period until your free consultation scheduled appointment. Therefore, we implemented an easy way to help us decide together which Fertilysis test is the right one for you and guide you through the process of performing it.
Answering the following questions helps us gain a better understanding of your case and fertility history. Share your medical background and specific needs, and our team will create a personalised testing plan just for you.
Our experts will provide tailored recommendations, and remain available via email or a free 15-minute call for any questions.

PERSONAL INFORMATION:

Please enter your first name.
Please let us know your last name.
Please provide your email address.
Date of Birth(*)
/ / Please enter a valid date.
Please enter a valid number.
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Please select your country
Please only use letters and not punctuation marks.
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Are you using a donor?(*)
Please provide an answer

FEMALE HISTORY:

Are your tubes open?(*)
Please answer by choosing from the list.
Gynecological examination/transvaginal ultrasound revealed a normal uterine cavity?(*)
Please answer by choosing from the list.
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Do you experience significantely painful periods?(*)
Please answer by choosing from the list.
Do you get brown spotting before your period?(*)
Please answer by choosing from the list.
Are any of the following ovarian reserve/egg quality markers abnormal? (select if yes):(*)
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History of reproductive tract infections? (select if yes):(*)
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Do you experience any genital tract infection symptoms? (select if yes):(*)
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Have you ever been diagnosed with any of the following? (select if yes):(*)
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Do you have or had any of the following? (select if yes):(*)
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Have you suspected or treated for Endometriosis? (select if yes)(*)
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Do you have irregular cycles? (select if yes)(*)
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MALE HISTORY:

In case of sperm donor skip this section

Has children in current or previous relationship?
Please select one of the two options.
Semen analysis issues? (select if yes):
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Sperm DNA fragmentation (DFI)?
Please select one of the options.
History of reproductive tract infections, symptoms? (select if yes):
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Diagnosed testicular varicocele:
Please answer from the list.

FERTILITY JOURNEY

Has children in current or previous relationship?(*)
Please select one of the three options.
How long have you been trying to conceive?(*)
Please select one of the options.
What types of pregnancy failure have you experienced? (select if yes):(*)
Please make a valid selection
Method of TTC? (select if yes):(*)
Please make a valid selection

If you have had IVF, please answer the following questions on average:

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Do you currently have any frozen embryos?(*)
Please select one of the options.
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Ideally what would be your next step and when?(*)
Please answer by choosing from the list.
Please enter a valid response.

SPECIALIZED TESTING

Have you had any of the following Reproductive immunology tests? (select if yes):(*)
Please make your selection
Have you had an endometrial biopsy for CD138 analysis for chronic endometritis?(*)
Please select one of the options.
Have you had endometrial biopsy for Microbiome Analysis in the past?(*)
Please select one of the options.
Have you had antibiotic treatment for endometritis/abnormal microbiome results/uterine infections?(*)
Please select one of the options.
Have you had a Uterine microbiome analysis?(*)
Please select one of the options.
Have you had a Vaginal microbiome analysis?(*)
Please select one of the options.
Have you had antibiotic treatment for abnormal vaginal microbiome results/ vaginal infections?(*)
Please select one of the options.
Have you had Genetic thrombophilia testing?(*)
Please select one of the options.
Have you and your partner  been tested by Chromosomal analysis (karyotypes) tested?(*)
Please select one of the options.
Please enter a valid response.
Personal Information consent:(*)
If you do not consent to disclose the information on this web form, unfortunately we will not be able to receive and answer your questions.

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FERTILYSIS, specializes in the investigation and treatment of unexplained infertility and recurrent miscarriages, providing answers where standard practices fail.

CONTACT INFO

Argyroupoleos 1, Argyroupoli, 16451,

Athens, Greece

+30 210 9920 274

[email protected]

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