For each question, choose the best answer as it applies to you:

Which best describes your preference?

A. I prefer to use conservative methods to try and get pregnant within the next 12 months.
B. I prefer to use aggressive methods to try and get pregnant within the next two months.
C. I'm not quite ready yet, but would like to get testing and good advice.
Other:

Husband's age:

29 or under
30-34
35-39
40-42
43 or over
I wish to use donor sperm

Wife's age:

29 or under
30-34
35-39
40-42
43 or over

ANSWER THE FOLLOWING FIVE QUESTIONS AND QUALIFY FOR A FREE PHONE CONSULTATION:

How is the sperm situation?

A. Don't know
B. It has been proven fine in the past
C. We suspect or know that it's a problem
Other:

How is the ovulation situation?

A. Not sure
B. Periods come regularly every month and/or ovulation testing normal
C. Periods are inconsistent or not at all
Other:

How is the tubal situation?

A. Not sure
B. No suspicion of any problem
C. We suspect or know that there's a problem
Other:

Briefly describe husband's daily life (job, stress level, general health and fitness level)

Briefly describe wife's daily life (job, stress level, general health and fitness level)

How would you like us to contact you?

PHONE
Email
Name

ourlocation