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1. How many alcoholic drinks do you consume per week
a.
0
b.
1
c.
2-3
d.
4
2. Do you use recreational drugs (marijuana, cocaine,
etc)?
a.
Yes
b.
No
3. For lubrication during intercourse, do you use:
a.
K-Y Jelly
b. Astroglide
c. Egg-whites
d. Nothing
4. Which of the following supplements do
you take:
a. Dr.prescribed prenatal vitamin
b. Store-brand prenatal vitamin
c. Daily multivitamin (ex: Centrum)
d. No vitamin supplements
5. Which of the following best describes
the frequency of intercourse during your cycle:
a. Every 48 hours when observing fertile cervical mucous
b. Every 36 hours when observing fertile cervical mucous
c. Every 24 hours when observing fertile cervical mucous
d. I am not observing cervical mucous to time intercourse
6. Which of the following are you doing to
determine when you are ovulating?
a. Observing cervical mucous
b. Checking cervical position
c. Charting your basal body temperature
d. Using ovulation predictor kits
e. All of the above
f. None of the above
7. Check all that apply to your husband:
8. Check all that apply to you:
9. When having intercourse, which position
do you use:
a. Missionary (man on top)
b. Rear-entry ("doggie-style")
c. Woman on top
d. Side-by-side
e. Other
10. Have you seen your Dr. for a physical
examination (including Pap smear) in the past 12-months)?
a. Yes
b. No
11. Are you using any form of contraceptive
that could prevent pregnancy (condoms, spermacides, etc)
a. Yes
b. No
Your Score
45- 60 points "Fertile Myrtle" - Your lifestyle will maximize
your chances for conception and healthy pregnancy. Good for you!!
35- 44 points There are areas in your lifestyle that could
be changed to improve your odds for conception.
0- 34 points You could be severely affecting your ability
to conceive. We strongly encourage you to review the FAQs to see what changes should be made to improve your fertility
lifestyle.
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