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Healthy Eating and Nutrition for Fertility
Thank you for taking the time to complete this anonymous survey as part of a project that I am working on as a 5th year Dietetics student at UBC.
1.
What is your age range (years)?
19 or under
20-24
25-29
30-34
35-39
40-44
45 or over
2.
How long have you been trying to conceive? Please provide your answer in months (for example: 10 months).
3.
Have you tried ovulation kits and/or period trackers to support conception?
Yes
No
4.
Have you or your partner ever been diagnosed with any reproductive concerns?
Unexplained infertility
Endometriosis
Polycystic ovarian syndrome
Hyper or hypothyroidism
Uterine cysts or polyps
Chronic kidney disease
Hyperprolactinemia
Celiac disease
Sperm disorders
MTHFR-deficiency
Other (please specify)
None of the above
5.
If yes, which options were offered to you?
Fertility tests
Assisted reproductive technology (IVF, GIFT, ZIFT, FET, etc.)
Prescription drugs
Nutrition/diet recommendations
Weight loss
Nutrition supplements
Other (please specify)
None of the above
6.
Were you referred to another healthcare professional upon being diagnosed? (dietitian, family doctor, OB/GYN, etc.)
No
Not applicable
Yes (please specify)
7.
How would you describe your knowledge/outlook on nutrition and fertility?
I know none at all
I know a little
I know a lot
Clear
8.
Would you ever consider fertility treatments?
Definitely
Probably
Probably not
Definitely not
9.
Which of the following resources would you find most helpful to learn about nutrition and fertility?
Online course
Webinar
E-book
Infographic
Other (please specify)
10.
If you would like to be the first to know about a free online webinar on fertility and healthy eating, please leave your email below. No other emails will be sent except for sign-up information when the course becomes available.