Infertility

Have you had any tests done before? If yes:

Woman:
HSGHormonesUltrasonographyHysteroscopy

Man:
SpermogramHormoneTestis Doppler

Woman's age

Man's age

Menstruation regularity

Any previous operations?

Any chronic diseases? If yes, please provide details.

At how many weeks did you miscarriage?
First miscarriageSecond miscarriageThird miscarriage

Any diagnosis for the etiology?
(Do you know the cause of the miscarriage?)

Regular intercourse (/week)?

Is this your first marriage?
YesNo

If no, have either of you had a pregnancy before?
YesNo