Anonymous questionnaire on infertility treatment |
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Q1: Have you received fertility treatment in another clinics? |
1, First-time visit; 2, Examination/consultation only; 3, Visit with treatment |
Q2: Please write down your annual household income. |
(thousand yen) |
Q3: Have you told others/colleagues in your workplace about this visit? |
1, Not plan to do; 2, Plan to do; 3, Told |
Q4: Do you know the differences between IUI and IVF? |
1, Do not know; 2, Do not know much; 3, Know vague; 4, Know mostly; 5, Know |
Q5: Do you know the differences between IVF and ICSI? |
1, Do not know; 2, Do not know much; 3, Know vague; 4, Know mostly; 5, Know |
Q6: Do you know about oocyte freezing? |
1, Do not know; 2, Do not know much; 3, Know vague; 4, Know mostly; 5, Know |
Q7: Which would you describe as infertile? |
1, Condition; 2, Disease |
Q8: Which applies to your current feelings? |
1, Depressed; 2, Slightly depressed; 3, Cannot say either; 4, A little looking forward; 5, Looking forward |
Q9: Would you consider IVF (egg retrieval, embryo transfer, etc.) as the first treatment? |
1, Not considering; 2, Not considering much; 3, Cannot say either; 4, Little consideration; 5, Considering |
Q10: Will you recommend the option of oocyte freezing for your daughter? |
1, Will not recommend; 2, Unlikely to recommend much; 3, Cannot say either; 4. Would Consider; 5, Would Recommend |
Q11: How much do you expect it will cost to perform one IVF procedure? |
(thousand yen) |
Q12: How many costs do you expect to incur until achieving pregnancy? |
(thousand yen) |
Q13: What is your impression of the costs in Q10 and Q11? |
1, Inexpensive; 2. Low cost; 3, Reasonable; 4, Expensive; 5, Excessively expensive |
Q14: Please provide any comments below regarding the insurance coverage of infertility treatment. |
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※The Answer will not affect the treatment plan. |
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