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. 2015 Jul 17;12:62. doi: 10.1186/s12978-015-0054-3

Table 1.

Domains, components, details and sources in the fertility experiences questionnaire

Domainsa Written component (paper or online) Phone interview component Details
General health [28] X Exercise, tobacco, caffeinated beverages, alcohol, past medical history, pap smear
Menstrual history X Age at menarche, frequency and intensity of menses (when not taking hormonal birth control or fertility treatment)
Sexual history X Number of lifetime sex partners, history of sexually transmitted infection
Pregnancies and attempts to conceive [23] Definitions and list of attempts Verification and detailed questions about attempts Start month/year for “attempt,” how attempt started and ended, partner for attempt
Desire to conceive during each attempt [29] X Likert scale for desire for pregnancy and pereceived partner desire for pregnancy at beginning, middle and end of each attempt
Pregnancy outcomes [11] Dates and types of outcomes Verification and details Live birth, miscarriage, ectopic, stillbirth, molar pregnancy, termination, currently pregnant, other, and date ended. For live birth: state where born, birth weight, sex, hospital stay of 7 days or more, breastfeeding.
Fertility-related medical evaluationsb X Ultrasound of uterus/ovaries, follicular ultrasound, hysterosalpingogram, hysteroscopy, D&C, blood tests
Fertility-related surgeriesb X C-section, cervical cryotherapy or LEEP, laparoscopy, laparotomy, surgical treatment of endometriosis, surgery on ovaries, tubes, or uterus, other abdominal or pelvic surgery, partner vasectomy reversal, partner other urologic surgery
Fertility-related diagnosesb X Unexplained infertility, endometriosis, PCOS, low progesterone or estrogen, not ovulating, abnormal ovulation, limited cervical mucus, pelvic adhesions, blocked fallopian tubes, uterine fibroids, uterine polyps, luteal phase defect, male factor, other
Fertility treatments recommended by physician or practitioner, and reasons for using or declining treatments X Details about treatments received, and linking timing to attempts to conceive, and whether linked to conception Fertility-enhancing drugs, artificial insemination, in vitro fertilization with or without intracytoplasmic sperm injection, donor semen or donor eggs, acupuncture, fertility diets, herbal treatments
Self-help measures for trying to conceive (fertility awareness, diet, etc.) Ascertained and linked to attempts to conceive, and whether linked to conception Timed intercourse by counting days, basal body temperature, urine ovulation test kits, cervical mucus or fluid; took herbs, fertility vitamins, or supplements; lost weight; adhered to fertility diets; took a daily drug to enhance fertility; took a drug for ovulation; took hormones like progesterone
Adoption experiences X Ever applied for adoption, any adopted children
Stress and social situation [12] X Likert scale questions about impact of fertility problems and/or treatment on life, relationships with partner, family, friends; level of support from family, partner, friends; negative reactions from family, partner, friends.
Experience of past fertility treatment[12] X Likert scale questions about perceptions of past treatment: had enough time, shared decision making, feeling listened to, receiving explanations, addressing emotional issues
Demographic information X Marital status and date, education, race, ethnicity, country of birth, country of parents’ birth, languages spoken, religious preference, occupation, income, whether have written records of fertility experiences, best times to contact by phone
Friends and family with infertility X Number of friends or family diagnosed with infertility, friends or family members who have used any of the fertility measures listed previously above
Hypothetical interest in participating in studies of fertility treatment X Would she have been willing to participate in a study that would involve lifestyle advice, education about fertile days, herbs or acupuncture, medication, artificial insemination, or IVF.
Sources of information X X Did the participant consult written records to complete the questionnaire?

aCitations indicate other studies from which sections of the questionnaire were taken or adapted

bItems in these sections of the questionnaire were adapted from questions used in research conducted by Mary Croughan, PhD, University of California, San Francisco