Female Infertility History Questionnaire
What a female infertility history questionnaire asks, with sample questions on periods, pregnancies, and fertility treatment.
The female infertility history questionnaire on this page covers periods, gynecologic and pregnancy history, earlier fertility tests and treatment, and general health. It's also called a female fertility history.
Female infertility history questionnaire, handled by the AI Doctor avatar
AI Doctor, a real-time AI healthcare assistant avatar, asks the questions on a female infertility history questionnaire in the patient's own language, strictly following the practice's instructions.
- Intake before the visit. Patients answer online before they arrive, or at a kiosk when they check in.
- Answers ready for the clinician. Clinicians see what the patient said before the visit starts.
- Less workload at the front desk. Staff spend less time handing out forms and entering answers by hand.
- Key details at a glance. The care team sees what matters up front and decides who needs attention first.
The form becomes a natural conversation: patients answer by talking, in their own words. AI Doctor is an information and patient-assistance interface. It collects answers for the care team to review. It doesn't diagnose, triage, or give treatment advice.
Sample female infertility history questionnaire questions
Typical questions, written out so you can see the level of detail. Every practice words its own form differently.
- How old were you at your first period?Periods
- How many days apart do your periods come?Periods
- When was your last Pap smear?Gynecologic history
- Have you ever used contraception?Gynecologic history
- Have you ever been pregnant?Pregnancies
- Was a past pregnancy with your current partner?Pregnancies
- How long have you and your partner been trying?Fertility history
- Have you had IUI or IVF before?Fertility history
- Have you had any surgeries?Medical history
- Which prescription medicines do you take?Medical history
- Do you smoke or drink alcohol?Lifestyle
- How many caffeinated drinks do you have daily?Lifestyle
These are examples to read, not a form to fill in.
Female infertility history questionnaire: FAQ
What does a female infertility history questionnaire ask?
The sample questions here are based on the Stanford Medicine Children's Health Female Patient Questionnaire and the Northwestern Medicine New Patient Health History Form. This page groups them into six areas: periods, gynecologic history, pregnancies, fertility history, medical history, and lifestyle.
Who answers a female infertility history questionnaire?
The patient. The Stanford form says to leave blank any question the patient doesn't know or is uncomfortable answering.
Is it the same as a female fertility history?
It can be. The Stanford form is headed Female Patient History, and it covers the same fertility history.
Does it ask about past fertility treatment?
Yes. The Stanford form asks about earlier tests such as a hysterosalpingogram or ultrasound, fertility medicines, IUI, and IVF, with details for each IVF cycle.
Does it ask about family history?
Yes. The Stanford form asks whether the patient, the partner, or either family has had conditions such as cystic fibrosis, sickle cell disease, or thalassemia.
What happens after the female infertility history questionnaire is completed?
The practice's team reviews the answers before the visit. AI Doctor only collects them; it does not interpret cycles or test results.
Does AI Doctor give medical advice?
No. It collects information for the care team. It doesn't diagnose, triage, or recommend treatment.
Can patient answers stay on our own servers?
Yes. RAVATAR offers on-prem deployment: the platform can run inside your own perimeter, so patient answers stay there. RAVATAR complies with GDPR and the EU AI Act.
Set up your AI Doctor in Genesis AI Avatar Studio
Genesis AI Avatar Studio is where you set up, test, and publish AI avatars for your website, mobile app, or Holobox. No coding or technical skills needed.
- 01Choose the AI Doctor avatar.
- 02Add your practice's FAQs and visit information.
- 03Talk to it, then publish it.
