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Free Second Opinion Rotunda would be happy to provide a second opinion on your problem. This is a free service for over 4 years now and we would be glad to answer your queries within 48 hours. Please fill in the following details. This should take about 15 minutes. This is basic medical information, which every infertile couple must know. While you don't have to fill in all the information, please remember that the more the detail you provide and the better the question you ask, the better our answer will be! All emails are personally answered by one of the members of our Clinical Team, so you can rest reassured that your privacy and confidentiality are strictly maintained. Full Name of Husband   Full Name of Wife   Address   Pincode   Country   Select Option United StatesCanadaAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBritish Virgin IslandsBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCook IslandsCosta RicaCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyIvory CoastJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandPolandPortugalPuerto RicoQatarReunionRomaniaRussiaRwandaS. Georgia and S. Sandwich Isls.Saint Kitts & NevisSaint LuciaSaint Vincent and The GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSt. HelenaSt. Pierre and MiquelonSudanSurinameSvalbard and Jan Mayen IslandsSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluU.S. Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin IslandsWallis and Futuna IslandsWestern SaharaYemenSerbia and MontenegroZaireZambiaZimbabwe Email Address   This is the email through which we will correspond with you. Contact Number     General Information of the Couple How long have you been married? Select Option 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 Years Select Option 0 1 2 3 4 5 6 7 8 9 10 11 Months How long have you been trying to get pregnant? Select Option 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 Years Select Option 0 1 2 3 4 5 6 7 8 9 10 11 Months How long have you been trying to get pregnant with the help of a doctor? Select Option 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 Years Select Option 0 1 2 3 4 5 6 7 8 9 10 11 Months Your consulting doctor was a Select Option General Gynecologist Infertility Specialist Other Why do you think you are not getting pregnant? Send us your diagnosis Fertility History of Female Partner What is your age? Select Option 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 Years Select Option 0 1 2 3 4 5 6 7 8 9 10 11 Months What is your height? Select Option 1 2 3 4 5 6 Feet Select Option 0 1 2 3 4 5 6 7 8 9 10 11 12 Inches What is your weight? Select Option 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 Kgs Occurance of Menstrual Periods Are they regular? Select Option Yes No Have you been told you have Endometriosis? Select Option Yes No Have you ever had a pelvic inflammatory disease? Select Option Yes No Have you had any pregnancies with the present partner? If "yes", please specify specify the number of the times with the respective years. Have you had pelvic surgeries? If "yes", please specify which ones, which years, and what were the findings. Have you had any pregnancies with a previous partner? If "yes", please specify the number of the times with the respective years and outcome. Have you had any miscarriages or abortions? If "yes", please specify the number of the times with the respective years and how many weeks pregnant were you each time. Have you had any tubal(ectopic) pregnancies? If "yes", please specify the number of the times with the respective years and outcome. Have you had any live births? If "yes", please specify the number of the times with the respective years. Do you have any medical problems or medications? If "yes", please specify details. Fertility History of Male Partner What is your age? Select Option 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 Years Select Option 0 1 2 3 4 5 6 7 8 9 10 11 Months What is your height? Select Option 1 2 3 4 5 6 Feet Select Option 0 1 2 3 4 5 6 7 8 9 10 11 12 Inches What is your weight? Select Option 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 Kgs Sperm Count   Million per ml Sperm Motility % Do you have problems with erection or ejaculation? If "yes", please specify in detail. Have you had any pregnancies with a previous partner? If "yes", please specify the number of the times with the respective years and outcome. Do you have any medical problems or medications? If "yes", please specify details. In case of an abnormal semen analysis report , please specify with respective details and dates of the reports Medical Test History Hysterosalpingogram (X-ray of the uterus and tubes)   Date   Result   Laparoscopy (Telescope placed through the belly button to see inside your abdomen)   Date   Result   Hysteroscopy (Telescope placed into the uterus through the vagina to see the inside of the uterus)   Date   Result   Hormonal Blood Tests (Please enter the values of your blood test reports below)   Date   Result   FSH   Date   Result   LH   Date   Result     Prolactin   Date   Result     TSH   Date   Result   Others   Name of the Test   Date   Result   Medical Treatment History Ultrasound Monitoring   Number of Treaments and respective dates   Result   Clomiphene Stimulation with Intercourse   Number of Treaments and respective dates   Result   Clomiphene Stimulation with Insemination   Number of Treaments and respective dates   Result   HMG Stimulation with Intercourse   Number of Treaments and respective dates   Result   Insemination without any Stimulation   Number of Treaments and respective dates   Result   Injectable HMG Stimulation with Insemination   Number of Treaments and respective dates   Result

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