Survey : Questions

1.

In what age range do you fall?

20 and younger

21-25

26-30

31-35

36-40

41-45

46 and older

2.

What is your sexual orientation?

Straight

Lesbian

Bisexual

Transgender

3.

What is your relationship status?

Single

Married

Living Together

Engaged

Divorced/Separated

4.

What is your annual household income?

Less than $25k

$25-$50k

$50k-$75k

$75k-$100k

More than $100k

5.

What is your highest level of education completed?

High School

Some College

BA or BS

Masters or Higher

None

6.

What is your ethnicity?

Caucasian

African American

Hispanic

Asian-Pacific Islander

Native American

Other

7.

Do you own or rent?

Own

Rent

8.

Do you have any children?

Yes

No

9.

Only if you answered YES to question #8, please check all that apply:

Conceived naturally

Conceived through ART (e.g. IUI, IVF, egg/sperm donation, etc.)

Adoption

Foster Care

Stepchildren

Used a surrogate

11.

How long have you been trying?

0-6 months

6-12 months

1-2 years

More than 2 years

Not trying

12.

Have you ever experienced pregnancy loss?

Yes, once

Yes, multiple times

Terminated a pregnancy

No

13.

Why did you initially turn to The AFA for information? (check all that apply)

Treatment options

Infertility prevention

Male reproductive health

LGBT family building

Adoption

Referral

Support

Other

14.

How did you first contact The AFA?

Website

Phone

Email

In person event

Comment:
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15.

Did you find the information you were seeking?

Yes, right away

Yes, but it took awhile

No

16.

If you were unsuccessful with infertility treatments such as IVF or IUI, what did you end up doing? (check all that apply)

Adopted

Used a traditional surrogate

Used a gestational surrogate

Chose sperm donation

Chose child-free living

Chose egg donation

Chose embryo donation

Does not apply

17.

Are you or your partner experiencing the difficulty?

Me

My partner

Both

Does not apply

18.

How long have you known about your infertility issue?

Less than 3 months

4-6 months

7-12 months

More than a year

Does not apply

19.

Who told you about your infertility issue?

My fertility specialist

My OBGYN

My partner's urologist or physician

Does not apply

Other

20.

Does your health care insurance cover assisted reproductive technology? (check all that apply)

Yes, all forms of ART

Yes, but only low tech procedures like IUI and laparoscopies

Yes, including IVF

Yes, including fertility medications

No

I don't know

I don't have health care insurance

21.

Do you have a family history of infertility?

Yes, on my mom's side

Yes, on my dad's side

No

I don't konw

22.

Men play some part in 40% of all infertility cases. Has the male involved in your attempt to conceive been checked?

Yes

No

Using a sperm donor

23.

If you're not quite ready to start a family yet, are there things you are doing to safeuard your fertility like avoiding environmental toxins and STD's?

Yes

No

Does not apply

24.

Please rank the usefulness of the following sections found on The AFA's website

	Have Not Viewed	Not Useful	Somewhat Useful	Very Useful	Extremely Useful
The AFA Library
The AFA Newfeed
Online Educational Modules
The AFA Blog
AFA Webinar Series
The AFA Support Section

Comment:
500 characters left.

25.	Briefly describe what you would like to see added or changed on The AFA's website? (www.theafa.org)
	350 characters left.

26.

Do you receive Connect, The AFA's free weekly e-mail newsletter?

Yes, I read it weekly

Yes, I read it periodically

No

No, but I'd like to start (please include your email in the comment section below)

Comment:
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