The truth and nothing but the truth

I’ve had to fill out many New Patient Forms over the past few years and I just completed yet another one for our new fertility specialist.

There’s the version you tell your doctor and then there’s the other version:

NEW PATIENT FORM

SOCIAL HISTORY

                Marital Status: (circle one) M   S   W   D   SEP

                Smoking: ___N/A______ (how many) packs per day for __N/A____ years
(Okay there were those months as a student in London but I had to! If I was gonna be sucking down second hand smoke every day, I might as well enjoy the whole damn cigarette)

                Alcohol: __8-10__ (number) drinks per week
(errr… make that 16 drinks a week . What can I say, we’ve got numerous social engagements; birthday parties, work functions, sporting events, dinner dates, oh my. It adds up! But before you call me an alcoholic I can refrain! I went cold turkey for three months during the IUI/Chlomid cycles… and I looked damn good.)

                Recreational  Drug Use:  __No___  (One word: college)

                Special Diet: __Vegetarian____ (except when I eat meat)

                Exercise Routine: ___Run 2-4x/wk, cardio at gym 2x/wk, yoga, hike, bike __ (No need to lie here. I’m damn proud that I get my ass up and work it girl!)


MENSTRUAL HISTORY                  

                Age at first period ___12______ (Maybe if I started trying then, I’d be preggers by now) 

                Age at menopause __n/a_____

                Period interval is __24-27______ days   (I better know this- I’ve been tracking it for three years!)

          Duration is approximately ___4-5______days

                Do you have pain or cramps with your period?  ___no__ (YES! My heart is torn out of my chest every time it comes!)

                Do you bleed or spot after intercourse? ___No____ (except from the handcuffs. Does that count?)         

CONTRACEPTIVE HISTORY

                Present method of contraceptive ____n/a____

                Previous methods:

                                Method                                               Duration                                             

                                The Pill                                                  16 years
(before you start your calculations- I originally got on it to regulate my periods. I swear.)

                                Pull Out

(to all you kiddies out there- this is NOT a viable method! But when you’re in a jam, you pretend it is.)                                        

GYNECOLOGIC HISTORY

                Do you have pain in your pelvis or female organs?  ___No___ (except when I get waxed- that fuckin kills my female organ)
                If yes, Explain: _________________________________________________________
               
                How often do you have intercourse: __Approx 2-3x/wk____ (Does oral count? Can I change my answer to 4-5x/wk? My husband is satisfied!)

Sexual history:
                               
                Satisfactory __Yes___ (Are we talking my overall sexual history? Well, there was that bartender in Cabo… he would have made my sexual history exemplary. Oh, well… I’ll have to stick with satisfactory.)                   

                Wish to discuss __No___ (that’s what my girlfriends and a bottle of wine are for)

                Do you have a history of infertility? __Yes____
                If yes, explain: __grab a drink- this is gonna take a while___________