{"id":16437,"date":"2024-02-29T15:27:02","date_gmt":"2024-02-29T14:27:02","guid":{"rendered":"https:\/\/www.dexeus.com\/fertility\/prediagnosis\/"},"modified":"2025-06-16T17:12:16","modified_gmt":"2025-06-16T15:12:16","slug":"online-prediagnosis","status":"publish","type":"page","link":"https:\/\/www.dexeus.com\/fertility\/en\/online-prediagnosis\/","title":{"rendered":"Online prediagnosis"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"16437\" class=\"elementor elementor-16437 elementor-3156\" data-elementor-post-type=\"page\">\n\t\t\t\t<div class=\"elementor-element elementor-element-d5ba0b0 e-con-full e-flex e-con e-parent\" data-id=\"d5ba0b0\" data-element_type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;,&quot;jet_parallax_layout_list&quot;:[]}\">\n\t\t<div class=\"elementor-element elementor-element-8fe9948 e-flex e-con-boxed e-con e-child\" data-id=\"8fe9948\" data-element_type=\"container\" data-settings=\"{&quot;jet_parallax_layout_list&quot;:[]}\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-f3056bc elementor-widget elementor-widget-heading\" data-id=\"f3056bc\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h1 class=\"elementor-heading-title elementor-size-default\">Online prediagnosis<\/h1>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-0619e65 e-flex e-con-boxed e-con e-parent\" data-id=\"0619e65\" data-element_type=\"container\" data-settings=\"{&quot;jet_parallax_layout_list&quot;:[]}\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-f8f4f52 elementor-widget elementor-widget-text-editor\" data-id=\"f8f4f52\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>Complete this form <strong>anonymously and free of charge<\/strong>, to obtain <strong>detailed information<\/strong> about the treatment that best suits your situation. We will tell you what it consists of, the chances of success, the time you need to carry it out and its price.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-30f8376 e-flex e-con-boxed e-con e-parent\" data-id=\"30f8376\" data-element_type=\"container\" data-settings=\"{&quot;jet_parallax_layout_list&quot;:[]}\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t<div class=\"elementor-element elementor-element-f3bf509 e-con-full e-flex e-con e-child\" data-id=\"f3bf509\" data-element_type=\"container\" data-settings=\"{&quot;jet_parallax_layout_list&quot;:[]}\">\n\t\t\t\t<div class=\"elementor-element elementor-element-732b28f dexeusfertility-preadignosis-form elementor-widget elementor-widget-shortcode\" data-id=\"732b28f\" data-element_type=\"widget\" data-widget_type=\"shortcode.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-shortcode\"><style type=\"text\/css\">#ipt_fsqm_form_wrap_9 .ipt_fsqm_form_logo img,\n\t#ipt_fsqm_form_wrap_9 .ipt-eform-width-restrain,\n\t#ipt_fsqm_form_wrap_9 .ipt_fsqm_form_message_restore,\n\t#ipt_fsqm_form_wrap_9 .ipt_fsqm_form_message_success,\n\t#ipt_fsqm_form_wrap_9 .ipt_fsqm_form_message_error,\n\t#ipt_fsqm_form_wrap_9 .ipt_fsqm_form_message_process,\n\t#ipt_fsqm_form_wrap_9 .ipt_fsqm_form_validation_error,\n\t#ipt_fsqm_form_wrap_9 .eform-ui-estimator {\n\t\tmax-width: 1800px;\n\t\tmin-width: 240px;\n\t}\n\n\t\/**\/<\/style><div\nid=\"ipt_fsqm_form_wrap_9\"\nclass=\"ipt_uif_front ipt_uif_common ipt_fsqm_form type_2 ui-front eform-ltr eform-override-element-material eform-override-alignment-centered\"\ndata-fsqmsayt=\"{&quot;auto_save&quot;:false,&quot;show_restore&quot;:true,&quot;restore&quot;:false,&quot;admin_override&quot;:false,&quot;user_update&quot;:false,&quot;interval_save&quot;:false,&quot;interval&quot;:&quot;30&quot;}\"\ndata-ui-type=\"2\"\ndata-ui-theme=\"[&quot;https:\\\/\\\/www.dexeus.com\\\/fertility\\\/wp-content\\\/uploads\\\/eform-custom-material\\\/form-theme-9.css?checksum=3901367654&amp;ver=4.18.0&quot;]\"\ndata-ui-theme-id=\"material-custom\"\ndata-eformanim=\"1\"\ndata-fsqmga=\"{&quot;enabled&quot;:false,&quot;manual_load&quot;:false,&quot;tracking_id&quot;:&quot;&quot;,&quot;cookie&quot;:&quot;auto&quot;,&quot;user_update&quot;:false,&quot;name&quot;:&quot;Prediagnostico Fertility EN&quot;,&quot;form_id&quot;:&quot;9&quot;}\"\ndata-fsqmreset=\"{&quot;reset&quot;:false,&quot;delay&quot;:10}\"\ndata-eformreg=\"{&quot;enabled&quot;:false,&quot;username_id&quot;:&quot;ipt_fsqm_form_9_pinfo_&quot;,&quot;password_id&quot;:&quot;ipt_fsqm_form_9_pinfo_&quot;,&quot;hide_pinfo&quot;:false,&quot;hide_meta&quot;:false,&quot;meta&quot;:[]}\"\ndata-eformscroll=\"{&quot;progress&quot;:false,&quot;message&quot;:false,&quot;offset&quot;:&quot;0&quot;,&quot;scrollOnError&quot;:true}\"\ndata-eform-cookie=\"0\"\ndata-subscription-form=\"false\"\ndata-instant-subscription=\"{&quot;doable&quot;:true,&quot;config&quot;:{&quot;enabled&quot;:false,&quot;min_tab&quot;:&quot;&quot;,&quot;debounce&quot;:&quot;3000&quot;},&quot;nonce&quot;:&quot;21f8051662&quot;}\"\n><style type=\"text\/css\">.ipt-uif-custom-material-custom [type=\"radio\"]:not(:checked) + label:before {display:none !important;}\n.ipt-uif-custom-material-custom [type=\"checkbox\"] + label:before {display:none !important;}\n.ipt-uif-custom-material-custom [type=\"checkbox\"] + label {padding-left: 20px !important;}\n.ipt-uif-custom-material-custom input[type=\"number\"] {text-align: center !important; 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t;,&quot;key&quot;:&quot;75&quot;,&quot;check&quot;:&quot;val&quot;,&quot;operator&quot;:&quot;eq&quot;,&quot;value&quot;:&quot;46&quot;,&quot;rel&quot;:&quot;or&quot;},&quot;2&quot;:{&quot;m_type&quot;:&quot;mcq&quot;,&quot;key&quot;:&quot;75&quot;,&quot;check&quot;:&quot;val&quot;,&quot;operator&quot;:&quot;eq&quot;,&quot;value&quot;:&quot;47&quot;,&quot;rel&quot;:&quot;or&quot;},&quot;3&quot;:{&quot;m_type&quot;:&quot;mcq&quot;,&quot;key&quot;:&quot;75&quot;,&quot;check&quot;:&quot;val&quot;,&quot;operator&quot;:&quot;eq&quot;,&quot;value&quot;:&quot;48&quot;,&quot;rel&quot;:&quot;or&quot;},&quot;4&quot;:{&quot;m_type&quot;:&quot;mcq&quot;,&quot;key&quot;:&quot;75&quot;,&quot;check&quot;:&quot;val&quot;,&quot;operator&quot;:&quot;eq&quot;,&quot;value&quot;:&quot;49&quot;,&quot;rel&quot;:&quot;or&quot;},&quot;5&quot;:{&quot;m_type&quot;:&quot;mcq&quot;,&quot;key&quot;:&quot;75&quot;,&quot;check&quot;:&quot;val&quot;,&quot;operator&quot;:&quot;eq&quot;,&quot;value&quot;:&quot;50&quot;,&quot;rel&quot;:&quot;or&quot;}},&quot;type&quot;:&quot;checkbox&quot;,&quot;m_type&quot;:&quot;mcq&quot;}},&quot;indexes&quot;:{&quot;ipt_fsqm_form_9_mcq_66&quot;:[&quot;ipt_fsqm_form_9_tab_3_control_li&quot;,&quot;ipt_fsqm_form_9_tab_3_control_li&quot;,&quot;ipt_fsqm_form_9_tab_3_control_li&quot;,&quot;ipt_fsqm_form_9_tab_3_control_li&quot;,&quot;ipt_fsqm_form_9_tab_3_control_li&quot;],&quot;ipt_fsqm_form_9_mcq_67&quot;:[&quot;ipt_fsqm_form_9_tab_4_control_li&quot;,&quot;ipt_fsqm_form_9_tab_4_control_li&quot;,&quot;ipt_fsqm_form_9_tab_4_control_li&quot;,&quot;ipt_fsqm_form_9_tab_4_control_li&quot;,&quot;ipt_fsqm_form_9_tab_4_control_li&quot;],&quot;ipt_fsqm_form_9_mcq_68&quot;:[&quot;ipt_fsqm_form_9_tab_5_control_li&quot;,&quot;ipt_fsqm_form_9_tab_5_control_li&quot;,&quot;ipt_fsqm_form_9_tab_5_control_li&quot;,&quot;ipt_fsqm_form_9_tab_5_control_li&quot;,&quot;ipt_fsqm_form_9_tab_5_control_li&quot;],&quot;ipt_fsqm_form_9_mcq_69&quot;:[&quot;ipt_fsqm_form_9_tab_6_control_li&quot;,&quot;ipt_fsqm_form_9_tab_6_control_li&quot;,&quot;ipt_fsqm_form_9_tab_6_control_li&quot;,&quot;ipt_fsqm_form_9_tab_6_control_li&quot;,&quot;ipt_fsqm_form_9_tab_6_control_li&quot;,&quot;ipt_fsqm_form_9_tab_7_control_li&quot;,&quot;ipt_fsqm_form_9_tab_7_control_li&quot;,&quot;ipt_fsqm_form_9_tab_7_control_li&quot;,&quot;ipt_fsqm_form_9_tab_7_control_li&quot;,&quot;ipt_fsqm_form_9_tab_7_control_li&quot;],&quot;ipt_fsqm_form_9_mcq_70&quot;:[&quot;ipt_fsqm_form_9_tab_6_control_li&quot;,&quot;ipt_fsqm_form_9_tab_6_control_li&quot;,&quot;ipt_fsqm_form_9_tab_6_control_li&quot;,&quot;ipt_fsqm_form_9_tab_6_control_li&quot;,&quot;ipt_fsqm_form_9_tab_6_control_li&quot;,&quot;ipt_fsqm_form_9_tab_7_control_li&quot;,&quot;ipt_fsqm_form_9_tab_7_control_li&quot;,&quot;ipt_fsqm_form_9_tab_7_control_li&quot;,&quot;ipt_fsqm_form_9_tab_7_control_li&quot;],&quot;ipt_fsqm_form_9_mcq_71&quot;:[&quot;ipt_fsqm_form_9_tab_6_control_li&quot;,&quot;ipt_fsqm_form_9_tab_6_control_li&quot;,&quot;ipt_fsqm_form_9_tab_6_control_li&quot;,&quot;ipt_fsqm_form_9_tab_6_control_li&quot;,&quot;ipt_fsqm_form_9_tab_6_control_li&quot;,&quot;ipt_fsqm_form_9_tab_7_control_li&quot;,&quot;ipt_fsqm_form_9_tab_7_control_li&quot;,&quot;ipt_fsqm_form_9_tab_7_control_li&quot;,&quot;ipt_fsqm_form_9_tab_7_control_li&quot;,&quot;ipt_fsqm_form_9_tab_7_control_li&quot;,&quot;ipt_fsqm_form_9_tab_7_control_li&quot;],&quot;ipt_fsqm_form_9_mcq_49&quot;:[&quot;ipt_fsqm_form_9_mcq_50&quot;,&quot;ipt_fsqm_form_9_mcq_65&quot;,&quot;ipt_fsqm_form_9_mcq_64&quot;],&quot;ipt_fsqm_form_9_mcq_65&quot;:[&quot;ipt_fsqm_form_9_mcq_57&quot;,&quot;ipt_fsqm_form_9_mcq_57&quot;,&quot;ipt_fsqm_form_9_mcq_57&quot;,&quot;ipt_fsqm_form_9_mcq_57&quot;,&quot;ipt_fsqm_form_9_mcq_57&quot;,&quot;ipt_fsqm_form_9_mcq_57&quot;,&quot;ipt_fsqm_form_9_mcq_57&quot;,&quot;ipt_fsqm_form_9_mcq_57&quot;,&quot;ipt_fsqm_form_9_mcq_57&quot;,&quot;ipt_fsqm_form_9_mcq_57&quot;,&quot;ipt_fsqm_form_9_mcq_57&quot;,&quot;ipt_fsqm_form_9_mcq_57&quot;,&quot;ipt_fsqm_form_9_mcq_57&quot;,&quot;ipt_fsqm_form_9_mcq_57&quot;,&quot;ipt_fsqm_form_9_mcq_57&quot;,&quot;ipt_fsqm_form_9_mcq_57&quot;,&quot;ipt_fsqm_form_9_mcq_57&quot;,&quot;ipt_fsqm_form_9_mcq_57&quot;,&quot;ipt_fsqm_form_9_mcq_57&quot;,&quot;ipt_fsqm_form_9_mcq_57&quot;,&quot;ipt_fsqm_form_9_mcq_60&quot;,&quot;ipt_fsqm_form_9_mcq_60&quot;,&quot;ipt_fsqm_form_9_mcq_60&quot;,&quot;ipt_fsqm_form_9_mcq_60&quot;,&quot;ipt_fsqm_form_9_mcq_60&quot;,&quot;ipt_fsqm_form_9_mcq_60&quot;,&quot;ipt_fsqm_form_9_mcq_59&quot;,&quot;ipt_fsqm_form_9_mcq_59&quot;,&quot;ipt_fsqm_form_9_mcq_59&quot;,&quot;ipt_fsqm_form_9_mcq_59&quot;,&quot;ipt_fsqm_form_9_mcq_59&quot;,&quot;ipt_fsqm_form_9_mcq_59&quot;],&quot;ipt_fsqm_form_9_mcq_61&quot;:[&quot;ipt_fsqm_form_9_mcq_60&quot;],&quot;ipt_fsqm_form_9_mcq_50&quot;:[&quot;ipt_fsqm_form_9_mcq_66&quot;,&quot;ipt_fsqm_form_9_mcq_66&quot;,&quot;ipt_fsqm_form_9_mcq_66&quot;,&quot;ipt_fsqm_form_9_mcq_66&quot;,&quot;ipt_fsqm_form_9_mcq_66&quot;,&quot;ipt_fsqm_form_9_mcq_66&quot;,&quot;ipt_fsqm_form_9_mcq_66&quot;,&quot;ipt_fsqm_form_9_mcq_66&quot;,&quot;ipt_fsqm_form_9_mcq_66&quot;,&quot;ipt_fsqm_form_9_mcq_66&quot;,&quot;ipt_fsqm_form_9_mcq_66&quot;,&quot;ipt_fsqm_form_9_mcq_66&quot;,&quot;ipt_fsqm_form_9_mcq_66&quot;,&quot;ipt_fsqm_form_9_mcq_66&quot;,&quot;ipt_fsqm_form_9_mcq_66&quot;,&quot;ipt_fsqm_form_9_mcq_66&quot;,&quot;ipt_fsqm_form_9_mcq_66&quot;,&quot;ipt_fsqm_form_9_mcq_66&quot;,&quot;ipt_fsqm_form_9_mcq_66&quot;,&quot;ipt_fsqm_form_9_mcq_66&quot;,&quot;ipt_fsqm_form_9_mcq_67&quot;,&quot;ipt_fsqm_form_9_mcq_67&quot;,&quot;ipt_fsqm_form_9_mcq_67&quot;,&quot;ipt_fsqm_form_9_mcq_67&quot;,&quot;ipt_fsqm_form_9_mcq_67&quot;,&quot;ipt_fsqm_form_9_mcq_67&quot;,&quot;ipt_fsqm_form_9_mcq_67&quot;,&quot;ipt_fsqm_form_9_mcq_68&quot;,&quot;ipt_fsqm_form_9_mcq_68&quot;,&quot;ipt_fsqm_form_9_mcq_68&quot;,&quot;ipt_fsqm_form_9_mcq_68&quot;,&quot;ipt_fsqm_form_9_mcq_68&quot;,&quot;ipt_fsqm_form_9_mcq_68&quot;],&quot;ipt_fsqm_form_9_mcq_64&quot;:[&quot;ipt_fsqm_form_9_mcq_69&quot;,&quot;ipt_fsqm_form_9_mcq_69&quot;,&quot;ipt_fsqm_form_9_mcq_69&quot;,&quot;ipt_fsqm_form_9_mcq_69&quot;,&quot;ipt_fsqm_form_9_mcq_69&quot;,&quot;ipt_fsqm_form_9_mcq_69&quot;,&quot;ipt_fsqm_form_9_mcq_69&quot;,&quot;ipt_fsqm_form_9_mcq_69&quot;,&quot;ipt_fsqm_form_9_mcq_69&quot;,&quot;ipt_fsqm_form_9_mcq_69&quot;,&quot;ipt_fsqm_form_9_mcq_69&quot;,&quot;ipt_fsqm_form_9_mcq_69&quot;,&quot;ipt_fsqm_form_9_mcq_69&quot;,&quot;ipt_fsqm_form_9_mcq_69&quot;,&quot;ipt_fsqm_form_9_mcq_69&quot;,&quot;ipt_fsqm_form_9_mcq_69&quot;,&quot;ipt_fsqm_form_9_mcq_69&quot;,&quot;ipt_fsqm_form_9_mcq_69&quot;,&quot;ipt_fsqm_form_9_mcq_69&quot;,&quot;ipt_fsqm_form_9_mcq_69&quot;,&quot;ipt_fsqm_form_9_mcq_70&quot;,&quot;ipt_fsqm_form_9_mcq_70&quot;,&quot;ipt_fsqm_form_9_mcq_70&quot;,&quot;ipt_fsqm_form_9_mcq_70&quot;,&quot;ipt_fsqm_form_9_mcq_70&quot;,&quot;ipt_fsqm_form_9_mcq_70&quot;,&quot;ipt_fsqm_form_9_mcq_70&quot;,&quot;ipt_fsqm_form_9_mcq_71&quot;,&quot;ipt_fsqm_form_9_mcq_71&quot;,&quot;ipt_fsqm_form_9_mcq_71&quot;,&quot;ipt_fsqm_form_9_mcq_71&quot;,&quot;ipt_fsqm_form_9_mcq_71&quot;,&quot;ipt_fsqm_form_9_mcq_71&quot;],&quot;ipt_fsqm_form_9_mcq_75&quot;:[&quot;ipt_fsqm_form_9_mcq_76&quot;,&quot;ipt_fsqm_form_9_mcq_76&quot;,&quot;ipt_fsqm_form_9_mcq_76&quot;,&quot;ipt_fsqm_form_9_mcq_76&quot;,&quot;ipt_fsqm_form_9_mcq_76&quot;,&quot;ipt_fsqm_form_9_mcq_76&quot;,&quot;ipt_fsqm_form_9_mcq_76&quot;,&quot;ipt_fsqm_form_9_mcq_76&quot;,&quot;ipt_fsqm_form_9_mcq_76&quot;,&quot;ipt_fsqm_form_9_mcq_76&quot;,&quot;ipt_fsqm_form_9_mcq_76&quot;,&quot;ipt_fsqm_form_9_mcq_76&quot;,&quot;ipt_fsqm_form_9_mcq_76&quot;,&quot;ipt_fsqm_form_9_mcq_76&quot;,&quot;ipt_fsqm_form_9_mcq_76&quot;,&quot;ipt_fsqm_form_9_mcq_76&quot;,&quot;ipt_fsqm_form_9_mcq_76&quot;,&quot;ipt_fsqm_form_9_mcq_76&quot;,&quot;ipt_fsqm_form_9_mcq_76&quot;,&quot;ipt_fsqm_form_9_mcq_76&quot;,&quot;ipt_fsqm_form_9_mcq_86&quot;,&quot;ipt_fsqm_form_9_mcq_86&quot;,&quot;ipt_fsqm_form_9_mcq_86&quot;,&quot;ipt_fsqm_form_9_mcq_86&quot;,&quot;ipt_fsqm_form_9_mcq_86&quot;,&quot;ipt_fsqm_form_9_mcq_86&quot;,&quot;ipt_fsqm_form_9_mcq_86&quot;,&quot;ipt_fsqm_form_9_mcq_85&quot;,&quot;ipt_fsqm_form_9_mcq_85&quot;,&quot;ipt_fsqm_form_9_mcq_85&quot;,&quot;ipt_fsqm_form_9_mcq_85&quot;,&quot;ipt_fsqm_form_9_mcq_85&quot;,&quot;ipt_fsqm_form_9_mcq_85&quot;]},&quot;base&quot;:&quot;9&quot;}\" \/>\n<input\ntype=\"hidden\" data-sayt-exclude class=\"ipt_fsqm_timer_data\" id=\"ipt_fsqm_timer_data_9\" value=\"{&quot;type&quot;:&quot;none&quot;}\" \/>\n<input\ntype=\"hidden\" data-sayt-exclude class=\"ipt_fsqm_epoc_data\" id=\"ipt_fsqm_epoc_data_9\" value=\"{&quot;CURRENTYEAR&quot;:2026,&quot;CURRENTDATE&quot;:1775369176000,&quot;CURRENTDAY&quot;:5,&quot;CURRENTMONTH&quot;:4,&quot;CURRENTHOUR&quot;:6,&quot;CURRENTMINUTE&quot;:6,&quot;CURRENTSECOND&quot;:16,&quot;CURRENTWEEK&quot;:14,&quot;CURRENTEPOC&quot;:20548}\" \/><div\nstyle=\"display: none;\" class=\"ipt_uif_hidden_init\"><form\nmethod=\"post\" action=\"\" class=\"ipt_uif_validate_form ipt_fsqm_main_form\" id=\"ipt_fsqm_form_9\" autocomplete=\"on\">\n<input\ntype=\"hidden\" data-sayt-exclude name=\"action\" id=\"action\" value=\"ipt_fsqm_save_form\" \/>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_epoc\" class=\"eform-epoc-value\" value=\"1775369176\" \/>\n<input\ntype=\"hidden\" class=\"ipt_fsqm_form_tab_pos\" name=\"fsqm_form9_tab_pos\" value=\"0\" id=\"fsqm_form9_tab_pos\" \/>\n<input\ntype=\"hidden\" id=\"ipt_fsqm_form_data_save\" name=\"ipt_fsqm_form_data_save\" value=\"63a37c8777\" data-sayt-exclude \/>\t\t\t<input\ntype=\"hidden\" name=\"_wp_http_referer\" value=\"\/fertility\/en\/wp-json\/wp\/v2\/pages\/16437\" \/>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"form_id\" value=\"9\" \/><div\nclass=\"ipt-eform-width-restrain\"><div\nclass=\"ipt-eform-content \"><div\ndata-settings=\"{&quot;can_previous&quot;:false,&quot;show_progress_bar&quot;:false,&quot;progress_bar_bottom&quot;:false,&quot;block_previous&quot;:true,&quot;any_tab&quot;:false,&quot;type&quot;:&quot;2&quot;,&quot;scroll&quot;:true,&quot;decimal_point&quot;:2,&quot;auto_progress&quot;:false,&quot;auto_progress_delay&quot;:&quot;1500&quot;,&quot;auto_submit&quot;:false,&quot;hidden_buttons&quot;:true,&quot;scroll_on_error&quot;:true}\" class=\"ipt_fsqm_main_tab ipt_uif_tabs horizontal\"><div\nclass=\"ipt-eform-tab-nav-wrap\"><ul><li\nid=\"ipt_fsqm_form_9_tab_0_control_li\"><a\nclass=\"eform-ripple\" href=\"#ipt_fsqm_form_9_tab_0\"><span\nclass=\"eform-tab-labels\">Step 1 <\/span><\/a><\/li><li\nid=\"ipt_fsqm_form_9_tab_1_control_li\"><a\nclass=\"eform-ripple\" href=\"#ipt_fsqm_form_9_tab_1\"><span\nclass=\"eform-tab-labels\">Step 2 <\/span><\/a><\/li><li\nid=\"ipt_fsqm_form_9_tab_2_control_li\"><a\nclass=\"eform-ripple\" href=\"#ipt_fsqm_form_9_tab_2\"><span\nclass=\"eform-tab-labels\">Step 3 <\/span><\/a><\/li><li\nid=\"ipt_fsqm_form_9_tab_3_control_li\"><a\nclass=\"eform-ripple\" href=\"#ipt_fsqm_form_9_tab_3\"><span\nclass=\"eform-tab-labels\">Step 4 <\/span><\/a><\/li><li\nid=\"ipt_fsqm_form_9_tab_4_control_li\"><a\nclass=\"eform-ripple\" href=\"#ipt_fsqm_form_9_tab_4\"><span\nclass=\"eform-tab-labels\">Step 4 <\/span><\/a><\/li><li\nid=\"ipt_fsqm_form_9_tab_5_control_li\"><a\nclass=\"eform-ripple\" href=\"#ipt_fsqm_form_9_tab_5\"><span\nclass=\"eform-tab-labels\">Step 4 <\/span><\/a><\/li><li\nid=\"ipt_fsqm_form_9_tab_6_control_li\"><a\nclass=\"eform-ripple\" href=\"#ipt_fsqm_form_9_tab_6\"><span\nclass=\"eform-tab-labels\">Step 4 <\/span><\/a><\/li><li\nid=\"ipt_fsqm_form_9_tab_7_control_li\"><a\nclass=\"eform-ripple\" href=\"#ipt_fsqm_form_9_tab_7\"><span\nclass=\"eform-tab-labels\">Step 5 <\/span><\/a><\/li><\/ul>\n<i\nclass=\"eform-tab-nav eform-tab-nav-right ipt-icomoon-angle-right disabled eform-ripple\"><\/i>\n<i\nclass=\"eform-tab-nav eform-tab-nav-left ipt-icomoon-angle-left disabled eform-ripple\"><\/i>\n<span\nclass=\"eform-tab-passive-notifier\"><\/span>\n<span\nclass=\"eform-tab-active-notifier\"><\/span><\/div><div\nid=\"ipt_fsqm_form_9_tab_0\" class=\"ipt_fsqm_form_tab_panel\"><div\nid=\"ipt_fsqm_form_9_layout_0_inner\" class=\"ipt-eform-layout-wrapper\"><div\nclass=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_main_heading_column\"><div\nclass=\"ipt_uif_column_inner\"><h3 class=\"ipt_fsqm_main_heading ipt_uif_heading ipt_uif_divider ipt_uif_align_left ipt_uif_divider_no_icon ipt_uif_divider_icon_no_bg\">\n<span\nclass=\"ipt_uif_divider_text\">\n<span\nclass=\"ipt_uif_divider_text_inner\">\nStep 1<span\nclass=\"subtitle\"><\/span>\t\t\t\t<\/span>\n<\/span><\/h3><div\nclass=\"clear-both\"><\/div><\/div><\/div>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_9[mcq][49][m_type]\" id=\"ipt_fsqm_form_9_mcq_49_m_type\" value=\"mcq\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_9[mcq][49][type]\" id=\"ipt_fsqm_form_9_mcq_49_type\" value=\"radio\" class=\"ipt_fsqm_hf_type\" \/><div\nclass=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_container_radio\" id=\"ipt_fsqm_form_9_mcq_49\"><div\nclass=\"ipt_uif_column_inner side_margin\"><div\nclass=\"ipt_uif_question\"><div\nclass=\"ipt_uif_question_label\">\n<label\nclass=\"ipt_uif_question_title ipt_uif_label\" for=\"ipt_fsqm_form_9_mcq_49\">I want to become a <span\nstyle=\"color:#fb91a3; font-weight:600;\">mother...<\/span><span\nclass=\"ipt_uif_question_required\">*<\/span><\/label><div\nclass=\"clear-both\"><\/div>\t\t\t\t\t\t<label\nclass=\"ipt_uif_question_subtitle ipt_uif_label\" for=\"ipt_fsqm_form_9_mcq_49\">Each circumstance is different and requires a specific treatment.<\/label><\/div><div\nclass=\"ipt_uif_question_content\"><div\nclass=\"ipt_uif_label_column column_3\">\n<input\ndata-num=\"\"\t\t\t\ttype=\"radio\"\nclass=\"check_me validate[required] ipt_uif_radio with-gap\"\nname=\"ipt_fsqm_form_9[mcq][49][options][]\"\nid=\"ipt_fsqm_form_9_mcq_49_options__0\"\nvalue=\"0\" \/>\n<label\nclass=\"eform-label-with-tabindex\" tabindex=\"0\" for=\"ipt_fsqm_form_9_mcq_49_options__0\" data-labelcon=\"&#xe18e;\">\n<img\nsrc=\"https:\/\/www.dexeus.com\/fertility\/wp-content\/uploads\/2021\/10\/pareja.png\" alt=\"con mi pareja masculina\" \/>...with my male partner\t<\/label><\/div><div\nclass=\"ipt_uif_label_column column_3\">\n<input\ndata-num=\"\"\t\t\t\ttype=\"radio\"\nclass=\"check_me validate[required] ipt_uif_radio with-gap\"\nname=\"ipt_fsqm_form_9[mcq][49][options][]\"\nid=\"ipt_fsqm_form_9_mcq_49_options__1\"\nvalue=\"1\" \/>\n<label\nclass=\"eform-label-with-tabindex\" tabindex=\"0\" for=\"ipt_fsqm_form_9_mcq_49_options__1\" data-labelcon=\"&#xe18e;\">\n<img\nsrc=\"https:\/\/www.dexeus.com\/fertility\/wp-content\/uploads\/2021\/10\/sola.png\" alt=\"yo sola\" \/>...on my own\t<\/label><\/div><div\nclass=\"ipt_uif_label_column column_3\">\n<input\ndata-num=\"\"\t\t\t\ttype=\"radio\"\nclass=\"check_me validate[required] ipt_uif_radio with-gap\"\nname=\"ipt_fsqm_form_9[mcq][49][options][]\"\nid=\"ipt_fsqm_form_9_mcq_49_options__2\"\nvalue=\"2\" \/>\n<label\nclass=\"eform-label-with-tabindex\" tabindex=\"0\" for=\"ipt_fsqm_form_9_mcq_49_options__2\" data-labelcon=\"&#xe18e;\">\n<img\nsrc=\"https:\/\/www.dexeus.com\/fertility\/wp-content\/uploads\/2021\/10\/femenina.png\" alt=\"con mi pareja femenina\" \/>...with my female partner\t<\/label><\/div><div\nclass=\"clear-both\"><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div><\/div><div\nclass=\"clear-both\"><\/div><\/div><div\nid=\"ipt_fsqm_form_9_tab_1\" class=\"ipt_fsqm_form_tab_panel\"><div\nid=\"ipt_fsqm_form_9_layout_1_inner\" class=\"ipt-eform-layout-wrapper\"><div\nclass=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_main_heading_column\"><div\nclass=\"ipt_uif_column_inner\"><h3 class=\"ipt_fsqm_main_heading ipt_uif_heading ipt_uif_divider ipt_uif_align_left ipt_uif_divider_no_icon ipt_uif_divider_icon_no_bg\">\n<span\nclass=\"ipt_uif_divider_text\">\n<span\nclass=\"ipt_uif_divider_text_inner\">\nStep 2<span\nclass=\"subtitle\"><\/span>\t\t\t\t<\/span>\n<\/span><\/h3><div\nclass=\"clear-both\"><\/div><\/div><\/div>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_9[mcq][50][m_type]\" id=\"ipt_fsqm_form_9_mcq_50_m_type\" value=\"mcq\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_9[mcq][50][type]\" id=\"ipt_fsqm_form_9_mcq_50_type\" value=\"slider\" class=\"ipt_fsqm_hf_type\" \/><div\nclass=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_container_slider\" id=\"ipt_fsqm_form_9_mcq_50\"><div\nclass=\"ipt_uif_column_inner side_margin\"><div\nclass=\"ipt_uif_question ipt_uif_question_vertical ipt_uif_question_centered\"><div\nclass=\"ipt_uif_question_label\">\n<label\nclass=\"ipt_uif_question_title ipt_uif_label\" for=\"ipt_fsqm_form_9_mcq_50_value\">My age ...<span\nclass=\"ipt_uif_question_required\">*<\/span><\/label><div\nclass=\"clear-both\"><\/div><\/div><div\nclass=\"ipt_uif_question_content\"><div\nclass=\"ipt_uif_empty_box ipt_uif_slider_box\">\n<input\ndata-floats=\"1\" type=\"number\" min=\"18\" max=\"50\" step=\"1\" data-nomin=\"\" data-show-count=\"\" data-labels=\"{&quot;first&quot;:false,&quot;last&quot;:false,&quot;rest&quot;:false,&quot;labels&quot;:[]}\" data-prefix=\"20\" data-suffix=\"\" class=\"ipt_uif_slider check_me validate[funcCall[iptUIFSliderVal]]\" data-min=\"18\" data-max=\"50\" data-step=\"1\" name=\"ipt_fsqm_form_9[mcq][50][value]\" id=\"ipt_fsqm_form_9_mcq_50_value\" value=\"18\" data-vertical=\"\" data-height=\"300\" \/><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_9[mcq][65][m_type]\" id=\"ipt_fsqm_form_9_mcq_65_m_type\" value=\"mcq\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_9[mcq][65][type]\" id=\"ipt_fsqm_form_9_mcq_65_type\" value=\"slider\" class=\"ipt_fsqm_hf_type\" \/><div\nclass=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_container_slider\" id=\"ipt_fsqm_form_9_mcq_65\"><div\nclass=\"ipt_uif_column_inner side_margin\"><div\nclass=\"ipt_uif_question ipt_uif_question_vertical ipt_uif_question_centered\"><div\nclass=\"ipt_uif_question_label\">\n<label\nclass=\"ipt_uif_question_title ipt_uif_label\" for=\"ipt_fsqm_form_9_mcq_65_value\">My age ...<span\nclass=\"ipt_uif_question_required\">*<\/span><\/label><div\nclass=\"clear-both\"><\/div><\/div><div\nclass=\"ipt_uif_question_content\"><div\nclass=\"ipt_uif_empty_box ipt_uif_slider_box\">\n<input\ndata-floats=\"1\" type=\"number\" min=\"18\" max=\"50\" step=\"1\" data-nomin=\"\" data-show-count=\"\" data-labels=\"{&quot;first&quot;:false,&quot;last&quot;:false,&quot;rest&quot;:false,&quot;labels&quot;:[]}\" data-prefix=\"20\" data-suffix=\"\" class=\"ipt_uif_slider check_me validate[funcCall[iptUIFSliderVal]]\" data-min=\"18\" data-max=\"50\" data-step=\"1\" name=\"ipt_fsqm_form_9[mcq][65][value]\" id=\"ipt_fsqm_form_9_mcq_65_value\" value=\"18\" data-vertical=\"\" data-height=\"300\" \/><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_9[mcq][64][m_type]\" id=\"ipt_fsqm_form_9_mcq_64_m_type\" value=\"mcq\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_9[mcq][64][type]\" id=\"ipt_fsqm_form_9_mcq_64_type\" value=\"slider\" class=\"ipt_fsqm_hf_type\" \/><div\nclass=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_container_slider\" id=\"ipt_fsqm_form_9_mcq_64\"><div\nclass=\"ipt_uif_column_inner side_margin\"><div\nclass=\"ipt_uif_question ipt_uif_question_vertical ipt_uif_question_centered\"><div\nclass=\"ipt_uif_question_label\">\n<label\nclass=\"ipt_uif_question_title ipt_uif_label\" for=\"ipt_fsqm_form_9_mcq_64_value\">My age ...<span\nclass=\"ipt_uif_question_required\">*<\/span><\/label><div\nclass=\"clear-both\"><\/div><\/div><div\nclass=\"ipt_uif_question_content\"><div\nclass=\"ipt_uif_empty_box ipt_uif_slider_box\">\n<input\ndata-floats=\"1\" type=\"number\" min=\"18\" max=\"50\" step=\"1\" data-nomin=\"\" data-show-count=\"\" data-labels=\"{&quot;first&quot;:false,&quot;last&quot;:false,&quot;rest&quot;:false,&quot;labels&quot;:[]}\" data-prefix=\"20\" data-suffix=\"\" class=\"ipt_uif_slider check_me validate[funcCall[iptUIFSliderVal]]\" data-min=\"18\" data-max=\"50\" data-step=\"1\" name=\"ipt_fsqm_form_9[mcq][64][value]\" id=\"ipt_fsqm_form_9_mcq_64_value\" value=\"18\" data-vertical=\"\" data-height=\"300\" \/><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div><\/div><div\nclass=\"clear-both\"><\/div><\/div><div\nid=\"ipt_fsqm_form_9_tab_2\" class=\"ipt_fsqm_form_tab_panel\"><div\nid=\"ipt_fsqm_form_9_layout_2_inner\" class=\"ipt-eform-layout-wrapper\"><div\nclass=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_main_heading_column\"><div\nclass=\"ipt_uif_column_inner\"><h3 class=\"ipt_fsqm_main_heading ipt_uif_heading ipt_uif_divider ipt_uif_align_left ipt_uif_divider_no_icon ipt_uif_divider_icon_no_bg\">\n<span\nclass=\"ipt_uif_divider_text\">\n<span\nclass=\"ipt_uif_divider_text_inner\">\nStep 3<span\nclass=\"subtitle\"><\/span>\t\t\t\t<\/span>\n<\/span><\/h3><div\nclass=\"clear-both\"><\/div><\/div><\/div>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_9[mcq][57][m_type]\" id=\"ipt_fsqm_form_9_mcq_57_m_type\" value=\"mcq\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_9[mcq][57][type]\" id=\"ipt_fsqm_form_9_mcq_57_type\" value=\"checkbox\" class=\"ipt_fsqm_hf_type\" \/><div\nclass=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_container_checkbox\" id=\"ipt_fsqm_form_9_mcq_57\"><div\nclass=\"ipt_uif_column_inner side_margin\"><div\nclass=\"ipt_uif_question ipt_uif_question_vertical ipt_uif_question_centered\"><div\nclass=\"ipt_uif_question_label\">\n<label\nclass=\"ipt_uif_question_title ipt_uif_label\" for=\"ipt_fsqm_form_9_mcq_57\">My medical history<span\nclass=\"ipt_uif_question_required\">*<\/span><\/label><div\nclass=\"clear-both\"><\/div><\/div><div\nclass=\"ipt_uif_question_content\"><div\nclass=\"ipt_uif_label_column column_random\">\n<input\ndata-num=\"\"\t\t\t\t\t\t\t\t\t\ttype=\"checkbox\"\nclass=\"check_me validate[required] ipt_uif_checkbox filled-in \"\nname=\"ipt_fsqm_form_9[mcq][57][options][]\" id=\"ipt_fsqm_form_9_mcq_57_options__0\"\nvalue=\"0\" \/>\n<label\nclass=\"eform-label-with-tabindex\" tabindex=\"0\" for=\"ipt_fsqm_form_9_mcq_57_options__0\">\n<img\nsrc=\"https:\/\/www.dexeus.com\/fertility\/wp-content\/uploads\/2021\/10\/baja-1.jpg\" alt=\"Baja\" \/>Low ovarian reserve\t\t\t\t<\/label><\/div><div\nclass=\"ipt_uif_label_column column_random\">\n<input\ndata-num=\"\"\t\t\t\t\t\t\t\t\t\ttype=\"checkbox\"\nclass=\"check_me validate[required] ipt_uif_checkbox filled-in \"\nname=\"ipt_fsqm_form_9[mcq][57][options][]\" id=\"ipt_fsqm_form_9_mcq_57_options__1\"\nvalue=\"1\" \/>\n<label\nclass=\"eform-label-with-tabindex\" tabindex=\"0\" for=\"ipt_fsqm_form_9_mcq_57_options__1\">\n<img\nsrc=\"https:\/\/www.dexeus.com\/fertility\/wp-content\/uploads\/2021\/10\/trompas-1.jpg\" alt=\"Ligadura de trompas\" \/>Tubal ligation\t\t\t\t<\/label><\/div><div\nclass=\"ipt_uif_label_column column_random\">\n<input\ndata-num=\"\"\t\t\t\t\t\t\t\t\t\ttype=\"checkbox\"\nclass=\"check_me validate[required] ipt_uif_checkbox filled-in \"\nname=\"ipt_fsqm_form_9[mcq][57][options][]\" id=\"ipt_fsqm_form_9_mcq_57_options__2\"\nvalue=\"2\" \/>\n<label\nclass=\"eform-label-with-tabindex\" tabindex=\"0\" for=\"ipt_fsqm_form_9_mcq_57_options__2\">\n<img\nsrc=\"https:\/\/www.dexeus.com\/fertility\/wp-content\/uploads\/2021\/10\/hereditaria-1.jpg\" alt=\"Enfermedad hereditaria\" \/>Hereditary disease\t\t\t\t<\/label><\/div><div\nclass=\"ipt_uif_label_column column_random\">\n<input\ndata-num=\"\"\t\t\t\t\t\t\t\t\t\ttype=\"checkbox\"\nclass=\"check_me validate[required] ipt_uif_checkbox filled-in \"\nname=\"ipt_fsqm_form_9[mcq][57][options][]\" id=\"ipt_fsqm_form_9_mcq_57_options__3\"\nvalue=\"3\" \/>\n<label\nclass=\"eform-label-with-tabindex\" tabindex=\"0\" for=\"ipt_fsqm_form_9_mcq_57_options__3\">\n<img\nsrc=\"https:\/\/www.dexeus.com\/fertility\/wp-content\/uploads\/2021\/10\/endometriosis-1.jpg\" alt=\"Soy seropositiva\" \/>Endometriosis\t\t\t\t<\/label><\/div><div\nclass=\"ipt_uif_label_column column_random\">\n<input\ndata-num=\"\"\t\t\t\t\t\t\t\t\t\ttype=\"checkbox\"\nclass=\"check_me validate[required] ipt_uif_checkbox filled-in \"\nname=\"ipt_fsqm_form_9[mcq][57][options][]\" id=\"ipt_fsqm_form_9_mcq_57_options__4\"\nvalue=\"4\" \/>\n<label\nclass=\"eform-label-with-tabindex\" tabindex=\"0\" for=\"ipt_fsqm_form_9_mcq_57_options__4\">\n<img\nsrc=\"https:\/\/www.dexeus.com\/fertility\/wp-content\/uploads\/2021\/10\/no-conozco-1.jpg\" alt=\"No conozco mi historia\" \/>I don't know my history \/ None of the above\t\t\t\t<\/label><\/div><div\nclass=\"clear-both\"><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_9[mcq][60][m_type]\" id=\"ipt_fsqm_form_9_mcq_60_m_type\" value=\"mcq\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_9[mcq][60][type]\" id=\"ipt_fsqm_form_9_mcq_60_type\" value=\"checkbox\" class=\"ipt_fsqm_hf_type\" \/><div\nclass=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_container_checkbox\" id=\"ipt_fsqm_form_9_mcq_60\"><div\nclass=\"ipt_uif_column_inner side_margin\"><div\nclass=\"ipt_uif_question ipt_uif_question_vertical ipt_uif_question_centered\"><div\nclass=\"ipt_uif_question_label\">\n<label\nclass=\"ipt_uif_question_title ipt_uif_label\" for=\"ipt_fsqm_form_9_mcq_60\">My medical history<span\nclass=\"ipt_uif_question_required\">*<\/span><\/label><div\nclass=\"clear-both\"><\/div><\/div><div\nclass=\"ipt_uif_question_content\"><div\nclass=\"ipt_uif_label_column column_random\">\n<input\ndata-num=\"\"\t\t\t\t\t\t\t\t\t\ttype=\"checkbox\"\nclass=\"check_me validate[required] ipt_uif_checkbox filled-in \"\nname=\"ipt_fsqm_form_9[mcq][60][options][]\" id=\"ipt_fsqm_form_9_mcq_60_options__0\"\nvalue=\"0\" \/>\n<label\nclass=\"eform-label-with-tabindex\" tabindex=\"0\" for=\"ipt_fsqm_form_9_mcq_60_options__0\">\n<img\nsrc=\"https:\/\/www.dexeus.com\/fertility\/wp-content\/uploads\/2021\/10\/baja-1.jpg\" alt=\"Baja\" \/>Low ovarian reserve\t\t\t\t<\/label><\/div><div\nclass=\"ipt_uif_label_column column_random\">\n<input\ndata-num=\"\"\t\t\t\t\t\t\t\t\t\ttype=\"checkbox\"\nclass=\"check_me validate[required] ipt_uif_checkbox filled-in \"\nname=\"ipt_fsqm_form_9[mcq][60][options][]\" id=\"ipt_fsqm_form_9_mcq_60_options__1\"\nvalue=\"1\" \/>\n<label\nclass=\"eform-label-with-tabindex\" tabindex=\"0\" for=\"ipt_fsqm_form_9_mcq_60_options__1\">\n<img\nsrc=\"https:\/\/www.dexeus.com\/fertility\/wp-content\/uploads\/2021\/10\/trompas-1.jpg\" alt=\"Ligadura de trompas\" \/>Tubal ligation\t\t\t\t<\/label><\/div><div\nclass=\"ipt_uif_label_column column_random\">\n<input\ndata-num=\"\"\t\t\t\t\t\t\t\t\t\ttype=\"checkbox\"\nclass=\"check_me validate[required] ipt_uif_checkbox filled-in \"\nname=\"ipt_fsqm_form_9[mcq][60][options][]\" id=\"ipt_fsqm_form_9_mcq_60_options__2\"\nvalue=\"2\" \/>\n<label\nclass=\"eform-label-with-tabindex\" tabindex=\"0\" for=\"ipt_fsqm_form_9_mcq_60_options__2\">\n<img\nsrc=\"https:\/\/www.dexeus.com\/fertility\/wp-content\/uploads\/2021\/10\/hereditaria-1.jpg\" alt=\"Enfermedad hereditaria\" \/>Hereditary disease\t\t\t\t<\/label><\/div><div\nclass=\"ipt_uif_label_column column_random\">\n<input\ndata-num=\"\"\t\t\t\t\t\t\t\t\t\ttype=\"checkbox\"\nclass=\"check_me validate[required] ipt_uif_checkbox filled-in \"\nname=\"ipt_fsqm_form_9[mcq][60][options][]\" id=\"ipt_fsqm_form_9_mcq_60_options__3\"\nvalue=\"3\" \/>\n<label\nclass=\"eform-label-with-tabindex\" tabindex=\"0\" for=\"ipt_fsqm_form_9_mcq_60_options__3\">\n<img\nsrc=\"https:\/\/www.dexeus.com\/fertility\/wp-content\/uploads\/2021\/10\/endometriosis-1.jpg\" alt=\"Soy seropositiva\" \/>Endometriosis\t\t\t\t<\/label><\/div><div\nclass=\"ipt_uif_label_column column_random\">\n<input\ndata-num=\"\"\t\t\t\t\t\t\t\t\t\ttype=\"checkbox\"\nclass=\"check_me validate[required] ipt_uif_checkbox filled-in \"\nname=\"ipt_fsqm_form_9[mcq][60][options][]\" id=\"ipt_fsqm_form_9_mcq_60_options__4\"\nvalue=\"4\" \/>\n<label\nclass=\"eform-label-with-tabindex\" tabindex=\"0\" for=\"ipt_fsqm_form_9_mcq_60_options__4\">\n<img\nsrc=\"https:\/\/www.dexeus.com\/fertility\/wp-content\/uploads\/2021\/10\/no-conozco-1.jpg\" alt=\"No conozco mi historia\" \/>I don't know my history \/ None of the above\t\t\t\t<\/label><\/div><div\nclass=\"clear-both\"><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_9[mcq][59][m_type]\" id=\"ipt_fsqm_form_9_mcq_59_m_type\" value=\"mcq\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_9[mcq][59][type]\" id=\"ipt_fsqm_form_9_mcq_59_type\" value=\"checkbox\" class=\"ipt_fsqm_hf_type\" \/><div\nclass=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_container_checkbox\" id=\"ipt_fsqm_form_9_mcq_59\"><div\nclass=\"ipt_uif_column_inner side_margin\"><div\nclass=\"ipt_uif_question ipt_uif_question_vertical ipt_uif_question_centered\"><div\nclass=\"ipt_uif_question_label\">\n<label\nclass=\"ipt_uif_question_title ipt_uif_label\" for=\"ipt_fsqm_form_9_mcq_59\">My medical history <span\nclass=\"ipt_uif_question_required\">*<\/span><\/label><div\nclass=\"clear-both\"><\/div><\/div><div\nclass=\"ipt_uif_question_content\"><div\nclass=\"ipt_uif_label_column column_random\">\n<input\ndata-num=\"\"\t\t\t\t\t\t\t\t\t\ttype=\"checkbox\"\nclass=\"check_me validate[required] ipt_uif_checkbox filled-in \"\nname=\"ipt_fsqm_form_9[mcq][59][options][]\" id=\"ipt_fsqm_form_9_mcq_59_options__0\"\nvalue=\"0\" \/>\n<label\nclass=\"eform-label-with-tabindex\" tabindex=\"0\" for=\"ipt_fsqm_form_9_mcq_59_options__0\">\n<img\nsrc=\"https:\/\/www.dexeus.com\/fertility\/wp-content\/uploads\/2021\/10\/baja-1.jpg\" alt=\"Baja\" \/>Low ovarian reserve\t\t\t\t<\/label><\/div><div\nclass=\"ipt_uif_label_column column_random\">\n<input\ndata-num=\"\"\t\t\t\t\t\t\t\t\t\ttype=\"checkbox\"\nclass=\"check_me validate[required] ipt_uif_checkbox filled-in \"\nname=\"ipt_fsqm_form_9[mcq][59][options][]\" id=\"ipt_fsqm_form_9_mcq_59_options__1\"\nvalue=\"1\" \/>\n<label\nclass=\"eform-label-with-tabindex\" tabindex=\"0\" for=\"ipt_fsqm_form_9_mcq_59_options__1\">\n<img\nsrc=\"https:\/\/www.dexeus.com\/fertility\/wp-content\/uploads\/2021\/10\/trompas-1.jpg\" alt=\"Ligadura de trompas\" \/>Tubal ligation\t\t\t\t<\/label><\/div><div\nclass=\"ipt_uif_label_column column_random\">\n<input\ndata-num=\"\"\t\t\t\t\t\t\t\t\t\ttype=\"checkbox\"\nclass=\"check_me validate[required] ipt_uif_checkbox filled-in \"\nname=\"ipt_fsqm_form_9[mcq][59][options][]\" id=\"ipt_fsqm_form_9_mcq_59_options__2\"\nvalue=\"2\" \/>\n<label\nclass=\"eform-label-with-tabindex\" tabindex=\"0\" for=\"ipt_fsqm_form_9_mcq_59_options__2\">\n<img\nsrc=\"https:\/\/www.dexeus.com\/fertility\/wp-content\/uploads\/2021\/10\/hereditaria-1.jpg\" alt=\"Enfermedad hereditaria\" \/>Hereditary disease\t\t\t\t<\/label><\/div><div\nclass=\"ipt_uif_label_column column_random\">\n<input\ndata-num=\"\"\t\t\t\t\t\t\t\t\t\ttype=\"checkbox\"\nclass=\"check_me validate[required] ipt_uif_checkbox filled-in \"\nname=\"ipt_fsqm_form_9[mcq][59][options][]\" id=\"ipt_fsqm_form_9_mcq_59_options__3\"\nvalue=\"3\" \/>\n<label\nclass=\"eform-label-with-tabindex\" tabindex=\"0\" for=\"ipt_fsqm_form_9_mcq_59_options__3\">\n<img\nsrc=\"https:\/\/www.dexeus.com\/fertility\/wp-content\/uploads\/2021\/10\/endometriosis-1.jpg\" alt=\"Soy seropositiva\" \/>Endometriosis\t\t\t\t<\/label><\/div><div\nclass=\"ipt_uif_label_column column_random\">\n<input\ndata-num=\"\"\t\t\t\t\t\t\t\t\t\ttype=\"checkbox\"\nclass=\"check_me validate[required] ipt_uif_checkbox filled-in \"\nname=\"ipt_fsqm_form_9[mcq][59][options][]\" id=\"ipt_fsqm_form_9_mcq_59_options__4\"\nvalue=\"4\" \/>\n<label\nclass=\"eform-label-with-tabindex\" tabindex=\"0\" for=\"ipt_fsqm_form_9_mcq_59_options__4\">\n<img\nsrc=\"https:\/\/www.dexeus.com\/fertility\/wp-content\/uploads\/2021\/10\/no-conozco-1.jpg\" alt=\"No conozco mi historia\" \/>I don't know my history \/ None of the above\t\t\t\t<\/label><\/div><div\nclass=\"clear-both\"><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_9[mcq][66][m_type]\" id=\"ipt_fsqm_form_9_mcq_66_m_type\" value=\"mcq\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_9[mcq][66][type]\" id=\"ipt_fsqm_form_9_mcq_66_type\" value=\"checkbox\" class=\"ipt_fsqm_hf_type\" \/><div\nclass=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_container_checkbox\" id=\"ipt_fsqm_form_9_mcq_66\"><div\nclass=\"ipt_uif_column_inner side_margin\"><div\nclass=\"ipt_uif_question ipt_uif_question_vertical ipt_uif_question_centered\"><div\nclass=\"ipt_uif_question_label\">\n<label\nclass=\"ipt_uif_question_title ipt_uif_label\" for=\"ipt_fsqm_form_9_mcq_66\">My medical history <span\nclass=\"ipt_uif_question_required\">*<\/span><\/label><div\nclass=\"clear-both\"><\/div><\/div><div\nclass=\"ipt_uif_question_content\"><div\nclass=\"ipt_uif_label_column column_random\">\n<input\ndata-num=\"\"\t\t\t\t\t\t\t\t\t\ttype=\"checkbox\"\nclass=\"check_me validate[required] ipt_uif_checkbox filled-in \"\nname=\"ipt_fsqm_form_9[mcq][66][options][]\" id=\"ipt_fsqm_form_9_mcq_66_options__0\"\nvalue=\"0\" \/>\n<label\nclass=\"eform-label-with-tabindex\" tabindex=\"0\" for=\"ipt_fsqm_form_9_mcq_66_options__0\">\n<img\nsrc=\"https:\/\/www.dexeus.com\/fertility\/wp-content\/uploads\/2021\/10\/baja-1.jpg\" alt=\"Baja\" \/>Low ovarian reserve\t\t\t\t<\/label><\/div><div\nclass=\"ipt_uif_label_column column_random\">\n<input\ndata-num=\"\"\t\t\t\t\t\t\t\t\t\ttype=\"checkbox\"\nclass=\"check_me validate[required] ipt_uif_checkbox filled-in \"\nname=\"ipt_fsqm_form_9[mcq][66][options][]\" id=\"ipt_fsqm_form_9_mcq_66_options__1\"\nvalue=\"1\" \/>\n<label\nclass=\"eform-label-with-tabindex\" tabindex=\"0\" for=\"ipt_fsqm_form_9_mcq_66_options__1\">\n<img\nsrc=\"https:\/\/www.dexeus.com\/fertility\/wp-content\/uploads\/2021\/10\/trompas-1.jpg\" alt=\"Ligadura de trompas\" \/>Tubal ligation\t\t\t\t<\/label><\/div><div\nclass=\"ipt_uif_label_column column_random\">\n<input\ndata-num=\"\"\t\t\t\t\t\t\t\t\t\ttype=\"checkbox\"\nclass=\"check_me validate[required] ipt_uif_checkbox filled-in \"\nname=\"ipt_fsqm_form_9[mcq][66][options][]\" id=\"ipt_fsqm_form_9_mcq_66_options__2\"\nvalue=\"2\" \/>\n<label\nclass=\"eform-label-with-tabindex\" tabindex=\"0\" for=\"ipt_fsqm_form_9_mcq_66_options__2\">\n<img\nsrc=\"https:\/\/www.dexeus.com\/fertility\/wp-content\/uploads\/2021\/10\/hereditaria-1.jpg\" alt=\"Enfermedad hereditaria\" \/>Hereditary disease\t\t\t\t<\/label><\/div><div\nclass=\"ipt_uif_label_column column_random\">\n<input\ndata-num=\"\"\t\t\t\t\t\t\t\t\t\ttype=\"checkbox\"\nclass=\"check_me validate[required] ipt_uif_checkbox filled-in \"\nname=\"ipt_fsqm_form_9[mcq][66][options][]\" id=\"ipt_fsqm_form_9_mcq_66_options__3\"\nvalue=\"3\" \/>\n<label\nclass=\"eform-label-with-tabindex\" tabindex=\"0\" for=\"ipt_fsqm_form_9_mcq_66_options__3\">\n<img\nsrc=\"https:\/\/www.dexeus.com\/fertility\/wp-content\/uploads\/2021\/10\/endometriosis-1.jpg\" alt=\"Soy seropositiva\" \/>Endometriosis\t\t\t\t<\/label><\/div><div\nclass=\"ipt_uif_label_column column_random\">\n<input\ndata-num=\"\"\t\t\t\t\t\t\t\t\t\ttype=\"checkbox\"\nclass=\"check_me validate[required] ipt_uif_checkbox filled-in \"\nname=\"ipt_fsqm_form_9[mcq][66][options][]\" id=\"ipt_fsqm_form_9_mcq_66_options__4\"\nvalue=\"4\" \/>\n<label\nclass=\"eform-label-with-tabindex\" tabindex=\"0\" for=\"ipt_fsqm_form_9_mcq_66_options__4\">\n<img\nsrc=\"https:\/\/www.dexeus.com\/fertility\/wp-content\/uploads\/2021\/10\/no-conozco-1.jpg\" alt=\"No conozco mi historia\" \/>I don't know my history \/ None of the above\t\t\t\t<\/label><\/div><div\nclass=\"clear-both\"><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_9[mcq][67][m_type]\" id=\"ipt_fsqm_form_9_mcq_67_m_type\" value=\"mcq\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_9[mcq][67][type]\" id=\"ipt_fsqm_form_9_mcq_67_type\" value=\"checkbox\" class=\"ipt_fsqm_hf_type\" \/><div\nclass=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_container_checkbox\" id=\"ipt_fsqm_form_9_mcq_67\"><div\nclass=\"ipt_uif_column_inner side_margin\"><div\nclass=\"ipt_uif_question ipt_uif_question_vertical ipt_uif_question_centered\"><div\nclass=\"ipt_uif_question_label\">\n<label\nclass=\"ipt_uif_question_title ipt_uif_label\" for=\"ipt_fsqm_form_9_mcq_67\">My medical history <span\nclass=\"ipt_uif_question_required\">*<\/span><\/label><div\nclass=\"clear-both\"><\/div><\/div><div\nclass=\"ipt_uif_question_content\"><div\nclass=\"ipt_uif_label_column column_random\">\n<input\ndata-num=\"\"\t\t\t\t\t\t\t\t\t\ttype=\"checkbox\"\nclass=\"check_me validate[required] ipt_uif_checkbox filled-in \"\nname=\"ipt_fsqm_form_9[mcq][67][options][]\" id=\"ipt_fsqm_form_9_mcq_67_options__0\"\nvalue=\"0\" \/>\n<label\nclass=\"eform-label-with-tabindex\" tabindex=\"0\" for=\"ipt_fsqm_form_9_mcq_67_options__0\">\n<img\nsrc=\"https:\/\/www.dexeus.com\/fertility\/wp-content\/uploads\/2021\/10\/baja-1.jpg\" alt=\"Baja\" \/>Low ovarian reserve\t\t\t\t<\/label><\/div><div\nclass=\"ipt_uif_label_column column_random\">\n<input\ndata-num=\"\"\t\t\t\t\t\t\t\t\t\ttype=\"checkbox\"\nclass=\"check_me validate[required] ipt_uif_checkbox filled-in \"\nname=\"ipt_fsqm_form_9[mcq][67][options][]\" id=\"ipt_fsqm_form_9_mcq_67_options__1\"\nvalue=\"1\" \/>\n<label\nclass=\"eform-label-with-tabindex\" tabindex=\"0\" for=\"ipt_fsqm_form_9_mcq_67_options__1\">\n<img\nsrc=\"https:\/\/www.dexeus.com\/fertility\/wp-content\/uploads\/2021\/10\/trompas-1.jpg\" alt=\"Ligadura de trompas\" \/>Tubal ligation\t\t\t\t<\/label><\/div><div\nclass=\"ipt_uif_label_column column_random\">\n<input\ndata-num=\"\"\t\t\t\t\t\t\t\t\t\ttype=\"checkbox\"\nclass=\"check_me validate[required] ipt_uif_checkbox filled-in \"\nname=\"ipt_fsqm_form_9[mcq][67][options][]\" id=\"ipt_fsqm_form_9_mcq_67_options__2\"\nvalue=\"2\" \/>\n<label\nclass=\"eform-label-with-tabindex\" tabindex=\"0\" for=\"ipt_fsqm_form_9_mcq_67_options__2\">\n<img\nsrc=\"https:\/\/www.dexeus.com\/fertility\/wp-content\/uploads\/2021\/10\/hereditaria-1.jpg\" alt=\"Enfermedad hereditaria\" \/>Hereditary disease\t\t\t\t<\/label><\/div><div\nclass=\"ipt_uif_label_column column_random\">\n<input\ndata-num=\"\"\t\t\t\t\t\t\t\t\t\ttype=\"checkbox\"\nclass=\"check_me validate[required] ipt_uif_checkbox filled-in \"\nname=\"ipt_fsqm_form_9[mcq][67][options][]\" id=\"ipt_fsqm_form_9_mcq_67_options__3\"\nvalue=\"3\" \/>\n<label\nclass=\"eform-label-with-tabindex\" tabindex=\"0\" for=\"ipt_fsqm_form_9_mcq_67_options__3\">\n<img\nsrc=\"https:\/\/www.dexeus.com\/fertility\/wp-content\/uploads\/2021\/10\/endometriosis-1.jpg\" alt=\"Soy seropositiva\" \/>Endometriosis\t\t\t\t<\/label><\/div><div\nclass=\"ipt_uif_label_column column_random\">\n<input\ndata-num=\"\"\t\t\t\t\t\t\t\t\t\ttype=\"checkbox\"\nclass=\"check_me validate[required] ipt_uif_checkbox filled-in \"\nname=\"ipt_fsqm_form_9[mcq][67][options][]\" id=\"ipt_fsqm_form_9_mcq_67_options__4\"\nvalue=\"4\" \/>\n<label\nclass=\"eform-label-with-tabindex\" tabindex=\"0\" for=\"ipt_fsqm_form_9_mcq_67_options__4\">\n<img\nsrc=\"https:\/\/www.dexeus.com\/fertility\/wp-content\/uploads\/2021\/10\/no-conozco-1.jpg\" alt=\"No conozco mi historia\" \/>I don't know my history \/ None of the above\t\t\t\t<\/label><\/div><div\nclass=\"clear-both\"><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_9[mcq][68][m_type]\" id=\"ipt_fsqm_form_9_mcq_68_m_type\" value=\"mcq\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_9[mcq][68][type]\" id=\"ipt_fsqm_form_9_mcq_68_type\" value=\"checkbox\" class=\"ipt_fsqm_hf_type\" \/><div\nclass=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_container_checkbox\" id=\"ipt_fsqm_form_9_mcq_68\"><div\nclass=\"ipt_uif_column_inner side_margin\"><div\nclass=\"ipt_uif_question ipt_uif_question_vertical ipt_uif_question_centered\"><div\nclass=\"ipt_uif_question_label\">\n<label\nclass=\"ipt_uif_question_title ipt_uif_label\" for=\"ipt_fsqm_form_9_mcq_68\">My medical history <span\nclass=\"ipt_uif_question_required\">*<\/span><\/label><div\nclass=\"clear-both\"><\/div><\/div><div\nclass=\"ipt_uif_question_content\"><div\nclass=\"ipt_uif_label_column column_random\">\n<input\ndata-num=\"\"\t\t\t\t\t\t\t\t\t\ttype=\"checkbox\"\nclass=\"check_me validate[required] ipt_uif_checkbox filled-in \"\nname=\"ipt_fsqm_form_9[mcq][68][options][]\" id=\"ipt_fsqm_form_9_mcq_68_options__0\"\nvalue=\"0\" \/>\n<label\nclass=\"eform-label-with-tabindex\" tabindex=\"0\" for=\"ipt_fsqm_form_9_mcq_68_options__0\">\n<img\nsrc=\"https:\/\/www.dexeus.com\/fertility\/wp-content\/uploads\/2021\/10\/baja-1.jpg\" alt=\"Baja\" \/>Low ovarian reserve\t\t\t\t<\/label><\/div><div\nclass=\"ipt_uif_label_column column_random\">\n<input\ndata-num=\"\"\t\t\t\t\t\t\t\t\t\ttype=\"checkbox\"\nclass=\"check_me validate[required] ipt_uif_checkbox filled-in \"\nname=\"ipt_fsqm_form_9[mcq][68][options][]\" id=\"ipt_fsqm_form_9_mcq_68_options__1\"\nvalue=\"1\" \/>\n<label\nclass=\"eform-label-with-tabindex\" tabindex=\"0\" for=\"ipt_fsqm_form_9_mcq_68_options__1\">\n<img\nsrc=\"https:\/\/www.dexeus.com\/fertility\/wp-content\/uploads\/2021\/10\/trompas-1.jpg\" alt=\"Ligadura de trompas\" \/>Tubal ligation\t\t\t\t<\/label><\/div><div\nclass=\"ipt_uif_label_column column_random\">\n<input\ndata-num=\"\"\t\t\t\t\t\t\t\t\t\ttype=\"checkbox\"\nclass=\"check_me validate[required] ipt_uif_checkbox filled-in \"\nname=\"ipt_fsqm_form_9[mcq][68][options][]\" id=\"ipt_fsqm_form_9_mcq_68_options__2\"\nvalue=\"2\" \/>\n<label\nclass=\"eform-label-with-tabindex\" tabindex=\"0\" for=\"ipt_fsqm_form_9_mcq_68_options__2\">\n<img\nsrc=\"https:\/\/www.dexeus.com\/fertility\/wp-content\/uploads\/2021\/10\/hereditaria-1.jpg\" alt=\"Enfermedad hereditaria\" \/>Hereditary disease\t\t\t\t<\/label><\/div><div\nclass=\"ipt_uif_label_column column_random\">\n<input\ndata-num=\"\"\t\t\t\t\t\t\t\t\t\ttype=\"checkbox\"\nclass=\"check_me validate[required] ipt_uif_checkbox filled-in \"\nname=\"ipt_fsqm_form_9[mcq][68][options][]\" id=\"ipt_fsqm_form_9_mcq_68_options__3\"\nvalue=\"3\" \/>\n<label\nclass=\"eform-label-with-tabindex\" tabindex=\"0\" for=\"ipt_fsqm_form_9_mcq_68_options__3\">\n<img\nsrc=\"https:\/\/www.dexeus.com\/fertility\/wp-content\/uploads\/2021\/10\/endometriosis-1.jpg\" alt=\"Soy seropositiva\" \/>Endometriosis\t\t\t\t<\/label><\/div><div\nclass=\"ipt_uif_label_column column_random\">\n<input\ndata-num=\"\"\t\t\t\t\t\t\t\t\t\ttype=\"checkbox\"\nclass=\"check_me validate[required] ipt_uif_checkbox filled-in \"\nname=\"ipt_fsqm_form_9[mcq][68][options][]\" id=\"ipt_fsqm_form_9_mcq_68_options__4\"\nvalue=\"4\" \/>\n<label\nclass=\"eform-label-with-tabindex\" tabindex=\"0\" for=\"ipt_fsqm_form_9_mcq_68_options__4\">\n<img\nsrc=\"https:\/\/www.dexeus.com\/fertility\/wp-content\/uploads\/2021\/10\/no-conozco-1.jpg\" alt=\"No conozco mi historia\" \/>I don't know my history \/ None of the above\t\t\t\t<\/label><\/div><div\nclass=\"clear-both\"><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_9[mcq][69][m_type]\" id=\"ipt_fsqm_form_9_mcq_69_m_type\" value=\"mcq\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_9[mcq][69][type]\" id=\"ipt_fsqm_form_9_mcq_69_type\" value=\"checkbox\" class=\"ipt_fsqm_hf_type\" \/><div\nclass=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_container_checkbox\" id=\"ipt_fsqm_form_9_mcq_69\"><div\nclass=\"ipt_uif_column_inner side_margin\"><div\nclass=\"ipt_uif_question ipt_uif_question_vertical ipt_uif_question_centered\"><div\nclass=\"ipt_uif_question_label\">\n<label\nclass=\"ipt_uif_question_title ipt_uif_label\" for=\"ipt_fsqm_form_9_mcq_69\">My medical history <span\nclass=\"ipt_uif_question_required\">*<\/span><\/label><div\nclass=\"clear-both\"><\/div><\/div><div\nclass=\"ipt_uif_question_content\"><div\nclass=\"ipt_uif_label_column column_random\">\n<input\ndata-num=\"\"\t\t\t\t\t\t\t\t\t\ttype=\"checkbox\"\nclass=\"check_me validate[required] ipt_uif_checkbox filled-in \"\nname=\"ipt_fsqm_form_9[mcq][69][options][]\" id=\"ipt_fsqm_form_9_mcq_69_options__0\"\nvalue=\"0\" \/>\n<label\nclass=\"eform-label-with-tabindex\" tabindex=\"0\" for=\"ipt_fsqm_form_9_mcq_69_options__0\">\n<img\nsrc=\"https:\/\/www.dexeus.com\/fertility\/wp-content\/uploads\/2021\/10\/baja-1.jpg\" alt=\"Baja\" \/>Low ovarian reserve\t\t\t\t<\/label><\/div><div\nclass=\"ipt_uif_label_column column_random\">\n<input\ndata-num=\"\"\t\t\t\t\t\t\t\t\t\ttype=\"checkbox\"\nclass=\"check_me validate[required] ipt_uif_checkbox filled-in \"\nname=\"ipt_fsqm_form_9[mcq][69][options][]\" id=\"ipt_fsqm_form_9_mcq_69_options__1\"\nvalue=\"1\" \/>\n<label\nclass=\"eform-label-with-tabindex\" tabindex=\"0\" for=\"ipt_fsqm_form_9_mcq_69_options__1\">\n<img\nsrc=\"https:\/\/www.dexeus.com\/fertility\/wp-content\/uploads\/2021\/10\/trompas-1.jpg\" alt=\"Ligadura de trompas\" \/>Tubal ligation\t\t\t\t<\/label><\/div><div\nclass=\"ipt_uif_label_column column_random\">\n<input\ndata-num=\"\"\t\t\t\t\t\t\t\t\t\ttype=\"checkbox\"\nclass=\"check_me validate[required] ipt_uif_checkbox filled-in \"\nname=\"ipt_fsqm_form_9[mcq][69][options][]\" id=\"ipt_fsqm_form_9_mcq_69_options__2\"\nvalue=\"2\" \/>\n<label\nclass=\"eform-label-with-tabindex\" tabindex=\"0\" for=\"ipt_fsqm_form_9_mcq_69_options__2\">\n<img\nsrc=\"https:\/\/www.dexeus.com\/fertility\/wp-content\/uploads\/2021\/10\/hereditaria-1.jpg\" alt=\"Enfermedad hereditaria\" \/>Hereditary disease\t\t\t\t<\/label><\/div><div\nclass=\"ipt_uif_label_column column_random\">\n<input\ndata-num=\"\"\t\t\t\t\t\t\t\t\t\ttype=\"checkbox\"\nclass=\"check_me validate[required] ipt_uif_checkbox filled-in \"\nname=\"ipt_fsqm_form_9[mcq][69][options][]\" id=\"ipt_fsqm_form_9_mcq_69_options__3\"\nvalue=\"3\" \/>\n<label\nclass=\"eform-label-with-tabindex\" tabindex=\"0\" for=\"ipt_fsqm_form_9_mcq_69_options__3\">\n<img\nsrc=\"https:\/\/www.dexeus.com\/fertility\/wp-content\/uploads\/2021\/10\/endometriosis-1.jpg\" alt=\"Soy seropositiva\" \/>Endometriosis\t\t\t\t<\/label><\/div><div\nclass=\"ipt_uif_label_column column_random\">\n<input\ndata-num=\"\"\t\t\t\t\t\t\t\t\t\ttype=\"checkbox\"\nclass=\"check_me validate[required] ipt_uif_checkbox filled-in \"\nname=\"ipt_fsqm_form_9[mcq][69][options][]\" id=\"ipt_fsqm_form_9_mcq_69_options__4\"\nvalue=\"4\" \/>\n<label\nclass=\"eform-label-with-tabindex\" tabindex=\"0\" for=\"ipt_fsqm_form_9_mcq_69_options__4\">\n<img\nsrc=\"https:\/\/www.dexeus.com\/fertility\/wp-content\/uploads\/2021\/10\/no-conozco-1.jpg\" alt=\"No conozco mi historia\" \/>I don't know my history \/ None of the above\t\t\t\t<\/label><\/div><div\nclass=\"clear-both\"><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_9[mcq][70][m_type]\" id=\"ipt_fsqm_form_9_mcq_70_m_type\" value=\"mcq\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_9[mcq][70][type]\" id=\"ipt_fsqm_form_9_mcq_70_type\" value=\"checkbox\" class=\"ipt_fsqm_hf_type\" \/><div\nclass=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_container_checkbox\" id=\"ipt_fsqm_form_9_mcq_70\"><div\nclass=\"ipt_uif_column_inner side_margin\"><div\nclass=\"ipt_uif_question ipt_uif_question_vertical ipt_uif_question_centered\"><div\nclass=\"ipt_uif_question_label\">\n<label\nclass=\"ipt_uif_question_title ipt_uif_label\" for=\"ipt_fsqm_form_9_mcq_70\">My medical history <span\nclass=\"ipt_uif_question_required\">*<\/span><\/label><div\nclass=\"clear-both\"><\/div><\/div><div\nclass=\"ipt_uif_question_content\"><div\nclass=\"ipt_uif_label_column column_random\">\n<input\ndata-num=\"\"\t\t\t\t\t\t\t\t\t\ttype=\"checkbox\"\nclass=\"check_me validate[required] ipt_uif_checkbox filled-in \"\nname=\"ipt_fsqm_form_9[mcq][70][options][]\" id=\"ipt_fsqm_form_9_mcq_70_options__0\"\nvalue=\"0\" \/>\n<label\nclass=\"eform-label-with-tabindex\" tabindex=\"0\" for=\"ipt_fsqm_form_9_mcq_70_options__0\">\n<img\nsrc=\"https:\/\/www.dexeus.com\/fertility\/wp-content\/uploads\/2021\/10\/baja-1.jpg\" alt=\"Baja\" \/>Low ovarian reserve\t\t\t\t<\/label><\/div><div\nclass=\"ipt_uif_label_column column_random\">\n<input\ndata-num=\"\"\t\t\t\t\t\t\t\t\t\ttype=\"checkbox\"\nclass=\"check_me validate[required] ipt_uif_checkbox filled-in \"\nname=\"ipt_fsqm_form_9[mcq][70][options][]\" id=\"ipt_fsqm_form_9_mcq_70_options__1\"\nvalue=\"1\" \/>\n<label\nclass=\"eform-label-with-tabindex\" tabindex=\"0\" for=\"ipt_fsqm_form_9_mcq_70_options__1\">\n<img\nsrc=\"https:\/\/www.dexeus.com\/fertility\/wp-content\/uploads\/2021\/10\/trompas-1.jpg\" alt=\"Ligadura de trompas\" \/>Tubal ligation\t\t\t\t<\/label><\/div><div\nclass=\"ipt_uif_label_column column_random\">\n<input\ndata-num=\"\"\t\t\t\t\t\t\t\t\t\ttype=\"checkbox\"\nclass=\"check_me validate[required] ipt_uif_checkbox filled-in \"\nname=\"ipt_fsqm_form_9[mcq][70][options][]\" id=\"ipt_fsqm_form_9_mcq_70_options__2\"\nvalue=\"2\" \/>\n<label\nclass=\"eform-label-with-tabindex\" tabindex=\"0\" for=\"ipt_fsqm_form_9_mcq_70_options__2\">\n<img\nsrc=\"https:\/\/www.dexeus.com\/fertility\/wp-content\/uploads\/2021\/10\/hereditaria-1.jpg\" alt=\"Enfermedad hereditaria\" \/>Hereditary disease\t\t\t\t<\/label><\/div><div\nclass=\"ipt_uif_label_column column_random\">\n<input\ndata-num=\"\"\t\t\t\t\t\t\t\t\t\ttype=\"checkbox\"\nclass=\"check_me validate[required] ipt_uif_checkbox filled-in \"\nname=\"ipt_fsqm_form_9[mcq][70][options][]\" id=\"ipt_fsqm_form_9_mcq_70_options__3\"\nvalue=\"3\" \/>\n<label\nclass=\"eform-label-with-tabindex\" tabindex=\"0\" for=\"ipt_fsqm_form_9_mcq_70_options__3\">\n<img\nsrc=\"https:\/\/www.dexeus.com\/fertility\/wp-content\/uploads\/2021\/10\/endometriosis-1.jpg\" alt=\"Soy seropositiva\" \/>Endometriosis\t\t\t\t<\/label><\/div><div\nclass=\"ipt_uif_label_column column_random\">\n<input\ndata-num=\"\"\t\t\t\t\t\t\t\t\t\ttype=\"checkbox\"\nclass=\"check_me validate[required] ipt_uif_checkbox filled-in \"\nname=\"ipt_fsqm_form_9[mcq][70][options][]\" id=\"ipt_fsqm_form_9_mcq_70_options__4\"\nvalue=\"4\" \/>\n<label\nclass=\"eform-label-with-tabindex\" tabindex=\"0\" for=\"ipt_fsqm_form_9_mcq_70_options__4\">\n<img\nsrc=\"https:\/\/www.dexeus.com\/fertility\/wp-content\/uploads\/2021\/10\/no-conozco-1.jpg\" alt=\"No conozco mi historia\" \/>I don't know my history \/ None of the above\t\t\t\t<\/label><\/div><div\nclass=\"clear-both\"><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_9[mcq][71][m_type]\" id=\"ipt_fsqm_form_9_mcq_71_m_type\" value=\"mcq\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_9[mcq][71][type]\" id=\"ipt_fsqm_form_9_mcq_71_type\" value=\"checkbox\" class=\"ipt_fsqm_hf_type\" \/><div\nclass=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_container_checkbox\" id=\"ipt_fsqm_form_9_mcq_71\"><div\nclass=\"ipt_uif_column_inner side_margin\"><div\nclass=\"ipt_uif_question ipt_uif_question_vertical ipt_uif_question_centered\"><div\nclass=\"ipt_uif_question_label\">\n<label\nclass=\"ipt_uif_question_title ipt_uif_label\" for=\"ipt_fsqm_form_9_mcq_71\">My medical history <span\nclass=\"ipt_uif_question_required\">*<\/span><\/label><div\nclass=\"clear-both\"><\/div><\/div><div\nclass=\"ipt_uif_question_content\"><div\nclass=\"ipt_uif_label_column column_random\">\n<input\ndata-num=\"\"\t\t\t\t\t\t\t\t\t\ttype=\"checkbox\"\nclass=\"check_me validate[required] ipt_uif_checkbox filled-in \"\nname=\"ipt_fsqm_form_9[mcq][71][options][]\" id=\"ipt_fsqm_form_9_mcq_71_options__0\"\nvalue=\"0\" \/>\n<label\nclass=\"eform-label-with-tabindex\" tabindex=\"0\" for=\"ipt_fsqm_form_9_mcq_71_options__0\">\n<img\nsrc=\"https:\/\/www.dexeus.com\/fertility\/wp-content\/uploads\/2021\/10\/baja-1.jpg\" alt=\"Baja\" \/>Low ovarian reserve\t\t\t\t<\/label><\/div><div\nclass=\"ipt_uif_label_column column_random\">\n<input\ndata-num=\"\"\t\t\t\t\t\t\t\t\t\ttype=\"checkbox\"\nclass=\"check_me validate[required] ipt_uif_checkbox filled-in \"\nname=\"ipt_fsqm_form_9[mcq][71][options][]\" id=\"ipt_fsqm_form_9_mcq_71_options__1\"\nvalue=\"1\" \/>\n<label\nclass=\"eform-label-with-tabindex\" tabindex=\"0\" for=\"ipt_fsqm_form_9_mcq_71_options__1\">\n<img\nsrc=\"https:\/\/www.dexeus.com\/fertility\/wp-content\/uploads\/2021\/10\/trompas-1.jpg\" alt=\"Ligadura de trompas\" \/>Tubal ligation\t\t\t\t<\/label><\/div><div\nclass=\"ipt_uif_label_column column_random\">\n<input\ndata-num=\"\"\t\t\t\t\t\t\t\t\t\ttype=\"checkbox\"\nclass=\"check_me validate[required] ipt_uif_checkbox filled-in \"\nname=\"ipt_fsqm_form_9[mcq][71][options][]\" id=\"ipt_fsqm_form_9_mcq_71_options__2\"\nvalue=\"2\" \/>\n<label\nclass=\"eform-label-with-tabindex\" tabindex=\"0\" for=\"ipt_fsqm_form_9_mcq_71_options__2\">\n<img\nsrc=\"https:\/\/www.dexeus.com\/fertility\/wp-content\/uploads\/2021\/10\/hereditaria-1.jpg\" alt=\"Enfermedad hereditaria\" \/>Hereditary disease\t\t\t\t<\/label><\/div><div\nclass=\"ipt_uif_label_column column_random\">\n<input\ndata-num=\"\"\t\t\t\t\t\t\t\t\t\ttype=\"checkbox\"\nclass=\"check_me validate[required] ipt_uif_checkbox filled-in \"\nname=\"ipt_fsqm_form_9[mcq][71][options][]\" id=\"ipt_fsqm_form_9_mcq_71_options__3\"\nvalue=\"3\" \/>\n<label\nclass=\"eform-label-with-tabindex\" tabindex=\"0\" for=\"ipt_fsqm_form_9_mcq_71_options__3\">\n<img\nsrc=\"https:\/\/www.dexeus.com\/fertility\/wp-content\/uploads\/2021\/10\/endometriosis-1.jpg\" alt=\"Soy seropositiva\" \/>Endometriosis\t\t\t\t<\/label><\/div><div\nclass=\"ipt_uif_label_column column_random\">\n<input\ndata-num=\"\"\t\t\t\t\t\t\t\t\t\ttype=\"checkbox\"\nclass=\"check_me validate[required] ipt_uif_checkbox filled-in \"\nname=\"ipt_fsqm_form_9[mcq][71][options][]\" id=\"ipt_fsqm_form_9_mcq_71_options__4\"\nvalue=\"4\" \/>\n<label\nclass=\"eform-label-with-tabindex\" tabindex=\"0\" for=\"ipt_fsqm_form_9_mcq_71_options__4\">\n<img\nsrc=\"https:\/\/www.dexeus.com\/fertility\/wp-content\/uploads\/2021\/10\/no-conozco-1.jpg\" alt=\"No conozco mi historia\" \/>I don't know my history \/ None of the above\t\t\t\t<\/label><\/div><div\nclass=\"clear-both\"><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div><\/div><div\nclass=\"clear-both\"><\/div><\/div><div\nid=\"ipt_fsqm_form_9_tab_3\" class=\"ipt_fsqm_form_tab_panel\"><div\nid=\"ipt_fsqm_form_9_layout_3_inner\" class=\"ipt-eform-layout-wrapper\"><div\nclass=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_main_heading_column\"><div\nclass=\"ipt_uif_column_inner\"><h3 class=\"ipt_fsqm_main_heading ipt_uif_heading ipt_uif_divider ipt_uif_align_left ipt_uif_divider_no_icon ipt_uif_divider_icon_no_bg\">\n<span\nclass=\"ipt_uif_divider_text\">\n<span\nclass=\"ipt_uif_divider_text_inner\">\nStep 4<span\nclass=\"subtitle\"><\/span>\t\t\t\t<\/span>\n<\/span><\/h3><div\nclass=\"clear-both\"><\/div><\/div><\/div>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_9[mcq][72][m_type]\" id=\"ipt_fsqm_form_9_mcq_72_m_type\" value=\"mcq\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_9[mcq][72][type]\" id=\"ipt_fsqm_form_9_mcq_72_type\" value=\"checkbox\" class=\"ipt_fsqm_hf_type\" \/><div\nclass=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_container_checkbox\" id=\"ipt_fsqm_form_9_mcq_72\"><div\nclass=\"ipt_uif_column_inner side_margin\"><div\nclass=\"ipt_uif_question ipt_uif_question_vertical\"><div\nclass=\"ipt_uif_question_label\">\n<label\nclass=\"ipt_uif_question_title ipt_uif_label\" for=\"ipt_fsqm_form_9_mcq_72\">My partner's medical history<span\nclass=\"ipt_uif_question_required\">*<\/span><\/label><div\nclass=\"clear-both\"><\/div><\/div><div\nclass=\"ipt_uif_question_content\"><div\nclass=\"ipt_uif_label_column column_random\">\n<input\ndata-num=\"\"\t\t\t\t\t\t\t\t\t\ttype=\"checkbox\"\nclass=\"check_me validate[required] ipt_uif_checkbox filled-in \"\nname=\"ipt_fsqm_form_9[mcq][72][options][]\" id=\"ipt_fsqm_form_9_mcq_72_options__0\"\nvalue=\"0\" \/>\n<label\nclass=\"eform-label-with-tabindex\" tabindex=\"0\" for=\"ipt_fsqm_form_9_mcq_72_options__0\">\n<img\nsrc=\"https:\/\/www.dexeus.com\/fertility\/wp-content\/uploads\/2021\/10\/pocos.jpg\" alt=\"Baja\" style=\"padding-left: 62px;\">I produce few sperm\t\t\t\t<\/label><\/div><div\nclass=\"ipt_uif_label_column column_random\">\n<input\ndata-num=\"\"\t\t\t\t\t\t\t\t\t\ttype=\"checkbox\"\nclass=\"check_me validate[required] ipt_uif_checkbox filled-in \"\nname=\"ipt_fsqm_form_9[mcq][72][options][]\" id=\"ipt_fsqm_form_9_mcq_72_options__1\"\nvalue=\"1\" \/>\n<label\nclass=\"eform-label-with-tabindex\" tabindex=\"0\" for=\"ipt_fsqm_form_9_mcq_72_options__1\">\n<img\nsrc=\"https:\/\/www.dexeus.com\/fertility\/wp-content\/uploads\/2021\/10\/ninguno.jpg\" alt=\"Baja\" style=\"padding-left: 58px;\">I do not produce sperm\t\t\t\t<\/label><\/div><div\nclass=\"ipt_uif_label_column column_random\">\n<input\ndata-num=\"\"\t\t\t\t\t\t\t\t\t\ttype=\"checkbox\"\nclass=\"check_me validate[required] ipt_uif_checkbox filled-in \"\nname=\"ipt_fsqm_form_9[mcq][72][options][]\" id=\"ipt_fsqm_form_9_mcq_72_options__2\"\nvalue=\"2\" \/>\n<label\nclass=\"eform-label-with-tabindex\" tabindex=\"0\" for=\"ipt_fsqm_form_9_mcq_72_options__2\">\n<img\nsrc=\"https:\/\/www.dexeus.com\/fertility\/wp-content\/uploads\/2021\/10\/vasectomia.jpg\" alt=\"Baja\" \/>Vasectomy\t\t\t\t<\/label><\/div><div\nclass=\"ipt_uif_label_column column_random\">\n<input\ndata-num=\"\"\t\t\t\t\t\t\t\t\t\ttype=\"checkbox\"\nclass=\"check_me validate[required] ipt_uif_checkbox filled-in \"\nname=\"ipt_fsqm_form_9[mcq][72][options][]\" id=\"ipt_fsqm_form_9_mcq_72_options__3\"\nvalue=\"3\" \/>\n<label\nclass=\"eform-label-with-tabindex\" tabindex=\"0\" for=\"ipt_fsqm_form_9_mcq_72_options__3\">\n<img\nsrc=\"https:\/\/www.dexeus.com\/fertility\/wp-content\/uploads\/2021\/10\/seropositivo.jpg\" alt=\"Baja\" \/>HIV-positive\t\t\t\t<\/label><\/div><div\nclass=\"ipt_uif_label_column column_random\">\n<input\ndata-num=\"\"\t\t\t\t\t\t\t\t\t\ttype=\"checkbox\"\nclass=\"check_me validate[required] ipt_uif_checkbox filled-in \"\nname=\"ipt_fsqm_form_9[mcq][72][options][]\" id=\"ipt_fsqm_form_9_mcq_72_options__4\"\nvalue=\"4\" \/>\n<label\nclass=\"eform-label-with-tabindex\" tabindex=\"0\" for=\"ipt_fsqm_form_9_mcq_72_options__4\">\n<img\nsrc=\"https:\/\/www.dexeus.com\/fertility\/wp-content\/uploads\/2021\/10\/hepatitis.jpg\" alt=\"Baja\" \/>Hepatitis B or C\t\t\t\t<\/label><\/div><div\nclass=\"ipt_uif_label_column column_random\">\n<input\ndata-num=\"\"\t\t\t\t\t\t\t\t\t\ttype=\"checkbox\"\nclass=\"check_me validate[required] ipt_uif_checkbox filled-in \"\nname=\"ipt_fsqm_form_9[mcq][72][options][]\" id=\"ipt_fsqm_form_9_mcq_72_options__5\"\nvalue=\"5\" \/>\n<label\nclass=\"eform-label-with-tabindex\" tabindex=\"0\" for=\"ipt_fsqm_form_9_mcq_72_options__5\">\n<img\nsrc=\"https:\/\/www.dexeus.com\/fertility\/wp-content\/uploads\/2021\/10\/hereditaria-1.jpg\" alt=\"Baja\" style=\"padding-left: 32px;\">Hereditary disease\t\t\t\t<\/label><\/div><div\nclass=\"ipt_uif_label_column column_random\">\n<input\ndata-num=\"\"\t\t\t\t\t\t\t\t\t\ttype=\"checkbox\"\nclass=\"check_me validate[required] ipt_uif_checkbox filled-in \"\nname=\"ipt_fsqm_form_9[mcq][72][options][]\" id=\"ipt_fsqm_form_9_mcq_72_options__6\"\nvalue=\"6\" \/>\n<label\nclass=\"eform-label-with-tabindex\" tabindex=\"0\" for=\"ipt_fsqm_form_9_mcq_72_options__6\">\n<img\nsrc=\"https:\/\/www.dexeus.com\/fertility\/wp-content\/uploads\/2021\/10\/no-conozco-1.jpg\" alt=\"Baja\" style=\"padding-left: 26px;\">Don't know my history \/ None of the above\t\t\t\t<\/label><\/div><div\nclass=\"clear-both\"><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div><\/div><div\nclass=\"clear-both\"><\/div><\/div><div\nid=\"ipt_fsqm_form_9_tab_4\" class=\"ipt_fsqm_form_tab_panel\"><div\nid=\"ipt_fsqm_form_9_layout_4_inner\" class=\"ipt-eform-layout-wrapper\"><div\nclass=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_main_heading_column\"><div\nclass=\"ipt_uif_column_inner\"><h3 class=\"ipt_fsqm_main_heading ipt_uif_heading ipt_uif_divider ipt_uif_align_left ipt_uif_divider_no_icon ipt_uif_divider_icon_no_bg\">\n<span\nclass=\"ipt_uif_divider_text\">\n<span\nclass=\"ipt_uif_divider_text_inner\">\nStep 4<span\nclass=\"subtitle\"><\/span>\t\t\t\t<\/span>\n<\/span><\/h3><div\nclass=\"clear-both\"><\/div><\/div><\/div>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_9[mcq][73][m_type]\" id=\"ipt_fsqm_form_9_mcq_73_m_type\" value=\"mcq\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_9[mcq][73][type]\" id=\"ipt_fsqm_form_9_mcq_73_type\" value=\"checkbox\" class=\"ipt_fsqm_hf_type\" \/><div\nclass=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_container_checkbox\" id=\"ipt_fsqm_form_9_mcq_73\"><div\nclass=\"ipt_uif_column_inner side_margin\"><div\nclass=\"ipt_uif_question ipt_uif_question_vertical\"><div\nclass=\"ipt_uif_question_label\">\n<label\nclass=\"ipt_uif_question_title ipt_uif_label\" for=\"ipt_fsqm_form_9_mcq_73\">My partner's medical history<span\nclass=\"ipt_uif_question_required\">*<\/span><\/label><div\nclass=\"clear-both\"><\/div><\/div><div\nclass=\"ipt_uif_question_content\"><div\nclass=\"ipt_uif_label_column column_random\">\n<input\ndata-num=\"\"\t\t\t\t\t\t\t\t\t\ttype=\"checkbox\"\nclass=\"check_me validate[required] ipt_uif_checkbox filled-in \"\nname=\"ipt_fsqm_form_9[mcq][73][options][]\" id=\"ipt_fsqm_form_9_mcq_73_options__0\"\nvalue=\"0\" \/>\n<label\nclass=\"eform-label-with-tabindex\" tabindex=\"0\" for=\"ipt_fsqm_form_9_mcq_73_options__0\">\n<img\nsrc=\"https:\/\/www.dexeus.com\/fertility\/wp-content\/uploads\/2021\/10\/pocos.jpg\" alt=\"Baja\" style=\"padding-left: 62px;\">I produce few sperm\t\t\t\t<\/label><\/div><div\nclass=\"ipt_uif_label_column column_random\">\n<input\ndata-num=\"\"\t\t\t\t\t\t\t\t\t\ttype=\"checkbox\"\nclass=\"check_me validate[required] ipt_uif_checkbox filled-in \"\nname=\"ipt_fsqm_form_9[mcq][73][options][]\" id=\"ipt_fsqm_form_9_mcq_73_options__1\"\nvalue=\"1\" \/>\n<label\nclass=\"eform-label-with-tabindex\" tabindex=\"0\" for=\"ipt_fsqm_form_9_mcq_73_options__1\">\n<img\nsrc=\"https:\/\/www.dexeus.com\/fertility\/wp-content\/uploads\/2021\/10\/ninguno.jpg\" alt=\"Baja\" style=\"padding-left: 58px;\">I do not produce sperm\t\t\t\t<\/label><\/div><div\nclass=\"ipt_uif_label_column column_random\">\n<input\ndata-num=\"\"\t\t\t\t\t\t\t\t\t\ttype=\"checkbox\"\nclass=\"check_me validate[required] ipt_uif_checkbox filled-in \"\nname=\"ipt_fsqm_form_9[mcq][73][options][]\" id=\"ipt_fsqm_form_9_mcq_73_options__2\"\nvalue=\"2\" \/>\n<label\nclass=\"eform-label-with-tabindex\" tabindex=\"0\" for=\"ipt_fsqm_form_9_mcq_73_options__2\">\n<img\nsrc=\"https:\/\/www.dexeus.com\/fertility\/wp-content\/uploads\/2021\/10\/vasectomia.jpg\" alt=\"Baja\" \/>Vasectomy\t\t\t\t<\/label><\/div><div\nclass=\"ipt_uif_label_column column_random\">\n<input\ndata-num=\"\"\t\t\t\t\t\t\t\t\t\ttype=\"checkbox\"\nclass=\"check_me validate[required] ipt_uif_checkbox filled-in \"\nname=\"ipt_fsqm_form_9[mcq][73][options][]\" id=\"ipt_fsqm_form_9_mcq_73_options__3\"\nvalue=\"3\" \/>\n<label\nclass=\"eform-label-with-tabindex\" tabindex=\"0\" for=\"ipt_fsqm_form_9_mcq_73_options__3\">\n<img\nsrc=\"https:\/\/www.dexeus.com\/fertility\/wp-content\/uploads\/2021\/10\/seropositivo.jpg\" alt=\"Baja\" \/>HIV-positive\t\t\t\t<\/label><\/div><div\nclass=\"ipt_uif_label_column column_random\">\n<input\ndata-num=\"\"\t\t\t\t\t\t\t\t\t\ttype=\"checkbox\"\nclass=\"check_me validate[required] ipt_uif_checkbox filled-in \"\nname=\"ipt_fsqm_form_9[mcq][73][options][]\" id=\"ipt_fsqm_form_9_mcq_73_options__4\"\nvalue=\"4\" \/>\n<label\nclass=\"eform-label-with-tabindex\" tabindex=\"0\" for=\"ipt_fsqm_form_9_mcq_73_options__4\">\n<img\nsrc=\"https:\/\/www.dexeus.com\/fertility\/wp-content\/uploads\/2021\/10\/hepatitis.jpg\" alt=\"Baja\" \/>Hepatitis B o C\t\t\t\t<\/label><\/div><div\nclass=\"ipt_uif_label_column column_random\">\n<input\ndata-num=\"\"\t\t\t\t\t\t\t\t\t\ttype=\"checkbox\"\nclass=\"check_me validate[required] ipt_uif_checkbox filled-in \"\nname=\"ipt_fsqm_form_9[mcq][73][options][]\" id=\"ipt_fsqm_form_9_mcq_73_options__5\"\nvalue=\"5\" \/>\n<label\nclass=\"eform-label-with-tabindex\" tabindex=\"0\" for=\"ipt_fsqm_form_9_mcq_73_options__5\">\n<img\nsrc=\"https:\/\/www.dexeus.com\/fertility\/wp-content\/uploads\/2021\/10\/hereditaria-1.jpg\" alt=\"Baja\" style=\"padding-left: 32px;\">Hereditary disease\t\t\t\t<\/label><\/div><div\nclass=\"ipt_uif_label_column column_random\">\n<input\ndata-num=\"\"\t\t\t\t\t\t\t\t\t\ttype=\"checkbox\"\nclass=\"check_me validate[required] ipt_uif_checkbox filled-in \"\nname=\"ipt_fsqm_form_9[mcq][73][options][]\" id=\"ipt_fsqm_form_9_mcq_73_options__6\"\nvalue=\"6\" \/>\n<label\nclass=\"eform-label-with-tabindex\" tabindex=\"0\" for=\"ipt_fsqm_form_9_mcq_73_options__6\">\n<img\nsrc=\"https:\/\/www.dexeus.com\/fertility\/wp-content\/uploads\/2021\/10\/no-conozco-1.jpg\" alt=\"Baja\" style=\"padding-left: 26px;\">Don't know my history \/ None of the above\t\t\t\t<\/label><\/div><div\nclass=\"clear-both\"><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div><\/div><div\nclass=\"clear-both\"><\/div><\/div><div\nid=\"ipt_fsqm_form_9_tab_5\" class=\"ipt_fsqm_form_tab_panel\"><div\nid=\"ipt_fsqm_form_9_layout_5_inner\" class=\"ipt-eform-layout-wrapper\"><div\nclass=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_main_heading_column\"><div\nclass=\"ipt_uif_column_inner\"><h3 class=\"ipt_fsqm_main_heading ipt_uif_heading ipt_uif_divider ipt_uif_align_left ipt_uif_divider_no_icon ipt_uif_divider_icon_no_bg\">\n<span\nclass=\"ipt_uif_divider_text\">\n<span\nclass=\"ipt_uif_divider_text_inner\">\nStep 4<span\nclass=\"subtitle\"><\/span>\t\t\t\t<\/span>\n<\/span><\/h3><div\nclass=\"clear-both\"><\/div><\/div><\/div>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_9[mcq][74][m_type]\" id=\"ipt_fsqm_form_9_mcq_74_m_type\" value=\"mcq\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_9[mcq][74][type]\" id=\"ipt_fsqm_form_9_mcq_74_type\" value=\"checkbox\" class=\"ipt_fsqm_hf_type\" \/><div\nclass=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_container_checkbox\" id=\"ipt_fsqm_form_9_mcq_74\"><div\nclass=\"ipt_uif_column_inner side_margin\"><div\nclass=\"ipt_uif_question ipt_uif_question_vertical\"><div\nclass=\"ipt_uif_question_label\">\n<label\nclass=\"ipt_uif_question_title ipt_uif_label\" for=\"ipt_fsqm_form_9_mcq_74\">My partner's medical history<span\nclass=\"ipt_uif_question_required\">*<\/span><\/label><div\nclass=\"clear-both\"><\/div><\/div><div\nclass=\"ipt_uif_question_content\"><div\nclass=\"ipt_uif_label_column column_random\">\n<input\ndata-num=\"\"\t\t\t\t\t\t\t\t\t\ttype=\"checkbox\"\nclass=\"check_me validate[required] ipt_uif_checkbox filled-in \"\nname=\"ipt_fsqm_form_9[mcq][74][options][]\" id=\"ipt_fsqm_form_9_mcq_74_options__0\"\nvalue=\"0\" \/>\n<label\nclass=\"eform-label-with-tabindex\" tabindex=\"0\" for=\"ipt_fsqm_form_9_mcq_74_options__0\">\n<img\nsrc=\"https:\/\/www.dexeus.com\/fertility\/wp-content\/uploads\/2021\/10\/pocos.jpg\" alt=\"Baja\" style=\"padding-left: 62px;\">I produce few sperm\t\t\t\t<\/label><\/div><div\nclass=\"ipt_uif_label_column column_random\">\n<input\ndata-num=\"\"\t\t\t\t\t\t\t\t\t\ttype=\"checkbox\"\nclass=\"check_me validate[required] ipt_uif_checkbox filled-in \"\nname=\"ipt_fsqm_form_9[mcq][74][options][]\" id=\"ipt_fsqm_form_9_mcq_74_options__1\"\nvalue=\"1\" \/>\n<label\nclass=\"eform-label-with-tabindex\" tabindex=\"0\" for=\"ipt_fsqm_form_9_mcq_74_options__1\">\n<img\nsrc=\"https:\/\/www.dexeus.com\/fertility\/wp-content\/uploads\/2021\/10\/ninguno.jpg\" alt=\"Baja\" style=\"padding-left: 58px;\">I do not produce sperm\t\t\t\t<\/label><\/div><div\nclass=\"ipt_uif_label_column column_random\">\n<input\ndata-num=\"\"\t\t\t\t\t\t\t\t\t\ttype=\"checkbox\"\nclass=\"check_me validate[required] ipt_uif_checkbox filled-in \"\nname=\"ipt_fsqm_form_9[mcq][74][options][]\" id=\"ipt_fsqm_form_9_mcq_74_options__2\"\nvalue=\"2\" \/>\n<label\nclass=\"eform-label-with-tabindex\" tabindex=\"0\" for=\"ipt_fsqm_form_9_mcq_74_options__2\">\n<img\nsrc=\"https:\/\/www.dexeus.com\/fertility\/wp-content\/uploads\/2021\/10\/vasectomia.jpg\" alt=\"Baja\" \/>Vasectomy\t\t\t\t<\/label><\/div><div\nclass=\"ipt_uif_label_column column_random\">\n<input\ndata-num=\"\"\t\t\t\t\t\t\t\t\t\ttype=\"checkbox\"\nclass=\"check_me validate[required] ipt_uif_checkbox filled-in \"\nname=\"ipt_fsqm_form_9[mcq][74][options][]\" id=\"ipt_fsqm_form_9_mcq_74_options__3\"\nvalue=\"3\" \/>\n<label\nclass=\"eform-label-with-tabindex\" tabindex=\"0\" for=\"ipt_fsqm_form_9_mcq_74_options__3\">\n<img\nsrc=\"https:\/\/www.dexeus.com\/fertility\/wp-content\/uploads\/2021\/10\/seropositivo.jpg\" alt=\"Baja\" \/>HIV-positive\t\t\t\t<\/label><\/div><div\nclass=\"ipt_uif_label_column column_random\">\n<input\ndata-num=\"\"\t\t\t\t\t\t\t\t\t\ttype=\"checkbox\"\nclass=\"check_me validate[required] ipt_uif_checkbox filled-in \"\nname=\"ipt_fsqm_form_9[mcq][74][options][]\" id=\"ipt_fsqm_form_9_mcq_74_options__4\"\nvalue=\"4\" \/>\n<label\nclass=\"eform-label-with-tabindex\" tabindex=\"0\" for=\"ipt_fsqm_form_9_mcq_74_options__4\">\n<img\nsrc=\"https:\/\/www.dexeus.com\/fertility\/wp-content\/uploads\/2021\/10\/hepatitis.jpg\" alt=\"Baja\" \/>Hepatitis B or C\t\t\t\t<\/label><\/div><div\nclass=\"ipt_uif_label_column column_random\">\n<input\ndata-num=\"\"\t\t\t\t\t\t\t\t\t\ttype=\"checkbox\"\nclass=\"check_me validate[required] ipt_uif_checkbox filled-in \"\nname=\"ipt_fsqm_form_9[mcq][74][options][]\" id=\"ipt_fsqm_form_9_mcq_74_options__5\"\nvalue=\"5\" \/>\n<label\nclass=\"eform-label-with-tabindex\" tabindex=\"0\" for=\"ipt_fsqm_form_9_mcq_74_options__5\">\n<img\nsrc=\"https:\/\/www.dexeus.com\/fertility\/wp-content\/uploads\/2021\/10\/hereditaria-1.jpg\" alt=\"Baja\" style=\"padding-left: 32px;\">Hereditary disease\t\t\t\t<\/label><\/div><div\nclass=\"ipt_uif_label_column column_random\">\n<input\ndata-num=\"\"\t\t\t\t\t\t\t\t\t\ttype=\"checkbox\"\nclass=\"check_me validate[required] ipt_uif_checkbox filled-in \"\nname=\"ipt_fsqm_form_9[mcq][74][options][]\" id=\"ipt_fsqm_form_9_mcq_74_options__6\"\nvalue=\"6\" \/>\n<label\nclass=\"eform-label-with-tabindex\" tabindex=\"0\" for=\"ipt_fsqm_form_9_mcq_74_options__6\">\n<img\nsrc=\"https:\/\/www.dexeus.com\/fertility\/wp-content\/uploads\/2021\/10\/no-conozco-1.jpg\" alt=\"Baja\" style=\"padding-left: 26px;\">Don't know my history \/ None of the above\t\t\t\t<\/label><\/div><div\nclass=\"clear-both\"><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div><\/div><div\nclass=\"clear-both\"><\/div><\/div><div\nid=\"ipt_fsqm_form_9_tab_6\" class=\"ipt_fsqm_form_tab_panel\"><div\nid=\"ipt_fsqm_form_9_layout_6_inner\" class=\"ipt-eform-layout-wrapper\"><div\nclass=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_main_heading_column\"><div\nclass=\"ipt_uif_column_inner\"><h3 class=\"ipt_fsqm_main_heading ipt_uif_heading ipt_uif_divider ipt_uif_align_left ipt_uif_divider_no_icon ipt_uif_divider_icon_no_bg\">\n<span\nclass=\"ipt_uif_divider_text\">\n<span\nclass=\"ipt_uif_divider_text_inner\">\nStep 4<span\nclass=\"subtitle\"><\/span>\t\t\t\t<\/span>\n<\/span><\/h3><div\nclass=\"clear-both\"><\/div><\/div><\/div>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_9[mcq][75][m_type]\" id=\"ipt_fsqm_form_9_mcq_75_m_type\" value=\"mcq\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_9[mcq][75][type]\" id=\"ipt_fsqm_form_9_mcq_75_type\" value=\"slider\" class=\"ipt_fsqm_hf_type\" \/><div\nclass=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_container_slider\" id=\"ipt_fsqm_form_9_mcq_75\"><div\nclass=\"ipt_uif_column_inner side_margin\"><div\nclass=\"ipt_uif_question ipt_uif_question_vertical\"><div\nclass=\"ipt_uif_question_label\">\n<label\nclass=\"ipt_uif_question_title ipt_uif_label\" for=\"ipt_fsqm_form_9_mcq_75_value\">My partner's age<span\nclass=\"ipt_uif_question_required\">*<\/span><\/label><div\nclass=\"clear-both\"><\/div><\/div><div\nclass=\"ipt_uif_question_content\"><div\nclass=\"ipt_uif_empty_box ipt_uif_slider_box\">\n<input\ndata-floats=\"1\" type=\"number\" min=\"18\" max=\"50\" step=\"1\" data-nomin=\"\" data-show-count=\"\" data-labels=\"{&quot;first&quot;:false,&quot;last&quot;:false,&quot;rest&quot;:false,&quot;labels&quot;:[]}\" data-prefix=\"\" data-suffix=\"\" class=\"ipt_uif_slider check_me validate[funcCall[iptUIFSliderVal]]\" data-min=\"18\" data-max=\"50\" data-step=\"1\" name=\"ipt_fsqm_form_9[mcq][75][value]\" id=\"ipt_fsqm_form_9_mcq_75_value\" value=\"18\" data-vertical=\"\" data-height=\"300\" \/><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div><\/div><div\nclass=\"clear-both\"><\/div><\/div><div\nid=\"ipt_fsqm_form_9_tab_7\" class=\"ipt_fsqm_form_tab_panel\"><div\nid=\"ipt_fsqm_form_9_layout_7_inner\" class=\"ipt-eform-layout-wrapper\"><div\nclass=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_main_heading_column\"><div\nclass=\"ipt_uif_column_inner\"><h3 class=\"ipt_fsqm_main_heading ipt_uif_heading ipt_uif_divider ipt_uif_align_left ipt_uif_divider_no_icon ipt_uif_divider_icon_no_bg\">\n<span\nclass=\"ipt_uif_divider_text\">\n<span\nclass=\"ipt_uif_divider_text_inner\">\nStep 5<span\nclass=\"subtitle\"><\/span>\t\t\t\t<\/span>\n<\/span><\/h3><div\nclass=\"clear-both\"><\/div><\/div><\/div>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_9[mcq][76][m_type]\" id=\"ipt_fsqm_form_9_mcq_76_m_type\" value=\"mcq\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_9[mcq][76][type]\" id=\"ipt_fsqm_form_9_mcq_76_type\" value=\"checkbox\" class=\"ipt_fsqm_hf_type\" \/><div\nclass=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_container_checkbox\" id=\"ipt_fsqm_form_9_mcq_76\"><div\nclass=\"ipt_uif_column_inner side_margin\"><div\nclass=\"ipt_uif_question ipt_uif_question_vertical ipt_uif_question_centered\"><div\nclass=\"ipt_uif_question_label\">\n<label\nclass=\"ipt_uif_question_title ipt_uif_label\" for=\"ipt_fsqm_form_9_mcq_76\">My partner's medical history<span\nclass=\"ipt_uif_question_required\">*<\/span><\/label><div\nclass=\"clear-both\"><\/div><\/div><div\nclass=\"ipt_uif_question_content\"><div\nclass=\"ipt_uif_label_column column_random\">\n<input\ndata-num=\"\"\t\t\t\t\t\t\t\t\t\ttype=\"checkbox\"\nclass=\"check_me validate[required] ipt_uif_checkbox filled-in \"\nname=\"ipt_fsqm_form_9[mcq][76][options][]\" id=\"ipt_fsqm_form_9_mcq_76_options__0\"\nvalue=\"0\" \/>\n<label\nclass=\"eform-label-with-tabindex\" tabindex=\"0\" for=\"ipt_fsqm_form_9_mcq_76_options__0\">\n<img\nsrc=\"https:\/\/www.dexeus.com\/fertility\/wp-content\/uploads\/2021\/10\/baja-1.jpg\" alt=\"Baja\" \/>Low ovarian reserve\t\t\t\t<\/label><\/div><div\nclass=\"ipt_uif_label_column column_random\">\n<input\ndata-num=\"\"\t\t\t\t\t\t\t\t\t\ttype=\"checkbox\"\nclass=\"check_me validate[required] ipt_uif_checkbox filled-in \"\nname=\"ipt_fsqm_form_9[mcq][76][options][]\" id=\"ipt_fsqm_form_9_mcq_76_options__1\"\nvalue=\"1\" \/>\n<label\nclass=\"eform-label-with-tabindex\" tabindex=\"0\" for=\"ipt_fsqm_form_9_mcq_76_options__1\">\n<img\nsrc=\"https:\/\/www.dexeus.com\/fertility\/wp-content\/uploads\/2021\/10\/trompas-1.jpg\" alt=\"Ligadura de trompas\" \/>Tubal ligation\t\t\t\t<\/label><\/div><div\nclass=\"ipt_uif_label_column column_random\">\n<input\ndata-num=\"\"\t\t\t\t\t\t\t\t\t\ttype=\"checkbox\"\nclass=\"check_me validate[required] ipt_uif_checkbox filled-in \"\nname=\"ipt_fsqm_form_9[mcq][76][options][]\" id=\"ipt_fsqm_form_9_mcq_76_options__2\"\nvalue=\"2\" \/>\n<label\nclass=\"eform-label-with-tabindex\" tabindex=\"0\" for=\"ipt_fsqm_form_9_mcq_76_options__2\">\n<img\nsrc=\"https:\/\/www.dexeus.com\/fertility\/wp-content\/uploads\/2021\/10\/hereditaria-1.jpg\" alt=\"Enfermedad hereditaria\" \/>Hereditary disease\t\t\t\t<\/label><\/div><div\nclass=\"ipt_uif_label_column column_random\">\n<input\ndata-num=\"\"\t\t\t\t\t\t\t\t\t\ttype=\"checkbox\"\nclass=\"check_me validate[required] ipt_uif_checkbox filled-in \"\nname=\"ipt_fsqm_form_9[mcq][76][options][]\" id=\"ipt_fsqm_form_9_mcq_76_options__3\"\nvalue=\"3\" \/>\n<label\nclass=\"eform-label-with-tabindex\" tabindex=\"0\" for=\"ipt_fsqm_form_9_mcq_76_options__3\">\n<img\nsrc=\"https:\/\/www.dexeus.com\/fertility\/wp-content\/uploads\/2021\/10\/endometriosis-1.jpg\" alt=\"Soy seropositiva\" \/>Endometriosis\t\t\t\t<\/label><\/div><div\nclass=\"ipt_uif_label_column column_random\">\n<input\ndata-num=\"\"\t\t\t\t\t\t\t\t\t\ttype=\"checkbox\"\nclass=\"check_me validate[required] ipt_uif_checkbox filled-in \"\nname=\"ipt_fsqm_form_9[mcq][76][options][]\" id=\"ipt_fsqm_form_9_mcq_76_options__4\"\nvalue=\"4\" \/>\n<label\nclass=\"eform-label-with-tabindex\" tabindex=\"0\" for=\"ipt_fsqm_form_9_mcq_76_options__4\">\n<img\nsrc=\"https:\/\/www.dexeus.com\/fertility\/wp-content\/uploads\/2021\/10\/no-conozco-1.jpg\" alt=\"No conozco mi historia\" \/>I don't know my history \/ None of the above\t\t\t\t<\/label><\/div><div\nclass=\"clear-both\"><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_9[mcq][86][m_type]\" id=\"ipt_fsqm_form_9_mcq_86_m_type\" value=\"mcq\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_9[mcq][86][type]\" id=\"ipt_fsqm_form_9_mcq_86_type\" value=\"checkbox\" class=\"ipt_fsqm_hf_type\" \/><div\nclass=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_container_checkbox\" id=\"ipt_fsqm_form_9_mcq_86\"><div\nclass=\"ipt_uif_column_inner side_margin\"><div\nclass=\"ipt_uif_question ipt_uif_question_vertical ipt_uif_question_centered\"><div\nclass=\"ipt_uif_question_label\">\n<label\nclass=\"ipt_uif_question_title ipt_uif_label\" for=\"ipt_fsqm_form_9_mcq_86\">My partner's medical history<span\nclass=\"ipt_uif_question_required\">*<\/span><\/label><div\nclass=\"clear-both\"><\/div><\/div><div\nclass=\"ipt_uif_question_content\"><div\nclass=\"ipt_uif_label_column column_random\">\n<input\ndata-num=\"\"\t\t\t\t\t\t\t\t\t\ttype=\"checkbox\"\nclass=\"check_me validate[required] ipt_uif_checkbox filled-in \"\nname=\"ipt_fsqm_form_9[mcq][86][options][]\" id=\"ipt_fsqm_form_9_mcq_86_options__0\"\nvalue=\"0\" \/>\n<label\nclass=\"eform-label-with-tabindex\" tabindex=\"0\" for=\"ipt_fsqm_form_9_mcq_86_options__0\">\n<img\nsrc=\"https:\/\/www.dexeus.com\/fertility\/wp-content\/uploads\/2021\/10\/baja-1.jpg\" alt=\"Baja\" \/>Low ovarian reserve\t\t\t\t<\/label><\/div><div\nclass=\"ipt_uif_label_column column_random\">\n<input\ndata-num=\"\"\t\t\t\t\t\t\t\t\t\ttype=\"checkbox\"\nclass=\"check_me validate[required] ipt_uif_checkbox filled-in \"\nname=\"ipt_fsqm_form_9[mcq][86][options][]\" id=\"ipt_fsqm_form_9_mcq_86_options__1\"\nvalue=\"1\" \/>\n<label\nclass=\"eform-label-with-tabindex\" tabindex=\"0\" for=\"ipt_fsqm_form_9_mcq_86_options__1\">\n<img\nsrc=\"https:\/\/www.dexeus.com\/fertility\/wp-content\/uploads\/2021\/10\/trompas-1.jpg\" alt=\"Ligadura de trompas\" \/>Tubal ligation\t\t\t\t<\/label><\/div><div\nclass=\"ipt_uif_label_column column_random\">\n<input\ndata-num=\"\"\t\t\t\t\t\t\t\t\t\ttype=\"checkbox\"\nclass=\"check_me validate[required] ipt_uif_checkbox filled-in \"\nname=\"ipt_fsqm_form_9[mcq][86][options][]\" id=\"ipt_fsqm_form_9_mcq_86_options__2\"\nvalue=\"2\" \/>\n<label\nclass=\"eform-label-with-tabindex\" tabindex=\"0\" for=\"ipt_fsqm_form_9_mcq_86_options__2\">\n<img\nsrc=\"https:\/\/www.dexeus.com\/fertility\/wp-content\/uploads\/2021\/10\/hereditaria-1.jpg\" alt=\"Enfermedad hereditaria\" \/>Hereditary disease\t\t\t\t<\/label><\/div><div\nclass=\"ipt_uif_label_column column_random\">\n<input\ndata-num=\"\"\t\t\t\t\t\t\t\t\t\ttype=\"checkbox\"\nclass=\"check_me validate[required] ipt_uif_checkbox filled-in \"\nname=\"ipt_fsqm_form_9[mcq][86][options][]\" id=\"ipt_fsqm_form_9_mcq_86_options__3\"\nvalue=\"3\" \/>\n<label\nclass=\"eform-label-with-tabindex\" tabindex=\"0\" for=\"ipt_fsqm_form_9_mcq_86_options__3\">\n<img\nsrc=\"https:\/\/www.dexeus.com\/fertility\/wp-content\/uploads\/2021\/10\/endometriosis-1.jpg\" alt=\"Soy seropositiva\" \/>Endometriosis\t\t\t\t<\/label><\/div><div\nclass=\"ipt_uif_label_column column_random\">\n<input\ndata-num=\"\"\t\t\t\t\t\t\t\t\t\ttype=\"checkbox\"\nclass=\"check_me validate[required] ipt_uif_checkbox filled-in \"\nname=\"ipt_fsqm_form_9[mcq][86][options][]\" id=\"ipt_fsqm_form_9_mcq_86_options__4\"\nvalue=\"4\" \/>\n<label\nclass=\"eform-label-with-tabindex\" tabindex=\"0\" for=\"ipt_fsqm_form_9_mcq_86_options__4\">\n<img\nsrc=\"https:\/\/www.dexeus.com\/fertility\/wp-content\/uploads\/2021\/10\/no-conozco-1.jpg\" alt=\"No conozco mi historia\" \/>I don't know my history \/ None of the above\t\t\t\t<\/label><\/div><div\nclass=\"clear-both\"><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_9[mcq][85][m_type]\" id=\"ipt_fsqm_form_9_mcq_85_m_type\" value=\"mcq\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_9[mcq][85][type]\" id=\"ipt_fsqm_form_9_mcq_85_type\" value=\"checkbox\" class=\"ipt_fsqm_hf_type\" \/><div\nclass=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_container_checkbox\" id=\"ipt_fsqm_form_9_mcq_85\"><div\nclass=\"ipt_uif_column_inner side_margin\"><div\nclass=\"ipt_uif_question ipt_uif_question_vertical ipt_uif_question_centered\"><div\nclass=\"ipt_uif_question_label\">\n<label\nclass=\"ipt_uif_question_title ipt_uif_label\" for=\"ipt_fsqm_form_9_mcq_85\">My partner's medical history<span\nclass=\"ipt_uif_question_required\">*<\/span><\/label><div\nclass=\"clear-both\"><\/div><\/div><div\nclass=\"ipt_uif_question_content\"><div\nclass=\"ipt_uif_label_column column_random\">\n<input\ndata-num=\"\"\t\t\t\t\t\t\t\t\t\ttype=\"checkbox\"\nclass=\"check_me validate[required] ipt_uif_checkbox filled-in \"\nname=\"ipt_fsqm_form_9[mcq][85][options][]\" id=\"ipt_fsqm_form_9_mcq_85_options__0\"\nvalue=\"0\" \/>\n<label\nclass=\"eform-label-with-tabindex\" tabindex=\"0\" for=\"ipt_fsqm_form_9_mcq_85_options__0\">\n<img\nsrc=\"https:\/\/www.dexeus.com\/fertility\/wp-content\/uploads\/2021\/10\/baja-1.jpg\" alt=\"Baja\" \/>Low ovarian reserve\t\t\t\t<\/label><\/div><div\nclass=\"ipt_uif_label_column column_random\">\n<input\ndata-num=\"\"\t\t\t\t\t\t\t\t\t\ttype=\"checkbox\"\nclass=\"check_me validate[required] ipt_uif_checkbox filled-in \"\nname=\"ipt_fsqm_form_9[mcq][85][options][]\" id=\"ipt_fsqm_form_9_mcq_85_options__1\"\nvalue=\"1\" \/>\n<label\nclass=\"eform-label-with-tabindex\" tabindex=\"0\" for=\"ipt_fsqm_form_9_mcq_85_options__1\">\n<img\nsrc=\"https:\/\/www.dexeus.com\/fertility\/wp-content\/uploads\/2021\/10\/trompas-1.jpg\" alt=\"Ligadura de trompas\" \/>Tubal ligation\t\t\t\t<\/label><\/div><div\nclass=\"ipt_uif_label_column column_random\">\n<input\ndata-num=\"\"\t\t\t\t\t\t\t\t\t\ttype=\"checkbox\"\nclass=\"check_me validate[required] ipt_uif_checkbox filled-in \"\nname=\"ipt_fsqm_form_9[mcq][85][options][]\" id=\"ipt_fsqm_form_9_mcq_85_options__2\"\nvalue=\"2\" \/>\n<label\nclass=\"eform-label-with-tabindex\" tabindex=\"0\" for=\"ipt_fsqm_form_9_mcq_85_options__2\">\n<img\nsrc=\"https:\/\/www.dexeus.com\/fertility\/wp-content\/uploads\/2021\/10\/hereditaria-1.jpg\" alt=\"Enfermedad hereditaria\" \/>Hereditary disease\t\t\t\t<\/label><\/div><div\nclass=\"ipt_uif_label_column column_random\">\n<input\ndata-num=\"\"\t\t\t\t\t\t\t\t\t\ttype=\"checkbox\"\nclass=\"check_me validate[required] ipt_uif_checkbox filled-in \"\nname=\"ipt_fsqm_form_9[mcq][85][options][]\" id=\"ipt_fsqm_form_9_mcq_85_options__3\"\nvalue=\"3\" \/>\n<label\nclass=\"eform-label-with-tabindex\" tabindex=\"0\" for=\"ipt_fsqm_form_9_mcq_85_options__3\">\n<img\nsrc=\"https:\/\/www.dexeus.com\/fertility\/wp-content\/uploads\/2021\/10\/endometriosis-1.jpg\" alt=\"Soy seropositiva\" \/>Endometriosis\t\t\t\t<\/label><\/div><div\nclass=\"ipt_uif_label_column column_random\">\n<input\ndata-num=\"\"\t\t\t\t\t\t\t\t\t\ttype=\"checkbox\"\nclass=\"check_me validate[required] ipt_uif_checkbox filled-in \"\nname=\"ipt_fsqm_form_9[mcq][85][options][]\" id=\"ipt_fsqm_form_9_mcq_85_options__4\"\nvalue=\"4\" \/>\n<label\nclass=\"eform-label-with-tabindex\" tabindex=\"0\" for=\"ipt_fsqm_form_9_mcq_85_options__4\">\n<img\nsrc=\"https:\/\/www.dexeus.com\/fertility\/wp-content\/uploads\/2021\/10\/no-conozco-1.jpg\" alt=\"No conozco mi historia\" \/>I don't know my history \/ None of the above\t\t\t\t<\/label><\/div><div\nclass=\"clear-both\"><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div><div\nclass=\"clear\"><\/div><div\nid=\"ipt_fsqm_form_9_button_container\" class=\"ipt_fsqm_form_button_container ipt_fsqm_form_button_container--outline eform-material-alternate-pb ipt-eform-material-button-container\"><div\nclass=\"eform-button-container-inner\">\n<button\ntype=\"button\" class=\"ipt_uif_button eform-material-button eform-ripple ipt_fsqm_form_button_prev medium primary-button\" name=\"ipt_fsqm_form_9_button_prev\" id=\"ipt_fsqm_form_9_button_prev\"> Previous<\/button>\n<button\ntype=\"submit\" class=\"ipt_uif_button eform-material-button eform-ripple ipt_fsqm_form_button_submit medium primary-button\" name=\"ipt_fsqm_form_9_button_submit\" id=\"ipt_fsqm_form_9_button_submit\"> Confirm<\/button>\n<button\ntype=\"button\" class=\"ipt_uif_button eform-material-button eform-ripple ipt_fsqm_form_button_next medium primary-button\" name=\"ipt_fsqm_form_9_button_next\" id=\"ipt_fsqm_form_9_button_next\"> Next<\/button><\/div><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div><\/form><\/div><div\nstyle=\"display: none;\" class=\"ipt_fsqm_form_message_success ui-widget ui-widget-content ui-corner-all ipt_uif_widget_box\"><div\nclass=\"ui-helper-reset ui-helper-clearfix ui-widget-header ui-corner-all\"><h3><i\ntitle=\"\" class=\" ipt-icomoon-checkmark-circle ipticm prefix\"><\/i>\nThank you for your answers, we are consulting our database and in a few seconds you will receive our answer based on our over 40 years of experience.<\/h3><\/div><div\nclass=\"ui-widget-content ui-corner-all ipt_fsqm_success_wrap\"><\/div><\/div><div\nstyle=\"display: none;\" class=\"ipt_fsqm_form_message_error ui-widget ui-widget-content ui-corner-all ipt_uif_widget_box\"><div\nclass=\"ui-helper-reset ui-helper-clearfix ui-widget-header ui-corner-all\"><div><i\ntitle=\"\" class=\" ipt-icomoon-laptop ipticm prefix\"><\/i>\nServer Side Error<\/div><\/div><div\nclass=\"ui-widget-content ui-corner-all\"><p>We faced problems while connecting to the server or receiving data from the server. Please wait for a few seconds and try again.<\/p><p>If the problem persists, then check your internet connectivity. If all other sites open fine, then please contact the administrator of this website with the following information.<\/p><p\nclass=\"jqXHR\">\n<strong>TextStatus: <\/strong><span\nclass=\"textStatus\">undefined<\/span><br\n\/>\n<strong>HTTP Error: <\/strong><span\nclass=\"errorThrown\">undefined<\/span><\/p><\/div><\/div><div\nstyle=\"display: none\" class=\"ipt_uif_widget_box ipt_fsqm_form_message_process\"><div\nclass=\"ui-widget ui-widget-header ui-corner-all\"><style type=\"text\/css\">.ipt_uif_ajax_loader,\n\t\t\t.ipt_uif_ajax_loader *,\n\t\t\tipt_uif_ajax_loader *::before,\n\t\t\tipt_uif_ajax_loader *::after {\n\t\t\t\tbox-sizing: border-box;\n\t\t\t}<\/style><div\nclass=\"ipt-eform-preloader-inline ipt_uif_ajax_loader\"><div\nclass=\"ipt-eform-preloader-inner\"><div\nclass=\"ipt-eform-preloader-circle\"><div\nclass=\"preloader-wrapper active\"><div\nclass=\"spinner-layer spinner-blue\"><div\nclass=\"circle-clipper left\"><div\nclass=\"circle\"><\/div><\/div><div\nclass=\"gap-patch\"><div\nclass=\"circle\"><\/div><\/div><div\nclass=\"circle-clipper right\"><div\nclass=\"circle\"><\/div><\/div><\/div><div\nclass=\"spinner-layer spinner-red\"><div\nclass=\"circle-clipper left\"><div\nclass=\"circle\"><\/div><\/div><div\nclass=\"gap-patch\"><div\nclass=\"circle\"><\/div><\/div><div\nclass=\"circle-clipper right\"><div\nclass=\"circle\"><\/div><\/div><\/div><div\nclass=\"spinner-layer spinner-yellow\"><div\nclass=\"circle-clipper left\"><div\nclass=\"circle\"><\/div><\/div><div\nclass=\"gap-patch\"><div\nclass=\"circle\"><\/div><\/div><div\nclass=\"circle-clipper right\"><div\nclass=\"circle\"><\/div><\/div><\/div><div\nclass=\"spinner-layer spinner-green\"><div\nclass=\"circle-clipper left\"><div\nclass=\"circle\"><\/div><\/div><div\nclass=\"gap-patch\"><div\nclass=\"circle\"><\/div><\/div><div\nclass=\"circle-clipper right\"><div\nclass=\"circle\"><\/div><\/div><\/div><\/div><\/div><div\nclass=\"ipt-eform-preloader-text\"><div\nclass=\"ipt-eform-preloader-text-inner ipt_uif_ajax_loader_text\">Thank you for your answers<\/div><\/div><div\nclass=\"clear\"><\/div><\/div><\/div><\/div><\/div><div\nstyle=\"display: none;\" class=\"ipt_fsqm_form_validation_error ui-widget ui-widget-content ui-corner-all ipt_uif_widget_box\"><div\nclass=\"ui-helper-reset ui-helper-clearfix ui-widget-header ui-corner-all\"><div><i\ntitle=\"\" class=\" ipt-icomoon-warning2 ipticm prefix\"><\/i>\n<span\nclass=\"fsqm_ve_text\">Error<\/span><\/div><\/div><div\nclass=\"ui-widget-content ui-corner-all\"><p\nclass=\"fsqm_ve_msg\">Some error has occured.<\/p><\/div><\/div><\/div><\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Complete this form anonymously and free of charge, to obtain detailed information about the treatment that best suits your situation. We will tell you what it consists of, the chances of success, the time you need to carry it out and its price.<\/p>\n","protected":false},"author":1,"featured_media":28628,"parent":0,"menu_order":1,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-16437","page","type-page","status-publish","has-post-thumbnail","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v26.8 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Free Online Prediagnosis | Dexeus Fertility<\/title>\n<meta name=\"description\" content=\"In just 5 clicks, Dexeus Fertility&#039;s Free Prediagnosis recommends the most suitable Assisted Reproduction treatment for you.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.dexeus.com\/fertility\/en\/online-prediagnosis\/\" \/>\n<meta property=\"og:locale\" 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