The Effects of Healthy Lifestyle on Fertility


Consent Form


You are being asked to participate in a project conducted through Maryville University by Chelsey Logan, Maryville senior seminar student and Professor Michael Donovan. This project is being conducted in partial fulfillment of the course requirements for Senior Seminar at Maryville University. Student candidates are learning to collect and assess data, so the results of the study may not be valid and will not be published or presented beyond the class . This course is in compliance with the Maryville University Institutional Review Board.


The purpose of this research is to look into the differences health choices make on your ability to conceive. If you agree to participate you will be asked to complete a survey. The research will take until December 2020 to complete. This project is not expected to involve risks of harm any greater than those ordinarily encountered in daily life. The benefits to this survey is that information provided can help other women who may be dealing with infertility and see the pros to adapting a healthier lifestyle when trying to conceive.  


All of your responses will be anonymous and will be kept confidential. In addition, no individual data from this project will be shared.  The group results of data from this study will be shared only with members of the Senior Seminar course, and the social science faculty of the College of Arts and Sciences. 


Your participation is voluntary and there is no penalty for your refusal to participate.  You need not answer all questions and you are free to withdraw your consent and to discontinue your participation at any time.  In the event of your early withdrawal, any information that you have provided up to that time will be destroyed.  


If you have any questions regarding this study, or if any problems arise, you may contact the researcher, Chelsey Logan, or the supervising faculty member, Dr. Michael Donovan at (314)-579-0441. You may also ask questions, state concerns regarding your rights as a research subject, or express any feelings of pressure to participate by contacting: Dr. Robert Bertolino, Chair of the Institutional Review Board at Maryville University, (314) 529-9659.


Maryville University investigators and their colleagues who are conducting research recognize the importance of your contribution to the research studies, which are designed to improve educational learning environments.  Maryville University investigators and their staffs will make every effort to minimize, control, and treat any complication that may arise as a result of this research.


Maryville University recognizes its federally mandated responsibility to ensure that research be conducted in an ethical and scholarly manner, respecting the rights and welfare of all the human participants. Any research misconduct, including but not limited to fabrication, falsification, or plagiarism in proposing, performing and reviewing research, or in reporting research results; should be reported to Dr. Jennifer Brunworth, the Research Integrity Officer at (314) 529-9689.


Advancing to the survey will signify your implied consent to participate. You are agreeing to participate in this study based on the information presented to you.  You may choose to withdraw without prejudice or penalty.  Please print a copy of this form which includes the name and phone number of the researcher and the IRB at Maryville University, should you have any questions.  


The date approval stamp on this consent form indicates that the project has been reviewed and approved by the Maryville University Institutional Review Board.  


Chelsey Logan                                                                                               9/20/2020

Student Researcher Date


______________________________ ____________

Supervising Faculty Member Date


Maryville University Institutional Review Board

Protocol Number: Pending 

Initiation Date: Pending

Termination Date: Pending

By click this link to complete the survey, you are acknowledging your voluntary participation for this study.

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©2020 by Chelsey Logan