THE CENTER FOR ADVANCED REPRODUCTIVE SERVICES (CARS) (The Center) CONSENT FOR IN VITRO FERTILIZATION AND EMBRYO TRANSFER

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "THE CENTER FOR ADVANCED REPRODUCTIVE SERVICES (CARS) (The Center) CONSENT FOR IN VITRO FERTILIZATION AND EMBRYO TRANSFER"

Transcription

1 THE CENTER FOR ADVANCED REPRODUCTIVE SERVICES (CARS) (The Center) CONSENT FOR IN VITRO FERTILIZATION AND EMBRYO TRANSFER Partner #1 Last Name (Surname): Partner #1 First Name: Partner #1 Last 5 Digits SS# DOB: Partner # 1Gender M/F (Circle One) Partner#2 Last Name (Surname): Partner #2 First Name: Partner #2 Last 5 Digits SS# DOB: Partner #2 Gender M/F (Circle One) Address: Phone Number: We (I), the undersigned, request, authorize and consent to the performance of the procedure of in vitro fertilization and embryo transfer (IVF/ET) by The Center for Advanced Reproductive Services, PC (CARS) (The Center), and, as appropriate, its employees, contractors, and consultants and authorized agents. We (I) understand that there are other options available to us to help us have a child. These may include but are not limited to adoption or treatments including such techniques as surgery, ovulation induction and sperm or egg donation. We (I) have had the opportunity to discuss these options as well as others with our (my) physician. In an attempt to have a child, we (I) now elect to utilize in vitro fertilization and embryo transfer at The Center for Advanced Reproductive Services. Source of Eggs and Sperm for This Procedure: Egg Source: For the purpose of providing the eggs in this procedure, listed below is the designated egg source for performing this procedure. Egg source: (For Anonymous Egg Donors (AED) use donor # where applicable otherwise use female s name) Sperm Source(s): For the purpose of fertilizing the eggs in this procedure, listed below is (are) the designated source of sperm for performing this procedure. Sperm source (1): If Donor Sperm, list sperm bank and donor number, otherwise list male s name. Sperm source (2): (in the case of same sex men splitting eggs or couples using both partner and donor sperm). We (I) understand and agree that in most circumstances only embryos from a single egg and sperm source will be transferred during the embryo transfer (that is, embryos from mixed sources may not be transferred at the same time). The choice of which embryos to transfer is usually based on embryo quality and the best medical judgment of the medical team in consultation with us (me). Description of the Procedure: The following is a general outline of the steps that may be required in the procedure of in vitro fertilization and embryo transfer (IVF/ET). We (I) consent to the performance of these steps: 1. Complete history and physical examination. 2. Administration of fertility drugs including but not limited to Gonal-F, Menopur, Bravelle, Follistim, Luveris (also called gonadotropins) and other medications including but not limited to oral contraceptive

2 Page: 2 pills (OCPs), GnRH agonists (including but not limited to Lupron), GnRH antagonists ((including but not limited to Ganirelix and Cetrotide), and hcg, to mature the eggs. 3. The use of blood tests to monitor hormone levels. 4. Ultrasound examinations of the ovaries to monitor growth of the developing follicles. Ultrasonography is a diagnostic procedure using sound waves that provides a picture of the ovaries and the growing follicles. No known risks have been associated with this procedure. 5. Providing or purchasing a sperm or testicular tissue specimen and preparation of the specimen for use in the fertilization procedure. 6. Undergoing ultrasound guided transvaginal egg retrieval, which requires anesthesia and involves insertion of a needle through the vaginal wall, into the ovary (ovaries) to obtain the eggs. 7. For IVF/ET, placing the eggs and the sperm together in a dish with culture medium to allow fertilization to occur. 8. For intracytoplasmic sperm injection (ICSI), insertion of an individual sperm into the egg using micromanipulation techniques and equipment. 9. Performing an embryo transfer by placing the embryo (or embryos), by means of a small tube inserted through the cervix, into the uterus of the woman who will carry the pregnancy. The woman who carries the pregnancy may be the female patient, female recipient/partner or a gestational carrier. 10. The use of intramuscular, oral, transdermal or vaginal progesterone and/or estrogens to maintain the uterine lining of the woman who will carry the pregnancy. 11. The utilization of antibiotics to reduce the risk of infection in the woman who underwent the egg retrieval and/or will carry the pregnancy. 12. The utilization of corticosteroids if needed to increase the likelihood of pregnancy in the woman who will carry the pregnancy. 13. A blood pregnancy test will be performed on the woman who will carry the pregnancy approximately 2 weeks after the embryo transfer to determine if pregnancy has occurred. How many eggs should be fertilized (have sperm added to them)? If numerous eggs are obtained, the number exposed to sperm will be decided upon by us (me) and our (my) physician. There are several options available for the eggs obtained during the egg retrieval: 1. All of the eggs can have sperm added to them. If too many embryos develop to safely transfer, the excess viable embryos can be frozen (cryopreserved) for our (my) future use. This option will require signing an additional consent for the embryo freezing. In the future, these embryos can be used to attempt a pregnancy, can be donated to another couple/individual, can be used for research or can be discarded after signing the appropriate written consent. 2. All or some of the eggs can have sperm added to them. If too many embryos develop to safely transfer, the excess viable embryos and any viable eggs can be discarded. These extra viable embryos and eggs will no longer be available for attempting a pregnancy. 3. Sperm may be added to only a few of the eggs and the excess eggs can be frozen (cryopreserved) for our (my) future use. (In other words, the excess eggs which are frozen are unfertilized). This option will require signing an additional consent for the egg freezing. In the future, these eggs can be used to attempt a pregnancy, donated to another couple/individual, used for research or discarded after signing the appropriate written consent. 4. Only some of the eggs can have sperm added to them and the remaining eggs can be discarded. (In other words, the excess eggs which are unfertilized will be discarded). These extra eggs will no longer be available for attempting a pregnancy. Each of these approaches has its advantages and disadvantages; If sperm is added to all of the eggs and fertilization and embryo development proceeds normally, there may be more embryos from which to select the embryos for transfer, maximizing the chances for pregnancy. If sperm is only added to only a few eggs, this may decrease the number of embryos available for transfer and this may reduce the chances of achieving a pregnancy in that cycle. American Society for Reproductive Medicine (ASRM) Guidelines for Embryo Transfer recommend the number of embryos which can be transferred to a woman based on the age of the woman who produced the egg and other specific circumstances. In order to minimize the disposal of potentially

3 Page: 3 viable embryos, the number of eggs to which sperm is added may be limited to fewer than the total number of eggs retrieved, when freezing of embryos is not elected. The number of eggs to which sperm will be added will be determined by the physician in consultation with the couple (individual). This choice may reduce the chances of achieving a pregnancy because there will simply be fewer embryos from which to select those to be transferred. If sperm is added to all of the eggs and the excess viable embryos are discarded and a pregnancy is not achieved, then the entire cycle must be repeated to generate new embryos for transfer because none were available to freeze. Fresh eggs have a limited period of time during which sperm can be added and it takes hours to tell if an egg has been fertilized. Therefore, it is not possible to attempt to fertilize a few eggs and then try again later if insufficient embryos result. The fresh eggs must be fertilized, frozen or discarded on the day of the egg retrieval. If sperm is added to an egg and it does not fertilize, it is considered non-viable and cannot be frozen or used for future attempts at pregnancy. Freezing of eggs is a relatively new technique and may not be as successful as freezing of embryos, more studies are needed. Cryopreserved eggs or embryos may be used in the future for our (my) further attempts at conception, or may be: 1. Donated to another couple or individual for their attempts to conceive. 2. Disposed of according to American Society for Reproductive Medicine (ASRM) Ethical Guidelines. 3. Transferred to another fertility center or long term storage facility. 4. Donated to research. The above options will occur only with our (my) additional written informed consent for that option. Non-Viable Eggs and Embryos. We (I) understand that some non-viable eggs and embryos may be used as a teaching aide for laboratory personnel before being discarded. We (I) understand that non-viable eggs and embryos will be discarded according to ASRM Ethical Guidelines. Cells and Biological Materials that Would Normally Be Discarded. I understand that some cells (such as granulosa cells which are cells from the ovary that are retrieved along with eggs) and biological materials such as follicular fluid (the fluid that the egg is found in) which are normally discarded may be used for research studies. These materials would never be used for any procedures that involve fertilization or creation of an embryo or a cell line without my written consent in advance. When these studies are completed, the materials will be discarded. Fertilization (Adding sperm to eggs): We (I) have reviewed the options and will indicate our (my) choice concerning use of eggs and embryos by initialing below. NUMBER OF EGGS TO WHICH TO ADD SPERM. Regarding the number of eggs to which sperm is to be added we (I) understand that we (I) have FOUR options and have initialed our (my) choice below (Please initial ONE option below): 1. Add Sperm to ALL Eggs and Freeze the Excess Embryos: We (I) request that sperm be added to all of the mature eggs. We (I) understand that viable embryos created in excess of those that can be safely transferred will be frozen (cryopreserved) and we (I) will sign a separate consent for cryopreservation of embryos.

4 Page: 4 2. Add Sperm to ALL or some of the Eggs and Discard the Excess Embryos: We (I) request that sperm be added to all of the mature eggs. We (I) request and consent that viable embryos created in excess of those that can be safely transferred will discarded. This disposal will follow ASRM Ethical Guidelines. These extra embryos will no longer be available for attempting a pregnancy. 3. Add sperm to only a few eggs and freeze the excess eggs. We (I) understand that ASRM Guidelines for Embryo Transfer determine the number of embryos which can be transferred to a woman. Therefore, you and your physician will decide the number of eggs which will be exposed to sperm. All the extra eggs (oocytes) that have not had sperm added to them (unfertilized) should be frozen (cryopreserved) for our (my) use in the future. This option will require signing an additional consent for egg freezing. In the future, these eggs can be used to attempt a pregnancy, donated to another couple/individual, used for research or discarded after signing the appropriate written consent. 4. Add sperm to only a few eggs and discard the excess eggs. We (I) understand that ASRM Guidelines for Embryo Transfer determine the number of embryos which can be transferred to a woman. Therefore, you and your physician will decide the number of eggs which will be exposed to sperm. All extra eggs (oocytes) that have not had sperm added to them (unfertilized) will be discarded. This disposal will follow ASRM Ethical Guidelines. These extra eggs will no longer be available for attempting a pregnancy. How will the eggs be fertilized? Intracytoplasmic Sperm Injection (ICSI) may be used for individuals whose sperm fertilizing capacity may be reduced due to male factor infertility, in situations where previous IVF cycles (utilizing conventional insemination techniques) have resulted in poor fertilization rates, where fertilization did not occur, or in some cases of unexplained infertility, where the potential of the sperm to fertilize an egg may be compromised. Male factor may be indicated by past medical history or by abnormal semen parameters, such as reduced sperm count, motility or abnormal morphology, on previous semen exams or in the sample provided at the time of the IVF procedure. ICSI must always be used when the source of the sperm is a sample of epididymal sperm or testicular tissue. In situations where male factor is the result of a genetic defect, the procedure may permit fertilization to occur normally but the genetic defect may be inherited by resulting offspring. Therefore, there is a theoretical increased risk of chromosomal abnormalities in children resulting from ICSI. There are risks associated with the ICSI technique. Mature oocytes (eggs) are required to perform ICSI. If none are retrieved, ICSI may not be possible. Eggs may be retrieved but viable sperm may not be available for use in ICSI. The ICSI procedure may damage or destroy one or more eggs. ICSI may result in fertilization, but subsequent embryo development may not occur.. We (I) understand that the decision to utilize ICSI does not guarantee fertilization. We (I) acknowledge that we (I) have discussed the possibility of the need for ICSI with our (my) physician and understand, agree and consent that: (Please check and initial ONE OPTION BELOW): Option 1: ICSI will be used in conjunction with our (my) IVF cycle based upon our (my) treatment plan.

5 Page: 5 Option 2: ICSI will not be used in conjunction with our (my) IVF cycle based upon our (my) treatment plan. We (I) will not permit the use of ICSI under any circumstances. We (I) understand that as a result of the decision to not use ICSI under any circumstances, fertilization may not occur and an embryo transfer and/or pregnancy may not result. Options 3: Although we (I) understand that the current plan is to NOT use ICSI in conjunction with the fertilization of the eggs, we (I) understand and consent that if semen sample(s) at time of egg retrieval are sub-optimal, based on the best medical judgment of the Center staff, ICSI may be used in conjunction with our (my) IVF cycle, despite any previous directive of ours (mine) to the contrary. We (I) understand that we (I) will be notified if ICSI is performed. Additional Information about IVF/ET: Blastocyst Culture involves placing embryos into culture in the laboratory for additional days to observe their continued development prior to freezing or transfer. The literature indicates that this technique may be useful in selecting the most viable embryos, resulting in transfer of fewer embryos with a corresponding reduction in the risk of multiple pregnancies. In some cases, one or more of the embryos may cease their development prior to reaching the blastocyst stage. This may result in fewer embryos for transfer and, in some cases, no embryo transfer at all. We (I) acknowledge that no technique, including blastocyst culture with a single embryo transfer can completely prevent multiple pregnancies. We (I) acknowledge that we (I) have discussed the possibility of the need for this procedure with our (my) physician and understand and agree that it will be utilized based on the best medical judgment of the Center staff at the time of our (my) procedure. We (I) understand that we (I) will be notified if blastocyst culture is performed. Selective Assisted Hatching may be used in situations where the zona pellucida (the outer shell surrounding the embryo) is abnormally thick. This condition may compromise the ability of the embryo to implant (attach to) in the uterine wall. Criteria for performing selective assisted hatching include appearance of the embryo and zona pellucida, age of the woman, baseline day 3 FSH levels, and previous medical history. Literature suggests that the procedure may benefit older women, those with elevated day 3 FSH levels and some cases of unexplained infertility. This procedure is performed immediately prior to the embryo transfer and involves opening a small hole in the zona pellucida using micromanipulation techniques. There are risks associated with this technique. Embryos may be damaged during the process, reducing the number of embryos available for transfer. Despite the use of assisted hatching, implantation (attachment) may not occur. Some studies have also suggested that hatching may increase the risk of multiple pregnancies particularly identical twins. However, further research is needed. We (I) acknowledge that we (I) have discussed the possibility of the need for this procedure with our (my) physician and understand and agree that it will be utilized based on the best medical judgment of the Center staff at the time of our (my) procedure. We (I) understand that we (I) will be notified if Selective Assisted Hatching is performed. Limits to the Success of IVF/ET: There are a number of reasons why IVF/ET may be unsuccessful: 1. Inadequate egg development may result in cancellation of the cycle prior to egg retrieval.

6 Page: 6 2. Ovulation may occur spontaneously before the eggs can be retrieved. 3. In rare cases, no eggs may be retrieved. 4. The eggs may not be normal. 5. A fresh semen sample may not be able to be produced the day of the procedure; a frozen specimen (if previously provided) will then be utilized, however, this may result in fewer eggs being fertilized. 6. Fertilization may not occur, or may occur abnormally, e.g. an egg may be fertilized by more than one sperm (polyspermia) and could develop abnormally. Fertilization may not occur or abnormal fertilization may occur, even with the use of intracytoplasmic sperm injection. Such embryos will not be transferred. 7. Intracytoplasmic sperm injection may result in damage, destruction or loss of one or more eggs (oocytes) or sperm. 8. Cleavage or cell division of fertilized eggs may not occur. 9. The embryos may not develop normally. 10. Selective assisted hatching may lead to damage or loss of one or more embryos. 11. The embryo transfer may be difficult or may not be possible. 12. Implantation of the embryos into the wall of the uterus may not occur, even with the use of selective assisted hatching. Laboratory. An event may occur in the laboratory resulting in loss or damage to some or all of the eggs or embryos. We (I) understand that assisted reproductive technologies involve the use of mechanical and/or electrical equipment. The Center will take reasonable measures to maintain and monitor this equipment. However, despite our best efforts, equipment failure may result in the damage or loss of one or more of our (my) sperm, eggs or embryos. We (I) understand and agree that The Center shall be responsible only for acts of negligence on its part and the part of its employees, contractors, and consultants. The program will account honestly for all gametes and embryos. Pregnancy Loss. Although pregnancy may be successfully established, there is still the possibility of miscarriage, ectopic pregnancy, stillbirth and/or congenital abnormalities (birth defects). Conceptions resulting from IVF/ET) have been associated with a slightly higher risk of birth defects than pregnancies resulting from a natural conception. However, it is still unclear whether the risk is related to patients, medications, or laboratory procedures. It is possible that infertile couples differ from the general population, and it is not the technology that leads to the higher risk. Risks of the IVF/ET Procedure: The following are risks and discomforts associated with this procedure: 1. Blood drawing and medication injections- mild discomfort and a risk of developing a bruise at the needle site. 2. Medications used to stimulate the woman who is providing the eggs may cause: a) Hyperstimulation - The fertility drugs/medications previously described may cause hyperstimulation of the ovaries which may cause discomfort (because more than one follicle is growing); hyperstimulation may result in ovarian enlargement requiring therapy including hospitalization and possible surgery with removal of an ovary. b) Cyst formation- The medications described above may result in large cysts forming on the ovaries. In the majority of cases, ovarian cysts induced by fertility drugs/medications disappear spontaneously requiring no intervention. In very rare instances (less than 1% of cycles) these cysts could result in significant abdominal discomfort which could result in the need for hospitalization for observation purposes. One of these cysts could rupture requiring emergency surgery to stop the bleeding and could result in a need for blood transfusions and possible loss of one or both ovaries (0.1% of cycles). c) Fluid shifts- Fluid shifts within the body may require hospitalization for observation and treatment (1%-3% of cycles). The high levels of estrogen associated with the use of these medications may alter the way in which the body handles fluids. More specifically, the blood vessels may become leaky resulting in the accumulation of fluid within the abdominal cavity (ascites) or around the lungs (pleural effusion). This accumulation of fluid may result in abdominal distension and discomfort with associated shortness of breath (due to the diaphragm being pushed upward by the accumulation of fluid in the abdomen). In severe cases, removal of this fluid from the abdomen or from the space around the lungs may be required using a small needle (0.5% of cycles). The leaky vessels may also result in the individual becoming dehydrated because the fluid is in the wrong place, i.e. in the abdomen instead of

7 Page: 7 in the blood vessels. Intravenous fluid administration may be required to maintain adequate blood flow to vital organs such as the kidneys. Severe dehydration could result in irreversible organ failure or blood clot formation leading to a pulmonary embolus (blood clots in the lung) or stroke (less than 0.1% of cycles). There are extremely rare reports in the literature of death occurring as a result of complications of OHSS (Ovarian Hyperstimulation Syndrome). OHSS is a risk that is inherent to ovulation induction therapy; prevention cannot be guaranteed. At times, when monitoring shows that the risk of OHSS is unacceptably high, a cycle may be canceled. Severe OHSS will rarely occur if hcg administration is withheld. d) Cancer --Many have worried that the use of fertility drugs could lead to an increased risk of cancer in particular, breast, ovarian, and uterine (including endometrial) cancers. One must be careful in interpreting research studies of women taking fertility drugs. Since all of these cancers are more common in women with infertility simply comparing women taking fertility drugs with women in the general population inevitably shows an increased incidence of cancer. When the analysis takes into account the increased cancer risk due to infertility per se, the evidence does not support a relationship between fertility drugs and an increased prevalence of breast or ovarian cancer. More research is required to examine the long-term impact fertility drugs may have on breast and ovarian cancer prevalence rates. For uterine cancer, the numbers are too small to draw conclusions, but it is at least possible that use of fertility drugs may indeed cause some increased risk of uterine cancer. e) Adnexal Torsion (Ovarian Twisting): Less than 1 percent (1%) of the time, the stimulated ovary can twist on itself, cutting off its own blood supply. Surgery is required to untwist or even remove it. 3. Egg retrieval may cause risks to the woman from whom the eggs are retrieved including: a) The egg retrieval requires the use of general anesthesia. Risks associated with anesthesia including nausea, difficulty breathing, respiratory distress or arrest and aspiration of fluid into the lungs requiring hospitalization. b) Possibility of bleeding, infection, or injury to the abdominal organs (including but not limited to the bowel and bladder) that may require immediate major surgery with possible resulting loss of the uterus and/or ovaries, hospitalization for intravenous antibiotic therapy, blood transfusion or, in rare cases, death. 4. Laboratory procedures- the growth of human embryos requires a source of protein. The Center may use a protein product derived from human blood. The manufacturing process involves several purification steps including heat treatment, treatment with detergents, and treatment with ethanol which is thought to render these products free of infectious disease agents such as the hepatitis virus and the virus responsible for AIDS. These blood products are used to treat up to 1 million patients every year for shock, burns, and many other medical emergencies. These products are thought to be extremely safe due to the screening and purification procedures utilized; however, there is a theoretical risk that the agents responsible for causing various infectious diseases could still be transmitted by utilization of these blood derived products. 5. The utilization of medications at the time of egg retrieval and embryo transfer may cause risk to the woman who will carry the pregnancya) Utilization of antibiotics may result in an allergic reaction, which may result in a rash. In its most severe form, an allergic reaction may be life threatening. The utilization of tetracycline/doxycycline is associated with an increased sensitivity to the sun and, therefore, caution should be taken to avoid prolonged sun exposure. The utilization of antibiotics may also be associated with nausea, vomiting, diarrhea, loss of appetite and vaginal yeast infections. b) Utilization of corticosteroids may be associated with mood changes, insomnia, gastrointestinal disturbances, masking of the signs of infection, interference with blood sugar levels and vaginal yeast infections. c) Utilization of intramuscular progesterone may be associated with soreness, swelling and infection at the site of injection. Early reports suggested a possible association between birth defects and the use of synthetic progestins. The intramuscular and vaginal progesterone utilized in this procedure is naturally occurring and is similar to that which is normally produced by the ovary; there is no evidence to date of an increased risk of birth defects, but we cannot guarantee that a future link will not be found. d) Utilization of vaginal, transdermal or oral estrogens or oral contraceptive pills can lead to rash at the application site and can result in blood clots (including blood clots in the lungs) or stroke both of

8 Page: 8 which can be life threatening. This complication is more likely to occur in smokers than non-smokers and in women with other medical conditions. 6. Embryo transfer may cause risks to the woman who will carry the pregnancy including: a) Discomfort, risk of developing infection and possible bleeding. b) A multiple pregnancy (twins, triplets or more) may occur even if only one embryo is transferred. Multiple pregnancies are associated with premature labor, pre-term delivery and increased risks of pregnancy complications for both mother and fetus. c) A pregnancy may implant outside of the uterus, in a fallopian tube (ectopic pregnancy) or elsewhere and require surgery for treatment. 7. Psychological stress. 8. Insurance coverage for any or all of the above procedures may not be available and we (I) will be personally responsible for all expenses of this treatment which are not covered by insurance. Embryo Transfer and Multiple Pregnancies. Transfer of multiple embryos can result in multiple pregnancy (twins, triplets or more), with an increased risk of miscarriage, premature labor and premature birth. A premature delivery may jeopardize the life and long term health of a child and may result in substantial costs both financially and emotionally. Pregnancies with more than one baby in the uterus may also increase the occurrence of pregnancy related medical complications for the woman who will be carrying the pregnancy such as high blood pressure and diabetes. Multiple pregnancy also increases the likelihood that a cesarean section will be required. We (I) understand that the Center follows the American Society for Reproductive Medicine (ASRM) Guidelines on the Number of Embryos Transferred. According to these guidelines, the number of embryos transferred, in each case, will be determined in consultation with the physician, based on our (my) individual circumstances. We (I) further understand that even if a single embryo is transferred there is still the risk of a multiple pregnancy if the embryo further divides resulting in monozygotic or identical twins (or even triplets or more). This risk is quite low but cannot be completely eliminated. Other Considerations: Confidentiality. We (I) understand the confidentiality of medical records, including any photographs, X-rays or recordings, will be maintained in accordance with applicable state and federal laws. We (I) may request our records be released to other physicians. Data from our (my) ART procedure will also be provided to the Centers for Disease Control and Prevention (CDC). The 1992 Fertility Clinic Success Rate and Certification Act requires that CDC collect data on all assisted reproductive technology cycles performed in the United States annually and report success rates using these data. Because sensitive information will be collected on you, CDC applied for and received an assurance of confidentiality for this project under the provisions of the Public Health Service Act, Section 308(d). This means that any information that CDC has that identifies you will not be disclosed to anyone else without your consent. Legal Actions. We (I) understand agree and consent that any legal actions that are required as a result of disagreements between the parties about the disposition or use of sperm, eggs or embryos will be at our (my) expense. We (I) expect this procedure to be performed with not less than the customary standard of care. We (I) understand the risks and benefits as outlined, and further understand and agree that The Center shall be responsible only for acts of negligence on its part and the part of its employees, contractors, and consultants and authorized agents. We (I) understand that the program does not guarantee a pregnancy or a successful pregnancy. We (I) have discussed the program s current success rates with our physician. We (I) have had the opportunity to review this treatment and ask questions of our (my) physician concerning alternatives to IVF, including adoption and no treatment.

9 Page: 9 The nature of IVF/ET has been explained to us (me), together with the known risks. We (I) understand the explanation that has been given to us. We (I) have had the opportunity to ask any questions we (I) might have and those questions have been answered to our (my) satisfaction. Any further questions may be addressed to The Center staff or IVF/ET Program Director, Dr. John Nulsen at We (I) acknowledge that IVF/ET is being performed at our (my) request and with our (my) consent. We (I) represent, agree and acknowledge that we (I) are (am) not married to individuals who are not parties to the informed consents signed as part of these procedures. / / Date Partner #1 Signature Print Name Time: AM/PM / / Date Witnessed By: Print Name Time: AM/PM / / Date Partner #2 Signature Print Name Time: AM/PM / / Date Witnessed By: Print Name Time: AM/PM *** If no partner, write N/A Note: Each Signature Must Be Witnessed Separately Physician Signature: This consent has been discussed with both partners, where applicable. / / Date Physician Signature Time: AM/PM Important: Please check here if a notarized version of this signature page is attached. (Note: it is acceptable for one member of the couple to sign in person in the office and the other to sign notarized version). Initials of CARS Representative

Consent for In Vitro Fertilization

Consent for In Vitro Fertilization Consent for In Vitro Fertilization Print Patient s Name Print Partner s Name We (I), the undersigned, request, authorize and consent to the procedure of In Vitro Fertilization (IVF) and Embryo Transfer

More information

Egg Donation Process, Risks, Consent and Agreement

Egg Donation Process, Risks, Consent and Agreement THE CENTER FOR HUMAN REPRODUCTION (CHR) 21 East 69 th Street, New York, NY 10021 T: 212-994-4400; F: 212-994-4499 Egg Donation Process, Risks, Consent and Agreement Updated on: 10/8/2014 Date: Egg Donor

More information

Consent for Frozen Donor Oocyte In Vitro Fertilization and Embryo Transfer (Recipient)

Consent for Frozen Donor Oocyte In Vitro Fertilization and Embryo Transfer (Recipient) Name of Patient: Name of Partner: We, the Patient and Partner (if applicable) named above, are each over the age of twenty-one (21) years. By our signatures below, I/we request and authorize the performance

More information

CONSENT TO PARTICIPATE IN THE IN VITRO FERTILIZATION-EMBRYO TRANSFER PROGRAM

CONSENT TO PARTICIPATE IN THE IN VITRO FERTILIZATION-EMBRYO TRANSFER PROGRAM CONSENT TO PARTICIPATE IN THE IN VITRO FERTILIZATION-EMBRYO TRANSFER PROGRAM I, after consultation with my physician, request to participate in the In Vitro Fertilization (IVF)-Embryo Transfer (ET) procedures

More information

Egg Donation Process, Risk, Consent and Agreement

Egg Donation Process, Risk, Consent and Agreement Department of Obstetrics and Gynecology Strong Fertility Center Kathleen Hoeger, MD, MPH Director Bala Bhagavath, MD Vivian Lewis, MD John T. Queenan, Jr., MD Wendy Vitek, MD Egg Donation Process, Risk,

More information

In Vitro Fertilization

In Vitro Fertilization Patient Education In Vitro Fertilization What to expect This handout describes how to prepare for and what to expect when you have in vitro fertilization. It provides written information about this process,

More information

In Vitro Fertilization (IVF) Page 1 of 11

In Vitro Fertilization (IVF) Page 1 of 11 In Vitro Fertilization (IVF) Page 1 of 11 This document is a part of your informed consent process. Both partners should read the entire document carefully. In vitro fertilization (IVF) is a treatment

More information

In - Vitro Fertilization Handbook

In - Vitro Fertilization Handbook In - Vitro Fertilization Handbook William F. Ziegler, D.O. Medical Director Scott Kratka, ELD, TS Embryology Laboratory Director Lauren F. Lucas, P.A.-C, M.S. Physician Assistant Frances Cerniak, R.N.

More information

Informed Consent Packet - In Vitro Fertilization (IVF)

Informed Consent Packet - In Vitro Fertilization (IVF) Center for Reproductive Medicine (CRM) Informed Consent Packet - In Vitro Fertilization (IVF) This packet contains the required IVF treatment consent documents. Please read, consider and, if you agree,

More information

Assisted Reproductive Technologies at IGO

Assisted Reproductive Technologies at IGO 9339 Genesee Avenue, Suite 220 San Diego, CA 92121 858 455 7520 Assisted Reproductive Technologies at IGO Although IGO no longer operates an IVF laboratory or program as such, we work closely with area

More information

טופס הסכמה לטיפולי הפרייה חוץ גופית

טופס הסכמה לטיפולי הפרייה חוץ גופית טופס הסכמה לטיפולי הפרייה חוץ גופית CONSENT FORM: IN-VITRO FERTILIZATION (IVF) 1. General In-vitro fertilization is performed in cases of impaired fertility, which may be caused by the following: Obstruction

More information

Risks and complications of assisted conception

Risks and complications of assisted conception Risks and complications of assisted conception August 005 Richard Kennedy British Fertility Society Factsheet www.fertility.org.uk No medical treatment is entirely free from risk and infertility treatment

More information

REPRODUCTIVE MEDICINE AND INFERTILITY ASSOCIATES Woodbury Medical Arts Building 2101 Woodwinds Drive Woodbury, MN 55125 (651) 222-6050

REPRODUCTIVE MEDICINE AND INFERTILITY ASSOCIATES Woodbury Medical Arts Building 2101 Woodwinds Drive Woodbury, MN 55125 (651) 222-6050 REPRODUCTIVE MEDICINE AND INFERTILITY ASSOCIATES Woodbury Medical Arts Building 2101 Woodwinds Drive Woodbury, MN 55125 (651) 222-6050 RECIPIENT COUPLE INFORMED CONSENT AND AUTHORIZATION FOR IN VITRO FERTILIZATION

More information

DARTMOUTH-HITCHCOCK MEDICAL CENTER Lebanon, New Hampshire IN VITRO FERTILIZATION PROCEDURE DESCRIPTION

DARTMOUTH-HITCHCOCK MEDICAL CENTER Lebanon, New Hampshire IN VITRO FERTILIZATION PROCEDURE DESCRIPTION DARTMOUTH-HITCHCOCK MEDICAL CENTER Lebanon, New Hampshire IN VITRO FERTILIZATION PROCEDURE DESCRIPTION I. INTRODUCTION A. The Assisted Reproductive Technology (ART) Program. The ART Program is operated

More information

Symposium on RECENT ADVANCES IN ASSISTED REPRODUCTIVE TECHNOLOGY

Symposium on RECENT ADVANCES IN ASSISTED REPRODUCTIVE TECHNOLOGY Symposium on RECENT ADVANCES IN ASSISTED REPRODUCTIVE TECHNOLOGY Dr Niel Senewirathne Senior Consultant of Obstetrician & Gynaecologist De zoyza Maternity Hospita 1 ART - IVF & ICSI 2 Infertility No pregnancy

More information

, hereby agree to a form of treatment known

, hereby agree to a form of treatment known Patient Consent for Therapy Human In Vitro Fertilization and Embryo Transfer This is to certify that I, as In Vitro Fertilization and Embryo Transfer., hereby agree to a form of treatment known I have

More information

INFORMED CONSENT AND AUTHORIZATION FOR IN VITRO FERTILIZATION OF PREVIOUSLY CRYOPRESERVED OOCYTES

INFORMED CONSENT AND AUTHORIZATION FOR IN VITRO FERTILIZATION OF PREVIOUSLY CRYOPRESERVED OOCYTES INFORMED CONSENT AND AUTHORIZATION FOR IN VITRO FERTILIZATION OF PREVIOUSLY CRYOPRESERVED OOCYTES We, the undersigned, as patient and partner understand that we will be undergoing one or more procedures

More information

Reproductive Technology. Chapter 21

Reproductive Technology. Chapter 21 Reproductive Technology Chapter 21 Assisted Reproduction When a couple is sub-fertile or infertile they may need Assisted Reproduction to become pregnant: Replace source of gametes Sperm, oocyte or zygote

More information

Community Hospital North. Clearvista Dr.

Community Hospital North. Clearvista Dr. 100% IVF Refund Program Community Hospital North Clearvista Dr. N Dr. David Carnovale and Dr. Jeffrey Boldt, along with everyone at Community Reproductive Endocrinology, are committed to providing you

More information

H. Christina Lee, M.D., J.D., H.C.L.D., F.A.C.O.G. 95 Highland Avenue, #100 Telephone (610) 868-8600 Bethlehem, PA 18017 Fax (610) 868-8700

H. Christina Lee, M.D., J.D., H.C.L.D., F.A.C.O.G. 95 Highland Avenue, #100 Telephone (610) 868-8600 Bethlehem, PA 18017 Fax (610) 868-8700 Overview Assisted reproductive technology (ART) The Centers for Disease Control and Prevention (CDC) defines ART to include "all fertility treatments in which both eggs and sperm are handled. In general,

More information

Fertility care for women diagnosed with cancer

Fertility care for women diagnosed with cancer Saint Mary s Hospital Department of Reproductive Medicine Fertility care for women diagnosed with cancer Information For Patients INF/DRM/NUR/16 V1/01/11/2013 1 2 Contents Page Overview 4 Our Service 4

More information

Lesbian Pregnancy: Donor Insemination

Lesbian Pregnancy: Donor Insemination Lesbian Pregnancy: Donor Insemination (Based on an article originally published in the American Fertility Association 2010 National Fertility and Adoption Directory. Much of this information will also

More information

Director, IVF Program, Division of Reproductive Endocrinology & Infertility

Director, IVF Program, Division of Reproductive Endocrinology & Infertility Director, IVF Program, Division of Reproductive Endocrinology & Infertility Date: January 17, 2006 To: From: RE: All IVF candidates Chief, Reproductive Endocrinology & Infertility Criteria for IVF program

More information

IVF OVERVIEW. Tracy Telles, M.D.

IVF OVERVIEW. Tracy Telles, M.D. IVF OVERVIEW By Tracy Telles, M.D. Dr. Hendler: Hello and welcome to KP Healthcast. I m your host Dr. Peter Hendler and today our guest is Dr. Tracy Telles. Dr. Telles is an IVF physician in Kaiser Walnut

More information

Authorized By: Holly C. Bakke, Commissioner, Department of Banking and Insurance.

Authorized By: Holly C. Bakke, Commissioner, Department of Banking and Insurance. INSURANCE DIVISION OF INSURANCE Actuarial Services Benefit Standards for Infertility Coverage Proposed New Rules: N.J.A.C. 11:4-54 Authorized By: Holly C. Bakke, Commissioner, Department of Banking and

More information

CONSENT FORM FOR IN VITRO FERTILIZATION. This consent form provides a description of the treatment that you are undertaking.

CONSENT FORM FOR IN VITRO FERTILIZATION. This consent form provides a description of the treatment that you are undertaking. CONSENT FORM FOR IN VITRO FERTILIZATION INSTRUCTIONS: This consent form provides a description of the treatment that you are undertaking. Read the consent completely. If you have any questions please speak

More information

Artificial insemination with donor sperm

Artificial insemination with donor sperm Artificial insemination with donor sperm Ref. 123 / 2009 Reproductive Medicine Unit Servicio de Medicina de la Reproducción Gran Vía Carlos III 71-75 08028 Barcelona Tel. (+34) 93 227 47 00 Fax. (+34)

More information

Clinical Policy Committee

Clinical Policy Committee Northern, Eastern and Western Devon Clinical Commissioning Group South Devon and Torbay Clinical Commissioning Group Clinical Policy Committee Commissioning policy: Assisted Conception Fertility assessment

More information

KUTTEH KE FERTILITY ASSOCIATES OF MEMPHIS, PLLC AND MEMPHIS FERTILITY LABORATORY, INC.

KUTTEH KE FERTILITY ASSOCIATES OF MEMPHIS, PLLC AND MEMPHIS FERTILITY LABORATORY, INC. 1 of 6 KUTTEH KE FERTILITY ASSOCIATES OF MEMPHIS, PLLC 80 Humphreys Center, Suite 307 Memphis, Tennessee 38120-2363 (901) 747-2229 AND MEMPHIS FERTILITY LABORATORY, INC. IN VITRO FERTILIZATION/EMBRYO TRANSFER

More information

MODEL FORM. [Program s SART Name and Number] INFORMED CONSENT FOR EGG DONORS

MODEL FORM. [Program s SART Name and Number] INFORMED CONSENT FOR EGG DONORS MODEL FORM [Program s SART Name and Number] INFORMED CONSENT FOR EGG DONORS You are agreeing to undergo a cycle of egg donation at [program s SART name]. Do not sign this document if you have not received

More information

Consent for Treatment

Consent for Treatment IVF_Consent_Booklet_Web_5.2015_IVFNE:IVFConsentBook.v2 5/28/2015 11:21 AM Page 1 Assisted Reproduction In Vitro Fertilization Intracytoplasmic Sperm Injection Assisted Hatching Embryo Cryopreservation

More information

Gestational Carrier / Directed Donor In-Vitro Fertilization Handbook

Gestational Carrier / Directed Donor In-Vitro Fertilization Handbook Gestational Carrier / Directed Donor In-Vitro Fertilization Handbook William F. Ziegler, D.O. Medical Director Scott Kratka, ELD, TS Embryology Laboratory Director Lauren F. Lucas, PA-C, M.S Physician

More information

Areas of Concern. Reproductive Ethics: Issues &

Areas of Concern. Reproductive Ethics: Issues & Reproductive Ethics: Issues & Areas of Concern Conception Control: under what conditions is conception control in harmony with a Christian ethic? Genetic Screening & Counseling: under what conditions should

More information

FERTILITY AND AGE. Introduction. Fertility in the later 30's and 40's. Am I fertile?

FERTILITY AND AGE. Introduction. Fertility in the later 30's and 40's. Am I fertile? FERTILITY AND AGE Introduction Delaying pregnancy is a common choice for women in today's society. The number of women in their late 30s and 40s attempting pregnancy and having babies has increased in

More information

Assisted Reproductive Technology

Assisted Reproductive Technology AMERICAN SOCIETY FOR REPRODUCTIVE MEDICINE Assisted Reproductive Technology A Guide for Patients PATIENT INFORMATION SERIES Published by the American Society for Reproductive Medicine under the direction

More information

In Vitro Fertilization Process, Risk, and Consent

In Vitro Fertilization Process, Risk, and Consent Department of Obstetrics and Gynecology Strong Fertility Center Kathleen Hoeger, MD, MPH Director Bala Bhagavath, MD Vivian Lewis, MD John T. Queenan, Jr., MD Wendy Vitek, MD In Vitro Fertilization Process,

More information

Uterine fibroids (Leiomyoma)

Uterine fibroids (Leiomyoma) Uterine fibroids (Leiomyoma) What are uterine fibroids? Uterine fibroids are fairly common benign (not cancer) growths in the uterus. They occur in about 25 50% of all women. Many women who have fibroids

More information

A POWERFUL IN VITRO FERTILIZATION

A POWERFUL IN VITRO FERTILIZATION A POWERFUL During the past 50 years technological advances in the field of bovine reproduction have led to some dramatic changes in the way cattle look, reproduce, perform, and even taste. Artificial Insemination

More information

Age and Fertility. A Guide for Patients PATIENT INFORMATION SERIES

Age and Fertility. A Guide for Patients PATIENT INFORMATION SERIES Age and Fertility A Guide for Patients PATIENT INFORMATION SERIES Published by the American Society for Reproductive Medicine under the direction of the Patient Education Committee and the Publications

More information

European IVF Monitoring (EIM) Year: 2010

European IVF Monitoring (EIM) Year: 2010 European IVF Monitoring (EIM) Year: 2010 Name of country: Poland Name and full address of contact person: Professor Rafal Kurzawa, MD PhD Fertility and Sterility Special Interest Group Polish Gynaecological

More information

MINISTRY OF HEALTH Quality and Service Administration. Fe r t i l i z at i o n. to I n - V i t r o. G u i d e. i n I s r a e l

MINISTRY OF HEALTH Quality and Service Administration. Fe r t i l i z at i o n. to I n - V i t r o. G u i d e. i n I s r a e l MINISTRY OF HEALTH Quality and Service Administration G u i d e to I n - V i t r o Fe r t i l i z at i o n i n I s r a e l Contents Introduction 3 The Natural Fertilization Process 4 In Vitro Fertilization

More information

Education Booklet for Informed Consent for Assisted Reproduction

Education Booklet for Informed Consent for Assisted Reproduction Education Booklet for Informed Consent for Assisted Reproduction In Vitro Fertilization (IVF) Intracytoplasmic Sperm Injection (ICSI) Embryo Freezing Frozen Embryo Transfer Donor Egg/Gestational Carrier

More information

Patient Information: Endometriosis Disease Process and Treatment

Patient Information: Endometriosis Disease Process and Treatment 1 William N. Burns, M. D. Associate Professor Department of Obstetrics & Gynecology Joan C. Edwards School of Medicine Marshall University Huntington, West Virginia, USA Patient Information: Endometriosis

More information

Recent Progress in In Vitro Fertilization and Intracytoplasmic Sperm Injection Technologies in Japan

Recent Progress in In Vitro Fertilization and Intracytoplasmic Sperm Injection Technologies in Japan Research and Reviews Recent Progress in In Vitro Fertilization and Intracytoplasmic Sperm Injection Technologies in Japan JMAJ 52(1): 29 33, 2009 Kaoru YANAGIDA* 1 Abstract The three basic pillars of fertility

More information

INFORMED CONSENT FOR EGG DONORS PRACTITIONER S GUIDE TO USING THE MODEL FORM

INFORMED CONSENT FOR EGG DONORS PRACTITIONER S GUIDE TO USING THE MODEL FORM INFORMED CONSENT FOR EGG DONORS PRACTITIONER S GUIDE TO USING THE MODEL FORM A. GENERAL GUIDELINES AND COMMENTS Purpose and Use of the Model Form This is a guide for practitioners to using the Model Informed

More information

Assisted reproductive technologies (ART) in Canada: 2011 results from the Canadian ART Register

Assisted reproductive technologies (ART) in Canada: 2011 results from the Canadian ART Register 1 Assisted reproductive technologies (ART) in Canada: 2011 results from the Canadian ART Register Joanne Gunby, M.Sc. CARTR Co-ordinator Email: gunbyj@mcmaster.ca Supported by the IVF Directors Group of

More information

Ovarian Cystectomy / Oophorectomy

Ovarian Cystectomy / Oophorectomy Cystectomy and Ovarian Cysts Ovarian cysts are sacs filled with fluids or pockets located on or in an ovary. In some cases, these cysts need to be removed surgically. Types of Cysts Ovarian cysts are quite

More information

Center for Women s Reproductive Care at Columbia University

Center for Women s Reproductive Care at Columbia University Center for Women s Reproductive Care at Columbia University Oocyte Recipients Greetings, Thank you for your interest in the Center for Women s Reproductive Care at Columbia University. We hope that the

More information

SO, WHAT IS A POOR RESPONDER?

SO, WHAT IS A POOR RESPONDER? SO, WHAT IS A POOR RESPONDER? We now understand why ovarian reserve is important and how we assess it, but how is poor response defined? Unfortunately, there is no universally accepted definition for the

More information

IN VITRO FERTILISATION IVF and ICSI

IN VITRO FERTILISATION IVF and ICSI IN VITRO FERTILISATION IVF and ICSI Page 1 of 7 WHAT ARE IVF and ICSI? IVF is short for in vitro fertilisation which means fertilisation outside the body. It usually involves stimulation of the ovaries

More information

it right? activity (page 4) to highlight ethical issues associated with IVF

it right? activity (page 4) to highlight ethical issues associated with IVF IN VITRO FERTILIZATION I V F In some cases, a sperm is directly injected into an egg IVF: THE MEETING OF SPERM AND EGG IN GLASS Louise Brown, the first test tube baby was born in 1978. Since then, there

More information

AGE & FERTILITY: Effective Evaluation & Treatment I. LANE WONG, MD, FACOG. www.hopefertilitycenter.com www.hopeivf.com

AGE & FERTILITY: Effective Evaluation & Treatment I. LANE WONG, MD, FACOG. www.hopefertilitycenter.com www.hopeivf.com Page 1 of 6 AGE & FERTILITY: Effective Evaluation & Treatment I. LANE WONG, MD, FACOG. www.hopefertilitycenter.com www.hopeivf.com Age has a profound effect on female fertility. This is common knowledge,

More information

The following chapter is called "Follow-ups with a Positive or a Negative Pregnancy Test".

The following chapter is called Follow-ups with a Positive or a Negative Pregnancy Test. Slide 1 Welcome to chapter 7. The following chapter is called "Follow-ups with a Positive or a Negative Pregnancy Test". The author is Professor Pasquale Patrizio. Slide 2 This chapter has the following

More information

Specialists In Reproductive Medicine & Surgery, P.A.

Specialists In Reproductive Medicine & Surgery, P.A. Specialists In Reproductive Medicine & Surgery, P.A. www.dreamababy.com Fertility@DreamABaby.com Excellence, Experience & Ethics Egg Donor Consent for Therapy Southwest Florida Egg Donation & Surrogacy

More information

Welcome to chapter 2. The following chapter is called "Indications For IVF". The author is Dr Kamini A. Rao.

Welcome to chapter 2. The following chapter is called Indications For IVF. The author is Dr Kamini A. Rao. Welcome to chapter 2. The following chapter is called "Indications For IVF". The author is Dr Kamini A. Rao. The indications for an IVF treatment have increased since the birth of the first IVF baby. The

More information

Lakeview Endocrinology and Diabetes Consultants. 2719 N Halsted St C-1. Chicago IL 60614 P: 773 388 5685 F: 773 388 5687. www.lakeviewendocrinolgy.

Lakeview Endocrinology and Diabetes Consultants. 2719 N Halsted St C-1. Chicago IL 60614 P: 773 388 5685 F: 773 388 5687. www.lakeviewendocrinolgy. Lakeview Endocrinology and Diabetes Consultants 2719 N Halsted St C-1 Chicago IL 60614 P: 773 388 5685 F: 773 388 5687 www.lakeviewendocrinolgy.com Patient information: Early menopause (premature ovarian

More information

Assignment Discovery Online Curriculum

Assignment Discovery Online Curriculum Assignment Discovery Online Curriculum Lesson title: In Vitro Fertilization Grade level: 9-12, with adaptation for younger students Subject area: Life Science Duration: Two class periods Objectives: Students

More information

Artificial insemination

Artificial insemination Artificial insemination What is involved? Artificial insemination is an assisted reproduction technique that consists of inserting laboratory-treated spermatozoa into the woman s uterus or cervical canal.

More information

Infertility Services Medical Policy For University of Vermont Medical Center and Central Vermont Medical Center employer groups

Infertility Services Medical Policy For University of Vermont Medical Center and Central Vermont Medical Center employer groups Infertility Services Medical Policy For University of Vermont Medical Center and Central Vermont Medical Center employer groups File name: Infertility Services File code: UM.REPRO.01 Last Review: 02/2016

More information

Abnormal Uterine Bleeding

Abnormal Uterine Bleeding Abnormal Uterine Bleeding WOMENCARE A Healthy Woman is a Powerful Woman (407) 898-1500 Abnormal uterine bleeding is one of the most common reasons women see their doctors. It can occur at any age and has

More information

30% Off Cycle 1. Possible Preliminary Discussions With Contract Negotiations

30% Off Cycle 1. Possible Preliminary Discussions With Contract Negotiations Specialists In Reproductive Medicine & Surgery, P.A. www.dreamababy.com Fertility@DreamABaby.com Excellence, Experience & Ethics Gestational Surrogacy Price List (2015) We here at Specialists in Reproductive

More information

Welcome to chapter 8. The following chapter is called "Monitoring IVF Cycle & Oocyte Retrieval". The author is Professor Jie Qiao.

Welcome to chapter 8. The following chapter is called Monitoring IVF Cycle & Oocyte Retrieval. The author is Professor Jie Qiao. Welcome to chapter 8. The following chapter is called "Monitoring IVF Cycle & Oocyte Retrieval". The author is Professor Jie Qiao. The learning objectives of this chapter are 2 fold. The first section

More information

WOMENCARE A Healthy Woman is a Powerful Woman (407) 898-1500. Endometriosis

WOMENCARE A Healthy Woman is a Powerful Woman (407) 898-1500. Endometriosis Endometriosis WOMENCARE A Healthy Woman is a Powerful Woman (407) 898-1500 The lining of the uterus is called the endometrium. Sometimes, endometrial tissue grows elsewhere in the body. When this happens

More information

Fertility Facts and Figures 2008

Fertility Facts and Figures 2008 Fertility Facts and Figures 2008 Contents About these statistics... 2 Accessing our data... 2 The scale of fertility problems... 3 Treatment abroad... 3 Contacts regarding this publication... 3 Latest

More information

ivf Step-by-step through IVF Optimising success Risks and side effects Decisions to be made Managing your cycle

ivf Step-by-step through IVF Optimising success Risks and side effects Decisions to be made Managing your cycle ivf Step-by-step through IVF Optimising success Risks and side effects Decisions to be made Managing your cycle IVF basics What happens in IVF? An IVF treatment cycle can be divided into five steps: 1.

More information

WOMENCARE A Healthy Woman is a Powerful Woman (407) 898-1500. Birth Control Pills

WOMENCARE A Healthy Woman is a Powerful Woman (407) 898-1500. Birth Control Pills Birth Control Pills WOMENCARE A Healthy Woman is a Powerful Woman (407) 898-1500 Birth control pills (also called oral contraceptives or "the pill") are used by millions of women in the United States to

More information

ASSISTED REPRODUCTIVE TECHNOLOGIES (ART)

ASSISTED REPRODUCTIVE TECHNOLOGIES (ART) ASSISTED REPRODUCTIVE TECHNOLOGIES (ART) Dr. Herve Lucas, MD, PhD, Biologist, Andrologist Dr. Taher Elbarbary, MD Gynecologist-Obstetrician Definitions of Assisted Reproductive Technologies Techniques

More information

East and North Hertfordshire CCG Fertility treatment and referral criteria for tertiary level assisted conception. December 2014

East and North Hertfordshire CCG Fertility treatment and referral criteria for tertiary level assisted conception. December 2014 East and North Hertfordshire CCG Fertility treatment and referral criteria for tertiary level assisted conception December 2014 1 1. Introduction This policy sets out the entitlement and service that will

More information

Illinois Insurance Facts Illinois Department of Financial and Professional Regulation Division of Insurance

Illinois Insurance Facts Illinois Department of Financial and Professional Regulation Division of Insurance Illinois Insurance Facts Illinois Department of Financial and Professional Regulation Division of Insurance Insurance Coverage for Infertility Treatment Revised November 2004 Infertility is a condition

More information

Final Version Two (Sept 2014) Eastern Cheshire Clinical Commissioning Group NHS Funded Treatment for Subfertility Policy

Final Version Two (Sept 2014) Eastern Cheshire Clinical Commissioning Group NHS Funded Treatment for Subfertility Policy Final Version Two (Sept 2014) Eastern Cheshire Clinical Commissioning Group NHS Funded Treatment for Subfertility Policy NHS FUNDED TREATMENT FOR SUBFERTILITY ELIGIBILITY CRITERIA Table of Contents 1.

More information

How do fertility drugs work?

How do fertility drugs work? How do fertility drugs work? Under normal circumstances, ovulation occurs once a month when a ripened egg which is ready to be fertilised is released from the ovaries. For couples who are trying to conceive,

More information

Nordic Fertility Society. Quality Guide. Checklist for ART Clinic and ART laboratory

Nordic Fertility Society. Quality Guide. Checklist for ART Clinic and ART laboratory Nordic Fertility Society Quality Guide Checklist for ART Clinic and ART laboratory Yes, not-applicable, No CLINICAL CHECK LIST PATIENT INFORMATION Is there a printed patient information on: Ovarian Stimulation?

More information

50% Off Cycle 3 $ 9,900 $ 8,700 $ 7,500

50% Off Cycle 3 $ 9,900 $ 8,700 $ 7,500 Specialists In Reproductive Medicine & Surgery, P.A. www.dreamababy.com Fertility@DreamABaby.com Excellence, Experience & Ethics In Vitro Fertilization Price List (2015) We here at Specialists in Reproductive

More information

Frequently Asked Questions About Ovarian Cancer

Frequently Asked Questions About Ovarian Cancer Media Contact: Gerri Gomez Howard Cell: 303-748-3933 gerri@gomezhowardgroup.com Frequently Asked Questions About Ovarian Cancer What is ovarian cancer? Ovarian cancer is a cancer that forms in tissues

More information

Ehlers-Danlos Syndrome Fertility Issues. Objectives

Ehlers-Danlos Syndrome Fertility Issues. Objectives Ehlers-Danlos Syndrome Fertility Issues Baltimore Inner Harbor Independence Day Brad Hurst, M.D. Professor Reproductive Endocrinology Carolinas Medical Center - Charlotte, North Carolina Objectives Determine

More information

Ovarian Cyst. Homoeopathy Clinic. Introduction. Types of Ovarian Cysts. Contents. Case Reports. 21 August 2002

Ovarian Cyst. Homoeopathy Clinic. Introduction. Types of Ovarian Cysts. Contents. Case Reports. 21 August 2002 Case Reports 21 August 2002 Ovarian Cyst Homoeopathy Clinic Check Yourself If you have any of the following symptoms call your doctor. Sense of fullness or pressure or a dull ache in the abdomen Pain during

More information

European IVF Monitoring (EIM) Year: 2008

European IVF Monitoring (EIM) Year: 2008 European IVF Monitoring (EIM) Year: 2008 Name of country POLAND Name and full address of contact person. professor Rafal Kurzawa MD PhD Fertility and Sterility Special Interest Group Polish Gynaecological

More information

OVARIAN CYSTS. Types of Ovarian Cysts There are many types of ovarian cysts and these can be categorized into functional and nonfunctional

OVARIAN CYSTS. Types of Ovarian Cysts There are many types of ovarian cysts and these can be categorized into functional and nonfunctional OVARIAN CYSTS Follicular Cyst Ovarian cysts are fluid-filled sacs that form within or on the ovary. The majority of these cysts are functional meaning they usually form during a normal menstrual cycle.

More information

Forming families for over 20 years IN VITRO. www.ctfertility.com

Forming families for over 20 years IN VITRO. www.ctfertility.com Forming families for over 20 years IN VITRO fertilization www.ctfertility.com Forming families for over 20 years Michael B. Doyle, M.D. Medical Director Introduction to IN VITRO fertilization Contents

More information

Assisted reproductive technology in Australia and New Zealand 2010

Assisted reproductive technology in Australia and New Zealand 2010 Assisted reproductive technology in Australia and New Zealand 2010 ASSISTED REPRODUCTION SERIES Number 16 Assisted reproductive technology in Australia and New Zealand 2010 Alan Macaldowie Yueping A Wang

More information

Pre-implantation Genetic Diagnosis (PGD)

Pre-implantation Genetic Diagnosis (PGD) Saint Mary s Hospital Department of Genetic Medicine Saint Mary s Hospital Pre-implantation Genetic Diagnosis (PGD) Information For Patients What is PGD? Pre-implantation genetic diagnosis (PGD) is a specialised

More information

Consent to Perform Preimplantation Genetic Screening (PGS) using. Comparative Genomic Hybridization (acgh) or Next Generation Sequencing (NGS)

Consent to Perform Preimplantation Genetic Screening (PGS) using. Comparative Genomic Hybridization (acgh) or Next Generation Sequencing (NGS) Consent to Perform Preimplantation Genetic Screening (PGS) using Array Comparative Genomic Hybridization (acgh ) or Next Generation Sequencing (NGS) Purpose The purpose of Preimplantation Genetic Screening

More information

Introduction Ovarian cysts are a very common female condition. An ovarian cyst is a fluid-filled sac on an ovary in the female reproductive system.

Introduction Ovarian cysts are a very common female condition. An ovarian cyst is a fluid-filled sac on an ovary in the female reproductive system. Ovarian Cysts Introduction Ovarian cysts are a very common female condition. An ovarian cyst is a fluid-filled sac on an ovary in the female reproductive system. Most women have ovarian cysts sometime

More information

Ethical issues in assisted reproductive technologies. Effy Vayena

Ethical issues in assisted reproductive technologies. Effy Vayena Ethical issues in assisted reproductive technologies Effy Vayena Assisted Reproductive Technologies (ART) All treatments or procedures that include the in vitro handling of human oocytes and human sperm

More information

IN VITRO FERTILIZATION (IVF) GAMETE INTRAFALLOPIAN TRANSFER (GIFT)

IN VITRO FERTILIZATION (IVF) GAMETE INTRAFALLOPIAN TRANSFER (GIFT) -1- IN VITRO FERTILIZATION (IVF) GAMETE INTRAFALLOPIAN TRANSFER (GIFT) Information for the Patient PHYSICIANS: William H. Kutteh, M.D., Ph.D. Diplomat - American Board of Obstetrics and Gynecology Subspecialty

More information

Section IV Financial Information

Section IV Financial Information Section IV Financial Information Payment In keeping with our desire to streamline and simplify IVF billing for you it is necessary to collect the full amount for in vitro fertilization before you start

More information

Endometriosis, Fertility and Pregnancy

Endometriosis, Fertility and Pregnancy This leaflet covers endometriosis and fertility. It provides information for women who have been diagnosed with endometriosis who would like to know if and how this can affect their fertility, and for

More information

CENTER FOR SPECIAL MINIMALLY INVASIVE SURGERY Camran Nezhat, MD and Associates 900 Welch Road, Suite 403 Palo Alto, CA 94304 (650) 327-8778

CENTER FOR SPECIAL MINIMALLY INVASIVE SURGERY Camran Nezhat, MD and Associates 900 Welch Road, Suite 403 Palo Alto, CA 94304 (650) 327-8778 CENTER FOR SPECIAL MINIMALLY INVASIVE SURGERY Camran Nezhat, MD and Associates 900 Welch Road, Suite 403 Palo Alto, CA 94304 (650) 327-8778 PATIENT HISTORY FORM Today s Date ** Please complete this form

More information

Birth after previous caesarean. What are my choices for birth after a caesarean delivery?

Birth after previous caesarean. What are my choices for birth after a caesarean delivery? Birth after previous caesarean Information for you Published September 2008 What are my choices for birth after a caesarean delivery? More than one in five women (20%) in the UK currently give birth by

More information

FREQUENTLY ASKED QUESTIONS ABOUT IVF

FREQUENTLY ASKED QUESTIONS ABOUT IVF FREQUENTLY ASKED QUESTIONS ABOUT IVF Is there something we can do to improve our chances of succes? Even though IVF treatment is a medical process on which you have no influence, there are a number of

More information

Causes for unintentional childlessness

Causes for unintentional childlessness Causes for unintentional childlessness We can define fertility as the inability to become pregnant after one year of regular sexual intercourse. The causes of infertility are evenly distributed among men

More information

Fertility-related choices. A decision aid for younger women with early breast cancer

Fertility-related choices. A decision aid for younger women with early breast cancer Fertility-related choices A decision aid for younger women with early breast cancer Fertility-related choices Section 1 About this booklet 1 Overview 3 Summary of fertility options 4 Section 2 Some background

More information

Birth Control Options

Birth Control Options 1 of 5 6/2/2014 9:46 AM Return to Web version Birth Control Options What is contraception? Contraception means preventing pregnancy, also called birth control. Most people know about options such as birth

More information

Female Reproductive System. Unit 8 Lesson 2 Continued

Female Reproductive System. Unit 8 Lesson 2 Continued Female Reproductive System Unit 8 Lesson 2 Continued Female Reproductive System Female Reproductive System Female produce ovum or egg cells. The egg (ovum) cell is the female sex cell. Female Reproductive

More information

Our laboratory guide for you and your embryos

Our laboratory guide for you and your embryos Lab guide Our laboratory guide for you and your embryos We hope that this guide will give you a better understanding of the journey you and your embryos will take through our laboratory, and help you contribute

More information

Clinical Reference Group Quality & Safety Committee Governing Body. Policy Screened

Clinical Reference Group Quality & Safety Committee Governing Body. Policy Screened Fertility Policy 1 SUMMARY This policy is intended to support individuals and couples who want to become parents but who have a possible pathological problem (physical or psychological) leading to them

More information

Guide to IVF Laboratory Results

Guide to IVF Laboratory Results Guide to IVF Laboratory Results PACIFIC CENTRE FOR REPRODUCTIVE MEDICINE 500-4601 Canada Way, Burnaby BC V5G 4X7 LAB-416-20140122-1 The following information will guide you through what results to expect

More information

patient education Fact Sheet PFS007: BRCA1 and BRCA2 Mutations MARCH 2015

patient education Fact Sheet PFS007: BRCA1 and BRCA2 Mutations MARCH 2015 patient education Fact Sheet PFS007: BRCA1 and BRCA2 Mutations MARCH 2015 BRCA1 and BRCA2 Mutations Cancer is a complex disease thought to be caused by several different factors. A few types of cancer

More information

Tower Hamlets CCG Fertility policy

Tower Hamlets CCG Fertility policy Tower Hamlets CCG Fertility policy Approved December 2014 Introduction Tower Hamlets CCG is responsible for commissioning a range of health services including hospital, mental health and community services

More information

The Menstrual Cycle. Model 1: Ovarian Cycle follicular cells

The Menstrual Cycle. Model 1: Ovarian Cycle follicular cells The Menstrual Cycle REVIEW questions to complete before starting this POGIL activity 1. Gonads produce both gametes and sex steroid hormones. For the female, name the: A. gonads ovaries B. gametes oocyte/ovum/egg

More information