Do you have embryos or eggs frozen at another IVF center?
If YES, how many, and at which center?
PRIOR FRESH IVF CYCLE HISTORY
PLEASE LIST YOUR IVF CYCLE IN ORDER FROM 1 ‐ X, AND TELL US FOR EACH CYCLE THE APPROXIMATE DATE STARTED, THE CENTER WHERE PERFORMED (IF POSSIBLE THE NAME OF TREATING PHYSICIAN), WHETHER THE CYCLE REACHED EGG RETRIEVAL, HOW MANY EGGS WERE OBTAINED, HOW MANY FERTILIZED, WHETHER YOU HAD AN EMBRYO TRANSFER, IF NOT, WHY NOT, HOW MANY EMBRYOS WERE TRANSFERRED, WHETHER AND HOW MANY EMBRYOS WERE CRYOPRESERVED, AND WHAT YOU WERE TOLD ABOUT THE QUALITY OF TRANSFERRED EMBRYOS. PLEASE DO NOT LIST HERE FROZEN‐TAHAWED IVF CYCLES.
Add Cycle
Did any of your IVF cycles result in freezing of embryos?
If YES, which cycles (refer to above cycle numbers), and list how many embryos were frozen in that cycle.
Did any of your IVF cycles involve culturing your embryos to blastocyst stage (day‐5)?
If YES, which cycles (refer to above cycle numbers)
Did any of your IVF cycles involve the use of preimplantation genetic diagnosis or screening (PGD/PGS)?
If YES, which cycles (refer to above cycle numbers)
Were any of your IVF cycles accompanied by complications, hospitalizations or other
unusual events?
If YES, please describe (and refer to above cycle numbers).
ADDITIONAL COMMENTS
