[p.1 of Form (8)] SAMP Consent to Designated Donation of Sperm. 1. I (name of donor) (hereinafter
|
|
- Linda Barton
- 5 years ago
- Views:
Transcription
1 [p.1 of Form (8)] SAMP Consent to Designated Donation of Sperm Part I DONOR S CONSENT 1. I (name of donor) (hereinafter (Surname, Given s) (ID No.) called the Donor ), DO HEREBY CONSENT to donating my sperm to the following couple (hereinafter called the Recipients ), (Surname, Given s) (ID No.) (husband s name), and (wife s name), (Surname, Given s) (ID No.) with the understanding that my sperm will be used for the treatment of the Recipients and that this consent cannot be revoked or varied once my sperm has been donated, subject to any written agreement to the contrary between the Donor and the Recipients. 2. I acknowledge that the nature and implications of my donation have been explained to me by and I have been given the opportunity to ask any question I wish. I have also been offered a suitable opportunity to take part in counselling with about the implications of the donation. 3. I understand that my sperm will be stored for a maximum period of 2 years from the date of freezing the sperm. If the aforesaid treatment of the Recipients cannot be successfully carried out within that period, or if before the expiry of the said maximum storage period, it becomes impossible for any reason whatsoever for the aforesaid treatment to be successfully carried out, or if excess sperm remains after the completion of the aforesaid treatment, I consent that the sperm obtained from me may be (please tick one) - [ ] disposed of in accordance with the Guidelines on disposal of gametes or embryos ( the Guidelines ) in the Code of Practice on Reproductive Technology and Embryo Research published from time to time by the Council on Human Reproductive Technology. [ ] donated anonymously for the treatment of other infertile couples, in which event my sperm would not be used to produce more than a total of 1/2/3* live birth events, including the event of the designated donation, if successful (failing which the Centre may dispose of the stored sperm in accordance with the Guidelines). [ ] donated for research (failing which the Centre may dispose of the stored sperm in accordance with the Guidelines). [ ] donated for quality control and/or training (failing which the Centre may dispose of the stored sperm in accordance with the Guidelines). 4.# I understand that the embryo(s) produced from the fertilization of my sperm will be used for the infertility treatment of the Recipients. If the aforesaid treatment cannot be successfully carried out, or if it becomes impossible for any reason whatsoever for the
2 [p.2 of Form (8)] aforesaid treatment to be successfully carried out, or if excess embryo(s) remain after the completion of the aforesaid treatment, I consent that the embryo(s) produced from the aforesaid fertilization may be handled in accordance with the Recipients instructions, as set out in para. 12 hereof. 5. I understand that under the Parent & Child Ordinance (Cap. 429), I shall not be the legal father of the child(ren) born from my donated sperm. I also agree never to seek to make any claim over such child(ren) under any circumstance whatsoever. 6. To the best of my knowledge and belief - (a) I am in good health and have no communicable disease or hereditary disorder, except as follows - (b) None of my relatives has ever suffered from any inheritable disease, except as follows - 7. For the purpose of determining whether I am suitable as a donor of sperm, I consent to undergoing such blood tests (including HIV test) and medical examinations as shall be prescribed by the Centre. 8. I acknowledge that the Information Sheets at Appendices X and XI of the Code of Practice on Reproductive Technology and Embryo Research have been read by me/explained to me*. I fully understand the contents of the Information Sheets and I agree that my personal data and information may be used for the purposes as set out therein.
3 [p.3 of Form (8)] Dated the day of (Month) (Year) Date of Birth (Donor s Signature) (dd/mm/yy) (Signature of Attending Doctor) (Signature of Witness) Position
4 [p.4 of Form (8)] Part II RECIPIENTS CONSENT 9. We (the Recipients), (husband s name), (Surname, Given s) (ID No.) and (wife s name), (Surname, Given s) (ID No.) of (address), being lawfully married and desirous of having a child, DO HEREBY CONSENT to receiving the sperm donated by (Surname, Given s) (ID No.) (the Donor) for infertility treatment. 10. We acknowledge that the nature and implications of the aforesaid treatment have been explained to us by and we have been given the opportunity to ask any question we wish. We have also been offered a suitable opportunity to take part in counselling with about the implications of the donation. 11. We fully understand and accept that - (a) the aforesaid treatment procedure may not result in a successful pregnancy; (b) the wife may not be able to carry the pregnancy to term; and (c) any child conceived or born as a result of the procedures may suffer from defect(s) of health or mental or physical impairment(s) as a result of congenital, hereditary or other reasons, similar to the situation of a normal pregnancy. 12.# We understand that the embryo(s) produced from the fertilization of the gametes of (please specify names of persons who are the origins of the gametes) will be used for the aforesaid infertility treatment and stored for such purpose for a maximum period of 2 years from the date of freezing the embryos, unless there are special circumstances justifying a longer storage period. If the aforesaid treatment cannot be successfully carried out within that period, or if, before the expiry of the said maximum storage period, it becomes impossible for any reason whatsoever for the aforesaid treatment to be successfully carried out, or if excess embryo(s) remain after completion of the aforesaid treatment, we consent that the embryo(s) produced from the aforesaid fertilization may be (please tick one) - [ ] disposed of in accordance with the Guidelines on disposal of gametes or embryos ( the Guidelines ) in the Code of Practice on Reproductive Technology and Embryo Research published from time to time by the Council on Human Reproductive Technology. [ ] donated anonymously for the treatment of other infertile couples, in which event the embryo(s) would not be used to produce more than a total of 1/2/3 * live birth events Note, including the event of the designated donation, if successful (failing which the Centre may dispose of the embryo(s) in accordance with the Guidelines).
5 [p.5 of Form (8)] [ ] donated for research (failing which the Centre may dispose of the embryo(s) in accordance with the Guidelines). [ ] donated for quality control and/or training (failing which the Centre may dispose of the embryo(s) in accordance with the Guidelines). 13. We understand that under the Parent & Child Ordinance (Cap. 429), we shall be the legal parents of the child(ren) born from the aforesaid treatment procedure. 14. We acknowledge that the Information Sheets at Appendices X and XI of the Code of Practice on Reproductive Technology and Embryo Research have been read by us/explained to us*. We fully understand the contents of the Information Sheets and we agree that our personal data and information may be used for the purposes as set out therein. Dated the day of (Month) (Year) (Husband s Signature) (Wife s Signature) Marriage Certificate No. (Signature of Attending Doctor) (Signature of Witness) Position * Delete whichever is inapplicable. # To be completed only if the embryo(s) were produced from the wife s egg(s) (oocytes). Note : If the Donor has indicated to donate surplus or unused sperm to other infertile couple, the limit of live birth event specified by the donor in para. 3 should also be considered for the case which the Recipients indicate to donate the surplus or unused embryos to other infertile couple. The total no. of live birth events produced by the excess sperm and embryos subsequently created should not be more than 3.
Counseling for Potential Clients of RT Services
Assisted Reproductive Technology Unit Department of Obstetrics and Gynaecology The Chinese University of Hong Kong The Prince of Wales Hospital Counseling for Potential Clients of RT Services Husband s
More informationFemale Patient Name: Social Security # Male Patient Name: Social Security #
Female Patient Name: Social Security # Male Patient Name: Social Security # THE CENTER FOR HUMAN REPRODUCTION (CHR) ILLINOIS/NEW YORK CITY * ASSISTED REPRODUCTIVE TECHNOLOGIES PROGRAM (A.R.T.) CRYOPRESERVATION
More informationMen s consent to the use and storage of sperm or embryos for surrogacy
HFEA MSG form Men s consent to the use and storage of sperm or embryos for surrogacy About this form This form is produced by the Human Fertilisation and Embryology Authority (HFEA), the UK s independent
More information[Act on Artificial Fertilisation and use of Human Gametes and Embryos for Stem-Cell Research] 1) No. 55/1996 1) Act No. 27/2008, Article 9
[Act on Artificial Fertilisation and use of Human Gametes and Embryos for Stem-Cell Research] 1) No. 55/1996 1) Act No. 27/2008, Article 9 as amended by Act No. 65/2006, Act No. 27/2008, Act No. 54/2008,
More informationCONSENT FOR CRYOPRESERVATION OF EMBRYOS
CONSENT FOR CRYOPRESERVATION OF EMBRYOS We, (Female Partner) and (Partner, Spouse), as participants in the in vitro fertilization (IVF) program at the Reproductive fertility center (REPRODUCTIVE FERTILITY
More informationCONSENT FOR ASSISTED REPRODUCTION In Vitro Fertilization, Intracytoplasmic Sperm Injection, Assisted Hatching, Embryo Freezing and Disposition
CONSENT F ASSISTED REPRODUCTION In Vitro Fertilization, Intracytoplasmic Sperm Injection, Assisted Hatching, Embryo Freezing and Disposition Please read the following consent carefully. If you do not understand
More informationMST and PNT allow eggs or embryos to be created for you containing your and your partner s nuclear genetic material D D M M Y Y D D M M Y Y
This form is produced by the Human Fertilisation and Embryology Authority (HFEA), the UK s independent regulator of fertility treatment and human embryo research. For more information about us, visit www.hfea.gov.uk.
More informationConsent for In Vitro Fertilization (IVF), Intracytoplasmic Sperm Injection (ICSI), and Embryo Cryopreservation/Disposition
Consent for In Vitro Fertilization (IVF), Intracytoplasmic Sperm Injection (ICSI), and Embryo Cryopreservation/Disposition Patient Name (please print) Patient DOB (MM/DD/YYYY) Patient eivf number Partner
More informationFill in this form if you are donating eggs and/or embryos created with your eggs for use in another person s mitochondrial donation
This form is produced by the Human Fertilisation and Embryology Authority (HFEA), the UK s independent regulator of fertility treatment and human embryo research. For more information about us, visit www.hfea.gov.uk.
More informationTHE CENTER FOR ADVANCED REPRODUCTIVE SERVICES (CARS) (The Center) CONSENT TO PERFORM THERAPEUTIC DONOR INSEMINATION WITH ANONYMOUS DONOR SPERM
THE CENTER FOR ADVANCED REPRODUCTIVE SERVICES (CARS) (The Center) CONSENT TO PERFORM THERAPEUTIC DONOR INSEMINATION WITH ANONYMOUS DONOR SPERM Partner #1 Last Name (Surname): Partner #1 First Name: Partner
More informationWomen s consent to the use and storage of eggs or embryos for surrogacy
Women s consent to the use and storage of eggs or embryos for surrogacy HFEA WSG form About this form This form is produced by the Human Fertilisation and Embryology Authority (HFEA), the UK s independent
More informationUNIVERSITY OF WASHINGTON MEDICAL CENTER Men s Health Center and Male Fertility Laboratory Sperm & Testis Cryopreservation Program Patient NAME and ID
UNIVERSITY OF WASHINGTON MEDICAL CENTER Men s Health Center and Male Fertility Laboratory Sperm & Testis Cryopreservation Program Patient NAME and ID CONSENT FOR MINOR s SPERM OR TESTIS CRYOPRESERVATION
More informationYour consent to donating your eggs
HFEA WD form (Gender-neutral version) Your consent to donating your eggs About this form This form is produced by the Human Fertilisation and Embryology Authority (HFEA), the UK s independent regulator
More informationConsent to Shipment of Frozen Embryos to and Short Term Storage of Frozen Embryos at the Family Fertility Center
1. Background On or about and requested clinic and treating physician) at (date), name(s) of parties underwent IVF treatment) (name of (address of clinic) to perform in vitro fertilization using: a. Oocyte
More informationD D M M Y Y D D M M Y Y. For clinic use only (optional) MD PNT only (gender-neutral): version 1; 3 April 2017
This form is produced by the Human Fertilisation and Embryology Authority (HFEA), the UK s independent regulator of fertility treatment and human embryo research. For more information about us, visit www.hfea.gov.uk.
More information3. Party/Parties requesting embryo donation for reproductive purpose
1. Background On or about (date), and (name(s) of parties requesting IVF treatment) requested (name of clinic and treating physician) at (address of clinic) to perform in vitro fertilization using: a.
More informationYour consent to the use of your sperm in artificial insemination
HFEA MGI form Your consent to the use of your sperm in artificial insemination About this form This form is produced by the Human Fertilisation and Embryology Authority (HFEA), the UK s independent regulator
More informationYour consent to your sperm and embryos being used in treatment and/or stored (IVF and ICSI)
HFEA MT form (Gender-neutral version) Your consent to your sperm and embryos being used in treatment and/or stored (IVF and ICSI) About this form This form is produced by the Human Fertilisation and Embryology
More informationFERTILITY CENTERS OF ILLINOIS FCI AND GAMETE RESOURCES, INC. - GRI TRANSFER/RECEIPT OF CRYOPRESERVED SPECIMEN(S) Address, City State, Zip
We, and, as rightful and legal owners, Patient Partner (if applicable) have made arrangements to have myour cryopreserved (frozen) specimen(s) transferred to Gamete Resources, Inc. for the purposes of
More informationWithdrawing your consent
HFEA WC form Withdrawing your consent About this form This form is produced by the Human Fertilisation and Embryology Authority (HFEA), the UK s independent regulator of fertility treatment and human embryo
More informationTHE CENTER FOR ADVANCED REPRODUCTIVE SERVICES (CARS) (The Center) CONSENT TO PERFORM THERAPEUTIC DONOR INSEMINATION WITH IDENTIFIED DONOR SPERM
THE CENTER FOR ADVANCED REPRODUCTIVE SERVICES (CARS) (The Center) CONSENT TO PERFORM THERAPEUTIC DONOR INSEMINATION WITH IDENTIFIED DONOR SPERM Partner #1 Last Name (Surname): Partner #1 First Name: Partner
More informationCONSENT In Vitro Fertilization, Intracytoplasmic Sperm Injection, Assisted Hatching, and Embryo Cryopreservation/Disposition
CONSENT In Vitro Fertilization, Intracytoplasmic Sperm Injection, Assisted Hatching, and Embryo Cryopreservation/Disposition Please Print PATIENT Name: Patient DOB: _/ _/ Patient eivf number: PARTNER Name
More informationConsent for In Vitro Fertilization with Donor Oocyte: Donor - Patient/Husband
with Donor Oocyte: Donor - Patient/Husband Name of Patient: Name of Partner: I, the Patient, and my husband (if applicable) named above, are each over the age of twenty-one (21) years. I am a healthy female
More informationCONSENT TO CRYOPRESERVATION AND STORAGE OF HUMAN EMBRYOS
1. Name(s) of Party/Parties A. Party/parties requesting freezing of embryos a. Couple We, and of County, City of in the state of are (married or domestic partners) and are over the age of twenty-one years.
More informationYour consent to disclosing identifying information
Your consent to disclosing identifying information HFEA CD form About this form This form is produced by the Human Fertilisation and Embryology Authority (HFEA), the UK s independent regulator of fertility
More informationYour consent to the storage of your eggs or sperm
Your consent to the storage of your eggs or sperm HFEA GS form About this form This form is produced by the Human Fertilisation and Embryology Authority (HFEA), the UK s independent regulator of fertility
More informationWomen s consent to treatment and storage form (IVF and ICSI)
Women s consent to treatment and storage form (IVF and ICSI) HFEA WT form About this form This form is produced by the Human Fertilisation and Embryology Authority (HFEA), the UK s independent regulator
More informationTHE LAW - CONCEPTION USING DONOR EGGS OR SPERM
Assisted Conception Unit 11 th Floor, Tower Wing Guy s Hospital, Great Maze Pond London SE1 9RT Tel:.020 7188 2300 Fax: 020 7188 0490 THE LAW - CONCEPTION USING DONOR EGGS OR SPERM Introduction If you
More informationSperm Donation Patient Information Becoming a sperm donor
Sperm Donation Patient Information Becoming a sperm donor b Contents Introduction 2 General information 2 What is sperm donation? 2 Who can use donated sperm? 2 Who can be a sperm donor? 2 Can I be paid
More informationCRYOPRESERVATION OF SEMEN FROM TESTICULAR TISSUE
INFERTILITY & IVF MEDICAL ASSOCIATES OF WESTERN NEW YORK CRYOPRESERVATION OF SEMEN FROM TESTICULAR TISSUE BUFFALOIVF.COM When you have scheduled your appointment with Dr Crickard or Dr Sullivan to sign
More informationIN VITRO FERTILIZATION (ICSI) WITH PREIMPLANTATION GENETIC DIAGNOSIS (PGD) CONSENT DOCUMENT SPANISH FERTILITY SOCIETY
IN VITRO FERTILIZATION (ICSI) WITH PREIMPLANTATION GENETIC DIAGNOSIS (PGD) CONSENT DOCUMENT SPANISH FERTILITY SOCIETY Ms. an adult with national I.D./passport no., marital status, and Mr. an adult with
More informationIntroduction 4. Important information about consent to legal parenthood 7. Women s consent to treatment and storage form (IVF and ICSI) (WT form) 9
Introduction 4 Important information about consent to legal parenthood 7 Women s consent to treatment and storage form (IVF and ICSI) (WT form) 9 Men s consent to treatment and storage form (IVF and ICSI)
More informationSection III Consent Forms
Section III Consent Forms Please read the consents prior to your IVF consultation appointment. Most people have questions regarding the consent forms. Your questions will be addressed during the appointment.
More informationGuide to Good Practice in fertility cases
2018 Guide to Good Practice in fertility cases This Guidance was reviewed in March 2018. The law or procedure may have changed since that time and members should check the up-to-date position. Resolution
More informationPreimplantation Genetic Testing (PGT) Fresh and Frozen Embryos Process, Risk, and Consent
Preimplantation Genetic Testing (PGT) Fresh and Frozen Embryos Process, Risk, and Consent PGT analysis is offered to patients that seek to identify a chromosomal abnormality in their embryos prior to initiating
More informationPage 1 of 5 Egg Freezing Informed Consent Form version 2018 Main Line Fertility Center. Egg Freezing. Informed Consent Form
Page 1 of 5 Egg Freezing Informed Consent Form version 2018 Egg Freezing Informed Consent Form Embryos and sperm have been frozen and thawed with good results for many years. Egg (oocyte) freezing is a
More informationWHAT YOU NEED TO KNOW ABOUT DONATING SPERM, EGGS OR EMBRYOS
14 February 2006 WHAT YOU NEED TO KNOW ABOUT DONATING SPERM, EGGS OR EMBRYOS Introduction The donation of sperm, eggs or embryos to help a couple have a child is one of the most generous gifts anyone can
More informationRecommended Interim Policy Statement 150: Assisted Conception Services
Southampton City Clinical Commissioning Group (CCG) took on commissioning responsibility for Assisted Conception Services from 1 April 2013 for its population and agreed to adopt the interim policy recommendations
More informationInformation for Recipient of Donor Oocytes
Introduction Thank you for expressing an interest as an oocyte recipient in our oocyte donation program at the Family Fertility Center. Our successful program was established since 1994 and is directed
More informationTHE ASSISTED REPRODUCTIVE TECHNOLOGY (REGULATION) BILL, 2008 AN ACT
THE ASSISTED REPRODUCTIVE TECHNOLOGY (REGULATION) BILL, 2008 AN ACT to provide for a national framework for the regulation and supervision of assisted reproductive technology and matters connected therewith
More information(Tentative Translation)
(Tentative Translation) Public Notice of the Ministry of Education, Culture, Sports, Science and Technology (MEXT) and the Ministry of Health, Labour and Welfare (MHLW) No. 2 of December 17, 2010 Table
More informationDirector of Commissioning, Telford and Wrekin CCG and Shropshire CCG. Version No. Approval Date August 2015 Review Date August 2017
Commissioning Policy for In Vitro Fertilisation (IVF)/ Intracytoplasmic Sperm Injection (ICSI) within tertiary Infertility Services, in Shropshire and Telford and Wrekin Owner(s) Version No. Director of
More informationCONSENT TO SERVE AS A DIRECTED DONOR OF SEMEN
CONSENT TO SERVE AS A DIRECTED DONOR OF SEMEN 1. PERMISSION. I, hereby consent to act as a directed donor of semen ( Specimens ) for the sole use by ( Recipient ) and ( Partner ) in artificial insemination
More information17. Storage of gametes and embryos
17. Storage of gametes and embryos This guidance note contains: Mandatory requirements Extracts from the HFE Act 1990 (as amended) Extracts from licence conditions Reference to relevant HFEA Directions
More informationSperm Donation - Information for Donors
Sperm Donation - Information for Donors The donation of sperm to help someone to have a child is one of the most generous gifts anyone can give. Many donors feel a sense of pride, knowing the joy they
More informationClinical Policy Committee
Clinical Policy Committee Commissioning policy: Assisted Conception Fertility assessment and investigations are commissioned where: A woman is of reproductive age and has not conceived after one (1) year
More informationGAMETE STORAGE. Reviewing body Review date Version no
GAMETE STORAGE Document History Date of publication July 2016 Version Number: V1 Review date July 2018 Consultation Consultee Which group Public health INPUT Derbyshire Affiliated Commissioning Committee
More informationSperm donation Oocyte donation. Hong Kong þ Guideline þ þ Hungary þ þ þ þ Israel þ þ þ þ Italy þ þ þ. Germany þ þ þ þ Greece þ þ þ þ
CHAPTER 8: Donation Although there has been a reduction in the use of donor sperm because of ICSI and the impact of the removal of anonymity in some countries (1), sperm donation is still used and has
More informationBlackpool CCG. Policies for the Commissioning of Healthcare. Assisted Conception
1 Introduction Blackpool CCG Policies for the Commissioning of Healthcare Assisted Conception 1.1 This policy describes circumstances in which NHS Blackpool Clinical Commissioning Group (CCG) will fund
More informationCOMMISSIONING POLICY FOR IN VITRO FERTILISATION (IVF)/ INTRACYTOPLASMIC SPERM INJECTION (ICSI) WITHIN TERTIARY INFERTILITY SERVICES V2.
COMMISSIONING POLICY FOR IN VITRO FERTILISATION (IVF)/ INTRACYTOPLASMIC SPERM INJECTION (ICSI) WITHIN TERTIARY INFERTILITY SERVICES V2.3 2017 Agreed at Cannock Chase CCG Signature: Designation: Chair of
More informationApplication to import or export donor sperm, eggs or embryos
donor sperm, eggs or embryos Effective: 1 Applying to import or export The import and export of donor sperm, donor eggs and embryos produced using donor sperm and/or eggs is governed in Victoria by the
More informationDisposition of Eggs Consent Form
Page 1 of 6 Disposition Eggs Consent Form version 2018 Disposition of Eggs Consent Form I have chosen to have my eggs retrieved from my ovaries. I may use my eggs when they are removed or at some time
More informationLEGAL CONSIDERATIONS
LEGAL CONSIDERATIONS As part of the egg donation process, you will be required to sign an agreement between yourself and the prospective parents. If you are doing an anonymous donation, we will keep your
More informationMore Fun Than Giving Blood CLINIC RECRUITED
More Fun Than Giving Blood CLINIC RECRUITED Are you thinking of becoming a sperm donor? Choosing to become a sperm donor is a generous act, and by entering our sperm donor program you can help make someone
More informationClinical 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 treatments
More informationSHIP8 Clinical Commissioning Groups Priorities Committee (Southampton, Hampshire, Isle of Wight and Portsmouth CCGs)
SHIP8 Clinical Commissioning Groups Priorities Committee (Southampton, Hampshire, Isle of Wight and Portsmouth CCGs) Policy Recommendation 002: Assisted Conception Services Date of Issue: September 2014
More informationPaper. Donation review conditional donation. Hannah Darby, Policy Manager. Decision
Paper Paper Title: Donation review conditional donation Paper Number: ELAC (06/11)2 Meeting Date: 8 June 2011 Agenda Item: 7 Author: For information or decision? Recommendation to the Annexes Hannah Darby,
More informationPOGO SURVIVORS CONFERENCE
POGO SURVIVORS CONFERENCE Dr. Karen Glass MD, FRCS(C), FACOG Director Fertility Preservation Program, CReATe Fertility Centre Assistant Professor, University of Toronto I HAVE NO CONFLICT OF INTEREST.
More informationDIABLO VALLEY ESTATE PLANNING COUNCIL THE NEW BIOLOGY: WHAT DO ESTATE PLANNERS NEED TO KNOW ABOUT ASSISTED REPRODUCTION OCTOBER 15, 2014
DIABLO VALLEY ESTATE PLANNING COUNCIL THE NEW BIOLOGY: WHAT DO ESTATE PLANNERS NEED TO KNOW ABOUT ASSISTED REPRODUCTION OCTOBER 15, 2014 Lisa C. Ikemoto Professor U.C. Davis School of Law APPROACH Assisted
More informationINTRACYTOPLASMIC SPERM INJECTION
1 Background... 2 2 Male Factor Infertility... 2 3 ICSI... 3 4 Surgical sperm aspiration... 4 5 What is the chance of success?... 6 6 What are the risks?... 7 M Rajkhowa, October 2004 Authorised by V Kay
More informationBromley CCG Assisted Conception Funding Form Checklist for Eligibility Criteria for NHS funding of Assisted Conception
Bromley CCG Assisted Conception Funding Form Checklist for Eligibility Criteria for NHS funding of Assisted Conception This form is for the use of administrators of Assisted Conception Units to notify
More informationRegulating mitochondrial donation: seeking expert views. Background document
Regulating mitochondrial donation: seeking expert views Background document June 2015 Contents Introduction 3 What we need from you 3 Licensing mitochondrial donation 4 Licensing the clinic to undertake
More informationHaringey CCG Fertility Policy April 2014
Haringey CCG Fertility Policy April 2014 1 SUMMARY This policy describes the clinical pathways and entry criteria for Haringey patients wishing to access NHS funded fertility treatment. 2 RESPONSIBLE PERSON:
More informationInformation For Egg Recipients
Egg Recipients Royal Devon and Exeter NHS Foundation Trust Information For Egg Recipients What is egg donation? Egg donation is a type of in-vitro fertilisation (IVF) treatment in which eggs are collected
More informationThe Gay Woman s Guide to Becoming a Mom PATH2PARENTHOOD. path2parenthood.org
The Gay Woman s Guide to Becoming a Mom PATH2PARENTHOOD path2parenthood.org For lesbians, there are a number of viable routes that can be considered when achieving motherhood is the goal. Whether you are
More informationAssisted Reproductive Technologies
Assisted Reproductive Technologies Textbook pages 224 231 Section 6.3 Summary Before You Read What do you think the phrase test-tube baby refers to? Write your ideas on the lines below. Mark the Text Check
More informationFriday, 13 January 2017 HFEA, 10 Spring Gardens, London SW1A 2BU
Friday, 13 January 2017 HFEA, 10 Spring Gardens, London SW1A 2BU Panel members Juliet Tizzard (Chair) Howard Ryan Trisram Dawahoo Members of the Executive Bernice Ash Secretary Director of Strategy & Corporate
More informationPlacename CCG. Policies for the Commissioning of Healthcare. Policy for Assisted Conception Services
Placename CCG Policies for the Commissioning of Healthcare Policy for Assisted Conception Services 1 Introduction 1.1 This document is part of a suite of policies that the CCG uses to drive its commissioning
More informationASSISTED CONCEPTION NHS FUNDED TREATMENT FOR SUBFERTILITY ELIGIBILITY CRITERIA & POLICY GUIDANCE
ASSISTED CONCEPTION NHS FUNDED TREATMENT FOR SUBFERTILITY ELIGIBILITY CRITERIA & POLICY GUIDANCE Version 1.0 Page 1 of 11 MARCH 2014 POLICY DOCUMENT VERSION CONTROL CERTIFICATE TITLE Title: Assisted Conception
More information2018 Oocyte Recovery and ICSI
2018 Oocyte Recovery and ICSI Equine Medical Services is one of the world s leading producers of in vitro produced embryos. While standard IVF techniques are ineffective with horses, ICSI (Intracytoplasmic
More informationFertility Tourism. Dr Karen Buckingham. National Women s Annual Clinical Report Day August 2013
Fertility Tourism Dr Karen Buckingham National Women s Annual Clinical Report Day August 2013 Cross Border Reproductive Care refers to the activity surrounding patients who travel outside of their country
More informationReproductive Technology, Genetic Testing, and Gene Therapy
Michael Cummings Chapter 16 Reproductive Technology, Genetic Testing, and Gene Therapy David Reisman University of South Carolina 16.1 Infertility Is a Common Problem In the US, about 13% of all couples
More informationcommandment. The second is like it: Love your neighbor as yourself. All the Law and the Prophets hang on these two commandments.
Having a Baby the New-Fashioned Way John F. Kilner October 6, 2015 1 Autonomy Utility Dignity Creation in the Image of God Then God said, Let Us make human beings in Our image, in Our likeness. (Genesis
More informationPolicy statement. Commissioning of Fertility treatments
Policy statement Commissioning of Fertility treatments NB: The policy relating to commissioning of fertility treatments is unchanged from the version approved by the CCG in March 2017. The clinical thresholds
More informationInfertility Counselling and Ethical Issues. Jennifer Hunt Wolfson Fertility Centre
Infertility Counselling and Ethical Issues Jennifer Hunt Wolfson Fertility Centre Overview 1. Legal framework 2. Impact of failure to conceive and pregnancy loss 3. The treatment experience 4. Role of
More information2018 Oocyte Recovery and ICSI
2018 Oocyte Recovery and ICSI Equine Medical Services is one of the world s leading producers of in vitro produced embryos. While standard IVF techniques are ineffective with horses, ICSI (Intracytoplasmic
More informationFrench law concerning medically-assisted reproduction
Human Reproduction vol 11 no 9 pp 1843-1847, 1996 OPINION French law concerning medically-assisted reproduction Jacques Lansac Gynaecology and Obstetrics Department, University Hospital Bretonneau 37044,
More informationHALTON CLINICAL COMMISSIONING GROUP NHS FUNDED TREATMENT FOR SUBFERTILITY. CONTENTS Page
HALTON CLINICAL COMMISSIONING GROUP NHS FUNDED TREATMENT FOR SUBFERTILITY CONTENTS Page 1. INTRODUCTION 2 2. GENERAL PRINCIPLES 2 3. DEFINITION OF SUBFERTILITY AND TIMING OF ACCESS TO TREATMENT 3 4. DEFINITION
More informationWOMEN & INFANTS HOSPITAL Providence, RI CONSENT FOR THAWING AND TRANSFER OF CRYOPRESERVED EMBRYOS. I and
*40668* 40668 WOMEN & INFANTS HOSPITAL Providence, RI 02905 CONSENT FOR THAWING AND TRANSFER OF CRYOPRESERVED EMBRYOS FOR inpatients: affix patient label OR I and (Print Patient s name) (Print Partner
More informationRESOLUTION CFM No /2013
RESOLUTION CFM No. 2.013/2013 (Published in Federal Official Gazette (D.O.U.) dated May 9 th, 2013, Section I, page 119) Adopts the ethical standards for use of assisted reproduction techniques, annexed
More informationAccess to IVF. Help us decide Discussion paper. South Central Specialised Commissioning Group C - 1
Access to IVF Help us decide Discussion paper South Central Specialised Commissioning Group 1 C - 1 Access to IVF treatment Contents 1. Background 3 2. Developing a single policy for NHS South Central..4
More informationFertility Policy. December Introduction
Fertility Policy December 2015 Introduction Camden Clinical Commissioning Group (CCG) is responsible for commissioning a range of health services including hospital, mental health and community services
More informationInformation about. Egg donation. Tel. (UK): +44(0) Tel. (Spain):
Information about Egg donation www.ginefiv.co.uk Tel. (UK): +44(0)203 129 34 19 Tel. (Spain): +34 91 788 80 70 Index This brochure contains the following information: Index About Ginefiv...3 Our Egg Donation
More informationNHS FUNDED TREATMENT FOR SUBFERTILITY. ELIGIBILITY CRITERIA POLICY GUIDANCE/OPTIONS FOR CCGs
NHS FUNDED TREATMENT FOR SUBFERTILITY ELIGIBILITY CRITERIA POLICY GUIDANCE/OPTIONS FOR CCGs CONTENTS Page 1. INTRODUCTION 2 2. GENERAL PRINCIPLES 2 3. DEFINITION OF SUBFERTILITY AND TIMING OF ACCESS TO
More informationNuffield Council on Bioethics
This response was submitted to the call for evidence by the Nuffield Council on Bioethics on Emerging techniques to prevent inherited mitochondrial disorders: ethical issues between January 2012 and February
More informationEgg Sharing Price list
Egg Sharing Price list IVF Egg Sharing with anonymous recipient COMPLETE PACKAGE S1 1575 An all-inclusive package for women who meet the egg donor criteria, need IVF or ICSI treatment and choose to share
More informationPROCEDURES LAPAROSCOPY
PROCEDURES - Further infertility work-up if indicated (ultrasound examination / semen decontamination etc.) - Office Hysteroscopy where indicated - Laparoscopic and /or hysteroscopic surgery where indicated
More informationResearch on the attitude of Japanese doctors who are providing IVF treatment against third party reproduction and reproductive tourism
Research on the attitude of Japanese doctors who are providing IVF treatment against third party reproduction and reproductive tourism Background About 40 to 50 thousands of Japanese couples are estimated
More informationGuidelines. for the. Storage, Use, and Disposal. of Sperm. from a Deceased Man. February 2000
Guidelines for the Storage, Use, and Disposal of Sperm from a Deceased Man February 2000 Prepared by the National Ethics Committee on Assisted Human Reproduction (NECAHR) c/o Ministry of Health PO Box
More informationApproved January Waltham Forest CCG Fertility policy
Approved January 2015 Waltham Forest CCG Fertility policy Contents 1 Introduction 1 2 Individual Funding Requests 1 2.1 Eligibility criteria 1 2.2 Number of cycles funded 2 2.3 Treatment Pathway 3 Page
More informationWOMEN & INFANTS HOSPITAL Providence, RI CONSENT FOR IN VITRO FERTILIZATION USING A GESTATIONAL CARRIER (PATIENT/INTENDED PARENTS) 1.
*40675* 40675 MR-838 (9-2017) WOMEN & INFANTS HOSPITAL Providence, RI 02905 CONSENT FOR IN VITRO FERTILIZATION USING A GESTATIONAL CARRIER (PATIENT/INTENDED PARENTS) 1. I, and (Print Patient s name) (Print
More informationInformation about The Storage of Sperm, Eggs and Embryos before starting Chemo or Radiotherapy Treatment
Information about The Storage of Sperm, Eggs and Embryos before starting Chemo or Radiotherapy Treatment Assisted Conception Services Glasgow Royal Infirmary 84 Castle Street Glasgow G4 0SF Telephone:
More informationWest Hampshire Clinical Commissioning Group Board
West Hampshire Clinical Commissioning Group Board Date of meeting 25 July 2013 Agenda Item 9 Paper No WHCCG13/089 Priorities Committee Statement Assisted Conception/IVF Key issues An Interim Policy Statement
More informationASSISTED REPRODUCTIVE TECHNOLOGY DISCLOSURE AND RISK REDUCTION ACT. Model Legislation & Policy Guide For the 2011 Legislative Year
ASSISTED REPRODUCTIVE TECHNOLOGY DISCLOSURE AND RISK REDUCTION ACT Model Legislation & Policy Guide For the 2011 Legislative Year INTRODUCTION The first baby born as a result of in vitro fertilization
More informationSTEM CELL RESEARCH: MEDICAL PROGRESS WITH RESPONSIBILITY
STEM CELL RESEARCH: MEDICAL PROGRESS WITH RESPONSIBILITY A REPORT FROM THE CHIEF MEDICAL OFFICER S EXPERT GROUP REVIEWING THE POTENTIAL OF DEVELOPMENTS IN STEM CELL RESEARCH AND CELL NUCLEAR REPLACEMENT
More informationCoParents Survey CoParents.co.uk Survey Results. Connection Services: Relationships Between Donors And Parents To Be
CoParents.co.uk Survey Results Connection Services: Relationships Between Donors And Parents To Be Contents Introduction... 3 About The Respondents... 4 Sperm Recipient & Donation Responses... 5 Females
More informationFamily Building Through Use of DONATED EMBRYOS. Robin L. Poe-Zeigler, MD, FACOG
Family Building Through Use of DONATED EMBRYOS Robin L. Poe-Zeigler, MD, FACOG DONATED EMBRYOS Where do these EMBRYOS come from?... Day 5 Blastocyst Embryos DONATED EMBRYOS Embryos are donated by Couples
More informationPolicy updated: November 2018 (approved by Haringey and Islington s Executive Management Team on 5 December 2018)
Islington CCG Fertility Policy First approved: 29 January 2015 Policy updated: November 2018 (approved by Haringey and Islington s Executive Management Team on 5 December 2018) Introduction Islington CCG
More informationSt Helens CCG NHS Funded Treatment for Subfertility Policy 2015/16
St Helens CCG NHS Funded Treatment for Subfertility Policy 2015/16 1 Standard Operating Procedure St Helens CCG NHS Funded Treatment for Sub Fertility Policy Version 1 Implementation Date May 2015 Review
More information