High Tech Survey #1081

1. Attempt:
   Sex: Girl Boy Sperm Sorting: MicroSort Ericsson Other Sperm Sorting None (PGD Only) PGD: Yes No
2. Cycle Type: Artificial Insemination: IUI, ICI, or IVI IVF (or GIFT/ZIFT/TET) FET (Frozen Embryo Transfer)
3. Attempt #: 1 2 3 4 5 6 7 8 9 10 11 12
4. Cycle Date:    
5. Fertility Clinic:

   Clinic Name:
   Clinic City:
   U.S. State:	Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington DC West Virginia Wisconsin Wyoming
   Country:

6. Why did you want to use gender selection?
   Family balancing or preference Medical need

   If using for a medical need, such as to avoid a
   sex-linked genetic disorder, please describe:
   

7. Are you or your spouse infertile or sterile? Yes
8. Did you use an egg or sperm donor? No Egg Donor Sperm Donor Donated Embryo

About You

1. Mother's Age:       Father's Age:    
2. Number of previous pregnancies and births:

   Pregnancies: 0 1 2 3 4 5 6 7 8 9 10 11 12+  Live Births: 0 1 2 3 4 5 6 7 8 9 10 11 12+

3. Genders of your current children:
   Boys: 0 1 2 3 4 5 6 7 8 9 10 11 12+  Girls: 0 1 2 3 4 5 6 7 8 9 10 11 12+
4. Previously, how easily did you become pregnant? Very easily, got pregnant on first or second try Fairly easily, took just a few tries Took quite a few tries, but managed it Took a long time Required IUI or IVF to get pregnant previously
5. If a semen analysis was performed, what were the results?

   Overall	Count	Morphology	Motility	Progression	pH
   Excellent Very Good Average Fair Poor		%	%	0 (None) 1 1+ 2 2+ 3- 3 4 (Fast!)
   	Million per mL	% Normal	% Moving	Speed

6. Where do you live?

   U.S. State: Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington DC West Virginia Wisconsin Wyoming or Other Country:

IVF (or GIFT/ZIFT/TET)

1. Fertility Drugs:
   

   Protocol: Long Lupron / BCP Protocol Antagon Protocol (No BCP, No Lupron) Lupron Microdose Flare Protocol Other

   FSH: Gonal-F Menopur / Repronex Follistim Other

   Comments:
   Gonal-F and Menopur
2. Egg Retrieval and Embryos:
   Antral follicle count 
   Number of eggs retrieved 
   Number of mature eggs 
   Number fertilized 
   Number viable embryos on day 3 
   Number viable embryos on day 5 
   Number of embryos transferred 
   Number of embryos frozen 
3. Number of embryos on day of transfer:
   

   Grade 1	Grade 2	Grade 3	Grade 4	Grade 5

4. Fertilization: Regular IVF ICSI Unknown
5. Transfer Day / Transfer Type:
   GIFT - Transfer egg and sperm to fallopian tube ZIFT/TET - Transfer 1-day or 2-day embryo to fallopian tube IVF 2-day transfer IVF 3-day transfer (Most common) IVF 4-day transfer IVF 5-day transfer - Blast transfer
   (GIFT, ZIFT, and TET are performed rarely.)
6. If you have extra embryos, what will you do with them? Freeze indefinitely Discard/destroy Donate to science Donate to another couple
   (This question refers to healthy embryos which will not be used because they are the wrong sex, or are not needed because you do not plan another pregnancy.)
7. Other comments about your IVF cycle:
   My Day 3 FSH test (pre-cycle) revealed an elevated FSH of 12.5 I was on Long Lupron protocol, and responded well.

MicroSort

1. Sort Percentage: %  
2. Which MicroSort facility performed your sort?
   GIVF in Fairfax, VA HRC in Laguna Hills, CA
3. Did you use fresh or frozen sperm?
   Fresh (Never frozen) Frozen once (after MicroSorting) Frozen twice (before and after MicroSorting)
4. Sperm Count:

   Pre-Sort:	Million
   Post-Sort:
   Post-Thaw:	(If frozen)

5. Did you get an extra vial? Yes
6. Other comments about MicroSort:
   I don't have my sort % yet, but 8 of the 9 embryos biopsied were female.

PGD - Preimplantation Genetic Diagnosis

1. Number of embryos biopsied for PGD:  
2. Number of PGD probes used:  
   Number of chromosomes checked; may also be referred to as "panel".
3. PGD Results:

   	Male	Female	Unknown
   Normal/OK:
   Normal/Arrested:
   Abnormal:

4. Was any genetic testing performed? Yes
   Example of genetic testing: Cystic Fibrosis.
   (Do not check if only sex/chromosomal testing was performed.)
   Describe:
   
5. Describe any abnormal embryos:
   2-probe PGD. Of the 9 embies that made it to biopsy: - 2 XX (apparently normal females, the ones we transfered) - 4 X "abnormal monosomy" (of which 3 had "fragmented nucleus") - 1 XY (apparently normal male) - 1 XXX "abnormal trisomy" - 1 XXXX "abnormal tetrasomy" See also my blog entry: http://www.ingender.com/cs/blogs/greenzelda/archive/2009/07/24/pgd-report-transfer.aspx
6. Other comments about PGD:
   

Expenses and Travel

Expense Totals

Expense Details

Other comments about expenses and travel:
We traveled from Eastern Canada to California, USA.

Cycle Outcome

1. Cycle Result: In Progress Waiting for Pregnancy Test (2ww) Positive Pregnancy Test No Pregnancy No Transfer Cancelled Cycle (No Answer)
2. Beta Results:
   1st beta 12dp5dt = 555 2nd beta 17dp5dt = 4248
3. Other Comments:

Pregnancy

1. Due Date: (or Birth Date) 
2. Number of Babies Conceived: 1 2 - Twins!! 3 - Triplets!!! 4 - Quads!!!! 5 - Quints!!!!!
   Choose the total number of sacs or babies ever observed by ultrasound, even if not all survived.
3. If you conceived multiples, type of multiples:
   
4. Pregnancy Problems:
   If you experienced any problems in this pregnancy (mother or baby) please describe:
   Moderate - large subchorionic hematoma detected via u/s at 7w5d (symptoms: bright red bleeding and cramps). 3cm x 3cm x 1cm