Forums  Gender Selection Gender Prediction Gender Disappointment Gender Odds

High Tech Survey #1289

Boy Attempt #3: PGD Only/IVF in November 2011

  1. Attempt:
    Sex: Sperm Sorting: PGD:
  2. Cycle Type:
  3. Attempt #:
  4. Cycle Date:    
  5. Fertility Clinic:
    Clinic Name:
    Clinic City:
    U.S. State:
    Country:
  6. Why did you want to use gender selection?

    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?

About You

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

    Pregnancies:  Live Births:

  3. Genders of your current children:
    Boys:  Girls:
  4. Previously, how easily did you become pregnant?
  5. If a semen analysis was performed, what were the results?
    OverallCount    Morphology     Motility   ProgressionpH
    % %
     Million per mL % Normal % Moving Speed
  6. Where do you live?

    U.S. State: or Other Country:

IVF (or GIFT/ZIFT/TET)

  1. Fertility Drugs:

    Protocol:

    FSH:

    Comments:
  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:
  5. Transfer Day / Transfer Type:
    (GIFT, ZIFT, and TET are performed rarely.)
  6. If you have extra embryos, what will you do with them?
    (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:

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:
     MaleFemaleUnknown
    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:
  6. Other comments about PGD:

Expenses and Travel

Expense Totals

$Multi-Cycle Package Total 

Number of cycles in package:  

$Cycle Total  
$Travel Total  
Number of nights: - Mom   - Dad  
Did you travel to another country? Yes

Expense Details

$Sperm Sorting or Sperm Separation
$PGD  
$Preliminary Testing and Consultation  
$Fertility Drugs  
$Sperm Cryopreservation  
$Embryo Crypreservation  
$Artificial Insemination (IUI/ICI/IVI)  
$IVF (or GIFT/ZIFT/TET)  

Other comments about expenses and travel:

Cycle Outcome

  1. Cycle Result:
  2. Beta Results:
  3. Other Comments:

Pregnancy

  1. Due Date: (or Birth Date) 
  2. Number of Babies Conceived:
    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:

Baby

  1. Sex:     Currently:
  2. CVS, amnio, or other genetic analysis results:

    If abnormal, please describe: