Insemination Reporting

We at IDANT are proud to take part in helping people obtain the families they so greatly desire. As part of our on-going efforts to maintain a high standard of quality control, regulatory agencies require that patients and physicians to report conceptions and full-term pregnancies resulting from the use of our donor semen.

We require this information in need to aid us in determining the fertility of new donors, limiting the number of pregnancies brought to full-term by an individual, donor following guidelines for geographic distribution, and various statistical analyses required by regulatory agencies.

Approximately three months after your last specimen order, you or your physician will receive a Pregnancy Report Form. Complete the form to the best of your knowledge, or make sure your physician fills it out and mails it to us in the postage-paid envelope. We have also provided this online form to simplify the process of reporting this information.

To report an insemination, please complete and submit the form below.

Physician/clinic information

Physician/clinic
Street Address (line 1)
Street Address (line 2)
City
State/Province
ZIP/Postal Code
Country
Work Phone Number
Fax Number
E-mail Address

Patient and donor information

Patient's initials/code
Age
Marital Status
Donor Code
Number of Cycles
Number of Units Used per Cycle
If your patient was taking fertility medications, please provide further information.

Insemination results

Date of Conception
Date of Delivery
Date of Miscarriage
Number of Boys
Number of Girls

Other information

Any other important information you would like to share with us about this case

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Insemination Reporting

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