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 the online form to simplify the process of reporting this information.

Please provide the following physician / clinic information:

Physician /Clinic

Street Address

Address (cont.)

City

State/Province

Zip/Postal Code

Country

Work Phone

FAX

E-mail

Please provide your patient and the donor information:

Patient's initials / code

Age

Marital Status

Donor Code

Number of Cycles

# of Units used/cycle

If your patient was taking fertility medications, please provide the information below.

Please provide the results of the insemination:

Date of Conception

Date of Delivery

Date of Miscarriage

Number of boys

Number of girls

Is there any other important information you would like to share with us about this case?.

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