Common Contracts

imprint

April 11th, 2014

• Filed
  April 11th, 2014

SOURCE GENETIC TESTING PLAN OOCYTE  Fresh  Frozen  None – PT and partner decline PGT  PGT (Sex Determination)  Intended Parent #1  Intended Parent #2  PGT-A (Aneuploidy Screening)  PGT-SR (Structural Rearrangements)  Donor (anonymous/known) ID:  PGT-M (Disease Testing) / Mutation: SPERM  Fresh  Frozen  Thaw, biopsy, and refreeze for PGT, embryos from cycle(s):  Frozen back up – only if needed  Decline sperm freeze for back up  Thaw, rebiopsy, and refreeze for PGT, embryo(s) #:  Intended Parent #1  Intended Parent #2 # of embryos to biopsy:  All embryos  Up to (#) of embryos  Donor (anonymous/known) ID:  Patient/couple wishes to OMIT GENDER in PGT results EMBRYO  Frozen  Not Applicable  Discard all abnormal embryos(Embryologist to review with physician before discarding any mosaic embryos) DONOR EMBRYO(If Applicable)  Not Applicable  Move abnormal embryos off-site to Reprotech after 1 year of storage  ID: TRANSFER PLAN CARRIER  Intended P