Common Contracts
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AGREEMENT AND CONSENT FOR THE TRANSFER OF HUMAN EMBRYOS IN CONNECTION WITH IN VITRO FERTILIZATIONNovember 11th, 2013
This document sets forth the terms pursuant to which I, , request, agree and consent to act as a gestational carrier in connection with infertility treatment provided to (the “Intended Mother”) and, if applicable, (the “Intended Father”), who shall be referred to in this form as the “Intended Parents”. My role as gestational carrier will involve having human embryos created through assisted reproductive technology and provided by the Intended Parents transferred into my uterus with the intent that I will become pregnant and be able to carry the pregnancy to term in an effort to assist the Intended Parents to achieve a pregnancy through the process called in vitro fertilization ("IVF"). The gestational carrier and IVF process will be undertaken through the Vincent Reproductive Medicine and IVF Program, Massachusetts General Hospital (MGH). This program, including respective employees, agents and assigns, will be referred to in this document as the "IVF Program".
