Pregnancy Report

  • Phone:  510.841.1858
  • Fax:      510.841.0332
  • Email:   click here

We maintain complete records of pregnancies and outcomes, that include not only births, but also miscarriages, stillbirths, and therapeutic abortions. This helps us maintain a donor's family limit, track health and medical information for donors, recipients, and children, and provide ongoing services to families after children are born.

This report concerns your most recent pregnancy with TSBC samples. If you are unsure about a question or prefer not to answer, just leave it blank or enter 'unsure' / 'withheld' and a Healthworker will follow-up with you. We guarantee complete confidentiality. No identifying information is released. If you prefer to mail or fax the form, click here for a pdf version or simply fill out the form below, print it, and fax or mail it in. Thank you for your time.

 

Pregnancy Report

1
Have you moved?
2
3
Please give us the details for this conception cycle.
A "cycle" is each time you ovulate. How many cycles total (including this one) have you inseminated using TSBC vials?
Include information from this cycle only. Do not include details from previous attempts that did not result in pregnancy.
4
Please give us the details of your insemination process for THIS cycle only. Do not include previous attempts that did not result in pregnancy.
An "insemination" is an attempt made to conceive during your fertile "cycle."
5
6
7
8
This question helps us determine how many vials of a particular donor to save. The only way to guarantee availability however is to purchase vials that you plan to use in the future.