Patient History Checklist
What kinds of information will be needed:
1. Patient History PDF
- Please fill out this Patient History Form completely.
That will save asking a lot of questions later!
- Infertility patient history – IVF/ICSI attempts, embryo transfers
- Endometrium, embryo morphology
- Medication (in addition to usual hormone treatments)
- Number and progress of pregnancies, outcome
- Treatments during pregnancy
- Relevant pre-existing conditions of both partners
(surgeries, chronic illnesses, etc.)
- Medication that must be taken on a regular basis
- Relevant history of conditions in the family (only blood relatives)
- Fertility history within the family
2. Letters of transferral (Sample 6 and 10 (laboratory)) for woman and man
- if both are covered by statutory health insurance
- Together with the sample package, privately insured patients or international patients will receive a private cost acceptance form that must be signed and returned alongside the blood samples.
3. Results of preliminary examinations
- carried out to clarify whether infertility exists