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