Pregnancy and Delivery Results Report Form

We hope your pregnancy and delivery have gone well. We need to confirm information concerning your delivery since we are required by the Centers for Disease Control to report all IVF pregnancies.

Please take a moment to answer the following questions, thank you for your timely response. We look forward to hearing about your family.

Pregnancy and Delivery Results Report Form

  • Please provide your email address so we may clarify any information provided if necessary. We will not release your email address or use it for any other purpose.
    Please select the type of procedure provided by NFC that resulted in pregnancy.
  • If “other” was selected for fertility procedure, please explain:
  • What was the approximate date of the procedure (month/year)?
  • Birth weight(s) of each baby.
  • Were there any complications to the pregnancy?
  • Problems with delivery?
    Select method of delivery
  • Gender and name of each child (Name information will not be reported to the CDC however Gender info will).
  • Additional information you would like to report to us (this information will not be reported to the CDC).