Informed Consent for Embryo Transfer

Procedure Name

Form Sections

Section 1info grid

Clinic Name

Attending Physician

Patient Full Legal Name

Patient Date of Birth

Partner Name (if applicable)

Partner Date of Birth

Transfer Type

Number of Embryos to Transfer

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Section 3text block

Section 4list block

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Section 12signature block

Patient Signature

Partner / Spouse Signature (if applicable)

Physician Signature

Witness Signature

Date and Time of Consent

Informed Consent for Embryo Transfer

Patient and Partner Information

Clinic Name

Attending Physician

Patient Full Legal Name

Patient Date of Birth

Partner Name (if applicable)

Partner Date of Birth

Transfer Type

Number of Embryos to Transfer

Nature and Purpose of Embryo Transfer

Embryo transfer is the final step of an IVF cycle. It involves placing one or more selected embryos (developed from eggs fertilized in a lab) into the uterus to establish a pregnancy. In a fresh cycle, the transfer takes place 3 to 6 days after egg retrieval. In a frozen embryo transfer (FET) cycle, previously frozen embryos are thawed and transferred after preparing the uterine lining with hormones. The procedure is minor and typically performed without sedation. Using abdominal ultrasound guidance, the physician inserts a thin, flexible catheter through the cervix and into the uterus to release the embryos. You will be asked to rest briefly afterward before discharge.

Single Embryo Transfer (SET) Policy

To minimize the risks of multiple pregnancy, this clinic strongly recommends Single Embryo Transfer (SET) in most patients, particularly those under 38 years of age or with high-quality blastocysts. SET significantly reduces the risk of twins or triplets while maintaining high cumulative pregnancy rates over multiple cycles. If you choose to transfer more than one embryo, you must discuss the risks of multiple gestation with your physician and sign the specific Multiple Embryo Transfer Acknowledgment.

Material Risks and Potential Complications

Multiple pregnancy: transferring more than one embryo carries a high risk of twins or triplets. Multiple pregnancies increase the risk of preterm birth, low birth weight, developmental issues, and maternal high blood pressure or gestational diabetes.

Ectopic pregnancy: the embryo can migrate and implant in a fallopian tube (1 to 2 percent of transfers), requiring surgery or medication.

Procedure discomfort: mild cramping during catheter insertion. Spotting or light bleeding after the procedure is common and usually harmless.

Thaw damage: frozen embryos may not survive the thawing process in an FET cycle, preventing the transfer from taking place.

Implantation failure: the embryo may fail to implant in the uterus, resulting in a negative pregnancy test.

Alternatives to Embryo Transfer

Continued cryopreservation: keeping embryos frozen for a future transfer cycle, if the uterine lining is not optimal or if personal timing changes.

Embryo donation or discard: choosing not to transfer and donating the embryos to another patient, to research, or discarding them.

Post-Transfer Care Guidelines

After the transfer, you are advised to: (1) Avoid strenuous physical activity, heavy lifting (over 15 pounds), and high-impact exercise until your pregnancy test. (2) Continue all prescribed hormonal support medications (progesterone, estrogen) exactly as directed. (3) Do not take any new medications without consulting the clinic. (4) Schedule your pregnancy blood test (usually 10 to 14 days after transfer).

Right to Decline

You have the right to cancel or postpone the embryo transfer at any time before the catheter is inserted. Remaining embryos will remain frozen in storage.

Patient and Partner Understanding

We confirm that we have read this document and understand the embryo transfer procedure, the recommendation for Single Embryo Transfer, the risks of multiple pregnancy, and the follow-up guidelines. All our questions have been answered.

Language Access

If English is not your primary language, a qualified interpreter is available at no cost. Please inform staff before signing.

Copy of Consent Acknowledgment

We acknowledge that we have been offered a copy of this signed consent form.

Patient and Partner Authorization

We voluntarily consent to the embryo transfer procedure. We authorize the thawing of our frozen embryos (if FET) and the transfer of the specified number of embryos into the uterus. We agree to follow all post-transfer instructions.

Signatures and Verification

Patient Signature

Partner / Spouse Signature (if applicable)

Physician Signature

Witness Signature

Date and Time of Consent

Document ID: CC-PENDING

CONSENTCOLLECT