Family Fertility Center

Welcome patients of Family Fertility Center in Bethlehem. Below you will find the forms required to set up a specimen storage account with ReproTech, and at the bottom, the forms needed to have your sperm, embryos or oocytes transferred back to Family Fertility Center.

If you are a patient who will be storing cryopreserved semen, embryos or oocytes, please download and complete the applicable forms indicated below and provide to Family Fertility Center.  Please note that the Specimen Transfer From RTL and Medical Information Release forms, listed at the bottom, are required upon return of your specimens to Family Fertility Center for ART procedures.  These Transfer FROM RTL forms require patient signatures in the presence of a notary.

We look forward to serving you.

Specimen Shipping Insurance is available exclusively to ReproTech clients through IMA, a premier insurance broker in the U.S.

Semen - all semen storage clients must complete C ACQ-100; E ACQ-100; N ACQ-100.  J ACQ-100 is only required for those individuals who have tested reactive for a communicable disease.  To have specimens returned to Family Fertility Center for ART procedures, BJ DIS-100 (see below Transfer FROM RTL forms) must be downloaded and provided to ReproTech.

Oocyte/Ovarian Tissue - all oocyte storage clients must complete AA ACQ-100; L ACQ-100; R ACQ-100. T ACQ-100 is only required for those who have tested reactive for a communicable disease.  To have specimens returned to Family Fertility Center for ART procedures, BJ DIS-100 (see below Transfer FROM RTL forms) must be downloaded and provided to ReproTech.

Embryo - Single clients must complete AC ACQ-100 and D ACQ-100.  Couples must complete  O ACQ-100 and D ACQ-100.  Additionally, if any client has tested reactive for a communicable disease, I ACQ-100 is required.  If any client has a positive cancer diagnosis, complete L ACQ-100.  To have specimens returned to Family Fertility Center for ART procedures, BJ DIS-100 (see below Transfer FROM RTL forms) must be downloaded and provided to ReproTech.

Donor Semen or Oocytes - all donor semen or donor oocyte storage clients must complete AE ACQ-100 and P ACQ-100. AL ACQ-100 is only required for those who have tested reactive for a communicable disease.  To have specimens returned to Family Fertility Center for ART procedures, BK DIS-100 must be downloaded and provided to ReproTech. 

 All Tissues - Transfer TO RTL

All Tissues (excluding donor tissue) - Transfer FROM RTL - The BJ DIS-100 form must be provided to ReproTech prior to return of your specimens to Family Fertility Center. Forms R DIS-100 (embryo clients) or S DIS-100 (semen clients) are only required for those who have tested reactive for a communicable disease or are missing some of the required testing.