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 form, at the bottom, is required upon RETURN of your specimens to Family Fertility Center for ART procedures. This Transfer FROM RTL forms require patient signatures (couples must BOTH sign) in the presence of a Notary Public.
We look forward to serving you.
Specimen Shipping Insurance is available exclusively to ReproTech clients through CNA Financial Corporation, a premier insurance broker in the U.S.

Semen/Testicular Tissue

All semen storage clients must complete a registration form, cryostorage agreement and transfer authorization.
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 a registration form, cryostorage agreeement and transfer authorization. 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 a registration form, cryostorage agreement for single clients and transfer authorization. Couples must each complete their portion of the registration form, cryostorage agreeement for couples and transfer authorization. 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 (Third Party Specimens)

All donor semen or donor oocyte storage clients must complete a registration form, cryostorage agreeement and transfer authorization. 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.

All Tissues – Transfer FROM RTL

The BJ DIS-100 form must be provided to ReproTech prior to RETURN of your specimens to Family Fertility Center. The Special Circumstance Release Forms, R DIS-100 (embryo clients), BC DIS-100 (oocyte 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.