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Referral form for Sperm Cryopreservation for Adolescents and Young Adults YF1.3 MAYA (Childhood, Adolescents and Young Adults) ___ Patient Name Date of Birth AddressPatient Guardian/NOK Phone number Email
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How to fill out fertility preservation is possible

01
Schedule a consultation with a fertility specialist to discuss your options for fertility preservation.
02
Decide on the type of fertility preservation method you want to pursue, such as egg freezing or sperm banking.
03
Undergo necessary medical evaluations and tests to assess your fertility status.
04
Follow the instructions provided by your fertility specialist for the specific fertility preservation procedure you have chosen.
05
Attend follow-up appointments and monitor your progress throughout the process.

Who needs fertility preservation is possible?

01
Individuals undergoing cancer treatment that may affect their fertility.
02
People with medical conditions that may impact their fertility in the future.
03
Individuals pursuing gender transition who want to preserve their fertility before starting hormone therapy.
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Fertility preservation refers to the methods and techniques used to save or store eggs, sperm, or embryos for future use, allowing individuals to retain their ability to reproduce despite potential medical, social, or age-related factors that may impact fertility.
Individuals facing medical treatments that may affect fertility, such as cancer patients undergoing chemotherapy, those with genetic disorders, or individuals looking to delay parenthood for personal reasons may be eligible for fertility preservation.
The process typically involves consulting with a fertility specialist, undergoing medical evaluations, and completing required consent forms before the actual procedure of egg retrieval or sperm collection can take place.
The primary purpose of fertility preservation is to enable individuals to maintain their fertility options for the future, despite medical conditions, interventions, or personal choices that may pose risks to their reproductive health.
Individuals must report medical history, current health status, reasons for preservation, and any prior fertility treatments. Additionally, demographic information is often required for proper record-keeping.
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