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Newfoundland and Labrador Fertility Services 35 Majors Path, St. Johns, NL A1A 4Z9 Telephone: (709) 7777444 Fax: (709) 7523648 Laboratory MedicineAutologous Sperm Cryopreservation Requisition Completion
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Obtain the CH-2174 autologous sperm cryopreservation form from your healthcare provider.
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Fill out all the required information on the form, including your personal details, medical history, and reason for seeking sperm cryopreservation.
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Make sure to sign and date the form where indicated.
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Return the completed form to your healthcare provider and follow any additional instructions they may provide.

Who needs ch-2174 autologous sperm cryopreservation?

01
Men who are undergoing medical treatments that may affect their fertility, such as chemotherapy or radiation therapy.
02
Men who are planning to undergo a vasectomy or other surgical procedures that may impact their ability to conceive naturally.
03
Men who have a medical condition that could potentially affect their sperm quality or quantity, such as genetic disorders or hormonal imbalances.
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ch-2174 autologous sperm cryopreservation is a medical procedure that involves the freezing and storage of an individual's own sperm for future use, often for fertility preservation.
Individuals who wish to preserve their own sperm, typically for medical reasons or future reproductive planning, are required to file ch-2174.
To fill out ch-2174, individuals must provide personal information, including medical history, consent for the procedure, and details about the sperm collection and storage process.
The purpose of ch-2174 autologous sperm cryopreservation is to enable individuals to preserve their reproductive cells for future use, especially in cases of medical treatments that may affect fertility.
The information that must be reported includes personal identification details, medical history, the rationale for sperm cryopreservation, and consent signatures.
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