This section is for patients with frozen stored embryos. If you have any queries, please do not hesitate to contact the embryology team on StorageExpiry@uhcw.nhs.uk

If you currently have embryos in storage that are expiring and you would like to extend storage or you no longer wish to continue with storage, you have the following three options:

CONTINUE STORAGE

If you wish to continue the storage of your embryos, you must complete Renewal Consent Form HFEA RE. This consent form can be downloaded and printed here.

 

Please print, complete and return this form:

By post to:

Embryology Team (Expiry)

Centre for Reproductive Medicine

UHCW NHS Trust

Clifford Bridge Road

Coventry

CV2 2DX

Alternatively, by email to: StorageExpiry@uhcw.nhs.uk

Please note we will require BOTH partners to compete a form each. We can only accept original ink signatures (not electronic).

There will continue to be an annual storage fee for embryo storage as indicated in our current price list.

 

If you wish to continue the storage of your embryos, you must complete new WT (egg provider) or MT (sperm provider) HFEA forms. These consent forms can be downloaded and printed here (WT) and here (MT).

 

WT form (egg provider)		MT form (sperm provider)
Pg 3	Complete sign and date	Pg 3	Complete sign and date
Pg 4	4.1 Tick no to egg storage.   4.2 Tick yes for embryos and indicate total number of years you would like to store.   Sign and date page 4	Pg 4	4.1 Tick no to sperm storage.   4.2 Tick yes for embryos and indicate total number of years you would like to store.   Sign and date page 4
Pg 5	4.3 Tick no for eggs.   4.4 Tick yes for embryos. Specify the additional number of years you would like to store (should not exceed 10 years from date of freeze). Sign and date page 5	Pg 5	4.3 Tick no for sperm.   4.4 Tick yes for embryos and specify the additional number of years you would like to store (should not exceed 10 years from date of freeze). Sign and date page 5
Pg 6 to pg 13	Please complete all sections. Sign and date each page.	Pg 6 to pg 14	Please complete all sections. Sign and date each page.

 

Please note we will require BOTH partners to compete a form each. We can only accept original ink signatures (not electronic).

Please print, complete and return:

By post to:

Embryology Team (Expiry)

Centre for Reproductive Medicine

UHCW NHS Trust

Clifford Bridge Road

Coventry

CV2 2DX

Alternatively, by email to: StorageExpiry@uhcw.nhs.uk

 

There will continue to be an annual storage fee for embryo storage as indicated in our current price list.

 

DISPOSE EMBRYOS

This can understandably be a very difficult decision to make. You can always discuss your feelings and thoughts with one of our supportive counsellors. An appointment can be made by emailing uhcwfcs@uhcw.nhs.uk

If you wish to dispose of the frozen embryos, please complete the

1) Embryo Disposal Tick List Consent Form.

• We require BOTH partners’ signatures and a copy of a form of photo ID (driving licence, passport) for each.
• We can only accept original ink signatures (not electronic).

2) HFEA WCS Form

• Complete section 3.1 to withdraw consent for storage.
• You must return a separate form for each partner
• We only accept original ink signatures (not electronic).
• Ensure you have signed and dated each page of the form.

We require two copies of the WCS form; one from the patient and one from the partner.

If you require further information or clarification or any form sent to you via email, please do not hesitate to contact the embryology team either by email to StorageExpiry@uhcw.nhs.uk or by calling 02476 968876.

 

DONATE EMBRYOS FOR TRAINING PURPOSES

Your remaining embryo(s) can be utilised by laboratory staff member for training purposes. If you wish to dispose of the frozen embryos and consent to their use for training purposes, please complete the:

1) Embryo Disposal Tick List Consent Form

• We require BOTH partners’ signatures and a copy of a form of photo ID (driving licence, passport) for each.
• We can only accept original ink signatures (not electronic).

2) HFEA WCS Form

• Complete section 3.2 and section 4 to provide consent to use of embryos in training.
• You must return a separate form for each partner.
• We only accept original ink signatures (not electronic).
• Ensure you have signed and dated each page of the form.

We require two copies of the WCS form; one from the patient and one from the partner.

f you require further information or clarification or any form sent to you via email, please do not hesitate to contact the embryology team either by email to StorageExpiry@uhcw.nhs.uk or by calling 02476 968876.

TO DONATE THE FROZEN EMBRYOS TO RESEARCH

Before deciding to donate your frozen embryos to research, please read this information sheet which explains what the embryos will be used for if they are donated to research. Then please complete the project consent form. Note, please put your initials in the boxes on the consent form, not ticks or crosses.

If you wish to donate your embryos to research, please complete and return:

1) Embryo Disposal Tick List Consent Form

• We require BOTH partners’ signatures on this form as well as a copy of a form of photo ID (driving licence, passport) for each. We can only accept original ink signatures (not electronic).

2) Embryo Research Consent Form

• We require both partners’ signatures on this form. We can only accept original ink signatures (not electronic).
• Please note, to donate the embryos to research we will require BOTH partners’ signatures and a copy of a form of photo ID (driving licence, passport) for each. We can only accept original ink signatures (not electronic).

If you require further information or clarification or any form sent to you via email, please do not hesitate to contact the embryology team either by email to StorageExpiry@uhcw.nhs.uk or by telephone 02476 968876.

This section is for patients with frozen stored eggs. If you have any queries, please do not hesitate to contact the embryology team on StorageExpiry@uhcw.nhs.uk

If you currently have eggs in storage that are expiring and you would like to extend storage or you no longer wish to continue with storage, you have the following three options:

CONTINUE IN STORAGE

 

If you wish to continue the storage of your eggs, you must complete Renewal Consent Form HFEA RG. This consent form can be downloaded and printed here.

 

Please print, complete and return form:

By post to:

Embryology Team (Expiry)

Centre for Reproductive Medicine

UHCW NHS Trust

Clifford Bridge Road

Coventry

CV2 2DX

Alternatively, by email to: StorageExpiry@uhcw.nhs.uk

 

We can only accept original ink signatures (not electronic).

There will continue to be an annual storage fee for embryo storage as indicated in our current price list.

 

If you wish to continue the storage of your eggs, you must complete GS HFEA forms (if you have no partner) or WT HFEA forms (if you have a partner). These consent forms can be downloaded and printed here (GS) or here (WT).

 

HFEA GS Form			WT form
Pg	Section	Information	Pg	Section	Information
2	1	Complete Name, DOB	3	1 & 2	Complete Name, DOB
2	2.1	Tick yes to eggs, no to sperm	3	3.1	Tick yes if you wish to create embryos
2		Sign and date the page declaration	3		Sign and date the page declaration
3	2.2	Leave blank	4	4.1	Tick yes to egg storage, specify the additional number of years you would like to store (should not exceed 10 years from date of freeze).
3	2.3	Tick yes, specify the additional number of years you would like to store (should not exceed 10 years from date of freeze).	4	4.2	Complete as per your wishes, sign and date.
3		Sign and date the page declaration	5	4.3	Tick yes, specify the additional number of years you would like to store (should not exceed 10 years from date of freeze).
4	3 to 4	Complete as per your wishes	5	4.4	Leave blank
4		Sign and date the page declaration	5		Sign and date the page declaration
5		Sign and date the page declaration	6 to 12		Complete sections as per your wishes and sign and date the page declaration.

 

We can only accept original ink signatures (not electronic).

Please print, complete and return form:

By post to:

Embryology Team (Expiry)

Centre for Reproductive Medicine

UHCW NHS Trust

Clifford Bridge Road

Coventry

CV2 2DX

Alternatively, by email to: StorageExpiry@uhcw.nhs.uk

 

There will continue to be an annual storage fee for embryo storage as indicated in our current price list.

 

DISPOSE Eggs

This can understandably be a very difficult decision to make. You always have the opportunity to discuss your feelings and thoughts with one of our supportive counsellors. An appointment can be made directly with the counselling team by emailing uhcwfcs@uhcw.nhs.uk.

 

If you would like the eggs to be removed from storage please complete and return:

 

1) Egg disposal tick list form

 

2) HFEA WCS Form

 

• Ensure you have signed and dated each page of the form.

Please note, to dispose the eggs we require an ink signature (not electronic) and a copy of a form of photo ID (driving licence, passport). We can also send you the printed form in the post. If you would like us to do this, please email StorageExpiry@uhcw.nhs.uk

 

TO DONATE THE FROZEN eggs TO RESEARCH

To help decide if you would like to donate your frozen eggs to research please read this information sheet. If you decide to donate the eggs to research, please complete this consent form. Note, please put your initials in the boxes on the consent form, not ticks or crosses.

If you would like to donate the eggs to research, please complete and return:

 

Egg Disposal Tick List Form

We require BOTH partners’ signatures on this form as well as a copy of a form of photo ID (driving licence, passport) for each. We can only accept original ink signatures (not electronic).

Egg Research Consent Form

We require both partners’ signatures on this form. We can only accept original ink signatures (not electronic).

Please note, to donate the eggs to research we require an ink signature (not electronic) and a copy of a form of photo ID (driving licence, passport).

 

We can also send you the printed form in the post. If you would like us to do this, please email StorageExpiry@uhcw.nhs.uk

 

By post to:

Embryology Team (Expiry)

Centre for Reproductive Medicine

UHCW NHS Trust

Clifford Bridge Road

Coventry

CV2 2DX

Alternatively, by email to: StorageExpiry@uhcw.nhs.uk