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. 2017 Apr 18;16(2):126–132. doi: 10.1002/rmb2.12014

Table 1.

Cycle‐based registry form: clinical outcome of assisted reproductive technology

Patient ID number (req) Unique ID for patient
Use of governmental support system for ART (req)

  1. Yes

  2. No

  3. Unknown
Woman's age at starting of therapy (req) ( ) years old
Man's age at starting of therapy (req) ( ) years old
Height and body weight at starting of therapy Height ( ) cm
Body weight ( ) kg
Pregnancy history Gravida ( )
Para ( )
Cause of infertility (req)

  1. Tubal dysfunction

  2. Endometriosis

  3. Antisperm antibody

  4. Male factor

  5. Unknown

  6. Others ( )

  7. Oocyte cryopreservation (medical indication)
Type of controlled ovarian stimulation

  1. Natural

  2. CC

  3. CC + hMG or FSH

  4. hMG or FSH

  5. GnRH agonist + hMG or FSH

  6. GnRH antagonist + hMG or FSH

  7. Others ( )

  8. Hormone replacement cycle
Method of oocyte pick up (req)

  1. Failed

  2. Endovaginal ultrasonography

  3. Laparoscopy

  4. Use of thawed egg or embryo

  5. Others ( )
Type of used egg or embryo (req) 1. Fresh egg or embryo
2. Frozen thawed embryo
3. Frozen thawed egg
※ If check (2. Frozen thawed embryo), input the registration number at oocyte pick up ( )
Therapeutic method (req)

  1. IVF–ET

  2. GIFT

  3. ICSI

  4. IVF‐ET + ICSI

  5. Thawed embryo

  6. Others ( )

  7. Oocyte cryopreservation (medical indication)
Type of sperm collection

  1. Ejaculated sperm

  2. TESE

  3. Others ( )
Sperm analysis ※ If check (1. Ejaculated sperm) in (Type of sperm collection), input the results of sperm analysis
Concentration ( ) ×106/mL (the second decimal place)
Motility ( ) %
If check (1. Fresh eggs or embryo) in (Types of used egg or embryo), input of following two items is necessary
Number of eggs retrieved ( )
Number of fertilized eggs ( )
If check (2. Frozen thawed embryo) in (Types of used egg or embryo), input of following item is necessary
Number of thawed embryos ( )
If check (3. Frozen thawed egg) in (Types of used egg or embryo), input of following two items is necessary
Number of thawed eggs ( )
Number of fertilized eggs after thawed ( )
If check any of three alternatives in (Types of used egg or embryo), input of following seven items is necessary
Stage of embryo at embryo transfer

  1. Egg (unfertilized)

  2. Cleavage embryos

  3. Blastocysts

  4. ET cancellation

  5. Others ( )
Number of egg or embryo transfers ( )
Number of frozen egg or embryos ( )
Assisted hatching

  1. Yes

  2. No
Luteal support

  1. None

  2. Progesterone (P)

  3. hCG

  4. hCG + P

  5. Estrogen + P

  6. Others ( )
Complications

  1. None

  2. Bleeding

  3. Infection

  4. OHSS (more than Stage II)

  5. Others ( )
Having pregnancy or not
  • 1

    None

  • 2

    Clinical pregnancy (Evidence by ultrasound of an intrauterine sac with or without a fetal heart) (Date of embryo transfer [day/month/year])


  • ※ If check (2. Clinical pregnancy), input the (Data items from pregnancy to delivery) form.


  • 3

    Undetermined


  • ※ Reselect (1. None) or (2. Clinical pregnancy) after determined.

req, required; ART, assisted reproductive technology; CC, clomiphene citrate; hMG, human menopausal gonadotropin; FSH, follicle‐stimulating hormone; GnRH, gonadotropin‐releasing hormone; IVF–ET, in vitro fertilization–embryo transfer; GIFT, gamete intrafallopian transfer; ICSI, intracytoplasmic sperm injection; TESE, testicular sperm extraction; OHSS, ovarian hyperstimulation syndrome.