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Terms and Conditions for Recipient of Free Non-Surrogacy IVF Cycle Drawing

I understand if I am the winner of the free (non-surrogacy) in vitro fertilization (IVF) cycle, this represents the use of physician and physical services of the Florida Institute for Reproductive Medicine for an IVF cycle. This is defined as the necessary treatment monitoring and physician services during an IVF cycle as well as the procedural involvement. Accordingly, what will be provided to me at no cost will include IVF cycle office monitoring visits, egg retrieval, and embryo transfer. If necessary, intracytoplasmic sperm injection (ICSI), assisted hatching, and cryopreservation (freezing) of excess embryos resulting from the IVF cycle will also be included.  I understand I will be responsible for purchasing medications necessary for the IVF cycle.  If a significant male fertility factor problem exists, which requires a sperm extraction procedure, such as epididymal aspiration or testicular biopsy, or donor sperm, those services would be performed at an additional cost to me. Necessary baseline pre-IVF testing, such as prenatal and communicable disease bloodwork, will be my financial responsibility. Therefore, this free IVF cycle is limited to those services which I personally will require to successfully proceed with a fresh in vitro fertilization cycle and embryo transfer. Any future, subsequent use of the frozen embryo(s) resulting from this free IVF cycle may be performed at my own expense. I understand that the free IVF cycle must be completed within one year of the date it is awarded. I am not able to transfer this free cycle to any other party or person, nor assign it. The free IVF cycle may not be sold to any other third party. Only one entry for the free IVF cycle per sexually intimate, reproducing couple is allowed. There is no actual monetary value associated with this, and it may not be exchanged for any monetary denomination. This free IVF cycle may only be utilized at the Florida Institute for Reproductive Medicine. If it is felt by the physicians at the Florida Institute for Reproductive Medicine that I am not medically fit to undergo an in vitro fertilization process or safely be pregnant, then solely at the discretion of the physicians at the Florida Institute for Reproductive Medicine the equivalent amount of services that would be extended to me by winning this IVF cycle may be applied to other services that would be applicable to me. I attest that I am 48 years of age or younger.

I understand there is no guarantee of pregnancy outcome with this treatment. I understand that if I am the recipient of the free IVF cycle, that this does not cover any associated travel costs, accommodations, food, lost wages, or the like in my travel between my area of residence and where the IVF services are performed. I agree to hold harmless the Florida Institute for Reproductive Medicine, its employees, staff, agents, and officers, for any unintended medical consequences of going through the in vitro fertilization process. This could include, but is not limited, to those rare occurrences potentially encountered during any in vitro fertilization process, such as bleeding, infection or any potential need for hospitalization. If such a medical event does occur that requires treatment of an issue related to the in vitro fertilization process, then payment for that treatment would be mine alone and/or through that of my own medical health insurance policy. Responsibility for any tax liability arising from winning the free IVF cycle is mine alone, and is to be determined by myself or my designated tax preparer.

Due to the sensitive nature of the seminar and the material presented we kindly request that no children attend.

Florida Institute for Reproductive Medicine proudly serving patients in North Florida and South Georgia including Savannah, Columbus, Jacksonville, Jacksonville Beach, Orange Park, St. Marys, Palm Coast, St. Augustine, Palatka, Lake City, Tallahassee, Daytona, Ponte Vedra, Gainesville, Orlando, Melbourne, Ormond Beach, New Smyrna, Port Orange, Brunswick, St. Simons Island, Thomasville, Tifton, Albany, Brunswick, Valdosta and Dothan Alabama.

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