Cycle Status and Updates or Notifications

Please use this form to input initial status of a new gestational surrogacy match and to update it throughout the journey.
  • Please provide the name of the Gestational Carrier.
  • Please provide the name(s) of the intended parents.
  • Please provide the name of the Agency coordinating the match.
  • Please provide the name of the cycle coordinator at the agency.
  • Please provide an update on the status of the match or cycle from the drop down menu. If the update you want to provide is not in the drop down menu, please include it in the Comment section at the bottom of the form. Please select as many categories as are appropriate for your update.
  • Please provide the date on which the GSA was executed and attach a copy of the GSA where indicated below. This information only needs to be provided once. You do not need to complete this field if the surrogate already is pregnant or other updates are being provided to the Team at TSEMCI.
  • If you are providing an update on the status of a cycle and upcoming med start date or the commencement of med start, please identify the date on which the surrogate is anticipated to start medication in furtherance of the cycle or the date on which medication was commenced (you may use this field to update information previously provided to our Team).
  • If you are providing an update on the status of a cycle and upcoming embryo transfer date, please identify the date on which the surrogate is anticipated to have embryo transfer or the date on which embryo transfer was conducted (you may use this field to update information previously provided to our Team). If the surrogate is providing this information please provide documentation from the IVF Clinic below so independent verification is not needed..
  • If you are providing an update on the status of a cycle and early pregnancy, please provide the date on which the surrogate obtained a positive Beta HcG. You may use this field to update information previously provided to our Team but you do not need to complete this field if the surrogate already is pregnant. If the surrogate is providing this information please provide documentation from the IVF Clinic below so independent verification is not needed.
  • If you are providing an update on the status of a cycle and pregnancy, please provide the date on which the surrogate had confirmation of pregnancy by fetal heartbeat on ultrasound. You may use this field to update information previously provided to our Team but you do not need to complete this field if the surrogate already is pregnant. If the surrogate is providing this information please provide documentation from the IVF Clinic below so independent verification is not needed.
  • If you are updating the Team at TSEMCI regarding a new pregnancy, please provide the date on which the surrogate is due to deliver. If the surrogate is providing this information please provide documentation from the IVF Clinic below so independent verification is not needed.
  • If you are providing an update to the Team at TSEMCI regarding a new pregnancy or recent delivery, please confirm the number of fetuses being carried or delivered by the surrogate from the drop down menu.
  • If the surrogate has experienced a pregnancy loss (miscarriage or still birth), please identify the date on which the treating physician confirmed the pregnancy was lost.
  • If the surrogate underwent an invasive procedure, please identify the date on which the procedure was conducted.
  • If you are providing an update to the Team at TSEMCI regarding the issuance of a bed rest or work restriction order (either pre or post partum), please identify the date at which the bed rest or work restriction BEGINS. Please also attach a copy of the bed rest or work restriction order below. Lost Wages should be submitted using the Lost Wage Reimbursement Form located under the Online Form Menu Tab.
  • If you are providing an update to the Team at TSEMCI regarding the issuance of a bed rest or work restriction order (either pre or post partum), please identify the date at which the bed rest or work restriction ENDS. Please also attach a copy of the bed rest or work restriction order below. Lost Wages should be submitted using the Lost Wage Reimbursement Form located under the Online Form Menu Tab.
  • If you are updating the Team at TSEMCI regarding a recent birth, please identify the date on which the surrogate delivered the baby(ies).
  • Please identify whether the delivery was vaginal or by c-section
    Please check the appropriate box to notify the Team at TSEMCI if there were any complications during or after delivery (complications often trigger additional compensation payments or an extension of time for the payment of insurance premiums). Please briefly describe the nature of the complications in the comment section below.
    Please identify the type of compensation you are requesting be issued to the surrogate. If the surrogate is completing the form, please make sure to provide any requested documentation below in an effort to avoid needing independent verification from the agency or the intended parent(s). Please only complete this form ONCE if you are requesting compensation due at confirmation of pregnancy. The TSEMCI Team will create a payment calendar for all subsequent payments which will be sent automatically to the surrogate. Upon receipt of this update, the TSEMCI Team will determine the amount of compensation due and payable to the surrogate. You may request that compensation may be sent for more than one event (i.e., final compensation due at delivery and c-section compensation).
  • Please provide any additional comments or information here.
  • Drop files here or
    If a surrogate is completing this form, please attach documentation from the IVF Clinic or your obstetrician which verifies any event listed on this form and for which you are requesting compensation (i.e., confirmation of embryo transfer or confirmation of fetal heartbeat by ultrasound). Agencies and Intended Parents do NOT need to attach any documents.
  • Please provide the name of the person completing the form
  • This field is for validation purposes and should be left unchanged.