First Name*Partner's First Name*Email Address* Province*AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukonSection WhiteUpload Your Success Story!Image One: You and Your Partner*min. size 310 x 310 pxImage Two: Baby or Family Photo*min. size 600 x 600 pxSelect Your NewLife Fertility Doctor*Select Your DoctorDr Samuel SulemanDr Salim DayaWhat Treatment(s) Did You Undergo?* In Vitro Fertilization (IVF) intrauterine insemination (IUI) Ovulation Induction Timed intercourse Egg donation Donor egg Donor sperm Gestational Carrier Frozen embryo transfer (FET) Egg freezing What was Your Infertility Diagnosis?* Endometriosis Ectopic pregnancy Advanced age Immune system disorders Premature ovarian failure Secondary infertility Recurrent miscarriage Unexplained infertility Male factor Tubal obstruction Pelvic adhesive disease Polycystic ovary syndrome (PCOS) Hypothalamic amenorrhea Fibroids None/Elective IVF Length of TreatmentHow long was your infertility journey? How many cycles did you undergo?*Your StoryShare your inspiring success story!*How did your NewLife Fertility physician and nursing team help to make your journey a success?*Helpful ResourcesDid anyone/anything else help you through your infertility journey?*Unique MomentsWhat were some highs or lows of your treatment(s)? What is unique/different about your story?*Provide Hope and InspirationWhat advice do you have for others struggling with infertility?*Working with NewLife IVFTell us about your experience with NewLife Fertility*NewLife Fertility has consent to use my first name (and my partner's first name)*YesNoCan we contact you via email if we have any questions?*YesNo This iframe contains the logic required to handle Ajax powered Gravity Forms.
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