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Research Subject Information Sheet

Sponsor: Reproductive Medicine Associates of New York, LLP

10th Floor

635 Madison Avenue

New York, New York 10022

United States

Protocol Title: The evaluation of clinical, non-clinical and social lifestyle choice(s) as it associates to the satisfaction, consultation and optimization of artificial insemination or assisted reproductive technology treatment(s).

Investigator: Alan B. Copperman, M.D.

10th Floor

635 Madison Avenue

New York, New York 10022

United States

You are being asked to be in a research study that will try to elucidate opinions, assumptions, inferences and/or views underlying the relationship between infertile patient’s clinical, non-clinical and social lifestyle choices and their experience(s) with artificial insemination or assisted reproductive technologies (ART) (hereafter referred to as “reproductive treatment(s)”) outcome. This may lead to better ways to prevent, detect and treat female/male infertility.

Your participation will involve participating in a survey/questionnaires that will take 15-30 minutes to complete. Up to 10000 subjects will participate in this research study.

Participation in this study will in no way affect your treatment cycle or chances of pregnancy, nor will it prevent later transfer of thawed embryos. There are no known risks associated with being in this research. If you are uncomfortable with a survey question, you have the choice to refuse response and leave blank. If you are confused as to the understanding of a question you may ask for clarification from the research staff.

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