Pregnancy Data Submission Form
We'd love to hear your results! Please complete this form with a summary of all transfers from a single transfer day. If you transferred both fresh and frozen embryos, kindly submit them on two separate forms to help us keep everything accurate and organized. If you have any questions or feedback, please reach out to pregcheck@vytelle.com and we'll be glad to support you. Thank you for partnering with us!
Ticket Name
Please type in the name of the producer the data corresponds to.
Who is submitting this form?
*
Type your full name.
Customer Name
*
Producer's name that the data is related to.
Ranch Name
Name the Satellite that you partner with. If we come direct to your operation, please include your farm name.
Customer's Email
*
Who is submitting this form?
Embryo Transfer Date
*
-
Month
-
Day
Year
Date
Embryo Type
*
Please Select
Fresh
Frozen
# of Transfers
*
# of Pregnancies
*
Conception Rate (%)
Did you use Vytelle ASSURE on these recipients? (USA ONLY)
*
Yes
No
Vytelle ASSURE Results (USA ONLY)
Please record the number of test results for each color from the report you received from Vytelle ASSURE testing.
Green - # of Transfers 🟢
Green - # of Pregnancies 🟢
Yellow - # of Transfers 🟡
Yellow - # of Pregnancies 🟡
Red - # of Transfers 🔴
Red - # of Pregnancies 🔴
No Result - # of Transfers 🚫
No Result - # of Pregnancies 🚫
(Hidden) - Sum of ASSURE Transfers
Vytelle ASSURE Conception Results
Green Conception Rate (%) 🟢
Yellow Conception Rate (%) 🟡
Red Conception Rate (%) 🔴
No Result Conception Rate (%) 🚫
Additional notes for context:
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