Apply for the IVF Challenge

Please fill out the form below. Since I can only take 2-3 couples in the first round I will be somewhat selective in the couples I choose. Please do not let this prevent you from applying as my criteria are very different from your average fertility clinics. After receiving your application, I will be contacting you by phone or email to clarify things and for both of us to ask any questions.

Name Email Phone Number Female's Age Male's Age Have you ever been pregnant before? Yes No For how long have you been trying to get pregnant? Please provide a brief history of your fertility issues