Form to request mouse IVF

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PI Date
Contact person Lab room
Phone Email
Department Cancer Center member?
PTAO Funding source  NIH etc.
Male
Zygosity
Male strain Age
# of males  submitted Fertility
Female
Zygosity
Female strain # of females if submitted
Vendor Stock #
Animal protocol # CCM #
Mouse room:

Brief description of the project and special note to GTTF:

When a male mouse repeatedly fails to plug or impregnate normal female mice due to unknown reasons, IVF is the preferred first choice of methods to overcome male fertility problems.  However, the success of IVF relies largely on that reasonable number of motile sperm can be retrieved.  This is often unknown until after the male mouse is euthanized, the sperm collected from cauda epididymides, and the sperm number and motility assessed under the microscope.  If an insufficient number of sperm and/or immotile sperm are found, the investigators will be informed on the day of the procedure and, if IVF is cancelled, a responsible charge levied for the service provided.  If a sufficient number of motile sperm are obtained, the transgenic facility will perform to produce offspring.

investigator's signature for agreeing to the terms

 GTTF's signature for acceptance of the project

Please click "Submit" button to send the request electronically to GTTF.  Click "Back" button on your web browser to print, sign and bring the form to Jordan 2223 (ext. 2-3990) to confirm the timeline of the service.  Electronic signature is not available at this time.