request an estimateRequest An Estimate For Uterine Transplantation

*Kindly submit all the queries

1. Name*

2. Date of Birth*

3. Address*

4. Email Id*

5. Contact Number*

6. Height*

7. Weight*

8. I have my own children*

9. I am married*

10. I am planning marriage shortly (6-12 months)*

11. I am planning marriage in 12 months or more*

12. I was born without uterus*

13. I lost my uterus (when, why)*

14. My uterus does not work (why)*

15. I have ovary*

16. I was born without vagina*

17. I underwent surgical creation of vagina*

18. Date of vaginal surgery (where, when)*

19. Vagina has not been created by surgery, but non-surgically, by dilatation*

20. Previous or ongoing diseases (namely)*

21. The main objective of the uterus transplantation is pregnancy and childbirth. The main condition of transplantation is to undergo artificial fertilization with partner and embryos freezing. I acknowledge and agree*

22. Do you have the possibility of frequent travelling to Chennai (several times a week) for a few months before transplantation and also long-term after transplantation?*

23. Do you have any relative who want to donate her uterus for your transplantation?*

24. It is: mother - sister - aunt - other relative*

25. How many times the donor delivered the child?*

26. How many times by caesarean section?*

27. How old is the donor?*

28. Her last menstruation period was in (year):*

29. Does the potential donor use hormonal replacement therapy for women after menopause?*

30. Does the donor have any serious illness? Especially diabetes, high blood pressure, cancer (namely)?*

31. Is she taking any medications (namely)?*

32. Did she undergo any surgical procedure? (namely) and when:*