If you are thinking of going through or have been through the fertility treatment process (IVF, Egg or Sperm Preservation, OI/IUI, etc.), we want to hear from you.
EMD Serono, a leader in fertility treatments and lab technologies, is looking to build an online video library of fertility stories featuring real patients like you. Your story will reach others going through similar experiences, giving them the support, inspiration, and hope they need as they navigate their own journey to parenthood.
Please fill out the application below to share your story with us. If selected, we'll be in touch to shoot a short video about your experience.
First name *
Last name *
Date of birth *
Phone number *
Email address *
Please select the option that best describes you. *
Where are you in your fertility journey? *
If you are trying to conceive, how long have you been trying?
If you've completed cycles with the help of an OB-GYN or Reproductive Endocrinologist (RE), what treatments have you tried? Check all that apply.
Are you using a donor? *
Are you using a surrogate? *
Please select all that apply. *
Share a brief summary of your fertility experience.
If you prefer, you may upload a testimonial video of your fertility story here.
Please upload a recent headshot. *
I agree to the below PRINT AND FILMING CONSENT AND RELEASE statement. *
By checking this box and providing my signature on this application, I understand that I may be chosen to appear in materials in print, video, film or on websites produced or sponsored by EMD Serono or its affiliates, including, but not limited to, photographs, print materials, commercials, film or video, posting on websites, webcasts or social media platforms (the “Works”) for patient education, promotional materials, advertising or other business purposes.
If chosen, I hereby consent to the photographing of myself in still and video or motion picture footage and/or the recording of my voice and the use of these photographs and/or recordings by EMD Serono in connection with EMD Serono’s initiative. I also agree that I may be identified by name.
I hereby agree to appear in any of the Works as determined by EMD Serono or its designees, in their sole discretion. I also hereby grant to EMD Serono and its designees the unrestricted, perpetual, worldwide right to reproduce, copy, modify, create derivative works and otherwise use, display, distribute, exhibit, transmit and broadcast the Works or any part thereof in any media, means or embodiment, now known or hereafter to become known, including my image and identity. I hereby waive any right of inspection or approval of my appearance in the Works.
I also hereby release EMD Serono, its designees, affiliates, advertising agencies and the facility in which the Works are filmed or photographed, and their respective employees, officers, directors, shareholders and agents from, and shall neither sue nor bring any proceeding against any such parties for, any claim or cause of action based upon or relating to the Works.
I warrant and represent that I am over the age of eighteen (18) years and that I am free to enter into this Agreement. I agree that this Agreement shall be governed by the laws of the Commonwealth of Massachusetts, without regard to its conflicts of laws provisions.