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I have seen many friends struggle with infertility and I have a child of my own; I would like to help a struggling woman or couple going through the same thing experience the joy and miracle of a child.
DONOR EGG AVAILABILITY: Available
- Age: 31
- Eye Color: Blue
- Hair Color: Blonde
- Height: 5'10''
- Weight: 194 lb
- Location: Texas
- Ethnic Background: Native American
- Prior Cycle History: 0X Donor
- Cycle Outcome Details:
- 1/2011: Description, e.g.: 30 eggs retrieved, 24 mature, 23 fertilized, 17 embryos cryopreserved. FET update: twin birth.
- Blood Type: O-
- Weight: 194 lb
- Height: 5'10''
- Eye Color: Blue
- Hair Color: Blonde
- Hair Type: Straight / Medium
- Skin Tone: Fair
- Do you have freckles? None
- Body Frame: Medium
- Dominant Hand: Right
- Do you use corrective lenses? yes
- Ethnic Background: Native American
- What was your age at first menstruation?
- How many days between menstrual cycles?
- How many days does your menstrual cycle last?
- Has your menstrual cycle ever been irregular?
- Are you currently sexually active?
- Has anyone in your family had problems becoming pregnant?
- How many sexual partners have you had in your lifetime?
- How many sexual partners have you had in the past year?
- Are you currently in a monogamous relationship?
- Have you ever been diagnosed for a sexually transmitted disease?
- Have you had any reproductive problems?
- Have you ever been pregnant?
- Do you smoke, or have you smoked in the past (cigarettes, e-cigarettes, etc)?
- Do you drink alcohol?
- Do you use recreational and/or illegal drugs?
- Do you have any allergies, or have you in the past?
- Describe your diet:
- Do you exercise?
- Are you currently under a physician's care for any reason?
- Are you currently or have you ever suffered from depression?
- Do you have a history of depression in your family?
- Have you ever undergone surgery?
- Have you ever been hospitalized for reasons other than those listed above?
- Have you had any piercings or tattoos in the past year?
- Have you ever traveled outside the United States?
- Heart defect:
- Hardening of the arteries:
- High cholesterol:
- Heart disease:
- Heart murmur:
- High blood pressure:
- Stroke:
- Thalassemia:
- Anemia:
- Sickle-cell anemia:
- Hemophilia:
- Leukemia:
- Lymphoma:
- Immune disorder:
- Autoimmune disorders:
- Lupus:
- Pneumonia:
- Allergies:
- Hay fever:
- Asthma:
- Emphysema:
- Cystic fibrosis:
- Chronic obstructive pulmonary disorder (COPD):
- Lung cancer:
- Tuberculosis:
- Cirrhosis of the liver:
- Colon cancer:
- Crohn's disease:
- Prostate cancer:
- Testicular cancer:
- Appendicitis:
- Gallstones:
- Ulcers of the stomach or duodenum:
- Diabetes - type I:
- Diabetes - type II:
- Hypoglycemia:
- Hypothyroid:
- Hyperthyroid:
- Thyroid cancer:
- Kidney disorder:
- Kidney stones:
- Down syndrome (trisomy 21):
- Klinefelter syndrome (XXY):
- Turner syndrome (X):
- Fragile X:
- Miscarriage:
- Endometriosis:
- Ovarian cysts:
- Polycystic ovaries:
- Ovarian cancer:
- Cervical cancer:
- Breast cancer:
- Premature menopause:
- Uterine fibroids:
- Uterine cancer:
- Gaucher disease:
- Wilson's disease:
- Tay-Sachs disease:
- Canavan disease:
- Hydrocephalus:
- Cerebral palsy:
- Neurofibromatosis:
- Epilepsy:
- Spinal cord disorders:
- Spina bifida:
- Migraines:
- Multiple sclerosis:
- Parkinson's disease:
- Huntington's disease:
- Alzheimer's disease:
- Unexplained senility or mental decline before age 50:
- Autism spectrum:
- Asperger's syndrome:
- Anxiety disorder:
- Depression:
- Manic depression:
- Bipolar disorder:
- Schizophrenia:
- Drug abuse:
- Alcoholism:
- Suicide:
- Deviated septum:
- Cleft palate/cleft lip:
- Marfan syndrome:
- Spinal muscular atrophy (SMA):
- Muscular dystrophy:
- Dwarfism:
- Congenital hip disorder:
- Gout:
- Osteoarthritis:
- Rheumatoid arthritis:
- Osteoporosis:
- Color blindness:
- Cataracts before age 50:
- Blindness:
- Glaucoma:
- Deafness before age 50:
- Acne:
- Eczema:
- Pigmentation disorder:
- Skin cancer:
- Club feet:
- Any other medical conditions not reported above?
- HIGH SCHOOL EDUCATION
- Year of Graduation:
- GPA:
- List applicable high school awards, honors, clubs, sports, other extracurricular activities:
- GPA:
- What were your favorite classes or subjects?
- What were your least favorite classes or subjects?
- Why do you want to become an egg donor?
- Describe your personality as a child:
- Describe your personality now:
- Describe your relationship with your parents as a child:
- Describe your relationship with your parents as a teen:
- Describe your relationship with your parents as an adult:
- What are your personal goals?
- What are your professional goals?
- What are you doing at this point in your life?
- What do you like most about yourself?
- Describe your likes and dislikes in life:
- What is your favorite color?
- What is your favorite food?
- What is your favorite music genre or music group?
- What is your favorite author or book?
- What is your favorite movie?
- What is your favorite season?
- Why?
- What is your favorite holiday?
- Why?
- What are your hobbies?
- Describe your dream vacation:
- What was the most memorable moment you remember from childhood?
- What is the most memorable and/or monumental moment in your life to date?
- As a child, what did you want to be when you grew up?
- What characteristics do you hold that you feel would be important for potential parents to know about you?
Donor Egg Availability:
AVAILABLE
