Oregon Health & Science University                                          PROFILE FOR SPERM DONOR  #6409

Andrology/Embryology Lab

3300 SW Bond Ave., CH10F

Portland, OR 97239-4501

Phone:  (503) 418-3700

 

PHYSICAL CHARACTERISTICS

 

FAMILY AND MEDICAL HISTORY

For each item below, if there is a history of the condition, the condition poses a risk of one percent or less to offspring.

The family relationship is indicated.

 

ABBREVIATIONS:                                        M=Mother, or Maternal    S=Sibling                     F,P=Father, or Paternal

N=Nephew or Niece                                              GF, GM=Grandfather, Grandmother

A=Aunt                             U=Uncle                        C=Cousin

 

MEDICAL HISTORY COMMENTS:  The donor’s mother (age 54), father (52), MGF (79), MGM (76), PGF (80), PGM (79), 1 M aunt (50), 2 M uncles (47, 48), 1 P aunt (49), 1 brother (26), and 1 sister (29) are all living and in good health.  The P uncle died at age 46 in a helicopter crash.  The PGF has cataracts.  The donor’s mother has postmenopausal osteoperosis.

Donor’s vision:  wears glasses for driving.

Donor’s hearing: good.

Donor’s dental history: good.

 

 

 

OCCUPATION:  Student

 

RELIGION:  None

                                                            

 

Sperm Donor Social History:                                                                

        

Recipients are often interested in knowing information about donors' personal interests. Please answer these questions as best as you can: some detail and an attempt to elaborate is appreciated. We may edit your answers for clarity or to protect your anonymity. Thank you.

1. Do you have any special talents? If so, please list them.

I have always excelled in sports.  Accomplished alpine climber.

2. Are there any special talents that seem to run in your family? (athletics, music, artistic, etc.). Please list, including family members.

 
Athletics.  Mother, father, brother, and I all played collegiate athletics. 

 

3. What are your interests and hobbies? If appropriate, please include when and at what level you do or did participate in this interest or hobby.  Please elaborate.

I run cross-country and track for my school.  I always dreamed of becoming a professional basketball player and still play twice a week on local teams.  I do a lot of backcountry skiing, alpine climbing, and rock climbing.  I have climbed and skied all over the country.  A few places I have climbed and/or skied at in the past few years are the Wind River Range, Absaroka Range, Rocky Mountain National Park, Ruth Gorge in Alaska, North Cascades of northern Washington and British Columbia, Patagonia, and nearly every area in the southwestern United States.  Other interests are home beer brewing, watching movies (I rarely watch a movie I don’t enjoy in some way), and reading (mostly historical fiction).

4. What did you enjoy studying in high school and college? 

 

My favorite class in high school was calculus.  In college my favorite classes were any microbiology courses, but especially microbial physiology. One of my fondest memories in college was a three-week medical relief trip to South East Asia.  Along with seven other students I worked at an orphanage that provided free health care to people of all ages in the area.  In addition to the medical experience and knowledge gained during this trip I also had the opportunity to live with a host family experiencing the local culture.  It was a wonderful experience that I hope to have the opportunity to do again in my life.

 

5. GPA, High School:  3.5                          GPA, College: 3.91                          I.Q.: 

 

6. How would you describe your personality characteristics?

 

(e.g. funny, quiet, shy, bold, leader, thoughtful, etc.) List as many as you can.

Easy -going, leader, competitive, active, adventurous, goofy, shy although people would probably say I am outgoing, focused.

7. Why do you want to be a sperm donor?

 

Because I think people who truly want a family and plan to have a family would make better than average parents and I would like to help them achieve that dream.

Additional Descriptive Characteristics:

 

Handedness:   Right

 

Foot/Shoe Size:       13

 

Hairy Chest:   NO

 

Hairy:   NO

 

Beard Color:      Light Brown

 

Any Distinguishing Features (Dimples, Cleft Chin, Roman Nose, Freckles, etc.):   None

Acne problems:     None

 

Reactivity/Sensitivity to sun exposure:  I’m not very sensitive to sun.  I tan very easily.

 

Donor Family Social History:                                                                                                 

	Education	Occupation	Interests	Eye color	Hair color	Height	Body Type
PGF	Bachelor	Investment consultant	Basketball, applied mathematics,	green	brown	6’	Athletic
PGM	Bachelor	Home maker	Gardening, card games	Blue	Blond	5’7’’	Thin
MGF	Medical Degree	General surgeon	Competitive running, reading	Brown	brown	6’4”	Athletic
MGM	Bachelor	Middle school teacher	Reading, gardening	Gray	brown	5’6”
Father	Medical Degree	Physician	Basketball, fly fishing, skiing	hazel	brown	6’3”	athletic
Mother	Bachelor	Nurse	Gardening, yoga	Brown	brown	5’9”	athletic
Brother	Bachelor	Construction foreman	Basketball, movies, skiing	Brown	Brown	6’6”	athletic
Brother
Sister	Bachelor	Energy efficiency consultant	Environmental politics, yoga	Hazel	Brown	5’8”	athletic
Sister
Cousin	Bachelor	Airline Pilot	Flying, surfing	Brown	Brown	6’	athletic

 

Comments about or additions to your family history:

 

Psychological Assessment and Comments from Paula Acker LCSW, an independent Psycho Social Counselor, following an Interview with donor 6409:

Referral Information:  Donor is a full time college student. He was referred by OHSU Fertility Consultants Andrology Dept. for a psychological assessment to be an anonymous donor for the OHSU Sperm Bank. This evaluation followed the guidelines of the American Society of Reproductive Medicine Mental Health recommendations for anonymous donors and included the PAI personality assessment inventory with results that follow in this report.

 

Motivation for Donation: Donor states his motivation to be a donor is to help those with infertility and also for the economic benefit.  He has grown up in a medical family with a physician father and nurse mother who have worked in the area of reproductive medicine and is sensitive to the issues that people face in desiring to have a child.  He also has family members that are gay and is supportive of those choosing to have children because they are in a same sex relationship.  Because he is a full time student the assistance from being a donor will be helpful to him.

 

Informal Mental Status and Behavioral Observations:  Donor was on time to this appointment and appropriately dressed. He was very warm and friendly with a very handsome face and smile.  He was friendly and upbeat in answers to questions and did not display any cognitive deficits. His language and mannerisms were in the normal range and there was no information obtained to suggest that he had any psychological difficulties or struggles. He was very pleasant, genuine and intelligent in our conversation and displayed a great likeability. 

 

Brief Psychosocial History:  Donor grew up in the Pacific Northwest. His father is a physician and his mother is a registered nurse. They divorced when he was seven years old.  He states they are both in excellent health.  His father has remarried and has two additional sons.  His mother had two children prior to her marriage to his father and he is closer to these siblings.  His older brother just had a baby boy, his first child.  He works as a construction foreman. His sister is thirty three and is married with two children. He states his siblings and their children are all in excellent health. Donor is a junior in college studying microbiology and is interested in pursuing a medical career. He is also very healthy he reports.

 

Psychological Family History:  Donor states there is no history of mental illness in the family of origin and he has never sought counseling.  He has never suffered from depression or sought psychological support for mental health issues.  There is no history of alcoholism in his family of origin. He has never had substance abuse problems or treatment he reports.  He is a social drinker averaging about 3-4 beers per week.  He is a non-smoker.  He has had a recent family loss of his ninety nine year old grandmother but is not suffering from any unanticipated loss or grief.  He appears to be a very psychologically stable man with an upbeat personality. He describes his personality as “shy, but outgoing and friendly and warms up quickly to people.”

 

Hobbies and Interests: Donors number one hobby is running and he belongs to a running club.  He does distance running. He is an outdoor enthusiast and enjoys skiing, cycle cross off road biking, camping, backpacking and fly fishing. He took a year off from college to climb mountains and climbed all over the southwest USA.

 

Results of the PAI Psychological Testing:  Donor was completely in the normal limits with no signs of psychopathology.  He describes no problems with antisocial behavior, hostility, moodiness or impulsivity.  He did not show marked anxiety, depression, or any problems associated with alcohol or drug dependency.  His self concept is a stable and positive confident person with lots of optimism.  He has a very clear sense of purpose and is adaptive to life stressors.

 

Recommendation:  Donor meets the psychological criteria to be an anonymous donor based on the recommendations by the Mental Health Professional Group of the American Society of Reproductive Medicine recommendations and along with his clinical interview and results of the PAI testing is recommended to be a donor for OHSU. Donor would like to be an Information Release Donor.

 

Paula Acker LCSW

Clinic Counselor OHSU

 

CHILDHOOD PAGE

 

1. In general, please describe your childhood.  Did your family stay in one place, or did you move often? What is your recollection of these places/homes? If you have siblings, how did you get along with them?

 

 I lived in the same house until I graduated from high school.  I have one older brother and one older sister.  My sister is much older than me so she always seemed like more of a caretaker or a grown up than my sister.  My brother and I got along fairly well.  We played together often though I am sure I annoyed him like little brothers are supposed to.  We are very close now that we are older.  We lived in a neighborhood that was very close knit.  I had the same 14 friends throughout my childhood.  We were all in the same class throughout my school years.  Most free time was spent playing outside with them.  I played a lot of sports when I was a kid.  Nearly everyday I was at some practice or some game.  My mother was a big time hippie and thought television was the devil.  We were only allowed to watch one movie a week and we always anxiously awaited movie night, which was Friday night.  We had 3 dogs all labs, one chocolate, one black, and one golden.  Molly was mine and she was the youngest chocolate lab.  We got her when I was 3 years old.

 

2. Were there any family members other than your parents and siblings with whom you regularly had contact? Please relate a story(or stories) or an incidence(or incidences) that you particularly remember of him/her/them. 

 

All of my family, except my immediate family, live in either Hawaii or California.  We would only visit family for holidays and during summer vacation.  My Dad’s father was always a hero to me.  He played basketball for a big time college program.  He had an incredible life and was an exceptional storyteller.  He actually went to an ivy league school when he was very young.  He was always an inspiration to me.

 

3. As a child, what was your favorite:     (Please include a reason, or why, if you can.)

   

Food(s): 

 

I have always loved peanut butter I still eat about 1lb of pb every 2 weeks.  Tamales was/is my favorite dish.  We had a housekeeper when I was younger and she always brought tamales on Mondays.  They were delicious.

   

Colors(s):

 

Dark Blue maybe cobalt blue.  We would go to Hawaii a lot to visit family and I always loved the color of the deep ocean there.   

   

Toy(s):

 

My basketball and hot wheels.                 

   

Indoor Game(s): 

 

Lego’s. I would build entire cities for weeks at a time then admire it for a few days and then tear it down and start over.      

   

Outdoor Game(s):   

 

Basketball, football, baseball, and trampoline.  I grew up in a neighborhood with 15 other boys my age who were all friends.  Everyday after school until dinner we would play some sort of sport.

   

Book(s): 

 

The only two books I can remember reading apart from the books for school were “Lord of the flies” and “Once a Runner”.  My grandfather gave me “Once a Runner” when I was about 8 or 9 years old.   It was his favorite book and it meant a lot to me to be able to share that with him.  I stole “Lord of the Flies” from my brother; he was reading it for school.  I was only 8 or so at the time, but I remember the story terrified me and fascinated me at the same time.  It is still one of my favorite books.

 

Sports(s):

 

I played sports year round including soccer, baseball, basketball, and football.  I enjoyed basketball the most and played it year round in addition to the other sports.

 

Other Activity(s):

 

Skiing and piano lessons.  I fell in love with the mountains and would beg my parents to move somewhere where I could ski everyday of the year.  I hated piano lessons though it was probably due more to the cranky old lady who taught me than actually hating playing the piano.

 

4. What is your earliest memory?

 

My earliest memory is of the beach at our beach house in Mexico.  I am not sure how old I was, but I had to be around 3 years old.  I just remember my brother teaching me how to make a sand castle and then when I was finished he smashed it.  I cried.

 

5. What did you do during the summers?

 

Summers were spent visiting family.  My mom would usually take summers off.  We would always go to Hawaii for two or 3 weeks to visit my dad’s family and then we would go to either California or Mexico to visit my mother’s family.  My mother’s family isn’t from Mexico they just all bought beach houses right next to each other so it was kind of like a family village down there.  As I got older vacations became shorted and I would go to basketball tournaments or basketball camps.

 

6. Are there any new  technologies you remember becoming available during your childhood which now are commonplace in our society, or which have now been replaced by a newer technology? Explain your recollection of these.

 

I remember video games and computer games were just starting to catch on.  We had a nintendo system that I thought was the greatest thing ever invented. Cds also came around when I was 8 or so.  That was really cool.  You could skip to the beginning of  whatever song you wanted.  Also cell phones started to become common place.  My parents had one of those car phones when I was growing up.  It looked like the regular phone from home except it was in your car.  They were huge and you had to have this giant antennae attached to your car to get reception.

 

7. Did you enjoy school as a child? Do you have any memories of teachers that influenced you, or that you especially liked (or disliked)?

I loved school as a child especially math.  In second grade I stapled a bunch of paper together about 11 pieces wide and 20 pages long and solved a giant long division problem. I would solve it almost to completion then add random numbers to the dividend and keep going.  I love math. My third grade teacher was the first teacher that really encouraged me to be curious.  She taught me that it is ok to get side tracked as long as you learn something along the way.  She kind of had a follow your heart approach to education. I don’t know if I would taken such an interest in science or research if I had not learned how to be curious.  It sounds weird to think you have to learn to be curious, but I think it is a skill that needs to be honed especially if you want to apply it in the scientific or medical field.

 

8. Did you have chores or tasks that you were regularly expected to do? What were they?

 

I fed the dogs and helped my brother mow the lawn.   I didn’t get to help my brother mow the lawn until I was 10.  That was an exciting day.

 

9. Any other recollections of importance that come to mind?