Oregon Health & Science University                                         PROFILE FOR SPERM DONOR  #6452

Andrology/Embryology Lab

3303 S.W. Bond Ave., 10th floor

Portland, OR 97239

Phone:  (503) 418-3700

 

PHYSICAL CHARACTERISTICS

 

Height:             5í 11Ē

 

Weight:              205

 

Hair Color:      Brown

 

Eye Color:       Blue

 

Hair Type:          Slightly Wavy

 

Complexion:   Fair         

 

Race:               Caucasian 

 

Mother=s Ethnic Background: Irish, Native American (great-grandmother)

 Father=s Ethnic Background: Irish

 

Blood Type:    B +

 

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.

 

Alcoholism:

 

Edema:

 

Mental disorders:

 

Allergy:

 

Emphysema:

 

Mental retardation:

 

Anemia:

 

Epilepsy:

 

Miscarriages:

 

Asthma:

 

Glaucoma:

 

Stillbirths:

 

Blindness:

 

Goiter:

 

Migraine:

 

Cancer:  PA (breast)

 

Gout:

 

Muscular dystrophy:

 

Cataracts:

 

Heart attack:

 

Myasthenia gravis:

 

Cirrhosis:

 

Heart disease:

 

Paraplegia:

 

Cleft palate or lip:

 

Hemophilia:

 

Parkinson=s:

 

Club foot:

 

Hermaphroditism:

 

Psoriasis:

 

Color blindness:

 

Hernia, inguinal:

 

Sickle cell anemia:

 

Cystic fibrosis:

 

Huntington=s chorea:

 

Tay Sachs disease:

 

Deafness:

 

Hypertension:

 

Thalassemia:

 

Diabetes:

 

Jaundice:

 

Undescended testicles:

 

Dislocated hip:

 

Juvenile arthritis:

 

 

 

Eczema:

 

Lymphedema:

 

 

 

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 donorís PGF (84), M aunt (60), 2 M uncles (53, 58), sister (42), 2 brothers (29, 40) and 2 daughters (1, 3)  are all living and in good health.  Deceased are the donorís father (at age 50, traumatic accident), mother (53, complications from having contracted Hepatitis C), PGM (74, stroke), MGF (78, unknown cause), MGM (74, aneurysm), P uncle (27, drug overdose), and P aunt (47, breast cancer).


Donorís vision:  good.


Donorís hearing:  good.


Donorís dental history:  braces as teenager to straighten teeth; otherwise, not many dental issues.

                                                           

 

EDUCATION:

 

Subject of study

 

Type of University

 

> 1 year college

 

 

 

 

 

Baccalaureate Degree

 

X (History)

 

Private university

 

Master=s Degree

 

 

 

 

 

Professional Degree

 

J.D. (Law)

 

Private university

 

OCCUPATION:  Teacher

 

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.


2.Are there any special talents that seem to run in your family?

(athletics, music, artistic, etc.). Please list, including family members.

 

Music ability is something that runs in my family: my paternal grandmother was a classically trained opera singer.  My father played guitar and I played the trumpet in a orchestra in high school. 

Athletics: my family is very athletic in general, my Grandfather still plays tennis well into his 80ís, I played Varsity sports in high school.  I still actively participate in organized and recreational sports.


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 have been an avid woodworker for several years.  I build furniture pieces for my friends and family as well as commissioned pieces for clients.  This isnít my profession but a creative outlet that I enjoy.  My skill level is master craftsman.

Other interests: snowboarding, tennis, camping, hiking and fishing. 


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

 

Humanities, History and politics.  I enjoy studying foreign languages as well and I have studied several. 

 

5. GPA, High School: unknown                GPA, College:   3.4              I.Q.:   133 

 

6. How would you describe your personality characteristics?

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

  

I am a funny person that is reserved when I first interact with a group of strangers.  Once I get to know people I think I am one of the more talkative and cordial people in a group. When the situation is appropriate, I tend to gravitate toward leadership roles because I feel I have something to add.

    

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

 

I have two reasons for wanting to become a donor.  First, is to help pay off my law school debt.  Secondly I think some people really could benefit from the donation to get a family started and I can only imagine the relief that must be felt by having donors available.


Additional Descriptive Characteristics:

 

Handedness: Right/Left/Ambidextrous:    Right

 

Foot/Shoe Size:              11

 

Hairy Chest: YES/NO:   yes

 

Hairy: YES/NO:    No

 

<>Beard Color:          Brown
 

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


Acne problems:     
none

 

Reactivity/Sensitivity to sun exposure:      none

 

Family Social History:                                                                                                  

       

Education

Occupation

Interests

Eye color

Hair color

Height

Body Type 

PGF

 

PhD, Berkeley

Professor

Tennis, Sailing, History

Brown

Brown

6í3

Tall Lean

PGM

 

B.A. Classics

Singer, HR Manager for a Corporation

Singing and Literature

Black

Green

5í6

Lean

MGF

 

High School

Sheriff

Travel and the outdoors

Brown

Brown

Stocky

MGM

 

High School

Office Manager

Travel and the outdoors

Brown

Black

5í5

Small

Father

 

Some College

Small Business Owner

Travel, history, music and gardening

Black

Brown

6í2

Stocky

Mother

 

High School

Day Care proprietor

Gardening and reading

Brown

Green

5í6

Petite

Aunt

 

College

Missionary

Travel, her work in the Church

Black

Brown

5í7

Medium

Your child

Infant

Infant

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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 6452:


Referral Information:
Donor is a married Caucasian man that is the father of two young daughters. He was referred by OHSU Fertility Consultants for a psychological evaluation to be an anonymous sperm donor.  This interview and evaluation followed the guidelines of the American Society of Reproductive Medicine Mental Health Professional Guidelines for anonymous donors and includes the PAI psychological testing with brief results to follow.

 

Motivation for Donation:  Donor states his motivation to be a donor is to help those who want to have children and for financial compensation as he has student loans to be paid. He has carefully considered all aspects of being a donor however, and is very positive about the opportunity to help others have children. He enjoys being a father very much and hopes to have more children in the future. He states his wife is also supportive of him being a donor.

 

Brief Mental Status and Behavioral Observations:  Donor was on time to this appointment and appropriately dressed. His mannerisms and language skills were in the normal range and he was a bright, alert, friendly and sweet man.  He did not display any cognitive deficits and he was oriented to person, place and time. There was no information obtained in this evaluation to suggest he has any emotional or psychological difficulties or struggles. He was engaging and asked interesting, intelligent, and important questions that showed he has been very thoughtful about being an anonymous donor. He was outgoing and had a bright smile throughout the evaluation.

 

Psychosocial History:  Donor grew up on the coast in Oregon. Both of his parents are deceased. His father died in an accident when he was fifty years old. He had no health problems prior to his passing away.  He has owned a motorcycle shop. His mother died at the age of fifty three from Hepatitis C she contracted through a blood transfusion when she was younger and giving birth to his brother. She has been a day care provider.  Donor has a younger half brother that is twenty nine years of age.  He works for a grocery store and has a daughter. He is single with no known health problems.  Donor graduated from Law School and also has an advanced degree in education and is a middle school teacher. After practicing law for a year or so he decided that he didnít like the long hours required to be an attorney and went back to school to become a teacher. His wife is also a teacher and they have their summers off to go camping and travel.  Donor just returned from an east coast trip with his students which he enjoyed very much. He states he is healthy.

 

Psychological Family History:  Donor states there is no history of mental illness in the family of origin and he has never sought counseling or had depression. He has no history of alcoholism in his immediate family but may have a great grandmother who was an alcoholic. He is a light social drinker averaging 2-3 drinks every couple of weeks. He is a non-smoker and states he does not use recreational drugs. He has no legal or financial problems. He is interested in being an Information Release Donor and is open to sharing his photo in the future if needed.

 

Hobbies and Interests:  Donor builds Craftsman style furniture.  He built the crib his daughters used and built it exactly to current crib codes. He built his own bedroom furniture and their childrenís bedroom sets. He loves camping, hiking, fishing, biking, and tennis. 

 

PAI Psychological Testing:  The PAI clinical report reveals no elevations that should be considered to indicate psychopathology.  It was entirely within the normal limits.  According to this testing and his self report he shows no problems with depression, hostility, moodiness, anxiety, or any problematic behaviors.  He reports no problems with alcohol or drug dependency or abuse. He has a positive self concept and a clear sense of purpose in his life and is goal oriented and adaptive to stressors.

 

Recommendation:  Donor meets the psychological criteria by the American Society of Reproductive Medicine Mental Health Professional Group for anonymous donors and along with the clinical interview is recommended as an anonymous donor for OHSU.

 

Paula Acker LCSW

Licensed Clinical Social Worker 

 

 

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?   

 

My parents were divorced when I was very young so I split time between my parents in two different states.  I enjoyed being able to go between the two states and seeing my family in each so it wasnít hard on me until I started doing sports in Junior High.  Then I had to stay in one spot which was with my mother.  But being from a two home family really helped me to see different parts of the country and how people lived and interacted with each other.  I think this experience allowed me take on some the more desirable traits and habits.  Plus, it made me someone that was much more willing to interact with new people and situations.

 

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.

 

 

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

   

Food(s):         Mexican food and pizza.

   

Colors(s):       Blue, because I loved the ocean.

   

Toy(s):            Transformers because I liked how they could change into various objects.

   

Indoor Game(s):       None really-I liked being outside.

   

Outdoor Game(s):    Baseball, football and tennis.

   

Book(s):  Even at a young age, I usually read books about real people from history such as biographies of American Founding Fathers or the Little House on the Prairie series.

 

Sports(s): baseball, football and tennis.

 

Other Activity(s): lots of fishing and camping, gardening, rock collecting and baseball cards.

  

4. What is your earliest memory?

 

My first memory is from when I was about 3.5 years old and we had an earthquake near our house.  There was a chicken ranch down the road and the farmer asked my mom and I if we could help get some of the chickens back into the giant barn that they lived in.  They were kept in by an electrical fence but the earthquake cut off the power and the chicks were everywhere. There were hundreds of these little yellow chicks and it was nearly impossible to catch them.  But the farmer gave me a couple of the chicks and my mom and I raised them until we gave them away several years later.

 

5. What did you do during the summers?

 

The summers I usually spent living with my dad and visiting various family members spread out across the country.  Typically that meant a lot of road trips and camping.   Later my summers were typically spent playing in baseball tournaments or going to summer camp.

 

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 microwaves and VCRís being new technologies.  You had to pay around $1200 to get one and everyone wanted one.  Now VCRís are obsolete and microwaves are a dime a dozen.

 

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 kid.  I used to ride my bike to school because I wanted to get there before the buses and everyone else.  I would just hangout until the school opened.  School and teachers were a very enjoyable experience for me as a kid. 

 

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

 

I had the usual chores of taking out the trash and cleaning the family cars for an allowance.  I also regularly cooked our Sunday night dinner, even at an early age.  I liked cooking and my family was brave enough to allow me to do it.  I eventually figured out how to cook so it wasnít that scary later on.

 

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