Oregon Health & Science University                 PROFILE FOR SPERM DONOR    #6488

Andrology/Embryology Lab

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

Portland, OR 97239

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 father (age 62), mother (60), 3 P aunts (66-70), 2 brothers (27, 39), and 1 sister (35) are all living and healthy; however, the youngest P aunt (66 y.o.) has cataracts, the oldest P aunt (70 y.o.) suffers from kidney failure and is on dialysis, the donor’s mother has a pacemaker for a heart murmur diagnosed at age 55, and the donor’s older brother was diagnosed with Type II diabetes at age 31 linked to a weight problem.

Deceased are the PGF (38, train accident), PGM (67, heart attack), a P uncle (74, liver cancer), MGF (75, stroke), and the MGM (63, emphysema).  The donor’s sister’s daughter (16 months old) is healthy with no birth defects and was conceived with sperm from a sperm donor.

Donor’s vision:  20/80.

Donor’s hearing:  very good.

Donor’s dental history:  1 cavity, 1 tooth capped after being knocked out.

 

 

OCCUPATION:  owner of a trade business

RELIGION:  Episcopal

  

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 play the piano and many percussion instruments and have done so since I was a child.                                              

 

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

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

 

My mother plays the violin and my brother is a guitarist in a band.                          

 

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 enjoy cycling, having rode across the country on a charity ride in college. I am an avid reader and try to spend at least an hour a day writing. I spend most weekends during the dry season hiking and camping and have summited many peaks.

 

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

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5. GPA, High School:          4.2                   GPA, College:           3.15                I.Q.: 143   

 

6. How would you describe your personality characteristics?

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

 

Thoughtful, extroverted, firm, friendly, funny, considerate, a little bit of a risk taker.

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

 

My sister and her husband were recipients of a donation program and having witnessed the process I developed a lot of empathy for people who want children but are unable to conceive.

Additional Descriptive Characteristics:

 

Handedness: Right/Left/Ambidextrous               Right handed

 

Foot/Shoe Size:                                                       13

 

Hairy Chest: YES/NO                                              yes

 

Hairy: YES/NO                                                         no

 

Beard Color:                                                              Brown

 

Any Distinguishing Features (Dimples, Cleft Chin, Roman Nose, Freckles, etc.):

Cleft chin, roman nose, large eyes, long fingers

 

Acne problems:

 

minor acne problems in childhood

 

Reactivity/Sensitivity to sun exposure:

 

fair-skinned

 

Donor Family Social History:
 

	Education	Occupation	Interests	Eye color	Hair color	Height	Body Type
PGF	high school	Railroader	Jack of all trades	Br	Br	5'9	slim
PGM	high school	Accountant	sewing	Br	Black	5'6	slim
MGF	Divinity school	Pastor	woodworking	Blue	Blond	6'2	slim
MGM	high school		Church organizer	Br	Br	5'10	round
Father	high school	Utility Tech	Motorcycles	Br	Br	5'8	slim
Mother	Masters Teaching	teacher	Decoupage, knitting	Br	Blond	5'7	round
Brother	BA Finance	Store manager	Handyman	Hazel	Blond	5'11	Round-ish
Brother	Masters Comparative Lit	publishing	Basketball, music	hazel	Brown	6'3	slim
Sister	Masters Teaching	Teacher	Surfing, cycling	Green	Blond	5'11	slim
Cousin	BA Business	Financial analyst	Socializing	Br	Black	5'8	firm
Aunt	high school	Teller	Church organizing	Gray	Blond	5'6	curvy
Aunt	BA English	Banking	painting	Br	Black	5'9	slim
Uncle	high school	auto-repair	Auto racing	Br	Br	5'10	slim

 

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 6488:

 

 

Referral Information:  Donor #6488 was referred to this office for a psychological evaluation to be an anonymous donor for Oregon Health and Sciences University Fertility Consultants.  Prior to this evaluation he had a medical evaluation and screening at OHSU. This evaluation was completed as a face to face in depth interview following the guidelines of the American Society of Reproductive Medicine Mental Health Professional Group recommendations for screening anonymous donors. This evaluation includes the PAI psychological testing and the results follow in this report.

 

Motivation for Donation:  Donor is a single Caucasian man who does not have any desire at this time in his life to have his own children.  He is very interested in helping others achieve their dreams of having a family and expresses how meaningful this will be to know that he helped others to have this fulfillment of a family. His sister and her husband have a young daughter via anonymous donation as her husband was infertile. Donor #6488 saw his sister struggle with wanting to have children and trying for so long before she was successful and that made him decide to become a donor. His family fully supports his decision.

 

Informal Mental Status and Behavioral Observation:  Donor is a very warm and engaging man with a bright smile.  He was on time to this appointment and appropriately dressed. His mannerisms and speech were in the normal range and he did not display any cognitive deficits.  He was oriented to person, place and time and his disposition was very friendly, caring, and kind. He displayed a good sense of humor in the evaluation and an upbeat personality. In fact I would state he has a sparkling personality.  He appears to be a very bright and intelligent man, nice looking, with a sense of independence and a good work ethic.

 

Psychosocial History:  Donor grew up in a small town in California.  His parents are about to celebrate their fortieth anniversary. His mother is sixty two and is a kindergarten teacher. She has taught school longer than anyone in her district and enjoys it so much she has no plans on retiring. His father is sixty four and works for a utility company. They are both in good health, but his mother has a pacemaker and takes blood thinners for her heart.  Donor has three siblings and he is the third born child in his family. His oldest brother is thirty nine and a manager of a grocery store. Also, his oldest brother suffers from a weight problem and was diagnosed with type II diabetes when he was thirty one. He has a thirty seven year old sister who is married and the mother of a child conceived through anonymous donation. She works as an administrative assistant. The youngest in the family is a twenty seven year old brother and he is a publisher in New York with an advanced degree in literature. His siblings are all healthy. Donor #6488 is a college graduate from a large prestigious school in California with a BA in English and Philosophy.  He works in his own company doing a job in the building trades. He really enjoys having his own business. He states to have no health concerns.

 

Psychological Family History: There is no history of mental illness in the family of origin and Donor #6488 has never sought counseling. He has no history of depression or needing psychiatric medication.  There is no history of alcoholism in the family he reports. He is currently a non-drinker having given up alcohol several months ago.  He is a non-smoker.  He does not use recreational drugs, but has tried them in the past during his college days.  He has no legal or financial problems and no bankruptcies. He did have an unexpected trauma recently of a close friend who became severely depressed and needed intervention but he handled that well.

 

Hobbies and Interests: Donor enjoys hiking in the summer and is trying to learn to ski and snowboard. He was a drummer in high school and he also plays the piano. He is writing two novels, both fiction, and that is a hobby for him as well.

 

Psychological Testing Results:  The clinical profile of the PAI psychological testing reveals no evaluations that indicate the presence of any clinical psychopathology.  He reports no problems with unusual thoughts, antisocial behavior, hostility, moodiness, unhappiness or depression.  The testing showed no concerns for anxiety, or any substance abuse dependency. He describes being reasonably self satisfied, confident and optimistic with the ability to be adaptive in the face of life stressors. He is friendly and extroverted and has a cheerful personality style.

 

Recommendation:  Donor is interested in being an Information Release Donor, and had no hesitation to do so.  He has carefully considered passing on his genetics to others and feels very positive about helping those that want very much to have a family.  He did not demonstrate any excessive emotional attachment to his genetic contribution or any potential offspring that may result.  His personal and familial family histories fall into the recommended guidelines of the American Society of Reproductive Medicine Mental Health recommendations for anonymous donors and along with his clinical interview and evaluation he 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?

 

     I was born in the same house and lived there all my life, going home at least three times a year. My father had a large extended family and my mother had moved there for her father's ministry. I got along well with all my siblings and we are all still close. I grew up a small town and knew my friends from kindergarten on. Going home is like a reunion and I sleep in the same bedroom I did when I was five. I entertain the thought of retiring to my parents house when I get old, I have such fond memories of the community, but considering its remoteness geographically and small size I enjoy the life I've made for myself here.

 

 

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.

 

My parents purchased their house from my father's oldest sister and her husband, and I was very close with her daughter, my younger brother and I being ring-bearers at her wedding when we were five and six, respectively. In fact, this year I helped her daughter with her college entrance essay. I had two sets of second cousins who were the same age as myself and close with all of them through childhood, especially the ones with the pool. We would regularly have three-family BBQs. I have many other uncles and aunts on my father’s side but was most close with these.

 

 

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

   

Food(s):                     hotdogs

      I didn't eat beef until college and so chicken and hotdogs were my Tri-tips

 

Colors(s):                   blue

            blue-gray would be a better description, but I have always loved the sky

 

Toy(s):                        X-Men figurines, erector set

        I collect comics as a child and loved the more metallic feel when building with the erector set

 

Indoor Game(s):       risk, monopoly

            The worst arguments I had as a child was in regards to risk alliances

 

Outdoor Game(s):    tag, hide and seek

            In a small town you can use an almost unlimited amount of space to play, and these games benefited the most from it.

 

Book(s):                     Science fiction and fantasy novels

            I might have read with more regularity in grade school than I do now, thinking back to just how many space operas and multi-book sagas I read.

 

Sports(s):                   Swimming, soccer, basketball

            Swimming was something I grew to love over years of being forced onto swim team, I and my siblings inherited my father's love for basketball, and soccer was the most fun I had on Saturday morning

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Other Activity(s):                                                                                                         

 

4. What is your earliest memory?

 

            Picking up my younger brother and holding him when he was a baby

 

5. What did you do during the summers?

 

            Went to camps (church, band, education), played at the river

 

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.

 

            My mother being a teacher I had the first Apple Iigs and grew up with an avid love of computers. Just recently I have moved over to Linux and have been teaching myself coding languages. Though I left the landline behind four years ago my parents still have (perhaps ironically) a rotary dial phone in the living room hardwired to the wall, a lovely anachronism considering how much they themselves use cell phones and computers.

 

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, and was a driven and interested student. My favorite teachers were probably my fourth grade teacher (who was also my first grade teacher) and my seventh grade teacher, both of whom were very considerate with me and, looking back, took extra time out to prepare projects and assignments to keep me interested. We had a healthy gifted and talented program through grade school that was also a great source of enjoyment for me.

 

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

 

            My parents had a somewhat large property and we spent most Saturdays mowing, sweeping, clearing out brush: almost all outside work my brothers and I did with my dad. We all also had to take turns washing the dishes and taking out the trash, which could turn into quit a debate with four children.

 

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

 

           I was a page in Washington D.C. for my congressman during my junior year of high school. Our main duty was running letters from offices around the capitol complex but we were given wide access to congress, being able to sit in on committee meetings and interview congress people. Our school was situated in the attic of the library of congress and we had an excellent staff of teachers. It gave me great insight at such a young age to the workings of government and gave me the desire to be involved and be interested for the remainder of my life. I would say it was a singularly defining time in my youth.