Oregon Health & Science University       PROFILE FOR SPERM DONOR        #6520

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 49), mother (47), PGF (78), PGM (75), MGF (84), MGM (74), 1 M aunt (50), and 1 sister (19) are all living and in good health; however, the PGF is reported to have bad asthma and multiple kidney stones at age 64, and the MGF is reported to have received a shunt placement for excess cerebrospinal fluid at age 80.

Donor’s vision:  great (doesn’t need glasses).

Donor’s hearing:  great.

Donor’s dental history:  braces.

 

 

OCCUPATION:  Allied Medical Field

 

RELIGION:  Undetermined

 

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.

 

Music (voice and many instruments), dancing (salsa and swing).  
I was a model for two years in California.                                              

 

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

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

Music and art and cooking on my maternal side, and athleticism and dancing/rhythm from my paternal side. 

 

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.

 

Rock climbing (I would rate myself at the upper-intermediate level), swing dancing, making and listening and seeing music, hiking/mountaineering, and reading about science and medicine.

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

 

 I was in a technology program in high school, emphasizing in math, science, and engineering. My favorite courses were music though.  I took college music courses in jazz theory and improvisation during high school as well, but my favorite college course so far has been physiology. 

5. GPA, High School: 3.2                           GPA, College: 3.4                            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.                      

Socially acute, funny, outgoing, witty, fun, and calm.  

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

 

 I personally know someone who may be unable to have children of her own; even though that is what she wants most in the world. I am happy to help out anyone in a similar situation as her. 

Additional Descriptive Characteristics:

 

Handedness: Right

 

 Foot/Shoe Size: 10 

 

Hairy Chest: NO

 

Hairy: NO

 

Beard Color: Brown

 

Any Distinguishing Features (Dimples, Cleft Chin, Roman Nose, Freckles, etc.): NO                                                                           

Acne problems: Mild during high school.

 

Reactivity/Sensitivity to sun exposure:

 

My body is very comfortable in the sun. I tan very easily.

 

Donor Family Social History:
                                                                                         

	Education	Occupation	Interests	Eye color	Hair color	Height	Body Type
PGF		Newspaper printer	Cards, music, dancing.	Brown	Brown	6’	Slender
PGM		Chicken farmer	COOKING	Green	Brown	5”5’	Average
MGF	Masters in engineering	Aeronautical engineer	Puzzles, cards, and planes.	Green	Brown	6’1’’	Slender
MGM	Secretarial School	Secretary	Cooking, cards, puzzles.	Blue	Blond	5’6’’	Average
Father		Check authenticator for a bank	Dancing, cooking, and basketball.	Brown	Brown	6’1’’	Slender
Mother	Masters in Business	Teacher of computer	Baking, cards, painting.	Green	Dirty blond	5’9’’	Average
Sister	In college	Barista	Traveling, tennis, food.	Green	Brown	5’11’’	Average
Sister
Cousin	In college	Pastry chef	Cooking, reading, running.	Brown	Dirty blond	5’6’’	Slender
Aunt	Bachelors in cartography	Clothing designer	Rowing, traveling, hiking.	Green	Brown	5’9”	Slender

 

Comments about or additions to your family history:

 

There is never a shortage of good food from anyone in my family. We all seem to have acquired the phenotypical disposition for palates that appreciate good food and the skills to make it ourselves. There are lots of dance lovers in the family also, and everyone in the family gets along with everyone else.

 

Psychological Assessment and Comments from Paula Acker LCSW, an independent Psycho Social Counselor, following an Interview with donor 6520:

Referral Information:  Donor 6520 was referred for a psychological evaluation to be an anonymous donor for Oregon Health and Sciences University. Prior to this assessment he had a medical evaluation and screening at OHSU.  This evaluation was done as a face to face interview following the guidelines of the American Society of Reproductive Medicine Mental Health Professional Group recommendations for anonymous donors.  This evaluation also included the PAI psychological testing and the results will follow in this report.

 

Motivation for Donation:  Donor is a new resident to Oregon and is single. He moved to Oregon with his girlfriend with the desire to go to nursing school after he establishes his residency. He would like to become a traveling nurse. His motivation to be a donor is to help those that are unable to have children and to pass his genes on to those who may need assistance.  He is also knowledgeable about infertility because his girlfriend’s sister has struggled with trying to conceive.  He has very positive feelings about being a donor and helping others. 

 

Informal Mental Status and Behavioral Observations: Donor 6520 is a very pleasant and personable young man.  He was oriented to person, place and time, and did not display any cognitive deficits.  He was intelligent and logical during this evaluation and had an upbeat and very sweet disposition.  He is very goal directed in his life and enjoys the present while thinking carefully and planning for his future. His affect was appropriate to the discussion, questions and answers.

 

Brief Psychosocial History: Donor grew up in California. His parents divorced when he was six years of age. His father is forty nine years old and hasn’t been in contact with his son for a couple of years.  His father’s  prior occupation was working at a large bank in the check fraud department. His mother is forty six years old and a college professor at a community college. She is healthy and has been remarried since this donor was nine years old. He has one sister who is nineteen and studying to be a sports medicine physical therapist.  Donor also has two stepsiblings, ages twenty three and twenty six, who are very close to him and part of his family.

 

Psychological Family History:  Donor states there is no history of mental illness in the family of origin and he has never sought counseling as an adult. There is no history of alcoholism in the family of origin.  Donor denies any use of recreational drugs or having any substance abuse problems.  He graduated from high school with a 3.0 GPA and has attended over two years of college. He has no legal or financial problems and is self supporting.  He is a non-smoker.  He works full time at a nursing facility in the memory care unit and really enjoys working with the elderly. He has recently become a medication aid. He has never had any depression or psychiatric problems. 

 

Hobbies and Interests:  Donor 6520 enjoys rock climbing, cooking and loves to dance.  He was a competitive swing dancer in California and he taught salsa dancing. His father is Cuban and he feels he inherited the gene for Latin music. He also climbs mountains and loves to read. His favorite readings are Scientific American. He is a musician and plays many instruments. 

 

Psychological Testing Results:  Donor took the PAI psychological tests and it did not indicate the presence of a psychological condition, acute emotional distress, or personality disorder. The testing did indicate this donor is a risk taker, and has a tendency to be rather impulsive. The testing showed he had an adventurous personality style and enjoys being spontaneous.

 

Recommendations:  Donor would like to be an Information Release Donor. He has carefully considered being a donor and feels comfortable passing on his genes anonymously.  He has the support of his girlfriend and she is considering becoming an anonymous egg donor.  He is a very likeable man and he did not demonstrate risk for any excessive emotional attachment to his sperm or the resulting offspring. His personal and familial mental health histories are within the guidelines that are acceptable for donors and based on the clinical interview and testing is recommended as a donor for OHSU. It was a pleasure to meet this very personable and intelligent donor. 

 

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 grew up in a wonderful and loving family. My childhood was very adventurous and fun. My parents always backed my decisions in life choices. (I.e. athletics or music) I was very active in all sports growing up, and my parents made it to every game. I have a sister three years younger than me and we had our basic sibling rivalries, but we always loved each other and we get along great.

 

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.

 

We would visit with my maternal grandparents quite often. They had a pool and so we would go there as much as possible. We would also sped quite a bit of time with my aunt, uncle, and cousins. My cousins were the same age as my sister and I, so we all became great friends.

 

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

   

Food(s): Ice cream…and it still is.    

   

Colors(s): Red                       

   

Toy(s): I loved RC cars and sports equipment                                              

   

Indoor Game(s): I loved video games, books, and board games.  

   

Outdoor Game(s): Kick the can, tag, and capture the flag.           

   

Book(s): The Hardy Boys, Goosebumps, and The Way Things Work.

 

Sports(s): Football, baseball, and basketball.

 

Other Activity(s): I played a lot of music: Piano, guitar, bass, drums, flute, trumpet, saxophone, and I sang in choir.

 

4. What is your earliest memory?

 

Watching Sesame Street with my babysitter.

 

5. What did you do during the summers?

 

I played a lot of outdoor sports with my friends. I would usually go to a summer camp for a week. I also loved to swim in the pool and the ocean.

 

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 was raised learning on and about computers, and the Internet became public. Pagers in junior high and cell phone in high school.

 

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 always enjoyed the social aspect of school, but it wasn’t until college that I truly appreciated the learning and knowledge and wisdom schooling has to offer.

 

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

 

I always loved helping my mom in the kitchen. I cleaned the bathrooms once a week and mopped the kitchen floor. My family always had a garden and each kid was assigned a vegetable to maintain. I planted and grew and harvested our corn.

 

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

 

My family ate dinner together every single night growing up. My mom would read a new manner to us all, and we were to practice that one manner at dinner that night. She would also through etiquette parties for my friends and I. She would cook a five-course meal, and would teach us all the manners to be used throughout the meal. I have always had great manners in mind, but usually choose not to use them.