PHYSICAL CHARACTERISTICS
| Height: 5' 9" | Weight: 150 | Hair Color: Dark Brown |
| Eye Color: Blue | Hair Type: Slightly Wavy | Complexion: Fair |
| Race: Caucasian | Mother's Ethnic Background:
Danish,
English
Father's Ethnic Background: German |
|
| Blood Type: O + | ||
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: MGM (esophagus, stomach) | 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: |
MEDICAL HISTORY COMMENTS: The donor's father (age 54), mother (52), PGF (74), PGM (72), MGF (76), three siblings (28-31), four half-siblings (7-15), three paternal uncles (45-51), three maternal uncles (48-54), child (2) are all living and healthy. The PGF had an aneurism at age 72, otherwise is in good health. The MGM died at age 68 of cancer of the esophagus and stomach: she smoked, drank coffee/alcohol on a regular basis.
Donor's vision: nearsighted.
Donor's hearing: perfect.
Donor's dental history: great teeth; last cavity in 1985; no one in
family has ever needed braces.
| EDUCATION: | Subject of study | Location of University | Type of University |
| > 1 year college | |||
| Baccalaureate Degree | Biology | Hawaii | private college |
| Master's Degree | |||
| Professional Degree |
OCCUPATION: Assistant in dental office. Aspiration: dentistry.
STATE OF BIRTH: California YEAR OF BIRTH: 1973 RELIGION: LDS
Social History:
1. Do you have any special talents?
Although I have never taken any formal art classes, I have always been pretty good at drawing and sculpting. I like leadership and have been student body president and captain of my high school basketball and track teams. I enjoy martial arts and am quite proficient with numchuks.
I enjoyed school and had an easy time with
memorizing
and math problems.
2. Are there any special talents that seem to run in your family? (athletics, music, artistic, etc.)
Dad has two high school records in basketball: most rebounds and most points scored.
I hold a state record in the 4x100 m for track and a high school record in high (6'5") and triple jump (44'11").
Both my brother and sister have been commissioned to paint several murals in towns around Oregon and Idaho.
Academics have always been a strong point in our
family.
3. What are your interests and hobbies?
Basketball: started at point guard all through junior high/high school; played varsity sophomore, junior, senior years; played one year of division II college basketball.
Running: did track through high school; competed in winter biathlon in 1990-1993.
Shaorin Kempo Karate: green belt.
Japanese history and culture: I speak and write Japanese and enjoy the country's history.
Surfing: recreationally.
Literature: I enjoy reading classics as well as modern fiction and nonfiction.
Travel: I love going new places and experiencing
different
cultures and climates.
4. What did you enjoy studying in high school and college?
High school: geography, science, math and physical education.
College: biology, physics, chemistry.
On the side: I really found East Asian history and
martial
arts to be fascinating.
5. High School GPA 4.0 College GPA3.79
I.Q. 147.3 (?...I've never been tested so I
took a
20 minute exam on the internet and scored 147.3)
6. How would you describe your personality characteristics?
In a crowd, I am initially reserved until I have
assessed
the situation, then I enjoy speaking out, leading, making jokes, being
outspoken. I am creative and quick-witted. Determined, focused,
courageous.
I like to win and really enjoy seeing others win, too.
7. Why do you want to be a sperm donor?
I have thoroughly enjoyed life and the talents I
have
been blessed with. I want to contribute the genes that have brought me
joy to families who need assistance.
Additional Descriptive Characteristics:
Handedness: Dominant handedness is right; tendency to
ambidexterity
in sports.
Foot/Shoe Size: 10.5 Hairy Chest:No
Hairy: No Beard Color: Dark
Brown
Any Distinguishing Features (Dimples, Cleft Chin, Roman Nose, Freckles, etc.):
Dimple on left cheek, birthmark on right leg above
the
knee, light blue eyes with dark ring around them.
Acne problems:
Clear complexion. No acne.
Reactivity/Sensitivity to sun exposure:
Tan easily. Sunburns don't peel and turn into a tan
quickly.
Do you smoke?
No
Family Social History:
| Education | Occupation | Interests | Eye Color | Hair Color | Height | Body Type | |
| PGF | college graduate | rancher | horses, education, fishing, camping, hunting | blue | brown | 5'9" | athletic |
| PGM | high school graduate | homemaker | bird-watching, cooking, travel | blue | brown | 5'8" | athletic |
| MGF | college graduate | colonel in Air Force (base commander) | investing/finance, golf | blue | brown | 6'1" | slim |
| MGM | some college | colonel's wife | golf, bridge, cards, social parties | brown | brown | 5'5" | slim |
| Father | law school graduate | international law, patent law | business, entertainment, fishing, hiking, outdoor activities | blue | brown | 6'1" | broad, athletic |
| Mother | college graduate | school teacher | movies, travel, camping | blue | sandy blond | 5'6" | slim |
| Brother | college graduate | artist/painter | camping, painting, dogs | blue | brown | 6'2" | athletic |
| Sister | some college | homemaker | dancing, surfing, scuba, hiking | blue | light brown | 5'6" | athletic |
| Sister | college graduate | high school art teacher | pottery, painting, camping | blue | light brown | 5'6½" | athletic |
| Two younger step-brothers; two younger step-sisters | All students as appropriate for their ages; all in good health. | ||||||
| Education | Occupation | Interests | Eye Color | Hair Color | Height | Body Type | |
| Cousin | I have about 25 cousins. | ||||||
| P Uncle | college graduate | school teacher, basketball coach | basketball | blue | brown | 6'4" | robust |
| P Uncle | medical school, college graduate | radiologist | travel, tennis | blue | brown | 5'10½" | athletic |
| P Uncle | medical school graduate | pediatrician | tennis | blue | blond/
brown |
6'2" | athletic |
| M Uncle | college graduate | executive vice president of a clothing company | golf | blue | blond | 6'0" | athletic |
| M Uncle | college graduate | colonel in Air Force | golf | brown | dark brown | 6'1" | slim |
| M Uncle | college graduate | lieutenant colonel in Air Force | golf | brown | brown | 6'4" | strong, athletic |
| Your Child | Being a two-year-old | loves fishing and exploring outside, loves trains and animals, too | blue | light brown | 3'2" (doctor's estimate: he will be 6'2"-6'3" when he stops growing) | ||
Comments about or additions to your family history:
I have no aunts that are blood-related.
Comments Following an Interview with the OHSU Fertility Consultants Clinic Counselor:
Donor #9832 is a very sweet 27-year-old man who is in the dental field. He has been married four years and is a father of a two-year-old with another on the way. He is motivated to be a donor to help an infertile couple as he has seen people go through infertility in his extended family and he has sympathy for them. He states his wife is very supportive of his participation as a donor at OHSU. They do not desire any additional children. His wife works in a managerial position.
Donor is the fourth of nine children in a blended family of three older full siblings, four younger step-siblings, and one child to whom he is not related. There is no family history of any mental illness and he is a non-smoker. He has never sought any type of counseling and appears to be a very emotionally stable, caring and thoughtful man. He feels very positive about passing on his genes anonymously to help another couple.
Donor describes his personality as "laid back," yet he is goal-oriented and focused and has been a good student. He enjoys many activities such as football, basketball, lifting weights, jogging, camping, surfing, and at one time held state record in track and sprint running.
Paula Acker, LCSW
Summary of the Taylor-Johnson Temperament Analysis:
The Taylor-Johnson Temperament Analysis was given to this donor and
he scored in the Excellent range in the areas of Composed,
Social/Active,
Sympathetic, Objective, Tolerant, and Self-Disciplined. An analysis of
his personality would be as follows:
A person scoring in the Excellent range of Composed would perhaps
display
freedom from excessive worry and anxiety, calmness and the ability to
recover
quickly after difficult situations.
The person whose personality is Social/Active may be one who is
enthusiastic
and socially involved. They may feel vitality and be a "go-getter" in
life
and have a wide variety of interests and activities.
Sympathetic is the opposite of Indifferent, so someone with this
characteristic
is kind, compassionate and understanding and may be more aware of
others'
feelings. This is a trait that is vital for good courtship, marriage
and
parental relationships as well.
Objective people are people that present as fair-minded, reasonable
and logical.
Tolerant personalities are those that show respect for others and
often
have freedom from any type of prejudice, are patient and do not
criticize.
And finally this donor showed in his personality test that he is
Self-Disciplined
which is reflected by a sense of orderliness, neatness, organizational
abilities and follow-through on plans and goals.
Paula Acker, LCSW
KID PAGE
1. In general, please describe your childhood.
I was born in California at the end of my dad's Air Force career. We
moved to Oregon and then to Utah where he attended law school. The
trailer
house we lived in is where my earliest memories are. My dad went to
school
all day and worked nights to support his wife and four children. I was
the youngest and we were always very close. My mom filled our days with
arts, crafts, field trips and playtime (she was always a great
teacher).
I remember following my brother and two sisters to a grove of wild
apple
trees and climbing around trying to find good apples without worms so
we
could take them to Mom to make apple pie. We moved to Idaho when I was
four where I went almost all the way through high school. The last
month
of my senior year we moved to Texas.
2. Were there any family members other than your parents and siblings with whom you regularly had contact?
We were always close to my father's parents. My grandparents had a
large
cattle ranch. We worked summers out there in rotations (two kids at a
time
for a one to two week stint). We moved water pipes, herded, branded,
fed,
and cared for 70+ Limousine cows. Each summer, we held a contest to see
who could trap out the most gophers in one week. I still have the
record
with 15 gophers in a week. Over the course of the years we managed to
name
every hill, lake, river, rock, grove of trees and trail after one of
the
grand-kids. We put up signs and built tree houses and forts. We rode
horses
a lot, too.
3. As a child, what was/were your favorite: Please include a reason, or why, if you can.
Food(s)? All fruits, pizza, lasagna, finger steaks, homemade wheat bread.
Color(s)? Red.
Toy(s)? Legos, bike, trampoline, basketball.
Indoor game(s)? Chess, checkers, Stratego, Risk, Monopoly, Power Barons.
Outdoor game(s)? Football, basketball, tag, baseball.
Book(s)? Curious George.
Sport(s)? Basketball, soccer, football.
Other activity(s)? Cross-country/downhill skiing, surfing,
scuba, hiking, camping, horseback riding, skateboarding.
4. What is your earliest memory?
When I was three years old, my pre-school teacher asked me to draw a
picture for him. I remember almost exactly what the picture looked like
even though he kept it and I haven't seen it since. I had drawn a hill
next to a lake with trees, a bear, three snakes, three puppies, three
squirrels,
some birds, frogs, fish and bees. The picture was very detailed, and my
teacher was convinced I was a genius. He had the picture evaluated at
the
psychology department at the local university and told my mom the
results.
5. What did you do during the summers?
Baseball, camping, travel, ranch work, swimming.
We always had a family reunion with my dad's family and, every now
and
then, one with my mom's family.
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?
Microwave: my mom swore she would never get one because it was useless; a conventional oven could do all we needed. My dad bought one for her, and we haven't been able to do without one since then.
VCR/BETA: watching movies at home was a great idea!
Intellivision, Atari, Nintendo, Sega: home game systems have
continued
to get better.
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 liked school and all of my teachers. I was very shy around other
kids
and didn't like to display my artwork or have my scores called out loud
even though I was praised for my work. I guess I just didn't like the
attention.
I gradually got used to being in the public eye and even began to enjoy
it!
8. Did you have chores or tasks that you were regularly expected to do?
We had a list of daily chores, weekly, and special chores that my mom kept track of on a calendar. We were all responsible to have them finished before Dad came home from work.
Clean room, make bed, clean bathtub, sink, vacuum, dust, help with
dinner,
wash dishes, put laundry away, pick up rocks in garden, weed, mow
grass,
sweep sidewalks, wash car, feed dog, etc.
9. Any other recollections of importance that come to mind?
I have always loved animals and as a child I watched a lot of nature programs and read a lot of books about creatures from all over the world.