Oregon Health & Science University PROFILE FOR SPERM DONOR #9890

Andrology/Embryology Lab

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

Portland, OR 97239

Phone: (503) 418-3700

PHYSICAL CHARACTERISTICS

Height: 6’ 1”	Weight: 165	Hair Color: Light Brown
Eye Color: Brown	Hair Type: Straight, Slightly Wavy	Complexion: Fair
Race: Caucasian	Mother’s Ethnic Background: English, Irish, German Father’s Ethnic Background: Scottish, Irish, native North American (Osage tribe)
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: Mother (mild)	Mental retardation:
Anemia:	Epilepsy:	Miscarriages:
Asthma:	Glaucoma:	Stillbirths:
Blindness:	Goiter:	Migraine:
Cancer: Mother (kidney, benign)	Gout:	Muscular dystrophy:
Cataracts:	Heart attack:	Myasthenia gravis:
Cirrhosis:	Heart disease:	Paraplegia:
Cleft palate or lip:	Hemophilia:	Parkinson’s:
Club foot:	Hermaphrodotism:	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 donor’s mother (67), father (63), brother (34), sister (38), three P uncles (67-73), two P aunts (76, 82), 1 M uncle (59), 3 M aunts (57-63) are all living and in good health. The two P aunts had minor strokes at age 70-71. The MGF died at age 82 (heart attack), the MGM at 75 (unknown cause), the PGF at 86 (unknown cause), the PGM at 82 (lung cancer), one P aunt in her 70s (died in her sleep).

Donor’s vision: 20/30.

Donor’s hearing: good.

Donor’s dental history: wisdom teeth removed, just cavities.

EDUCATION:	Subject of study	Type of University
> 1 year college
Baccalaureate Degree	B.S. (Biology)	large university
Master's Degree
Professional Degree

OCCUPATION: Post baccalaureate student, science-related

RELIGION: None, agnostic

Social History:

1. Do you have any special talents?

Low body fat.

Athletic.

Strong visuospacial thinking.

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

Low body fat (Mother, Father, brother, sister)

Athletic (Father, brother, sister)

Music: Father: piano & organ

Brother: guitar

Artistic drawing (brother)

3. What are your interests and hobbies?

Science (biology, psychology, anthropology)

Strategy board games

Reading

Exercise

Health & Nutrition

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

Theater

Biology (micro & macro)

Nutrition

Psychology

Anthropology

Biochemistry

Organic Chemistry

Anatomy & physiology

5. High School GPA 3.3 College GPA 3.3 I.Q.

6. How would you describe your personality characteristics?

Likeable

Thoughtful

Funny

Self-reliant

Helpful

Caring

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

Additional Descriptive Characteristics:

Handedness: Right Foot/Shoe Size: 10.5 - 11

Hairy Chest: Moderate amount on chest

Hairy: Moderate amount on chest and forearms

Beard Color: Individual hairs range form: blond to red-blond, red-brown and dark brown. As a composite, my beard appears mostly dark red-brown, burgundy brown.

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

Dimples, attached ear lobes, potters thumb, slim waist and hips

Acne problems:

None

Reactivity/Sensitivity to sun exposure:

Average Caucasian sensitivity

Do you smoke?

No

Family Social History:

	Education	Occupation	Interests	Eye color	Hair color	Height	Body Type
PGF				Brown	Brown	6’	slim
PGM				Brown	Auburn	5’ 6”	slim
MGF
MGM
Father				Brown	Brown	5’ 10”	Med.
Mother				Grey	Light Brown	5’ 6”	Slim
Brother				Brown	Brown	5’ 9”	Slim
Sister				Grey	Light Red	5’ 7”	Med.

Comments Following an Interview with the OHSU Fertility Consultants Clinic Counselor:

Referral Information: Donor is a thirty one year old single Caucasian male that is a full time student in the medical field. He was referred for a psychological evaluation and interview by OHSU Fertility Consultants. He has completed his medical evaluation and has been donating to OHSU for one year but has not been matched with recipients yet. This was a one hour in depth evaluation following the Guidelines of The American Society of Reproductive Medicine Mental Health Professional Group psychological assessments for anonymous donors.

Motivation for Donation: Donor states his motivation is primarily financial in being a sperm donor. He was not sure why there was such a large need for donors. In this interview I explained to him the reasons why people elect to build a family using an anonymous donor, including infertile male partners, single woman and lesbian couples. He was very open minded about having his donation used by any of these groups and stated to have no ethical conflict with any aspect of being a donor. He further stated that he feels his genes are already in the population as he himself is a genetic combination of so many other people. He has a B.S. in Biology and thoroughly understands how genes are combined over and over in each generation.

Informal Mental Status and Behavioral Observations: Donor was on time to this evaluation and appropriately dressed. His mannerisms and language skills were in the normal range. He was oriented to person, place and time. He did not display any cognitive abnormalities and answered all questions in a thoughtful, intelligent, and insightful way. He presented as an emotional mature adult with well developed coping skills. He appeared to be very comfortable with being an anonymous donor and was very warm and engaging in this interview.