Oregon
Health & Science University
PROFILE
FOR SPERM DONOR #9890
Andrology/Embryology
Lab
3303 S.W.
Bond Ave., 10th 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, |
|
|
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. |
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.