top of page
_1.webp)
DONOR 1
Fullname
15032023
Country
USA
Address
Eye Color
Blue
Hair Color
Light Brown
Height
6'
Ethnicity
White/Caucasian
Education
Graduate degree
Hobbies
Eating, Using a computer, Playing video games, Playing an instrument
Anything else would you like to mention about your family medical history to the
Adoptive parent
Anything else would you like to mention about your talents,skills,interests
DONOR 2
Fullname
Donor Egg
Country
USA
Address
Eye Color
Blue
Hair Color
Dark Brown
Height
5'1"
Ethnicity
White/Caucasian
Education
Graduate degree
Hobbies
Reading, Horseback riding
Anything else would you like to mention about your family medical history to the
Adoptive parent
Special interests listed on her form volunteering, reading, horseback riding
Anything else would you like to mention about your talents,skills,interests
Mother's father: died age 78, diabetes, epilepsy.
Mother's mother: died age 79, congestive heart failure, had thyroid disease
Father's father: died 77 lung cancer, also had prostate cancer
Father's mother: died age 74 stroke, had diabetes and nonmalignant brain tumor
Mother 50, father 51 and 3 siblings (25, 23, 21) were healthly at the time of donation
BASIC INORMATION
Full name
15032023
Donor Egg
Country
USA
USA
Address
Eye color
Blue
Blue
Hair color
Light Brown
Dark Brown
Height
6'
5'1"
Ethnicity
White/Caucasian
White/Caucasian
Education
Graduate degree
Graduate degree
Hobbies
Eating, Using a computer, Playing video games, Playing an instrument
Reading, Horseback riding
Anything else would you like to mention about your talents, skills, interests
Special interests listed on her form volunteering, reading, horseback riding
Anything else would you like to mention about your family medical history to the
adoptive parent
Mother's father: died age 78, diabetes, epilepsy.
Mother's mother: died age 79, congestive heart failure, had thyroid disease
Father's father: died 77 lung cancer, also had prostate cancer
Father's mother: died age 74 stroke, had diabetes and nonmalignant brain tumor
Mother 50, father 51 and 3 siblings (25, 23, 21) were healthly at the time of donation
Photos
PHOTOS
EMBRYO
How many embryos do you wish to donate
What are the grades of the embryos?
3
Have the embryos been genetically tested
No
Do you know the gender of the embryos
no
Have the embryos from this batch resulted in a life birth
Age of embryos when they were frozen
Yes
Not sure
How long ago the embryos were created
Genetic mother’s age at the egg retrieval
Less than 15 years ago
Less than 30 years old
Have the embryos from this batch been already donated to another adoptive parent
No
Embryo
MEDICAL HISTORY
DONOR 1
DONOR 2
Allergy
Alzheimer
Anxiety
Donor
Asthma
Autism
Bipolar disorder
Cancer
Donor's grandparent
Celiac disease
Cystic fibrosis
Depression
Diabetes
Donor's grandparent
Epilepsy
Donor's grandparent
Fibromyalgia
Fragile X syndrome
Heart conditions
Donor's grandparent
Hemochromatosis
High blood pressure
Donor
Huntington’s disease
Lupus
Marfan syndrome
Multiple sclerosis
Obesity
Donor
Phenylketonuria
Polycystic kidney disease
Rheumatoid arthritis
Schizophrenia
Stroke
Donor's grandparent
Substance abuse
Tay-Sachs disease
Medical Histroy
DONOR 1
Allergy
Alzheimer
Anxiety
Donor
Asthma
Autism
Bipolar disorder
Cancer
Celiac disease
Cystic fibrosis
Depression
Diabetes
Epilepsy
Fibromyalgia
Fragile X syndrome
Heart conditions
Hemochromatosis
High blood pressure
Donor
Huntington’s disease
Lupus
Marfan syndrome
Multiple sclerosis
Obesity
Donor
Phenylketonuria
Polycystic kidney disease
Rheumatoid arthritis
Schizophrenia
Stroke
Substance abuse
DONOR 2
allergy
alzheimer
anxiety
asthma
autism
bipolar disoder
cancer
Donor's grandparent
celiac disease
cystic fibrosis
depression
diabetes
Donor's grandparent
epilepsy
Donor's grandparent
fibromyalgia
fragile x syndrome
heart conditions
Donor's grandparent
hemochromatosis
high blood pressure
huntington's disease
lupus
marfan syndrome
multiple sclerosis
obesity
phenylketonuria
polycystic kidney disease
rheumatoid arthritis
schizophrenia
stroke
Donor's grandparent
substance abuse
Information on egg/sperm donor
Letter
bottom of page