Personal Information
  • Body Type
    Apple
  • Height
    5 ft 8 in
  • Weight
    185
  • Any recent change in weight?
    No
  • Bone structure
    Medium
  • Body and facial features
    Medium
  • Dexterity
    Right handed
Skin & Teeth
  • Tan ability
    Slight
  • Skin condition
    Medium
  • Dimples
    No
  • Teeth condition
    Good
  • Orthodontic work?
    Yes
  • How old were you?
    19
Eyes, Vision and Hearing
  • Eye color
    Brown
  • Eye shape
    Almond
  • Eye size
    Average
  • Eye set
    Average
  • How is your vision?
    Fair
  • Do you need glasses or contact or have had corrective laser surgery?
    Yes
  • If yes, were/are you?
    Farsighted
  • Do you have astigmatism?
    No
  • How is your hearing?
    Good
Hair
  • Hair color
    Medium brown
  • Hair texture
    Medium
  • Hair fullness
    Thick
  • Baldness
    No
  • Premature graying?
    No
Sexual History
  • Marital status
    Single
  • Living arrangement
    Living together with a sexual partner
  • Total number of sexual partners in the last month
    1
  • Total number of sexual partners in the last 6 months
    1
  • Total number of sexual partners in the last 5 years
    15
  • Current sexual practice
    Vaginal, Oral given
  • Past sexual practice
    Vaginal, Oral given
  • Have you had sexual contact with a person who has injected drugs for a non-medical reason? (includes intravenous, intramuscular or subcutaneous injections)
    No
  • Have you had sexual contact with a person who has hemophilia or another blood clotting disorder who may have received human derived blood clotting factors?
    No
Sexual History
  • Have you engaged in sexual contact in exchange for money or drugs?
    No
  • Have you engaged in sexual contact with a person who has had sex in exchange for money or drugs?
    No
  • Have you had sexual contact with any person known or suspected to have infection with HIV (AIDS), a positive HIV test, Hepatitis B infection, Hepatitis C infection, Zika Virus, or any other sexually transmitted infection?
    No
  • In the last year, have you had vaginal intercourse without the use of a condom?
    No
  • Have you had sexual contact with a man who is homosexual or bisexual?
    No
  • Have you had sexual contact with an individual who was born in or lived in any of the following countries since 1977: Cameroon, Central African Republic, Chad, Congo, Equatorial Guinea, Gabon, Niger or Nigeria?
    No
Race and Ethnicity
  • Race
    Caucasian
  • Are you adopted?
    No
  • Mother
    Dutch
  • Maternal grandmother
    Dutch
Race and Ethnicity
  • Maternal grandfather
    Dutch
  • Paternal grandmother
    German
  • Paternal grandfather
    Dutch
  • Religion
    N/A
Menstrual
  • Age at which you had your first period
    13
  • I sometimes have bleeding after intercourse
    No
  • I sometimes have bleeding in between my normal periods
    No
  • Longest number of days of bleeding
    10
  • Shortest number of days of bleeding
    4
  • Longest time from the start of one period to the start of the next
    32
  • Shortest time from the start of one period to the start of the next
    20
Gynecologist visits
  • Have you ever been told you might have trouble having children?
    No
  • Have you ever had a pelvic exam?
    Yes
  • Have you ever had an abnormal PAP smear?
    No
Use of birth control
  • Oral Contraceptives (birth control pills)
    Never
  • Birth Control Patches (Xulane)
    Never
  • Progesterone Injections (Depo-Provera)
    Never
  • Progesterone Implants (Implanon, Nexplanon)
    Currently
  • Intrauterine Device (IUD) Paragard, Mirena, Kyleena, Liletta, Skyla
    Never
  • Barrier contraceptives (Condoms, Diaphragms, Cervical caps)
    Never
  • Sterilization (tubal ligation, Essure tubal plugs)
    Never
Pregnancy History
  • Tell us about your pregnancy history
    I have never been pregnant and have never tried to become pregnant
Tattoos and Piercings
  • First time
    2016-08-08
  • Was this a Tattoo or Piercing?
    Piercing
  • Location on Body:
    Ear
  • Location on Body:
    Ear
  • Location on Body:
    Ear
  • Was this a Tattoo or Piercing?
    Piercing
  • Location on Body:
    Ear
Lifestyle
  • Athletic talents
    None
  • Interests or Hobbies
    Outdoors, Music, Cuisine, Pets, Reading, Acting, Baking / Cooking
  • Amount of exercise
    Occasional
  • Type of exercise
    Other
  • Type of diet
    Any
  • Quality of diet
    Average
Drugs and Alcohol
  • Alcohol use
    Tried at least once
  • Tobacco use
    Tried at least once
  • Heroin or opiates
    Never
  • Cocaine, crack
    Never
  • Crystal meth
    Never
  • LSD / Acid
    Never
  • PCP / Angel Dust
    Never
  • Other illegal drugs not listed above
    Never
Legal history
  • I have been in trouble with the law
    No
  • I have been arrested before, but not convicted.
    No
  • I have been convicted of a crime.
    No
  • I have spent at least one hour in jail or prison.
    No
  • I have spent more than 72 consecutive hours in prison in the last year.
    No
CJD - Creutzfeldt–Jakob disease
  • Has one or more blood relatives been diagnosed with CJD?
    No
CJD - Creutzfeldt–Jakob disease
  • Have you ever been diagnosed with vCJD or any other form of CJD?
    No
  • Have you received any transfusion of blood or blood components in the U.K. or France between 1980 to the present?
    No
  • Have you lived cumulatively for 5 years or more in Europe from 1980 until the Present?
    No
Education
  • High school
    Attended but did not graduate
  • College
    Attended but did not graduate
  • What college degrees have you earned?
    None yet
  • Trade school
    I graduated from a trade school
  • Type of trade school
    Nursing assistant
Education
  • How many languages do you speak
    1
  • Which languages do you speak?
    English
  • Musical training or talents
    Singing, Instrument
  • Artistic training or talents
    None
  • Current employment
    I work full-time outside the home
Donor Info
  • Egg donation experience
    No previous egg donations
  • If you have donated before, how many times?
    0
  • Personal statement

    I have 11 siblings, only 1 of which is adopted, high fertility runs in the family I have a strong immune system, I have never had an std/sti

Donor Info
  • Access to the office
    Far away
  • Donor Type
    Egg Donor