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EC 1790

Personal Information
  • Age
    20
  • Body Type
    Hourglass
  • Height
    5 ft 10 in
  • Weight
    142
  • Any recent change in weight?
    No
  • Bone structure
    Medium
  • Body and facial features
    Medium
  • Dexterity
    Right handed
Skin & Teeth
  • Tan ability
    Medium
  • Skin condition
    Medium
  • Dimples
    No
  • Teeth condition
    Good
  • Orthodontic work?
    Yes
  • How old were you?
    13
Eyes, Vision and Hearing
  • Eye color
    Brown
  • Eye shape
    Almond
  • Eye size
    Large
  • Eye set
    Average
  • How is your vision?
    Excellent
  • Do you need glasses or contact or have had corrective laser surgery?
    No
  • Do you have astigmatism?
    No
  • How is your hearing?
    Good
Hair
  • Hair color
    Light brown
  • Hair texture
    Medium
  • Hair fullness
    Thick
  • Baldness
    No
  • Premature graying?
    No
Sexual History
  • Marital status
    Single
  • Living arrangement
    Living together with a non-sexual partner / friend
  • Sexual orientation
    Bisexual
  • 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
    3
  • Current sexual practice
    Vaginal, Oral given, Oral received
  • Past sexual practice
    Vaginal, Oral given, Oral received
  • 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?
    Yes
  • 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
  • Ethnicity
    German, Russian
  • Mother
    German, English, Irish
  • Maternal grandmother
    Irish
Race and Ethnicity
  • Maternal grandfather
    German, English
  • Paternal grandmother
    Welsh, French
  • Paternal grandfather
    Swedish, Scottish
  • Religion
    Non-Denominational
Menstrual
  • Age at which you had your first period
    14
  • I sometimes have bleeding after intercourse
    No
  • I sometimes have bleeding in between my normal periods
    No
  • Longest number of days of bleeding
    7
  • Shortest number of days of bleeding
    4
  • Longest time from the start of one period to the start of the next
    38
  • Shortest time from the start of one period to the start of the next
    24
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)
    In the past
  • Birth Control Patches (Xulane)
    In the past
  • Progesterone Injections (Depo-Provera)
    Never
  • Progesterone Implants (Implanon, Nexplanon)
    Never
  • Intrauterine Device (IUD) Paragard, Mirena, Kyleena, Liletta, Skyla
    Currently
  • Barrier contraceptives (Condoms, Diaphragms, Cervical caps)
    Currently
  • 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
    2018-10-25
  • Was this a Tattoo or Piercing?
    Piercing
  • Location on Body:
    Navel
  • Sterile Needles Used?
    Yes
  • Second time
    2020-09-15
  • Location on Body:
    Navel
  • Sterile Needles Used?
    Yes
  • Third time
    2021-03-10
  • Location on Body:
    Navel
  • Sterile Needles Used?
    Yes
  • Was this a Tattoo or Piercing?
    Piercing
  • Location on Body:
    Navel
  • Sterile Needles Used?
    Yes
Lifestyle
  • Interests or Hobbies
    Photography, Art/Crafts, Outdoors, Yoga, Pets, Reading, Baking / Cooking
  • Type of exercise
    Swimming, Biking, Yoga
  • Type of diet
    Pescetarian
  • Quality of diet
    Good
Drugs and Alcohol
  • Alcohol use
    Tried at least once
  • Tobacco use
    Never
  • 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
Medical History
  • Have you injected drugs for a non-medical reason in the last 5 years?
    No
  • Do you have hemophilia and/or received human-derived clotting factor concentrates in the last 5 years?
    No
  • Have you in the last 12 months lived in the same dwelling with another person with hepatitis B infection or hepatitis C infection?
    No
  • Have you been exposed in the preceding 12 months to known or suspected HIV (AIDS), Hepatitis B, and/or Hepatitis C infected blood through a needle stick or through contact with an open wound, non-intact skin, or mucous membrane?
    No
  • Have you ever been diagnosed with any form of hepatitis?
    No
  • Have you been in juvenile detention, lock up, jail or prison in the last 12 months?
    No
  • In the last 12 months, have you gotten a new tattoo, ear piercing or body piercing, or had acupuncture treatment in which NON STERILE instruments may have been used?
    No
  • In the last 8 weeks, did you receive a smallpox vaccination (vaccinia virus)?
    No
  • In the last 12 months, have you had any contact with someone who received a smallpox vaccination or who was diagnosed with smallpox?
    No
  • Have you ever been diagnosed with smallpox?
    No
Defects
  • Birth defects / Congenital abnormalities
    None
  • Chromosome abnormalities
    None
  • Specific genetic mutations and variants
    None
  • Cancer
    Breast cancer
CJD - Creutzfeldt–Jakob disease
  • Has one or more blood relatives been diagnosed with CJD?
    No
  • Have you ever received injections of human pituitary-derived growth hormone?
    No
  • Have you ever received a dura mater transplant?
    No
  • Have you ever been diagnosed with dementia or any degenerative or demyelinating disease of the central nervous system (CNS) or other neurological disease of unknown etiology?
    No
Medical History
  • In the last 12 months, were you diagnosed with or treated for West Nile Virus?
    No
  • In the last 12 months, were you diagnosed with or treated for Syphilis?
    No
  • In the last 12 months, were you diagnosed with or treated for Chlamydia or gonorrhea infection?
    No
  • Have you ever received a blood transfusion?
    No
  • Have you ever been turned down to be a blood donor?
    No
  • Have you ever received a transplant of any tissue, cells or fluids from a non-human, animal source?
    No
  • Have you ever had intimate contact with a recipient of a transplant of any tissue, cells or fluids from a non-human, animal source?
    No
  • Were you born in or did you live in any of the following countries since 1977?
    No
  • Did you have a blood transfusion or have any medical treatment involving blood in any of the following countries since 1977?
    No
  • Have you been vaccinated in the last 6 months?
    Yes
  • If yes, please explain
    Flu Shot
Other Risk Factors
  • Neurologic problems
    None
  • Diseases with genetic risk factors
    None
  • Problems that affect fertility
    None
  • Psychological / Emotional problems
    I have been seen or treated by a psychologist or psychiatrist
  • If you answered yes to any of the above, please explain.
    I have gone to therapy for issues like bereavement and amid my parent's separation.
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
  • Have you spent three months or more cumulatively in the U.K. from the beginning of 1980 through the end of 1996?
    No
Family Medical
  • Family Birth defects / Congenital abnormalities
    None
  • Family birth defect comments
    N/A
  • Family Chromosome abnormalities
    None
  • Family - Specific genetic mutations and variants
    N/A
  • Family genetic comments
    N/A
  • Family - Specific genetic mutations and variants
    None
  • Family - Cancer
    Breast Cancer
  • Family genetic comments
    N/A
Family Medical
  • Family cancer comments
    My paternal grandmother had breast cancer and has since been in remission for nineteen years. Cancer (breast or otherwise) is not common in my family, and this is the only case of cancer I am aware of within my family.
  • Family - Neurologic problems
    None
  • Family - Diseases with genetic risk factors
    None
  • Family disease comments
    N/A
  • Family - Diseases with genetic risk factors
    None
  • Family disease comments
    N/A
  • Family - Problems that affect fertility
    None
  • Family fertility comments
    NA
Education
  • High school
    Graduated high school
  • College
    Currently attending
  • What is/was your college major?
    Psychology
  • What college degrees have you earned?
    None yet
  • Trade school
    I did not attend a trade school
Education
  • How many languages do you speak
    2
  • Which languages do you speak?
    English, French
  • Musical training or talents
    Singing
  • Artistic training or talents
    Photography
  • Current employment
    I work part-time outside the home
Donor Info
  • Egg donation experience
    No previous egg donations
  • If you have donated before, how many times?
    0
  • Personal statement

    Thank you for allowing me the opportunity to be apart of your journey as you build your family. I am rooting for you and a successful pregnancy, and am excited to help you in this process. I am currently pursuing an education in Psychology, with plans to be a Licensed Mental Health Counselor in the near future. My desire to be of service in improving and enriching the lives of others underlies both my professional goals, as well as egg donation.

Donor Info
  • I am interested in becoming a donor because:
    I think the process is fascinating and wanted to be involved
  • Access to the office
    Far away
  • Donor Type
    Egg Donor

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1-630-357-6540

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