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SC 1312

Personal Information
  • Body Type
    Hourglass
  • Height
    5 ft 1 in
  • Weight
    125
  • Any recent change in weight?
    No
  • Bone structure
    Medium
  • Body and facial features
    Medium
  • Dexterity
    Right handed
Skin & Teeth
  • Tan ability
    Slight
  • Skin condition
    Oily
  • Dimples
    No
  • Teeth condition
    Good
  • Orthodontic work?
    No
Eyes, Vision and Hearing
  • Eye color
    Brown
  • Eye shape
    Almond
  • Eye size
    Small
  • 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?
    Excellent
Hair
  • Hair color
    Dark brown
  • Hair texture
    Medium
  • Hair fullness
    Thick
  • Baldness
    No
  • Premature graying?
    No
Sexual History
  • Marital status
    Single
  • Living arrangement
    Living with parents / family
  • Sexual orientation
    Heterosexual
  • Total number of sexual partners in the last month
    0
  • Total number of sexual partners in the last 6 months
    0
  • Total number of sexual partners in the last 5 years
    1
  • Current sexual practice
    Oral given
  • Past sexual practice
    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
    Hispanic
  • Are you adopted?
    No
  • Mother
    Mexican
  • Maternal grandmother
    Mexican
Race and Ethnicity
  • Maternal grandfather
    Mexican
  • Paternal grandmother
    Mexican
  • Paternal grandfather
    Mexican
  • Religion
    Catholic
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
    5
  • Shortest number of days of bleeding
    3
  • Longest time from the start of one period to the start of the next
    40
  • Shortest time from the start of one period to the start of the next
    26
Gynecologist visits
  • Have you ever been told you might have trouble having children?
    No
  • Have you ever had a pelvic exam?
    No
  • 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)
    Never
  • 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
Lifestyle
  • Athletic talents
    Running, Dancing
  • Interests or Hobbies
    Art/Crafts, Yoga, Reading, Working out
  • Amount of exercise
    Regular
  • Type of exercise
    Running, Dance, Yoga, Aerobics
  • Type of diet
    Vegetarian
  • Quality of diet
    Good
Drugs and Alcohol
  • Alcohol use
    Never
  • 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
    Other
  • Birth defects / Congenital abnormalities (Other)
    My fingers are unusually flexible. When I want, I can bend them upwards and they look like they are broken, but my fingers just have an abnormal flexibility.
  • Chromosome abnormalities
    None
  • Specific genetic mutations and variants
    None
  • Cancer
    None
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?
    No
Other Risk Factors
  • Neurologic problems
    Other
  • Diseases with genetic risk factors
    None
  • Problems that affect fertility
    None
  • Psychological / Emotional problems
    Other
  • Psychological / Emotional problems (Other)
    I went to a group counseling when I was a kid. we had a psychologist.
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
  • Are you a current or former U.S. military member, civilian military employee, or dependent of a military member or civilian employee who resided at U.S. military bases in
    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
    Babies that died at birth
  • Family birth defect comments
    Almost all babies born in my family ( both, my mother's and father's side) are born healthy. Twins run in my family, especially in my father's side. My Father's mother has a cousin that is a twin but her twin sister died at birth.
  • Family Chromosome abnormalities
    None
  • Family - Specific genetic mutations and variants
    None
  • Family - Cancer
    Leukemia, Other
  • Family Cancer (Other)
    Uterine
Family Medical
  • Family cancer comments
    My father's brother, died of leukemia at age 16. He is the only one in my family to have had that cancer. My maternal grandmother died of uterine cancer when my mother was 15 years old. My aunt ( my mother's oldest sister) had ovarian cancer last year but it was extirpated successfully and she is currently healthy. Those 3 cases of cancer are the only ones in my family history in the past two generations.
  • Family - Neurologic problems
    None
  • Family - Diseases with genetic risk factors
    Diabetes, High Blood Pressure
  • Family disease comments
    Both my father and mother deal with High blood pressure. My aunt (My mother's sister) has diabetes type 2.
  • Family - Diseases with genetic risk factors
    Diabetes, High Blood Pressure
  • Family disease comments
    Both my father and mother deal with High blood pressure. My aunt (My mother's sister) has diabetes type 2.
  • Family - Problems that affect fertility
    None
Education
  • High school
    Graduated high school
  • College
    Planning to attend
  • Trade school
    I did not attend a trade school
Education
  • How many languages do you speak
    2
  • Which languages do you speak?
    Spanish and English
  • Musical training or talents
    Singing
  • Artistic training or talents
    Drawing, Painting
  • 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

    I am a very cheerful and happy person. I was raised in Mexico and my family members were all kind and warm to me.  As far as I know, no member of my family has ever suffered from depression or such.  I am an artistic and athletic teenager. I am talented in the art of drawing and painting. My mother used to be an artist too.  I currently exercise at least 3 times a week. I am currently in my senior year of high school and I have a GPA of 3.7 approximately. I do well in school. I am very fond of running. In fact, I was in the track and field girl team in my high school during my freshman and junior years. I won first place at the district junior varsity level in both of the races I participated at: the 800 meters and the mile. I inherited my running and endurance from my dad. two of my father's brothers have talent at track and field too. My uncle runs marathons.  I won second place at a local bike race

    I have a twin sister, and we're very close.

    I was born here in the United States, but I was raised in Mexico. I didn't come back to this country until shortly before high school. I did not know any English, but I learned it fast during my freshman year. During the first semester of my sophomore year, I was in the Language Center program of the school. which basically was mostly students whose first language was not English.  After I took the specialized TELPAS practice test for English learners students, I got the highest score out of all the language center students.

    I am a hard-working student. I dream of finishing college with a bachelor's degree in Art teaching. I would also like to make my own graphic novel someday. I practice drawing regularly.

    I hope this information about me lets me be considered as a good candidate for being an egg donor. That would be an honor to me.

Donor Info
  • I am interested in becoming a donor because:
    I know someone with infertility and always wanted to help, I think it would be a rewarding experience for me, 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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Naperville, IL 60540
1-630-357-6540

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