This donor has passed a rigorous medical examination to ensure absolute safety. Our screening process includes strict testing for infectious diseases (HIV, Hepatitis B/C, STIs), an evaluation of lifestyle habits, and a general physical assessment. We confirm the donor is currently in excellent health and free from transmissible conditions.
Assess your vision without corrective contact lenses
Do you wear contact lenses or have you had corrective surgery?
If yes, describe a problem:
What is the condition of your teeth?
Have you ever had braces?
Do you use nicotine products?
Do you drink alcoholic beverages?
If yes, how much alcohol do you drink?
Describe your diet
Estimate the level of nutrition:
Do you have allergies?
If yes, describe what exactly you are allergic to:
What is your sexual orientation?
How many children do you have?
Age at the time of the first menstruation:
The interval between menstruation is:
Have there been cases of multiple pregnancies in the family:
Please provide information about your biological relatives (indicate only natural hair and eye color):
Relative
Height, cm
Weight, kg
Eye color
Natural hair color
Primary medical history
Mother:
Father:
Complete the table
Family (which relative has the disease)
Age
Cause of death
Disease
The age at which was diagnosed
| Have you ever been diagnosed with or suspected of having any neurological disease (including dementia or degenerative /demyelinating disease of the CNS or other neurological disease of unknown etiology)? | No |
| Have you or any of your sexual partners ever been diagnosed with or suspected of having West Nile Virus (based on symptoms and/or laboratory results or confirmed WNV viremia), experienced symptoms of WNV infection? | No |
| Have you ever been exposed to known or suspected HIV, Hepatitis B, Hepatitis C infected blood or body fluids through skin inoculation, open wounds, non-intact skin or mucous membranes? | No |
| Have you or any of your sexual partners has had sex in the preceding 12 months with a person known to have HIV, clinically active HBV or clinically active HCV? | No |
| Have you or any of your sexual partner(s) ever received, blood, blood components, blood products, or other human tissues that are known to be possible sources of blood-borne pathogens? | No |
| Have you or your sexual partners been diagnosed with Zika virus in the past 6 months? | No |
| Have you travelled to an area with Zika virus transmission? | No |
| Alcoholism | No |
| Drug addiction | No |
| Alzheimer's disease / dementia before age 60 | No |
| Aneurysm | No |
| Fear / panic attacks | No |
| Attention deficit / hyperactivity disorder | No |
| Autism or Asperger's syndrome | No |
| Bipolar disorder | No |
| Blood coagulation disorders / hemophilia | No |
| Blindness before the age of 50 | No |
| Brain tumor / abnormality | No |
| Breast cancer | No |
| Cerebral palsy | No |
| Non-union of the lip or palate | No |
| Colorectal cancer | No |
| Flat feet | No |
| Depression | No |
| Epilepsy or seizures | No |
| Extra or fused fingers or toes | No |
| Genetic disorders | No |
| Hearing disorders / deafness under the age of 50 | No |
| Heart attack before age 50 | No |
| Heart defect | No |
| Huntington's disease | No |
| Immune disorders | No |
| Kidney defect / disorder / cancer | No |
| Intellectual disability / developmental delay | No |
| Melanoma | No |
| Mental retardation | No |
| Obsessive-compulsive disorder | No |
| Ovarian cancer | No |
| Pancreatic cancer | No |
| Parkinson's disease before the age of 60 | No |
| Pituitary disorder | No |
| Prostate cancer before the age of 50 | No |
| Schizophrenia | No |
| Speech disorders / lisping / stuttering | No |
| Split spine | No |
| Stroke under the age of 50 | No |
| Uterine cancer | No |
| Tourette syndrome | No |
| Vision disorders | No |
| Vitiligo / pigmentation disorders | No |
| Death before the age of 50, including childhood | No |
| Other cancer diagnoses before the age of 50 | No |
| Other congenital defects | No |
| Other health disorders | No |
| Diabetes | No |
| Hypertension | No |
| Rheumatoid arthritis | No |
| Pathology of the thyroid gland | No |
| Endometriosis | No |
“Big Five” personality traits of the Donor
1
Extraversion
2
Emotionality
3
Openness to New Experiences
4
Conscientiousness
5
Agreeableness
A
Psychological assessment of the donor:
The donor decided to participate in the oocyte donation program for the following reasons: first, because it is an opportunity to receive additional financial support; second, out of curiosity, whether she is healthy, can be a donor, is genetically suitable; and third, she will be glad if with her participation some couple can become parents.
The donor is married. She has a daughter, who is now 5 years old. She is very active, restless, stubborn, characteristic, brave and learns and develops very quickly. She likes to study and be creative, especially drawing.
She says about her family with a smile that they are happy and have fun together. She and her husband have been together for more than 10 years, they have known each other since childhood, they are partners, friends, and close people to each other.
They currently live in a house with her husband's grandmother. Her mother and her grandmother live nearby. The donor has an older brother and sister - 14 and 15 years older. They are from the mother's first marriage. The donor's father never lived with them. The mother raised her alone. From the age of 3 months, the donor's mother had to work. Therefore, she often grew up with her grandmother and grandfather. The mother was strict, taught her to respect her elders, it was not customary to shout or quarrel at home. She worked hard to support her family. The donor's grandfather was like a father - he cared for her in a manly way, protected her, and was a reliable support. The grandmother became the closest person to her, warm, loving. She was the most beloved granddaughter out of all 5. And now she and the grandmother are close, she often visits her, she helps her with her daughter.
Donor grew up in a village, where there was more space and freedom. She spent a lot of time in nature with her friends as a child. It was a fun and interesting childhood. She studied well at school. She liked computer science, although mathematics was not easy. She preferred the humanities. She was engaged in dancing, singing. She took part in school and extracurricular performances and events. For some time she was engaged in embroidery, but then she lost interest. In childhood, the donor had a difficult relationship with her sister, sometimes they did not understand each other, they would pick on each other. But when they grew up, everything passed - now they are friends, close people.
After school, the donor studied at a vocational school, after which she received a secondary specialized education in the specialty of hairdresser. But she is afraid to work in this specialty - it is scary to harm someone, to do something wrong. She intends to first get more qualifications and experience.
The donor manifests herself as an open, smiling, simple person. In communication, she is sincere, direct, humorous. She is a kind, positive, sensitive and emotional person. In her intentions and commitments, the donor is responsible, conscientious, persistent.
