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 believes that the oocyte donation program is of great importance to society, thanks to it, more couples who want to become parents have this opportunity. She was interested in information about donation programs, about various aspects, and in the end she also decided to try to become a donor. This is not her first donation program. All her relatives know about her participation in it. They understand and support her, she explains to everyone in detail what the program is and what it is for.
The donor is unmarried, has a 2.5-year-old daughter. She raises her on her own. According to the donor, her daughter is developed beyond her years, active, intelligent, mobile. She loves to dance, is interested in cars and technology.
The donor's mother tragically died 5 months ago, which was a heavy loss and blow for her. Her mother was a close person and support for the donor. Now she feels lonely without her, trying to learn to cope with all situations on her own. She and her mother are similar – both are soft, friendly, non-conflicting, and accommodating. She dedicated her life to her family and loved ones, and was ready to help, listen, and understand everyone.
The donor's father is more reserved, closed, focused on the inner world. But for the donor, he is a kind, warm, loving person.
The donor has a brother who is 10 years older than her, who already has his own family and children. They have friendly, good relationships, communicate, visit each other.
The donor was calm, balanced, quiet in childhood. She was playful, kind, a favorite among her relatives. She studied well, had a greater talent for the humanities. She attended music school, played the piano. She was engaged in dancing, drawing. She was a creative child, as well as sporty, mobile. She loved walks with friends and active recreation - roller skating, cycling, etc. She liked to spend school holidays with her grandmother in the capital.
After the 9th grade, she entered college. She moved with her mother to live in the city where her mother was from. Student life was interesting for her, full of everything new – friends, teachers, a new place to live.
The donor has a secondary specialized education – Pastry Chef. She worked in a restaurant, cafe. Now she is not working, because she is on maternity leave.
The donor is sincere, open, friendly, polite in communication. She shows empathy, sensitivity, and benevolence to others. She has a positive and optimistic outlook on life. She is characterized by such qualities as punctuality, responsibility, and conscientiousness. She is a person who strives to be useful to others, to help, is non-conflict, compliant, and mild in character. She does not know how to refuse, it is easy to negotiate and get along with her. Responsive, sensitive, vulnerable, but collected, independent, and self-sufficient.
She understands the content and obligations of the donation program, understands the responsibility and medical risks associated with the program. She leads a healthy lifestyle, is optimistic about completing the program, and follows the doctor's recommendations. She sees no obstacles in the way of fulfilling the donor's obligations. She has no financial, emotional, or other coercion from other persons to participate in the donor program. According to the candidate, there are no cases of mental illness, substance abuse, etc. in the family history. Considering the above, this candidate can be recommended as an oocyte donor.
