Oregon Health & Science University                                          PROFILE FOR SPERM DONOR  #9889

Andrology/Embryology Lab

3303 S.W. Bond Ave., 10^th floor

Portland, OR 97239

Phone:  (503) 418-3700

 

PHYSICAL CHARACTERISTICS

 

FAMILY AND MEDICAL HISTORY

For each item below, if there is a history of the condition, the condition poses a risk of one percent or less to offspring.

The family relationship is indicated.

 

ABBREVIATIONS:                                             M=Mother, or Maternal    S=Sibling                          F,P=Father, or Paternal

N=Nephew or Niece                                                GF, GM=Grandfather, Grandmother

A=Aunt                             U=Uncle                         C=Cousin

 

MEDICAL HISTORY COMMENTS: The donor=s father(age 66), mother(55), PGM(77), 2 P Aunts/Uncles(63/68), 4 maternal Aunts/Uncles(45-53), and one male sibling are all living and in good health, with the following health problems noted: PGM(hip/knee surgery); one P Uncle(back surgery, otherwise good); father(back surgery, hypertension); one M Uncle(prostate cancer, but cured); one M aunt(knee surgery).  Deceased are the PGF(at 87, of lung cancer[heavy smoker]); the MGF(at 34, suicide); the MGM(at 93, cancer in lungs); one P Uncle(at 24, MVA); one M Uncle(at 30, MVA); one M Aunt(stillbirth, cause unknown).  

The donor=s vision: requires corrective lenses.     The donor=s hearing: good.

The donor=s dental history: excellent, except oral surgery (root canals) on two teeth following a dental accident.

 

OCCUPATION: Project manager for a non-profit agency.

RELIGION: none

Social History:                                                                                                                          

                                                                                           

1. Do you have any special talents?

                     Artistic, musical, sense of humor, poet        

 

2. Are there any special talents that seem to run in your family? (athletics, music, artistic, etc.)

                     Artistic, musical, sense of humor                                                                

 

3. What are your interests and hobbies?

                    Drawing, reading, writing, playing the saxophone,

 

4. What did you enjoy studying in high school and college?

                    English and Science

 

5. High School GPA    4.0                 College GPA       3.5                                     I.Q.

 

 

6. How would you describe your personality characteristics?

                    Funny, shy, leader, caring, honest                                              

 

7. Why do you want to be a sperm donor?

                      To give something back to the world as I am healthy and I think it is a good idea to pass on my genetics.

 

Additional Descriptive Characteristics:

 

Handedness:       Right                                                        Foot/Shoe Size:       11

 

Hairy Chest:         No                       Hairy:         No              Beard Color:

 

Any Distinguishing Features (Dimples, Cleft Chin, Roman Nose, Freckles, etc.):

 

Acne problems:   No

 

Reactivity/Sensitivity to sun exposure:   No

 

Do you smoke?     No

 

Family Social History:                                                                                                           

 

 

 

Comments Following an Interview                                                                      

with the OHSU Fertility Consultants Clinic Counselor:

 

Referral Information: Donor learned about sperm donation from a friend who had been a donor. H has gone through all of his medical screening. he was referred for a psychological assessment for sperm donation by OHSU Fertility consultants. This will be his first time participating in a program as an anonymous donor. in addition to this screening he has taken the Taylor Johnson Temperament Analysis that will be independently interpreted with a separate report by this writer.

 

Motivation to be a Donor: Donor states that his motivation to be a sperm donor is to give something back to the world as he is healthy and thinks it is a good idea to pass on his genetics. He hopes to have his own children one day but is not currently ready to become a father at this stage of his life. He has carefully considered passing on his genes and is aware there could be up to twelve families with children in the Northwest from his donation and then more could be conceived through samples sent outside this area. He does not want to be an information release donor and is aware that he has a choice in this matter. He thinks it is a great idea to help someone else become a parent. He has no restrictions on who receives his donation and is comfortable with same sex or single parents along with heterosexual couples.

 

Informal Mental Status Exam and Behavioral Observations: Donor is a very sweet, friendly, outgoing and pleasant young man. He did not appear to have any cognitive deficiencies.  He was logical, understanding and asked excellent questions and appears to be very intelligent. He describes himself as having an excellent sense of humor, and as being fun to be around.

 

Brief Psychosocial History: Donor has a college degree (BA) in Communications and Business. He works full time for a non-profit marketing company. His parents are both retired. His father is 66 years of age and has been retired for ten years and is in good health. His mother is 55 years old and has been a stay at home mother. His father worked for many years for a large industrial company as a supervisor. He has one brother with a degree in Computer Science who works full time professionally.

 

Psychiatric History and Family Medical History: Donor has no history of mental illness in his family of origin. He has never sought counseling. He is a non-smoker and rarely ever has any alcohol. He averages one drink per month. He does not use recreational drugs. He has no legal or financial problems and does not have any debts from being a college student. he has no history of physical, sexual, or psychological abuse. He has never experienced any depression that he reports nor has he ever been prescribed any antidepressants. He states there are no health problems in his family of origin.

 

Understanding of Sperm Donation Procedures, Risks and Concerns: Donor is aware of the consequences of being a sperm donor. He understands that passing his genes anonymously means that he is unlikely to ever know the recipients of his donation. He is aware that there is the inherent risk in this process to have some regrets and he is willing to take that risk. There is no evidence to suggest that he will be disturbed or feel a sense of loss associated with his donation. He has no ethical conflict with being a donor.

 

Hobbies, Interests, and Activities: Donor enjoys recreational sports, watching movies with his friends, drawing, and playing video games. His favorite video game is Halo 3.

 

Recommendation: Donor meets the American Society of Reproductive Medicine criteria for being a donor and therefore I recommend him.

 

Paula Acker, LCSW

 

 

Summary of the Taylor-Johnson Temperament Analysis:

Donor #9889 has taken the Taylor Johnson Temperament Analysis for his participation as a donor for Oregon Health and Sciences University Fertility Consultants.  He scored tin the Aexcellent@ range in four of the nine measurements of personality style and scored in the Aacceptable@ range in two measurements.  He scored in the Aimprovement desirable@ range in two areas and in one area he scored in the range of Aimprovement needed.@  The reader of this evaluation needs to remember that this donor is just twenty four years old and this is not unusual for someone in the young adult age range.

The first Aexcellent@ score was in the range of Aactive-social@ verses Aquiet.@  This describes a person that is socially involved, has an ability to sustain friendships, and enjoys the pleasure of their friends and family.  It is also a measurement of someone who is likely to get involved in social activities such as community, club, or group events.  It indicates a desire for companionship and energy and vitality for new activities and experiences.

The second >excellent@ score was in the range of Asympathetic@ verses Aindifferent.@  This personality trait indicates a man that is kind, caring, understanding, and compassionate to others.  This is a measurement of a persons ability to be empathetic to others and care about their welfare, and sympathetic to the plight of those less fortunate.  It also indicates the desire to help those in need and these individuals are the ones we seek in times of stress or trouble.

The third Aexcellent= score was in the range of Adominant@ verses Asubmissive.@  This character trait is often misunderstood to be Abossy.@ However that is not what this measures.  This is a measurement of confidence, assertiveness, and competitiveness.  It is someone who has good ego-strength.  They have the ability to influence others, show initiative, be clear, firm, and to stand up for their rights and beliefs.  They are self reliant in life and go-getters.  Submissive would indicate someone who is a follower and not a leader.  Dominant personality people are natural born leaders.

The fourth >excellent@ score was in the range of Atolerant@ verses Ahostile.@  A tolerant person is accepting, open minded and thoughtful about others beliefs and lifestyles.  They are free from racial or political prejudice, and are not inclined to criticize others philosophies in life.  They are considerate individuals.  A hostile personality would be a person that is highly critical, judgmental, and feels threatened by fears or a sense of personal inadequacy.

The first Aacceptable@ score was in the range of Acomposed@ verses Anervous.@  A composed person is one that is relaxed, tranquil, and not overly nervous.  They are willing to try new things without too much hesitation.  They are free of excessive worry and anxiety.  They recover quickly from stressful situations.  A nervous person would be just the opposite.  They would be highly stressed, anxious, and unable to relax.  They are more likely to have nervous habits like smoking, drinking, or nail biting.

The second Aacceptable= score was in the range of Aself disciplined@ verses Aimpulsive.@  This measures a person=s ability to complete tasks on time, neatness, orderliness, and the ability to make plans and follow through.  They are able to set goals in advance and organize details to complete the task, event, project or trip. They are deliberate, and usually avoid frequent shifts of interests or goals.  An impulsive person would be one that drops plans to try something that hasn=t been thought through, or is disorganized.

Donor #9889 scored in the Aimprovement desirable@ range in Adepressive@ verses Alight hearted.@  This indicates a person who may have a bit more serious personality.  They may be emotional tired from personal relationships or pressures, or under a lot of stress from work or family. It also could indicate that during this test he was experiencing some stress or frustration.  In his individual interview he did not appear depressed nor has he ever had depression however.

The second score of Aimprovement desirable@ was in the measurement of Aexpressive responsive@ verses Ainhibited.@  He actually scored close to the line on this measurement which could indicate he is very close to the >acceptable@ range.  This is a measurement of being demonstrative, affectionate, and unrestrained in interpersonal relationships.  It measures the ability to be friendly, talkative, and express warm hearted feelings for others.  It is the ability to share joys and sorrows with others that one cares about.

The last score on the Taylor Johnson Temperament Analysis was in the measurement of Asubjective@ verses Aobjective.@  Donor scored in the Aimprovement needed@ range.  Once again he did score close to the line of Aimprovement desirable.@  This is a measurement of a person=s ability to evaluate life=s events and certain situations accurately.  It is the ability to be analytical, impartial, and introspective without fears and doubts. It is the ability to be fair minded, reasonable, and logical.  Being too subjective indicates a person who may be preoccupied, self conscious, or overly introspective.                                                                                      

Paula Acker LCSW

 

 

 

        

                

                KID PAGE                          

 

1. In general, please describe your childhood.                                                   

Family stayed in one place. Got along with siblings well.

 

2. Were there any family members other than your parents and siblings with whom you regularly had contact?

Grandma from father=s side. Always baked chocolate chip cookies. So good!

 

3. As a child, what was/were your favorite:                                                   

Food(s)?                                  Cookies

Color(s)?                                  Red

Toy(s)?                                     Legos

Indoor game(s)?                     Basketball

Outdoor game(s)?                  Running in sprinklers

Book(s)?                                  Dr. Seuss

Sport(s)?                                  Basketball, football                             

Other activity(s)?                    Playing the saxophone

 

4. What is your earliest memory?

The cookies baked by grandma.

 

5. What did you do during the summers?

Had fun, relaxed.

 

6. Are there any Anew@ technologies you remember becoming available during your childhood which now are commonplace in our society, or which have now been replaced by a newer technology?

 

 

7. Did you enjoy school as a child?  Do you have any memories of teachers that influenced you, or that you especially liked (or disliked)?

Yes I enjoyed school. I really didn=t have a negative thought towards any of my teachers.

 

8. Did you have chores or tasks that you were regularly expected to do?

Cleaned room, summer job.

 

9. Any other recollections of importance that come to mind?