Oregon Health & Science University                                         PROFILE FOR SPERM DONOR  #9894

Andrology/Embryology Lab

3303 SW Bond Ave., CH10F

Portland, OR   97239-4501

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 69), P aunt (65), and M uncle (66) are all living and in good health.  Deceased are the donor’s mother (age 65, brain tumor), PGF (93, gastrointestinal failure from medication side effect), PGM (98, heart attack), MGF (91, stroke), and MGM (89, old age).  The donor has no siblings.

Donor’s vision: 20/20.

Donor’s hearing: normal.

Donor’s dental history: several fillings; otherwise, perfect teeth.  No orthodontics; retained wisdom teeth.

 

 

EDUCATION:	Subject of study	Type of University
> 1 year college
Baccalaureate Degree	B.A. (Mathematics)	private liberal arts college
Master=s Degree	Civil Engineering
Professional Degree

 

OCCUPATION:  Post Baccalaureate student

 

RELIGION:  None

 

                                                                                         

Social History:

                                                                                         

1. Do you have any special talents?

I am an accomplished cyclist.  I have a knack for taking an effective strategic approach to problem solving, both in games (e.g., chess) and in my everyday life.  I am adept at abstract thinking and pattern recognition.  I feel that my aesthetic sense is well developed, and it serves me well in many arenas, including drawing, painting, writing, cooking, etc.

 

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

My father’s side of the family seems to be very strong in abstract, analytical thinking.  My father is and my great-grandfather was a philosopher, my grandfather was and my cousin is an architect.  In keeping with this, I have degrees in Mathematics and Engineering.

 

3. What are your interests and hobbies?

As I mentioned above, I am an accomplished cyclist.  I have won several races and set several records.  In addition to cycling, I enjoy gardening, dancing, cooking, and reading.  I write as a hobby and have had my work published in several periodicals.

 

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

I particularly enjoyed math, history, and creative writing.       

 

5. High School GPA  3.5                                College GPA  3.6                    I.Q.  155

 

6. How would you describe your personality characteristics?

I am highly sensitive and empathetic towards the people around me.  I would not call myself quiet or shy, but at the same time I don’t feel the need to fill up a silence with chatter.  I am highly enthusiastic about the things that engage me.  I approach situations analytically; very much with my head, rather than my heart.  I take criticism very seriously – sometimes, perhaps, more so than is warranted – and constantly strive to address my shortcomings.  Because of this, I feel that I am a highly moral person, always considering the potential impact that my decisions might have on the people around me.

 

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

I want to be a sperm donor to help women and couples have children who might otherwise not be able to.  My mother passed away a couple years ago, and that has helped me realize how important a part of life parenting is.  I intend to raise children of my own, but in the meantime, I hope to take some satisfaction from knowing that I have helped others down that path.

 

 

Additional Descriptive Characteristics:

 

Handedness:  Right                                                                            Foot/Shoe Size:  14

 

Hairy Chest:  Yes                     Hairy:  No                                         Beard Color:  Brown

 

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

None.

 

Acne problems:

No.

 

Reactivity/Sensitivity to sun exposure:

I acquire a deep tan; I don’t burn easily.

 

Family Social History:                                                                                                      Donor #:      9894

	Education	Occupation	Interests	Eye color	Hair color	Height	Body Type
PGF	PhD	architect	photography, gardening
PGM	PhD	nurse	gardening
MGF	high school	carpenter	woodworking, gardening
MGM	high school	homemaker	quilting, sewing, gardening
Father	Masters	philosophy teacher	gardening, hiking, backpacking, bicycling, cooking, philosophy		light brown	6’1”	thin
Mother	Masters	artist	drawing, painting, gardening, hiking, bicycling, community service		dark brown	5’10”	thin
Sister	Masters	account manager	travel, spectator sports, reading
Cousin	PhD	architect	bicycling, reading, music, drawing
Aunt	BA	homemaker	sewing, gardening, movies
Uncle	BA	publishing representative	reading, gardening, movies

 

Donor 9894 Evaluation by Paula Acker LCSW, Licensed Clinical Social Worker and  Infertility Counselor

 

Referral Information:  Donor was referred for a psychological assessment to be an anonymous sperm donor for Oregon Health and Sciences University.  Prior to this evaluation he had a medical evaluation and has been donating.  This face to face evaluation followed the guidelines of the American Society of Reproductive Medicine Mental Health Professional Group recommendations for anonymous donors. This evaluation also includes the PAI testing and the initial results of this psychological screening tool.

 

Motivation for Donation:  Donor is Caucasian and a recently engaged man who initially decided to be a donor to pass his genetic contribution on to others. He very much wants to be a father himself one day and hopes that his donation will make many other families happy.  He grew up with a sibling who is adopted and understands from his parents that infertility is a difficult issue. He was a surprise to his parents after they adopted and then were able to conceive him naturally. He is open to all families and individuals who choose to start a family through sperm donation.

 

Informal Mental Status and Behavioral Observations: Donor 9894 is a somewhat reserved man who was on time to this appointment and appropriately dressed. His mannerism and speech were in the normal range and he did not display any cognitive deficits.  He was intelligent and logical in answering questions and became more open and friendly as the interview proceeded. His affect was appropriate to the content of the discussion.

 

Brief Psychosocial History:  Donor grew up on the West Coast. His father is a retired university professor. He is seventy years old and in good health.  His mother passed away a few years ago at the age of sixty five from a brain tumor.  She had worked as a graphic designer. Donor graduated from a private small liberal arts college in the Midwest with a BA in mathematics.  He has completed his Masters Degree. He owns his own home.

 

Psychological Family History:  There is no history of mental illness in the family of origin. Donor had sought professional guidance through counseling for relationship issues but is no longer in counseling and experiencing a very healthy and satisfying relationship.  He has no history of depression.  There is no history of alcoholism in his family of origin and he is a light social drinker averaging about two to three drinks per week at the most.  He does not have any legal or financial problems he reports, and no bankruptcies.  He is a non-smoker. He does not use recreational drugs.  He has not experienced any recent unexpected losses, or any trauma.

 

 

Hobbies and Interests:  Donor enjoys gardening in his yard and growing vegetables.  He likes to bicycle and rode his bicycle to this appointment.  He also enjoys reading, hiking, and cooking.

 

Psychological Testing Results:  Donor took the PAI psychological test.  It indicated that he is a stable man without any psychopathology and the entire test results were in the normal limits.  He has no problems with moodiness, impulsivity, hostility, or depression. He does not have marked anxiety or any difficulties with physical health, and the tests reflected no significant problems with alcohol or drug abuse or dependency.

 

Recommendations:  He has carefully considered passing on his genes and feels very positive about doing so. He has support from his fiance’ to be an anonymous donor.  His mental health history falls within the guidelines acceptable of being a donor and based on the clinical interview and psychological testing he is recommended as a donor for OHSU.

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Paula Acker LCSW

                                                                       

  KID PAGE                     

1. In general, please describe your childhood.

While I was growing up my family never moved.  My father still lives in the same house I grew up in.  I have one sister, adopted.  I didn’t get along too well with her.  Partly because we were so different, partly because I was kind of a brat, and partly because she was always trying to act like a third parent.  We’re very close now, though.

 

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

I saw a lot of my paternal grandparents growing up.  They were very sweet people, and were amazingly patient with me, their grandchild.  They lived in Seattle, and it was always exciting to go up there and have new parks to explore and new museums and a different zoo to go to.

 

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

Food(s)?        Peanut butter.  Pizza.  Fish & chips.

Color(s)?        Red.

Toy(s)?           Lego’s, blocks, Star Wars action figures.

Indoor game(s)?        Chess, Monopoly, Dungeons and Dragons,

                                     Atari video games, computer games.

Outdoor game(s)?     Capture the Flag, tag, hide & seek

Book(s)?        The Hobbit, Chronicles of Narnia, Madeleine L’Engle, The Great Brain.

 

Sport(s)?        Swimming and bicycling.  I really didn’t like organized sports.

Other activity(s)?       Going to movies, drawing, fishing, hiking, summer camp.

 

4. What is your earliest memory?

My earliest memories are pretty hazy, and not particularly fixed in time, so it's hard to say which is the earliest. I have memories of holidays, certainly, as they have the benefit of being unusual, and easily tied down in time. I remember giving and getting a great deal of affection from my parents -- lots of hugs. I remember regularly taking the trip out to Gresham for my sister's piano lessons. I remember hiking with my dad in Forest Park. I remember sitting on the couch, eating popcorn and watching "Happy Days". I have vague recollections of liking broccoli.

 

5. What did you do during the summers?

We had a rope swing hanging from a tree in our backyard.  I’d spend hours out playing on that.  I’d run around the neighborhood playing games with the neighbor kids.  I’d have sleepovers with various friends.   My family would take trips, to Seattle, San Francisco, Michigan, and the San Juan Islands.  My aunt lived on San Juan Island; some of my favorite memories are of poking through the tide pools on the beach below her house, looking at hermit crabs and anemones.  I went to summer camp in the Cascades for a couple years, and on the Oregon Coast for a couple years.  Sometimes my dad and I would go backpacking and fishing together.

 

6. Are there any “new” 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?

The technology that made the biggest impression on me was probably the personal computer.  They were just coming into the home when I was in elementary school, and by the time I was in middle school we had a Commodore 64 of our own.

 

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)?

I have to say, I really didn’t think much of school.  I got bored with the assignments very quickly.  It seemed a lot of pointless busywork to me.  And I really hated writing – it was just such a slow way to express myself.  The two teachers that have the biggest place in my memory were the ones in 4^th and 7^th grade, who pushed me the hardest to just get over it and write anyway, and who taught me to write more effectively.  That had a huge impact on the rest of my school experience, across the board.

 

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

I was expected to clean my room regularly, to put away the dishes, and to set the table.  Our family also had a chore rotation, where each of us gave a good cleaning to one room each week, and we rotated through the rooms.  That was probably a really good system, as no one got bored, no one got stuck cleaning the bathrooms all the time, and me and my sister’s lack of thoroughness didn’t mean any room got particularly bad before our parents got to it.

 

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