Registo como dador de óvulos

Ajudar a formar uma família

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Last Page

Personal Information

Username *
First Name *
Last Name *
Password *
Confirm Password *
Email Address *
Address *
City *
State *
Postal Code
Country *
Cell Phone *
Your Age Today *
Birth Date
Have you ever donated your eggs before?
List below the dates you donated and the results of each of your egg donations (# eggs retrieved, # of embryos made, # of embryos frozen, pregnancy result, birth result).
Please select the egg donation fee
Other fee (specialty donor, Ivy league, high IQ)
AMH
Genetic Result
Where Did You Learn About Fertility Heaven? *
Please Fill all The Required Fields to Proceed.

Screening Questions

Would you like to be anonymous to recipients?
Have you ever been convicted of a crime?
Are you adopted?
Have you used antidepressants within the last year?
Have you smoked tobacco within the last year?
Have you ever been hospitalized for substance abuse, depression, or any other psychological problem?
Does your family have any history of cancer or heart disease under the age of 55?
Have you ever been diagnosed with any gynecological issues such as fibroids, ovarian cysts, endometriosis, Pelvic inflammatory disease, fertility issues, ovarian, uterine?
If you answered yes to any of the above please explain?
Please Fill all The Required Fields to Proceed.

Education & Work

College Education
Please list the college and degree you are pursuing and have achieved or certificate program completed?
What is your highest college GPA?
Check the tests you have taken.
Did you graduate from High School?
Are you currently employed?
Please describe the type of work you do now and in the past. Leave out specific company names.
Please Fill all The Required Fields to Proceed.

DONOR CHARACTERISTICS

Height
Weight (Insert weight in lbs)
Eye Color
Hair Color (Natural hair color)
Hair Type
Complexion
What is your blood type?
Plastic surgery procedures?
What is your race?
What ethnic groups do you belong to? Please check those that are significant
List specific ethnic groups you belong to below, separated by commas. For example Hungarian, Austrian.
Please Fill all The Required Fields to Proceed.

Realtionship Status

Relationship Status
Name of contact in case of emergency
Relationship of contact to you?
Emergency contact number
Please Fill all The Required Fields to Proceed.

GENERAL HEALTH INFORMATION

What is your eye vision?
Have you had surgery to correct your vision?
Did you have braces?
How is your hearing?
What is your sexual orientation?
Do you have health insurance?
How many glasses of alcohol do you drink per week on average?
Do you take any drugs or prescription drugs?
Please check if you have used any of the following. Many clinics require drug testing before you will be qualified to donate.
Have you had any of the following?
Please list the dates and describe each of the above that you have checked.
Please check below any STD's you and/or your partner have been diagnosed with.
Please list any illnesses, hospitalizations, operations or surgeries you have had and the date
Have you, or any family member, ever been under the care of a psychiatrist?
Have you, or any family member, ever received treatment for drug and/or alcohol abuse?
Have you had counseling or psychotherapy?
Are there any medical conditions for which you are currently being seen or treated?
Please describe the details if you answered yes to any of the questions above.
Please Fill all The Required Fields to Proceed.

MENSTRUAL CYCLE

When was your last pap smear and what were the results?
Are you on birth control? If yes, what type of birth control and the name?
Have you ever had an abnormal pap smear?
What was the age of your first menstrual period?
Are your menstrual cycles regular?
How many days does your period last?
What kind of birth control are you using?
Please select all that apply?
Do you have an incidence of twins in your family.
Please Fill all The Required Fields to Proceed.

FAMILY GENETIC HISTORY

Mother

Mother's Age
Ethnicity
Height feet
Weight
Eye Color
Hair Color (natural)
Hair Type
Complexion
Vision
Describe any health issues? If mother passed away please list date and reason

Father

Father's Age
Ethnicity (Father)
Height feet
Eye Color
Hair Color
Hair Type
Complexion
Weight
Vision
Describe any health issues. If father passed away please list date and reason
Do you have siblings?
Age
Gender
Height
Eye Color
Hair Color
Hair Type
Complexion
Weight
Vision
List any Health Issues
Do you have 2nd sibling?
Age
Gender
Height
Eye Color
Hair Color
Hair Type
Complexion
Weight
Vision
List any Health Issues
Do you have 3rd sibling?
Age
Gender
Height
Eye Color
Hair Color
Hair Type
Complexion
Weight
Vision
List any Health Issues
Do you have 4th sibling?
Age
Gender
Height
Eye Color
Hair Color
Hair Type
Complexion
Weight
Vision
List any Health Issues
Do you have 5th Sibling?
Age
Gender
Height
Eye Color
Hair Color
Hair Type
Complexion
Weight
Vision
List any Health Issues

Siblings

Please list all half siblings here and cover the same questions you did for your first siblings:

Grandmother (Mother's side)

Grandmother's Age (Mother's side)
Ethnicity
List grandmother's characteristics: eye color, hair color, height, weight, and complexion.
Describe your grandmother's health issues she experienced during her life. If she passed away, please provide her age at death and what she died from

(Grandfather) Mother's side

Grandfather's Age (Mother's Side)
Ethnicity
List grandfather's characteristics: eye color, hair color, height, weight, and complexion
Describe your grandfather's health issues he experienced during his life. If he passed away, please provide his age at death and what he died from

Grandmother (Father's side)

Grandmother's Age (Father's side)
Ethnicity
List Grandmother's characteristics: eye color, hair color, height, weight, and complexion:
Describe your grandmother's health issues she experienced during her life. If she passed away, please provide her age at death and what she died from:

(Grandfather) Father's side

Grandfather's Age (Father's Side):
Ethnicity:
List grandfather's characteristics: eye color, hair color, height, weight, and complexion:
Describe your grandfather's health issues he experienced during his life. If he passed away, please provide his age at death and what he died from:
Please Fill all The Required Fields to Proceed.

FAMILY HEALTH HISTORY

Please check if your parents, grandparents, aunts, uncles, first cousins or any family member has had the following conditions. Most donors have at least 5 health conditions (some many more), so be sure to list everything after you have talked to your family
For each item you checked above, write the name of the health disorder and the name of the person in your family who has or had it and their relation to you.
Please Fill all The Required Fields to Proceed.

PERSONALITY

Why do you want to be an egg donor?
What are your special talents and hobbies? (Artist, Athlete, Dancer, Musician, Singer)
What has been your favorite vacation and why?
What are your favorite foods?
What has been your biggest personal or professional achievement?
Please Fill all The Required Fields to Proceed.

PHOTOS (please click "update" after uploading photos)

UPLOAD YOUR BEST FLATTERING PHOTOS

Do not upload photos with filters, hats, sunglasses or from far distances. Please resize large photos. Ideal photos are 300 x 300 for uploading. If you have difficulty uploading photos and video email them to INFO@FERTILITYHEAVEN.COM

Main profile photo - Camera facing *
Maximum file size: 30 MB
Camera facing includes your whole body *
Maximum file size: 30 MB
Fun Photo *
Maximum file size: 30 MB
Sport or Activity Photos *
Maximum file size: 30 MB
Your Choice Photo
Maximum file size: 30 MB
Photo with Big Smile
Maximum file size: 30 MB
Photo with Parents or Siblings
Maximum file size: 30 MB
Photo of you as an Infant
Maximum file size: 30 MB
Photo of you as a Toddler
Maximum file size: 30 MB
Photo of you from age 4 to 10
Maximum file size: 30 MB
Upload video of less than 30 seconds
Maximum file size: 200 MB

Terms

I certify that the information I provide on my Fertility Heaven profile page accurately reflects my background, academic achievements, medical history, as well as my personal characteristics. I understand that I could be subject to civil or criminal charges if I purposely fraudulently misrepresent myself or purposely leave out important and relevant information about my background, lifestyle choices, drug use or health history of myself or my immediate family members which includes parents, siblings, grandparents, aunts, uncles and cousins, which must be ascertained to determine if I am a good genetic candidate for egg donation. I understand that if I cancel the cycle, I will be responsible for reimbursing the intended parents the costs for my medical expenses. I have educated myself on egg donation. I have done research and read the Fertility Heaven egg donor pages to educate myself on the process. I have assessed the risks involved, and I want to be an egg donor. Do you agree to the above stated terms? *