The Potential for Future Blood Testing

Additional laboratory testing may be requested by the Embryo Recipients including HIV, Hepatitis and inheritable diseases. This blood testing is purely optional but often encouraged

 

Source of Embryos

The information you provide here will remain confidential. These materials may only be released in their entirety with your written permission. Those items shaded will not be posted on the web site.

Much of the information requested below will not be seen by any other persons other than the medical staff of Specialists In Reproductive Medicine & Surgery, P.A. Many of the questions below are quite personal and the answers will not be posted on the Embryo Donation web site.

It is understood that some of the embryos were created using donor eggs and donor sperm. If so, please indicate the following (Check all that apply):

Options	Applicant Initials
The Embryos were NOT created using donor eggs or sperm (i.e. only your own eggs and sperm were used).
All of the embryos were created using donor eggs.
All of the embryos were created using donor sperm.
We have a mixture of embryos that were created by both our own egg/sperm as well as donated eggs/sperm.

We appreciate your honesty in answering the questions listed in this application. Any missing information will require follow-up and significantly delay your posting in any of the databases.All of the embryos were created using donor sperm.

Limiting Sipulations

You are free to make specific stipulations regarding what type of patient(s) you feel comfortable assisting. Please select all that you AGREE to

Marital Status: Married Couples Unmarried Couples Single Females Single Males Lesbian Couples Homosexual (Male) Couples

Race: Mixed Race African-American Arctic Asian Caucasian Hispanic Indigenous Australian Native American Pacific North East Asian South East Asian West African, Bushmen, Ethiopian Other Race

Religion: Agnostic Buddhist Catholic Christian Hindu Jewish Muslim/Islam No Religion