Egg Donor Profiles

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ED0500817

Profile

GENERAL DETAILS

  1. Age:                                 26 yrs           Year of Birth:1990
  2. Husband Age:                   32 years
  3. Native:                              Manali
  4. Height:                              5’2”
  5. Weight:                             48 kgs.
  6. Education:                        From Year to         Year 7th std
  7. Religion:                            Hindu
  8. Veg/Non-Veg:                   Non veg
  9. Nationality:                        Indian

10.   Identity Proof:                    voter id, pan card

11.   Blood Group:                     O Positive

12.   Languages known:            Tamil, English

 

Physical Appearance

  1. Physical Build                                                  Medium

 

         

  1. Skin Complexion

Slightly Dark       

  1. Eye Color:                                   Black
  2. Hair Color:                                  Black
  3. Natural Texture of Hair:                         Thick

           

 

Marital Status

Married               Divorced              Single                 Separated

 

MARRIED

  1. Date of Marriage:              2007
  2. Has your husband accompanied you for the interview? Yes
  3. If not, reason for the same:   

 

  1. Have you been married more than once?                            
  2. Does your husband agree?                              Yes          
  3. Do you have a marriage certificate or any proof of marriage?

  No           

If yes, Proof Type                        ID Number

 

Divorced

  1. Have you legally obtained a divorce dissolving your marriage?

Yes           No

  1. Would your family accept for you donating your eggs? Yes No
  2. Which relative of yours would accompany you for the entire medical procedures?
  3. What is the short reason for dissolution of your marriage?

 

  1. Do you plan to further your family if you remarry? Yes        No

 

  1. Do you have any children from your earlier marriage?

Yes           No

 

 

SINGLE

  1. Have you ever been married earlier?                Yes           No
  2. Do you have any children from your earlier marriage?

Yes           No

  1. Do you know that Indian Surrogacy Law Centre does not accept egg donors who have not married?

Yes           No

  1. Which relative of yours would accompany you for the entire medical procedures?

 

SEPARATED

  1. What is the reason you have separated from your husband?

 

  1. Since when you have been separated?                                Year
  2. Would your husband agree with you donating your eggs?

Yes           No

  1. With whom are you presently staying?

 

 

PERSONAL CHARACTER

  1. Please describe your personality and character?

Shy type.

  1. What do you like most about yourself?

She is a kind person.

  1. What are your hobbies and interest?

Tailoring

  1. What is the work that you would love to do most? Taking care of

children

  1. How do you emotionally feel about being an egg donor?

She feels happy

  1. What was your most interesting subject in your education?

Tamil.

  1. How attached are your towards your family? Father in law is no more.

Mother in law will support

 

HABITS

  1. Do you use tobacco or do you smoke?                       No
  2. Do you consume alcohol?                                          No
  3. Does your husband use tobacco?                               Yes
  4. Does your husband consume alcohol?                       No

 

PREGNANCIES

  1. Have you ever had a fertility problem?                                  No
  2. If YES, please give details

 

  1. Have you had a multiple birth?                         Yes           No
  2. How many children do you have?

Male

1

Female

1

           

  1. Have you ever suffered a miscarriage?                       No
  2. Have you ever any ectopic pregnancies?                    No
  3. Have you suffered a stillbirth?                                    No
  4. Have you suffered from Post-natal Depression?          No

If yes, please provide details of the same.

         

  1. Have you undergone surrogacy earlier?                      No
  2. Have you taken up egg donation earlier?                    No

If yes, please provide details of the same.

 

  1. Please give details of deliveries:

 

1

2

3

4

Normal/

C-Section

Normal

Daughter

C –sec.

Son

 

 

Dates of Birth

29/05/2008

10/05/2010

 

 

Weight

3kgs.

2.150 kg.

 

 

Was pregnancies full term?

Full Term

1 month earlier

 

 

Did any of your children have a medical problem at birth

 

 

 

 

Do any of your children have health problems? (Physical or Psychological)

 

 

 

 

Blood Group

 

 

 

 

 

FAMILY PLANNING

  1. Have you done family planning?                                           No 
  2. Present contraception method?                                            No

Describe -

  1. Has your husband done family planning?                              No
  2. If answer to the above two questions is No, do you understand the importance of abstaining from Intercourse at the time of ovulation?

No

  1. Have you completed your family?           Yes             

 

MEDICAL

  1. Have you gained or lost over 10 kilos in the past six mmonths?

No

  1. If yes, please give details
  2. Have you been immunized?                             Yes          
  3. Have you ever had any psychiatric problems?   No
  4. Are you presently taking any medication?         No
  5. Do you have any diseases, such as, diabetes/epilepsy, etc.

no

7.     Are you known allergic to any particular drug or substance/food?

No            If yes, specify

8.     How long is an average monthly cycle for you?            30-33  days

9.     How long do your periods last?                3                            Days

10. What the next expected date of your menstruation for scheduling medical screening?  today

11. Do you wear glasses?                                                No

If yes, what is the type and power?

 

FAMILY MEDICAL HISTORY:

  1. Does anyone in your family have any genetic diseases, such as, diabetes, epilepsy or any heart problem?                        No
  2. Does anyone in your family have twin children?          No
  3. Is there some medical condition in your family that you might consider would pass on genetically?                              No

 

MEDICAL (PARTNER):

1.     Is your husband suffering from disease that is transmittable orally, such as, TB, etc.                                                                      No

2.     Is your husband suffering from any Sexually Transmittable Disease?

          No

3.     Is your husband suffering from any psychiatric problem or any mental issue?                                                                        No

 

SUPPORT

  1. Do you have someone to offer practical and emotional support?

Yes           The children are staying in hostel inside the school

Name and relation:

  1. Is your family aware of your intention to become a surrogate mother/egg donor?

Yes          

Convenience

  1. If chosen, how far are you prepared to travel to a clinic?                                               
  2. Are you willing to travel to any other city other than your present residence?                                                      No  Chennai

 

EMPLOYMENT:

  1. Are you currently employed?                                      No 
  2. Occupation/Nature of work:                                     
  3. Previous occupation:                            
  4. If YES, how many hours a day/week?                                          
  5. Would your employer allow you time off to attend hospital/clinic appointments for treatment etc.?                      Yes           No
  6. If you are employed or have been employed, what is the pay that you had been receiving?
  7. Is your spouse currently employed?                  Yes           basically driving.  But constrained to do painting work.
  8. Nature of work/occupation of your spouse:

 

Family details

Please write a short statement about you, your family, and most importantly your reasons for wanting to be a surrogate mother/egg-donor. Please also mention other information you wish to communicate to the intended parents.

 

She has 1 elder brother m arried and settled in Manali.

He has one younger brother married and settled in Chennai

LEGAL COUNSELLING

Are you being forced into taking up the egg donation/surrogacy arrangement by anyone?                 No

Are you willing to be a surrogate mother/egg donor only out of your Free Will?

Yes          

Do you or your spouse have any criminal convictions, or criminal proceedings pending?                                                         No

EGG DONOR

1.               Do you know that you have to complete your family before you can get enrolled with Givlifes Egg Donor Program?

Yes completed

2.               Do you know that you have a risk of becoming infertile, if selected?

Yes          

3.      you informed of the following:

(a)            The basic process of Egg Donation        Yes           No

(b)             The gametes (eggs) that would be retrieved from you by ART by stimulation with hormonal drugs would be the sole property of the childless couple.                                                           Yes          

(c)             You would have no control over the gametes that have been retrieved from you or the child that may be created/born out of such gametes?

Yes           No

(d)            You still remain an anonymous Egg Donor, shall have no knowledge of who would be using your gametes?                            No

(e)            You would not be making any attempt to identify the childless couple whom you are helping.                                     No

4.               Do you have any doubts/queries?

 

 

 

 

SURROGATE:

Do you know

1.               That you would be carrying a child for another couple?

Yes           No

2.               That you will have no rights over the child that would be born to you?

Yes           No

3.                That yourself and your family would be paid a compensation for the efforts for helping the childless couple?

Yes           No

4.               That you would be required to sign a surrogacy agreement that would govern your conduct before, during and after the surrogacy arrangements?

Yes           No

5.               You cannot claim any rights over the child that may be born out of this arrangement during or after the surrogacy arrangement?

Yes           No

6.               You would take up all medical risks that you may be exposed to in the process and sign your consent in the consent forms for the same?

Yes           No

7.               You would not hold GIFTLIFE and Indian Surrogacy Law Centre for any medical risks, known or unknown and you will absolve ISLC for all risks, including medical that you may incur?

Yes           No

 

 

COMPENSATION:

  1. What is your monthly income?     Rs.650 per day (contract)
  2. What is the monthly income of your family?
  3. Do you or anyone in your family own any movable or immovable assets? They are in lease house.
  4. If you were selected, how much compensation according to you would be appropriate for your services?

Rs.50,000/- (Rupees Fifty thousand only)

  1. What would you do with the compensation that would get out of this effort?

 

  1. Something that you would like to communicate to childless couple that you would help in the process?  They are happy to help childless couple.

 

 

 

 

Comments by interviewer