Egg Donor Initial Checklist

9,3,1 egg donor CL

If you would like to become an egg donor or an egg sharer, complete this self-assessment form to see if you meet the current rigorous criteria for donors. Simply answer ‘yes’ or ‘no’ to the following questions. Your response will be calculated and you will receive a pop-up message either declining your offer to be an egg donor or inviting you to contact Midland Fertility, to get more information or to make an appointment for initial tests and counselling.

For more information on becoming an egg donor or an egg sharer, email Donna Rea-Gardner, the Midland Fertility egg and embryo donation coordinator.

LU: 20/8/14/JAA

 YesNo
1Are you generally fit and healthy?
2Are you aged 18 - 35 years
3Do you smoke?
4Have you been advised you may need fertility treatment to conceive?
5Is your BMI? (select one)
(a) less than 19 
(b) Between 19 and 30 
(c) More than 30 
6Are your blood relatives generally fit and healthy?
7Do you have regular periods (ie every month , or so)?