Potential Sperm Donor Initial Checklist

If you would like to become a sperm donor, 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 a sperm donor or inviting you to contact MFS on 01922 455911, to get more information or to make an appointment for initial tests and counselling.

		Yes	No
1	Are you generally fit and healthy?
2	Are you aged 18 - 45 years
3	Have you recently, or are you currently using illegal drugs?
4	Have you or your partner ever had a sexually transmitted disease such as herpes or genital warts?
5	Are your blood relatives generally fit and healthy?
6	As far as you know, has anyone in your family had any of the following:
	a - juvenile diabetes (insulin dependent)
	b - severe epilepsy
	c - cystic fibrosis
	d - severe asthma
	e - haemophilia
7	Sperm donors need to be able to commit to about an hour (depending on travelling time) each week to donate. Would this be a problem for you?
8	The law allows that identifying information about the sperm donor may be held for possible future release to any child born from donor sperm, should they request it after they reach the age of 18. Would you be happy to possibly be identified as the genetic father of any child born from your donor sperm in the future?