Egg Donor Application

Donor Prescreening Questionnaire

 

Helping another woman become a parent is the greatest gift you can give them. Our anonymous egg donors at Conceptions believe in families and the inner strength of every woman. Donating your eggs and supporting another woman to become a mother is a highly personal decision but one based in caring and compassion.

Egg Donor Requirements

 

We are actively seeing inspired and empowered women ages 19-33 years old to donate their eggs for patients in need.

Anonymous Egg Donors are compensated up to $7,500 for their time and effort and can donate up to six times. Qualifications to become an egg donor include:

  • Healthy women 19 to 33 years old
  • No significant personal or family history of medical/health conditions
  • No significant personal or family history of mental health conditions
  • No recent travel to Zika virus regions or current Coronavirus disease.
  • BMI between 19-29 (BMI Calculator)
  • Non-Smoker
  • No Drug Use for 12 months (No marijuana for 3 months)
  • Regular periods
  • No body piercings or tattoos for 12 months (unless using sterile technique)
  • Ok to leave a detailed message at daytime phone number?*
  • Ok to leave a detailed message at evening phone number?*
  • Height:
  • Weight:
  • Have you donated before*? 
  • Do you have health insurance?
  • If yes, who is your insurance carrier:
  • Have you completed grade school?*
  • Have you completed high school?*
  • Are you currently in college?*
  • Are you currently pursuing an advanced degree*?
  • Do you have regular cycles?
  • Do you currently use contraceptives?*
  • If yes, what type:
  • Have you ever been pregnant?
  • Have you ever been diagnosed with infertility?*
  • Have you ever travelled to Europe?*
  • Have you ever lived on/been stationed at a military base?*
  • Have you ever visited/lived in Africa? *
  • Please list any allergies:*
  • Current prescriptions:*
  • Any current medical illnesses?*
  • Are there any medical illnesses in your family?*
  • Details of family medical illnesses:*
  • Are there any mental health issues in your family?*
  • Details of family mental health issues:*
  • Are you available for regular appointments between 7:00 am and 10:00 am?
  • Do you have a fear of needles?*
  • Have you used illicit drugs?*
  • Details of illicit drugs used:
  • Have you ever been prescribed any neuroleptic agents?*
  • Details of any neuroleptic agents:
  • Have you ever been incarcerated?*
  • Have you ever used injectable drugs?*
  • Have you ever engaged in prostitution?*
  • Have you had any partners that have engaged in prostitution?*
  • Have you ever been exposed to HIV?*
  • Are you currently sexually active?*
  • Are you in a monogamous relationship?*
  • Do you have a gay partner?*
  • Have you ever been rejected as a blood donor?*
  • Are you a smoker?*
  • Do you have tattoos or body piercings?*
  • If yes, what is the date of the most recent:
  • Do you have regular access to emails and internet?*

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