Embryo Donor Application - Identifying Information (1/13)

Thank you for considering donating your embryos to Embryo Donation International (EDI)! After the information is entered, the staff of EDI will review it and contact the facility that created your embryos. If we feel that we can find a wonderful home for your embryos, we will contact you and start the process to bring the embryos to our facility. We do our best to accomplish all of this within 10 days of your application!

Why "Embryo Donation" and NOT "Embryo Adoption"?

Adoption refers to the legal process where a new relationship is created between a parent and a live child. Adoptions can only be granted by the court after the birth of a child. Embryo donation, however, is regulated by the Federal Drug Administration (FDA) and not the courts. While we at EDI feel your embryos deserve a tremendous amount of respect, assigning personhood to an embryo has tremendous moral, ethical and legal ramifications. For a detailed discussion on this topic, please click here.

General Information

The information you provide on this form will be placed in our Embryo Search database system. Your name will never be released without your expressed permission. Segments of the information will also be loaded onto our Website. Click here if you want to see an example of the embryo donation section of our Website.

Choose A Charity

By selecting a charity below, we will .

Choose A Charity *

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 only be seen by the medical staff of Embryo Donation International. Many of the questions 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

 

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.

Donation Process

Please select one of the following donation processes you are interested in. Click here for more information on the different types of donation.

 

Identity Disclosure Program Option

From the perspective of a donor-conceived offspring, you can imagine that they would be curious about the embryo donors and may also want to connect with any existing genetic siblings. Embryo donors may also be curious about the donor-conceived offspring. Now, EDI offers you, the embryo donors, the option to direct the disclosure in anonymous and approved embryo donation procedures.

It is strongly recommended that you click here and review these options in detail. In summary, the Identity Disclosure Program (IDP) allows for the following:
  1. You get to decide if you are willing to have the donor-conceived offspring contact you at a later date.
  2. You will decide when you are willing to be contacted by the donor-conceived offspring when the offspring reaches a certain age or older.
  3. You may also decide how the first contact will take place (i.e., phone, email, text, videoconference, in person or other methods of communication).

Please understand that if you commit to the IDP, the following will take place:
  1. Once the IDP consents are signed, you will be unable to change your mind regarding future contact. Signing the consents is a commitment on your part to allow your identity to be disclosed and contact to potentially be made.
  2. By agreeing to the IDP, it will still be up to the recipients to disclose to the child that contact is actually possible. If the recipients do not disclose to the donor-conceived offspring their actual genetic origins, you will not be contacted.
  3. Contact from the donor-conceived offspring could take place many years down the road when your life circumstances could be different than they are now.
  4. Your identifying information will be released to the donor-conceived offspring should you not respond to EDI to set up the method of contact or if you fail to contact the donor-conceived offspring within a reasonable period of time after being requested to do so.
  5. Your identifying information will, by default, be made available to the donor-conceived adult when they reach age 18, whether contact did or did not take place in the past.
  6. Many embryo donors have fulfilling, although potentially limited relationships with the donor-conceived offspring and the recipient(s) who raise them. There is no question that the embryo recipients are the parents to the donor-conceived offspring. That stated, the donors and the genetically-related siblings living in the donor’s home may play an important role in the health and well-being of the donor-conceived offspring. There may also be true benefits to the embryo donors and the genetically-related siblings by having a relationship with the donor-conceived offspring. Studies are ongoing.
  7. The embryo donors decide the minimal age at which the donor-conceived offspring may initiate contact. There is data to suggest, however, that earlier contact may be better for the well-being of the donor-conceived offspring.

If you need help to work though the decision to participate in the IDP, a skilled Mental Health Professional (MHP) will be found to assist you. Do you need MHP assistance? *

Preliminary Embryo Information

When were they created? *
What IVF facility were they created
Name Location
Is there more than one storage facility that currently has your embryos? *
What IVF facility were they created
Where are they currently being stored? *
How many are currently stored? *
Are there any residual storage fees currently? *

In order for us to review the information about your embryos, please download, complete and fax/mail to the facility where the embryos were originally created so EDI can contact them. If the cryopreserved embryos have been moved to more than one facility, EDI will need releases for each facility that had contact with them.

Consent for Transfer to and Acceptance by EDI of Cryopreserved Donated Embryos
Release of Records to EDI

Limiting Stipulations/Recipient Characteristics

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

Partner Status/Sexual Orientation:

You have a choice if you would like to stipulate the partner status and sexual orientation of the embryo recipient(s). Please choose any or all of the options below:

Married

Unmarried but with Partner

Single (by choice, divorced or widowed)
 

Race:

All races below are currently sellected. Please uncheck any races you do not want to receive your embryos. Because nearly all embryo donors and recipients are made up of a mixture of races, a recipient qualifies if 50% or more of their ancestry is the race that you specify below. In order to match your donated embryos to recipients, recipients are described as predominantly one race or a mixture of two races but not more.
 

Religion:

Embryo recipients commonly have a predominant religion in their home, which is the religion an embryo donor-conceived child will be raised in. Please choose any or all of the predominant household religions listed below that you will allow the embryo recipients to be:
     
     
     
 

Eduction Level:

Please indicate what level of education you want at least one of your embryo recipient(s) should have accomplished.

High School

College

Advanced Degree:
 

Location:

Please indicate if you want to exclude potential embryo recipients that currently live near you:
 

Other:

If there are any other stipulations you feel are important, please list them below remembering that if you are too restrictive, the embryos are unlikely to be chosen:
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