Egg Donors Eligibility Quiz

Can we contact you?

1. Have you ever been pregnant before?

2. Do you have children?

3. Do You want to become an egg donor?

4. Are you between the age 18 and 35?

5. Have you injected drugs for a non-medical reason in the preceding five years, including intravenous, intramuscular, or subcutaneous injections? (*)

6. Do you have hemophilia. If yes, do you use human-derived clotting factor? (*)

7. Have you engaged in sex in exchange for money or drugs in the preceding five years? (*)

8. Have you had sex in the preceding 12 months with any person described in the previous 4 items of this section or with any person known or suspected to have HIV infection, clinically active hepatitis B infection, or hepatitis C infection? (*)

9. Have you been exposed in the preceding 12 months to known or suspected HIV, HBV, and /or HCV – infected blood through percutaneous inoculation (e.g., needle-stick) or through contact with an open wound, non-intact skin, or mucous membrane? (*)

10. Have you been incarcerated for more than 72 consecutive hours during the previous 12 months? (*)

11. Have you had close contact within 12 months preceding donation with another person having clinically active viral hepatitis (e.g., living in the same household, where sharing of kitchen and bathroom facilities occurs regularly)? (*)

12. Have you had a tattoo, ear piercing, or body piercing in the last 12 months in which instruments were shared? (*)

13. Have you been diagnosed with viral hepatitis after age 11? Unless evidence from the time of illness documents that the hepatitis was identified as hepatitis (e.g., a reactive IgM anti-HAV test)? (*)

14. Have you had a recent smallpox vaccination (vaccinia virus) in the last 60 days? (*)

If less than 60 days did the scab separate by some other means than spontaneously?

15. Do you have a clinically recognizable vaccinia virus infection contracted by close contact with someone who received the smallpox vaccine ? The Physical assessment should also check for this. (*)

16. Have you had a medical diagnosis of WNV infection? (*)

17. Have you had both a fever and a headache (simultaneously) during the 7 days prior to donation? (*)

18. Are you or any close contacts a xenotransplantation product recipient? Have you, your sexual partner, or any member of his/her household ever had a transplant or other medical procedure that involved being exposed to live cells, tissues, or organs from an animal? (*)

19. Have you had a transfusion or received blood or blood products in the last 48hrs? (*)

20. Have you been diagnosed with or treated for Chlamydia? (*)

21. Have you been diagnosed with or treated for Gonorrhea? (*)

22. Have you ever been diagnosis with vCJD or any other form of CJD? (*)

23. Have yoy ever had a diagnosis of dementia or any degenerative or demyelinating disease of the central nervous system (CNS) or other neurological disease of unknown etiology? (*)

24. Have you ever received a dura mater transplant? (*)

25. Have you ever taken human pituitary-derived growth hormone? (*)

26. Have you ever had a blood relative diagnosed with CJD? (*)

27. Have you spent three months or more cumulatively in the UK from the beginning of 1980 through the end of 1996? (*)

28. Are you a current or former U.S. military member, civilian military employee, or dependent of a military member or civilian employee who resided at U.S. military bases in Northern Europe (Germany, U.K., Belgium, and the Netherlands) for 6 months or more from 1980 through 1990, or elsewhere in Europe (Greece, Turkey, Spain, Portugal, and Italy) for 6 months or more from 1980 through 1996? (*)

29. Have you lived cumulatively for 5 years or more in Europe from 1980 until the present (note this criterion includes time spent in the U.K. from 1980 through 1996)? (*)

30. Have you received any transfusion of blood or blood components in the U.K. between 1980 and the present? (*)

31. Have you injected bovine insulin since 1980, unless you can confirm that the product was not manufactured after 1980 from cattle in the U.K.? (*)

32. If this is a repeat donation within 6 months of your last full medical history interview have the answers to the above questions changed? (*)