Embryo Recipient Application

Introduction:

After you complete this application, we will review it and possibly contact you via email or phone for clarification. We will do our best to contact you within 10 business days after receiving all of your information regarding your acceptance status.

If you have not already done so, please visit the Embryo Search section and review what donated embryos we currently have available. If you have registered on the site (upper right hand corner of the top of page), you will be able to keep your favorite embryo choices within your personalized folder. Through registration, we will also contact you via email when new embryos are posted on the site. There are a number of other advantages, so be sure to register!

We encourage you to become familiar with the information provided in the Downloads section (link directly to embryo recipient section and not just the webpage please). The most important documents in this section are the first two called the "Embryo Donation Recipient General Information, EDI" and the "Frozen Donor Embryo Transfer Price List, EDI". This website and the EDI's blog also contain a wealth of additional information, so enjoy.

Once you are accepted as an embryo recipient and you have found embryos that meet your requirements, you will need to do the following:

  1. Place the embryos on reserve with the non-refundable Case Management Fee.
  2. Once the embryos are reserved, you will then have six weeks to become an established patient with EDI (in person, via phone interview or Skype) and you will have another four months after that to have the embryos transferred.

Please complete the following application carefully and completely so that there will be no delays in confirming your acceptance as an embryo recipient here at Embryo Donation International.

Embryo Recipient Options

Please select one or more of the following recipient options. Please be sure you understand the options before making your choice. If you would like more information on the different options, please click here.

Embryo Donation International does not discriminate against those who provide or receive donated embryos with respect to race, religion, ancestry, sexual preference or marital status.

 

Partner Status/Sexual Orientation:

Please indicate your current partner status and sexual orientation. Please only choose one.

Married

Unmarried but with Partner

Single (by choice, divorced or widowed)

 

Race:

Please select any of the races below that describe you and your partner (when one exists) understanding that both donors and recipients may be a mixture of races. Please check all of those that apply if you and/or your partner have at least 50% of a listed race in your background.

     
     
     
     
 
 

Religion:

You may have a predominant religion in the home which is the religion the embryo donor-conceived child will most likely be raised in. Please indicate what is the predominant religion in your home and choose only one.

     
     
     
 
 

Education Level:

Please indicate the highest level of education you achieved. Choose only one.

High School

College

Advanced Degree:


Contact Information

 

Embryo Recipient

 
Full Name:
Address:
Country:
City:
State:
Postal Code:
    It is OK to use this
to contact me
Email
Cell Phone:
Work Phone:
Home Phone:
     
Do you have video
conferencing abilities?
 
 

Partner

 
Full Name
   
   
   
   
   
   
    It is OK to use this
to contact me
Email
Cell Phone:
Work Phone:
Home Phone:
     
Do you have video
conferencing abilities?
 

Embryo Recipient General Information:

 

Embryo Recipient

Birth Date
Current Age
Height feet inches
Weight (Pounds)
 

Partner

Birth Date
Current Age
Height feet inches
Weight

Embryo Recipient Ethnic Background

The staff at EDI can sometimes guide you towards embryos with specific characteristics based on the information you provide below.

 

Embryo Recipient

 
Race/Ethnic Background
(Example: 50% English, 50% Irish)
 
Current Religion:  
 

Partner

Race/Ethnic Background
(Example: 50% English, 50% Irish)
Current Religion:

Medical/Surgical/Infertility History

 

Embryo Recipient

Current Health Problems
Current Medications
Do You Smoke Cigarettes?
Total Length of Infertility (Years)
 

Partner

Current Health Problems
Current Medications
Do You Smoke Cigarettes?
 

Infertility Narrative (See Instructions Below)


By clicking “yes” below, you will allow us to post the country in which you live in, (if in the US, the general region in which you live), the type of embryo donation procedure you have agreed to (Anonymous, Approved and/or Open Embryo Donation) and this infertility narrative to a webpage for review by potential donors. It is our hope that patients who are uncertain about donating their embryos may feel more confident about doing so after reading your story. Other information in this application will not be posted. Understanding that we want this to be your story, we would suggest the following:

  • Write the story as though you are speaking to the potential embryo donor.
  • Be specific, but not so detailed that one of your friends or family could figure out the story was yours. Please use only your first names or an alias within the story to personalize it.
  • Providing your areas of employment without being too specific can help paint a picture of who you are and the home in which you will raise a child. We suggest you use general terms such as “healthcare, finance, manufacturing, etc.” or other terms to further protect your privacy.
  • If your eduction, hobbies, unusual traits or gifts are important to you and you believe the potential donor would like to know these, please also comment on these.
  • Feel free to cover such areas as your motivations, partnership/marriage when appropriate, your religion if it is important to you, your hopes and dreams of conceiving, delivering and raising a child.
  • Explain what you have gone through thus far to have a child. If you do not have a substantial infertility history, emphasize the reasons for wanting to receive donated embryos.
  • Consider thanking embryo donors for making embryo donation possible.
  • Remember to write from the heart hoping to encourage potential embryo donors to donate their embryos.
  • Try to keep your story within 750 words or less. Certainly use more if you need to understanding that long stories are less likely to be read to completion. Extraordinary short stories, however, may appear incomplete.


If you agree, your story here may be featured on our various social media sites, newsletter, website and other public relation materials. EDI reserves the right to edit the stories with respect to grammar and spelling but will not significantly change the content. Not all stories submitted will necessarily be used.

If I/we do not feel comfortable with posting our story, we may keep this section blank (i.e., Only complete the narrative if you are willing to post).

You are not to feel compelled to agree for EDI to use your story. If you choose to not allow EDI to post your story, your ranking to receiving embryos as well as your medical care here at EDI will not be changed in any way.

We have read and understand the above and hereby allow EDI to list the country in which I/we currently live (the region of the country if within the US), the type of embryo donation procedure I/we have agreed to and to use my/our story to encourage patients to donate their embryos:

Embryo Recipient Signature
Partner Signature

Gynecologic History/Infertility Evaluation

Gynecologic Surgery:
Has an HSG (Hysterosalpingogram) been performed and are your Fallopian tubes open?
If your Fallopian tubes are not open or you have had them operated on, please provide details:
Has your uterine cavity been evaluated within the past two years by a sonohystergram or diagnostic hysteroscopy?
If your uterine cavity has undergone surgery, please provide details:

Obstetrical History/Children in the Home:

 

Embryo Recipient

Number of pregnancies:
Number of term deliveries (37 weeks gestational age or more):
Number of preterm deliveries (20 – 36 weeks & 6 days gestational age):
Number of spontaneous losses (Less than 20 weeks gestational age)
If you have had two or more spontaneous losses, have you undergone an evaluation for recurrent pregnancy loss? Did they find a reason for the losses? (Please provide details)
Number of elective terminations:
Total Number of living children:
Total Number of living children with current partner:
Number of living children with other partners:
Number of adopted children:
   
Is there anything else you would like to add that we have not yet asked or that you feel is important?
   
 

Partner

   
Number of living children with other partners:
Number of adopted children:

Completion Of Application

Typed Name(s) Below Will Act as Signature(s)

 

Embryo Recipient

Signed Name
Signed Date
 
I acknowledge that the information supplied above is true and accurate.
 
 

Partner

Signed Name
Signed Date
 
I acknowledge that the information supplied above is true and accurate.
Important Links and Info
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