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Egg Donor Screening Application

Our role in the donor recruitment process is to forward your information to clinics that may currently need donors. We cannot guarantee that you will receive a response, but most applicants do.  If the clinics are interested, you will receive a detailed physical and psychological screen to complete and potentially an appointment to come to the office for an examination.

There is  a list below of the major clinics that are members of InfertilitySpecialist.com in the United States divided by state. We apologize for the length of the form but we wanted to present all clinic donation options in a easy "to decide format".  The clinics are arranged by state then city.  If you want to enquire about donation at a particular clinic place a check in the box beside the clinic name. There is no limit to the number of "checks", but remember you should live within a two hour drive of the fertility clinic. Once you have selected the clinics you want to contact press the submit button ONCE at the end of the form. You do not need to submit the form for each clinic selected as your choices are recorded and transmitted with one press of the submit button.

We created links to all clinics so that you can review their personnel and facilities. Do not select a "become a donor" option on these Web sites rather navigate back to this application form to submit your request.

ALL QUESTIONS IN THE FORM MUST BE ANSWERED

First Name: Last Name:
Street Address 1:  
Street Address 2:  
City: State: Zip:
E-mail (required):    
Telephone:    


Potential Donor Questions

1. Please state your age: 

2. Are you a high school graduate? No. Do you have a college degree? No

3. What is your height? Weight?

4. Do you smoke? Yes  No

5. Do you use illegal drugs?

6. Do you drink alcohol excessively? Yes  No

7. Do you have, or have you ever been exposed to, HIV, AIDS? Yes  No

8. Are you physically and emotionally healthy? Yes  No

9. Please explain any physical or emotional disabilities below:

10. Have you ever been pregnant and delivered a healthy child?

11. Do you know the significant medical history of immediate and extended family members (3 generations – self, children, parents, grandparents, aunts, uncles and cousins)? 

12. Why do you want to become an egg donor?


The Next Section of the Questionnaire Details Where You Would Like to Donate Your Eggs. Remember You Should Live Within a Two Hour Drive of the Clinic You Choose. Links to the Clinics are Provided so You May Review their Services. Please Complete this From after Deciding Upon a Clinic (s)

Alabama      
Birmingham

The University of Alabama School of Medicine Reproductive Endocrine Fertility Clinic

     
Arizona      

Chandler, Arizona Fertility Clinics

Arizona Reproductive Medicine Specialists

Glendale, Arizona Fertility Clinics

West Valley Fertility Clinic

Phoenix, Arizona Fertility Clinics

Arizona Reproductive Medicine Specialists

Tuscan, Arizona Fertility Clinics

     
California      

Beverly Hills

ART Reproductive Center
Center for Reproductive Health and Gynecology
Southern California Reproductive Center

Burbank

Center for Reproductive Health and Gynecology
Center for Fertility and Gynecology

Corona

Pacific Reproductive Care

Fullerton

Huntington Reproductive Centers

Irvine

Pacific Reproductive Care

La Jolla

Scripps Clinic and Research Foundation
The Reproductive Sciences Center

Laguna Hills

Huntington Reproductive Centers

Los Angeles

Huntington Reproductive Centers
Pacific Fertility Center
Pacific Reproductive Care

Palo Alto

Fertility Physicians of Northern California

Pasadena

Huntington Reproductive Center

San Diego

Fertility Specialists Medical Group

San Francisco

Pacific Fertility Center
UCSF Fertility Group

San Jose

Fertility Physicians of Northern California

Santa Barbara

Southern California Reproductive Center

Tarzana

Center for Fertility and Gynecology
Huntington Reproductive Centers

Valencia

Center for Reproductive Health and Gynecology
Southern California Reproductive Center

Ventura

Southern California Reproductive Center

Westlake Village

Huntington Reproductive Centers

West Los Angeles

Huntington Reproductive Centers

     
Colorado      

Fort Collins

Rocky Mountain Reproductive Center

Boulder

University of Colorado, Health Sciences Center, Advanced Reproductive Medicine Fertility Clinic

Colorado Springs

University of Colorado, Health Sciences Center, Advanced Reproductive Medicine Fertility Clinic

     
Connecticut      

Trumbull, CT Park Avenue Fertility and Reproductive Medicine

     
Delaware      

Newark
Delaware Institute for Reproductive Medicine

Milford

Delaware Institute for Reproductive Medicine

     
Florida      

Jacksonville, Orange Park

Assisted Fertility Program- Marwan Shaykh, MD

Kissimmee

The Center for Infertility and Reproductive Medicine

Margate/Plantation IVF Florida

Miami

Fertility and IVF Center of Miami
South Florida Institute for Reproductive Medicine

Orlando

The Center for Infertility and Reproductive Medicine

Palm Beach Gardens

IVF Florida
South Florida Institute for Reproductive Medicine

Pembroke Pines
IVF Florida
South Florida Institute for Reproductive Medicine

Winter Park/Orlando Area

Fertility C.A.R.E. Fertility Center of Assisted Reproduction and Endocrinology

     
Georgia      
Alpharetta
     
Atlanta      
Atlanta Center for Reproductive Medicine      
     
Decatur      
     
Marietta
     
Atlanta Center for Reproductive Medicine      
Woodstock      
Atlanta Center for Reproductive Medicine      
Iowa City



     
West Des Moines      
Donald C. Young, DO, Mid Iowa Fertility
Katherine S. Hauser, MD, Mc Farland Clinic-Reprod Medicine
     

Illinois

Arlington Heights

Karande and Associates

Buffalo Grove

Fertility Centers of Illinois

Chicago-River North

Fertility Centers of Illinois

Crystal Lake

Fertility Centers of Illinois

Deerfield

Karande and Associates

Glenview

Fertility Centers of Illinois

Highland Park

Fertility Centers of Illinois
Hinsdale Center for Reproduction

Hoffman Estates

Karande and Associates
Fertility Centers of Illinois

Joliet and Mokena Illinois Fertility Clinics

Reproductive Health Specialists, Ltd.

Lindenhurst

Fertility Centers of Illinois

Naperville

Randy S. Morris, M.D.,

Oak Brook Fertility Center

Fertility Centers of Illinois

Oak Brook

Oak Brook Fertility Center

Oak Brook Terrace

Fertility Centers of Illinois

Orland Park

Fertility Centers of Illinois

Skokie

North Shore Fertility

Saint Charles

Karande and Associates
     
Indiana

Bonaventura Reproductive Medicine

     
Kansas      

Kansas City

Center for Advanced Reproductive Medicine

Olathe

Midwest Reproductive Center

Overland Park/Kansas City

Center for Advanced Reproductive Medicine

Reproductive Resource Center of Greater Kansas City (RRC)

Shawnee Mission

Daniel L. Stewart, MD, Reproductive Med & Infertility

Wichita

David A. Grainger, MD, Bruce L. Tjaden, DO, Center For Reproductive Mdcn
     
Kentucky      

Louisville KY

Fertility and Endocrine Associates

     
Louisiana      

Baton Rouge / New Orleans

A Woman's Center for Reproductive Medicine

Lafayette

Fertility and Women's Health Center of Louisiana

Mandeville

Fertility Institute of New Orleans

New Orleans

Fertility Institute of New Orleans

     
Maine      
Maryland      

Baltimore

Fertility Center of Maryland

Maryland Area/Fairfax VA

     
Massachusetts      

Baystate Reproductive Medicine, Baystate Health

 

     
Michigan      

Dearborn

Center for Reproductive Medicine, David M. Maagyar, DO, F.A.C.O.G

Center for Reproductive Medicine, Maria F. Hayes, MD, F.A.C.O.G

Center for Reproductive Medicine, Gary R. Jones, MD, F.A.C.O.G

Grand Rapids Kalamazoo

Michigan IVF

     
Minnesota      

Minneapolis

Bruce Campbell, MD, Lisa Erickson, MD, Center For Reproductive Med, 2800 Chicago Ave, # 3, Minneapolis, MN, 55407- (612) 863-5390

Rochester

Mayo Clinic

St. Paul

Paul Kuneck, MD, Center For Reproductive Med, 360 Sherman St., # 160, St. Paul, MN., 55102- (651) 268-2575

     
Mississippi      

Jackson, Mississippi

Randall Hines, MD, Bryan D. Cowan, MD, University Ob/Gyn Assoc

     
Missouri      
Chesterfield Anthony Pearlstone, MD, Infertility Institute, 226 S. Woods Mill Rd., # 39w., Chesterfield MO, 63017- (314) 205-8809

Kansas City

Midwest Women's Health Care, 6400 Prospect Ave., # 598, Kansas City, MO, 64132- (816) 444-6888

St. Louis

Ronald P. Wilbois, MD, Infertility & IVF Ctr, 3009 N. Ballas Rd ,# 359C, St. Louis MO, 63131-(636) 225-5483

     
Nebraska      

Omaha, Nebraska

Heartland Center for Reproductive Medicine- 7308 S. 142nd Street, Omaha, NE 68138 , (402) 717- 4200

Nebraska Methodist Hospital REI

     
       
Nevada      

Las Vegas

Fertility Center of Las Vegas

     
New Jersey      

Bedminster

The Center for Reproductive Endocrinology

Edison

The Center for Advanced Reproductive Medicine and Fertility

Englewood Cliffs

Reproductive Medicine Associates

Lakewood, NJ

Allen Morgan, MD, Shore IVF & Reproductive Medicine

Lawrenceville

The Infertility Program at Delaware Valley OB/Gyn

Livingston, NJ

The Institute for Reproductive Medicine & Science at Saint Barnabas (IRMS)

Marlton

South Jersey Fertility Center(SJFC)

Montclair

University Reproductive Associates

Morristown

Reproductive Medicine Associates

Somerset

IVF New Jersey

Reproductive Medicine Associates

Vorhees

Louis Manara, MD

West Orange

Reproductive Medicine Associates

     
New Mexico      

Albuquerque

Center for Reproductive Medicine of New Mexico

Reproductive Medicine & Fertility Center- Satellite

     
New York      
East Setauket

The Division of Reproductive Endocrinology

Livingston, NJ

The Institute for Reproductive Medicine & Science at Saint Barnabas (IRMS)

Manhasset, NY

Center for Human Reproduction North Shore University Hospital

Reproductive Medicine Associates of New York

Port Jefferson

Long Island Fertility and Endocrinology Associates

Rochester

The Institute For Reproductive Health And Infertility

Trumbull, CT

Park Avenue Fertility and Reproductive Medicine

White Plains

Reproductive Medicine Associates of New York

Yorktown Heights

Westchester Reproductive Medicine
     
North Carolina      

Durham

Duke University School of Medicine, Reproductive Endocrinology and Infertility

Greensboro, High Point, Winston Salem

Premier Fertility- Jeffrey Deaton, MD
     
North Dakota      

Fargo

Merit Care Medical Group, 737 Broadway, Fargo, ND, 58123

     
Ohio      

Beachwood

Cleveland Clinic Fertility Center

Cincinnati

The Institute for Reproductive Health

Bethesda Center for Reproductive Health and Fertility

Cleveland

Cleveland Clinic Foundation

Youngstown

Cleveland Clinic Fertility Center

The Reproductive Center

     
Oklahoma      

Oklahoma City

OB/GYN Specialists, Reproductive Health and Infertility, University of Oklahoma

 

     
Oregon      

Portland

OHSU Fertility Consultants

Oregon Reproductive Medicine (formerly Portland Center Reproductive)

Northwest Fertility Ctr.

     
Pennsylvania      

Abington

Abington Reproductive Medicine, P.C.

Allentown

Infertility Solutions, P.C.

Pittsburgh

Center for Fertility and Reproductive Endocrinology

Reproductive Health Specialists (RHS)

Center for Fertility and Reproductive Endocrinology

Scranton, Wilkes/Barre

Infertility Solutions, P.C.

Wexford

Reproductive Health Specialists (RHS)

The Center for Fertility and Gynecology

     
Rhode Island      

Providence

Women & Infants Hospital

     
South Carolina      

Anderson

Reproductive Endocrinology and Infertility

West Columbia

Advanced Fertility & Reproductive Endocrinology Institute, LLC

Greenville

Reproductive Endocrinology and Infertility

Piedmont Reproductive Endocrinology Group

Spartanburg

Reproductive Endocrinology and Infertility

Piedmont Reproductive Endocrinology Group

     
South Dakota      

Sioux Falls

Sanford Women's Health

     
Tennessee      
Chattanooga

Fertility Center of Chattanooga

Johnson City

Center for Applied Reproductive Science

Memphis

Fertility Associates of Memphis

     
Texas      

Angleton

Obstetrical & Gynecological Associates

Dallas/Plano

Dallas, Ft. Worth Fertility Associates

James Douglas, MD

Houston

Center for Women's Medicine, Michael Allon, MD

Houston IVF

The Center of Reproductive Medicine

Houston Fertility Institute

Obstetrical & Gynecological Associates

The Center for Reproduction and Women's Health Care

Cooper Institute for Advanced Reproductive Medicine

North Houston

North Houston Center for Reproductive Medicine

San Antonio

Reproductive Medicine Associates of Texas

Sugar Land

Obstetrical & Gynecological Associates

Webster

The Center of Reproductive Medicine

The Woodlands

Baylor College of Medicine, Woodlands Fertility Center

     
Utah      

Salt Lake City

Reproductive Care Center

     
Vermont      

Burlington

Fletcher Allen Health Care

     
Virginia      

Arlington, VA

Dominion Fertility

Rafat A. Abbasi, MD, Mid Atlantic Fertility Ctr.

Charlottesville, VA

Reproductive Medicine and Surgery Center of Virginia

Fairfax, Virginia Fertility Clinics

Genetics & IVF Institute

Muasher Center for Fertility and IVF

Newport News,VA

The Jones Institute for Reproductive Medicine 

Norfolk/VA. Beach

The Jones Institute for Reproductive Medicine

Roanoke

Assisted Fertility Program

     
Washington State      
Bellevue/Seattle

Overlake Reproductive Health, INC

Washington Center for Reproductive Medicine

Kirkland

Northwest Center for Reproductive Sciences

     
Wisconsin      

Green Bay

Aurora Health Care, Mark F. Severino, MD

Milwaukee

The Advanced Institute of Fertility (AIOF)

Reproductive Specialty Center

     
     
       

 

 

 

 

   

 

   


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