Egg Share Programme

If you’re interested in becoming an egg-sharer, please complete the details below, providing as much information as you can. You’ll then be contacted by one of our Patient Advisors to discuss your initial application.

Personal Details

Required fields are marked with *

Title *

Surname *

First Name(s) *

Date of Birth * Please note: Maximum age for initial enquiry is prior to 35th birthday

Email Address *

Ethnicity *

Address *

Postcode *

Telephone (work)

Telephone (home)

Telephone (mobile)

Preferred Contact Method *

Eligibility

BMI * Click here to calculate your BMI To be accepted as an egg share provider your BMI should be between 19 and 29

Have you had a clear smear within last 3 years? *

Do you have any history of inheritable disease (personal or family)? *

If yes, please provide further information *

Have you ever tested positive for HIV, Hepatitis B or Hepatitis C? *

Do you have any existing children with any health issues? *

If yes, please provide further information

Are you a smoker? * For advice and support regarding quitting smoking, visit www.smokefree.nhs.uk

Have you had previous IVF and a history of poor response to ovarian stimulation? *

If yes, please provide further information

How did you hear about this programme?

Data Protection We'd like to keep you up to date with what's happening at Manchester Fertility Services - such as new treatments we have available, breakthroughs in the treatment of infertility, our open evenings and newsletter. If you don't want this sort of information, please tick this box. Please note we do NOT share your information with any third parties. Your details will only be used by us to send you relevant information.

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Egg Share Programme

Personal Details

Eligibility

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