HEREDITY CHOICE PO Box 1050 +1 661 944 1222 Pearblossom, CA 93553-1050 stork@qnet.com Rev. 99-11 For Tomorrow's Child Some women are turning to artificial insemination as a means of fulfilling their hopes for a family. Many recognize genes as blueprints of life, and welcome the opportunity to choose a donor with qualities important to them. Heredity Choice is the semen bank where all donors are high achievers. Every donor has excellent physical and mental health, a sound and sociable personality and has proved himself highly creative. The choice of physical characteristics, personality traits and the importance of various abilities or minor disorders is personal and must be decided by the future parent(s). The services of Heredity Choice are available to women regardless of marital status, race or sexual orientation. We do not require physician referral, but support both physician-assisted and home insemination. ~ Confidentiality ~ Heredity Choice guarantees client confidentiality, with records encrypted. ~ Donor Screening ~ Donors offered by Heredity Choice have undergone rigorous examinations and testing for hereditary defects. If a donor has a minor disorder, such as impacted wisdom teeth, myopia, or allergy, this is stated in his description. Heredity Choice has no arbitrary limit on the number of offspring from each donor. Donors with numerous offspring have a proven track record of high fertility and develop a clear picture of the traits that they tend to pass on. No donors have any risk factors for HIV. All donors have been tested for HIV-1, HIV-2, Hepatitis B, Hepatitis C, and syphilis, and have been found nonreactive at least six months before their frozen semen is shipped. ~ Immunizations ~ Before attempting pregnancy a woman should either have been immunized or test positive for rubella, measles and mumps anti- bodies. A history of rubella and measles is no guarantee of immu- nity, as some other disease may have been misdiagnosed. Her physician can arrange testing. Any necessary immunizations, including flu and pneumonia shots, should be given at least two months before insemination. ~ Semen preparation ~ All semen has been washed using density-gradient separation. This process removes most of the non-motile sperm. The semen is resuspended in a state-of-the-art extender to ensure high motility and fertility. Semen from Heredity Choice contains no antibiotics and no seminal plasma. ~ Insemination ~ If the insemination is to be performed by a physician, nurse, or nurse practitioner, be sure she will be available on Saturdays and Sundays if needed. Many women successfully inseminate at home helped by their spouse or by a friend. Practice in advance of need is strongly recommended. ~ Fertility ~ For women who have not conceived after four insemination cycles, ultrasound and a partial infertility workup may be indicat- ed. The woman older than 35 should consider beginning insemi- nations and an infertility workup at the same time. ~ Early Pregnancy Loss ~ At least a third of pregnancies, however conceived, are lost during the first 14 weeks. Such a loss can be emotionally painful, but is usually unavoidable. After the first loss many doctors watch their patients' serum progesterone and perform an endometrial biopsy. ~ Shipping Containers ~ Liquid nitrogen dry shippers have a one week or three week holding time, and a shipping weight of 12 or 23 pounds. A three month holding time can be obtained by using a 'wet' thermos storage tank, weighing 57 pounds. Liquid nitrogen keeps the straws frozen at -196 degrees C (-320 degrees F), only 77 Celsius degrees above absolute zero. ~ Costs ~ Frozen semen costs $125 per straw, generally one straw per insemination. This price includes a syringe, catheter and Makler cannula for performing the insemination. If ovulation is timed by daily testing with an ovulation predictor kit or by ultrasound, two inseminations per cycle are recommended. For home insemination a vaginal speculum is needed. Metal specula are available from Heredity Choice in four sizes and cost $15 each. If not timing with ultrasound, an ovulation predictor kit such as "Clearplan Easy" is recommended and can be bought at your pharmacy. The cost is about $25 for five tests. For use of a dry shipper tank or 'wet' storage tank, a refundable deposit of $650 is required. The shipper or tank rental is $75 per month and includes liquid nitrogen and normal wear but not loss or accidental damage. The delivery charge for a 23 pound dry shipper within the USA is approximately $70 for FedEx Standard Overnight. The client must return the tank to Heredity Choice by FedEx 2Day, UPS, or Priority Mail, insured for $650. ~ Ordering ~ If the order comes from anyone other than a licensed physician, the recipient and her spouse or a witness must sign and return the Consent Agreement for Artificial Insemination. ~Further Reading ~ Smith, P. E. (1984). Selection against genetic defects in semen donors. Clin. Genet. 26, 87-108. ================================================= HEREDITY CHOICE PO Box 1050 +1 661 944 1222 Pearblossom, CA 93553-1050 stork@qnet.com D O N O R D E S C R I P T I O N S All donors have been tested and found nonreactive for HIV-1, HIV-2, Hepatitis B, Hepatitis C and syphilis. Rev. 99-10 _________________________________________________ Donor Black-Red Summary: A great scientist and a delightful person. Ancestry: Ashkenazi Proved non-carrier: Tay-Sachs Eye color: Brown Hair color: Black Hair type: Straight Height: 1.8 m (5'11") Born: 1950's Weight at 24: 69 Kg (152 lbs) General appearance: Athletic build. His offspring look like their mothers. Personality: Extroverted with a sweet nature. Family oriented. Achievements: A world-traveling academic who has made major contributions in his field. Music: Very accomplished amateur. Athletics: Competent in amateur field sports. Manual dexterity: Excellent. General health: Excellent. Ancestors long lived. Blood type: A + Blood pressure: 110/76 mm Hg (normal) Offspring: Consistently outstanding physical coordination. Musically inclined with notable academic ability. _________________________________________________ Donor Blue-Blue Summary: A distinguished scientist from a family where high achievement is the norm. Ancestry: European Alpine Eye color: Brown Hair color: Black Hair type: Straight Height: 1.7 m (5'6") Weight at 24: 57 Kg (125 lbs) Born: 1950's General appearance: Pleasant, even features. His offspring look like their mothers. Personality: Strong sense of curiosity, cheerful, stable temperament. Achievements: Professor at a major university, he has achieved national recognition in his field. All of his close relatives are also high achievers. Music: Proficient. Athletics: Competent in softball and swimming. Manual dexterity: Good. General health: Excellent. Three grandparents lived to 80's, the fourth dying young in an accident. Blood type: 0 + Blood pressure: 120/84 mm Hg (normal) Defects: Slight allergic rhinitis (hay fever) Comments: The estimated excess recurrence risk is 11% for allergic rhinitis. _________________________________________________ Donor Blue-Green Summary: An excellent scientist with an attractive combination of British and Slavic features. Ancestry: British and Ukrainian Eye color: Brown Skin tone: Medium. Tans easily Hair color: Black Hair type: Wavy Height: 1.7 m (5'9") Weight: 70 Kg (150 lbs) Born: 1960's General appearance: Ruggedly handsome, with strong eyebrows, crinkly eyes, and a square jaw. His offspring look like their mothers. Personality: Settles in well in a large organization, quietly doing his own thing (which is invariably brilliant). Enjoys photography, sports. Achievements: Has demonstrated outstanding academic and scientific ability. Superb as a lecturer. Son of a systems analyst. Music: Good ability. Athletics: Active amateur Manual dexterity: Excellent General health: Excellent Blood type: A + Blood pressure: 120/80 mm Hg (normal) Offspring: His offspring love music, and take their 'work' very seriously. Defects: Dental malocclusion. Mild allergy. Comments: The estimated excess risk for dental malocclusion is 30%, and for allergy, 11% _________________________________________________ Donor Black-Black Summary: Tall, innovative and Rh negative Ancestry: Mainly British Eye color: Hazel Skin tone: Fair Hair color: Blond to Brown Hair type: Straight Height: 1.9 m (6'4") Weight at 24: 80 Kg (175 lbs) Born: 1940's General appearance: Attractive, regular features. High forehead. Looks the 'proper British gentleman'. Tall, slender and muscular. Personality: Warm and persevering. Great with children and animals. Well balanced introvert/extrovert, with broad interests. Achievements: A distinguished economist whose work has been original and influential. Published in three different fields. Music: Loves music. Athletics: Coordination average; stamina excellent. Manual dexterity: Very good. General health: Excellent. Parents lived to or past their late 70's, dying of causes with no family aggregation. Blood type: A - Blood pressure: 110/70 mm Hg (normal) Offspring: Strong in mathematics and graphics, tending to look like each other, usually blond-haired and blue-eyed. Mothers of his 27 offspring report them to be exceptionally happy babies. Defects: Embedded third molars, dental malocclusion. One parent developed late onset Dupuytren nodule, a benign growth on the palm. Comments: The estimated excess recurrence risk is 30% for embedded third molars, 30% for dental malocclusion, and less than 25% for Dupuytren nodule. This donor is older than the American Society for Reproductive Medicine recommended age limit. Heredity Choice considers the opportunity to screen against serious late-onset disorders presented by an older donor to be valuable. _________________________________________________ Donor Brown-Brown Summary: Gifted computer scientist with great athletic and good music ability. Ancestry: British Eye color: Hazel Skin tone: Fair Hair color: Brown Hair type: Straight Height: 1.9 m (6'1") Weight at 24: 64 Kg (140 lbs) Born: 1960's General Appearance: Attractive, friendly face. Lean athletic build. Personality: Warm and congenial. Considered by coworkers "the diplomat." Never loses his temper. Achievements: Very successful in computer science with 17 patents. Impressive academic history. Chess champion in junior high school. Relatives are consistent high achievers in academia and athletics. SAT: 780+770 at age 17. GRE: 800+750 at age 21. Music: Good ability. Athletics: College track star, also placed frequently in statewide college swimming competitions. Manual dexterity: Average. General health: Excellent. All grandparents lived beyond age 78, dying of causes without family aggregation. Blood type: 0 + Blood pressure: 128/84 mm Hg (normal) Apolipoprotein E alleles: E2/E3. This result indicates that his offspring have a 40% lower chance of developing Alzheimer's disease than the general population. Defects: Embedded third molars. One of 2 siblings has mild allergies. Comments: Estimated excess recurrence risk for embedded third molars 30%, and for allergy, 5%. _________________________________________________ Donor Black-Green Summary: Exceptionally healthy mathematician/computer systems analyst with well-rounded intellect. Ancestry: North-west European (Swedish) Eye color: Blue Skin tone: Fair and Ruddy Hair color: Blond Hair type: Straight Height: 1.8 m (6'0") Weight at 24: 90 Kg (200 lbs) Born: 1940's General appearance: Handsome and well proportioned. Personality: Warm, personable and charming. Outgoing. Enjoys reading, swimming. Achievements: Excellent mathematical ability and linguistic aptitude. Highly successful computer systems analyst and cryptographer. Father a professor. IQ: 99.75 percentile Music: Strong appreciation. Athletics: Excellent balance and very good stamina. Bicycles to work. Manual dexterity: Average General health: Excellent Blood type: 0+ Blood pressure: 120/80 mm Hg (normal) Comment: The nearly complete absence of defects in this donor is notable. _________________________________________________ Donor Blue-Red Summary: Bright, productive, and handsome Ancestry: Northern European Eye color: Blue-green Hair color: Dark blond Hair type: Wavy-curly Height: 1.8 m (6'0") Weight at 24: 82 Kg (180 pounds) Born: 1950s General appearance: Very handsome 'movie star' face. Well-proportioned. Full lips. Personality: Quietly charismatic. Slightly extroverted. Enjoys running, photography, tennis and reading. Achievements: Professor of chemistry who has achieved inter- national recognition in his field, with over 200 published papers. SAT mathematics 800 (highest possible), verbal 640. Combined G.R.E. mathematics 900 (highest possible that year), verbal 720. Music: Proficient amateur Athletics: Excellent stamina Manual dexterity: Excellent General Health: Excellent. Father died in 70s of heart attack. Mother alive and well in 70s. Blood Type: A + Blood Pressure (untreated): 150/84 mm Hg Offspring: Our most prolific donor with 37 offspring around the world. Invariably bright, musical and athletic, they tend to look like their mothers with the donor's full lips. Defects: Myopia -4 D. Minor chin tic (quiver) when stressed. Comments: The excess recurrence risk is 19% for myopia requiring glasses and 50% for the chin tic. Note: This donor has been with Heredity Choice for 15 yrs. He has been home-test screened for HIV, but for religious reasons, will not have blood drawn to test for hepatitis or syphilis. He has no risk factor for any of these diseases. _____________________________________________ Donor Blue-Black Summary: Outstanding mathematician, handsome, charismatic and athletic with music ability. Ancestry: Mainly British, part Cherokee. Eye color: Blue Skin color: Fair Hair color: Strawberry blond Hair type: Curly Height: 1.8 m (5'11") Weight at 24: 68 Kg (150 lbs) General Appearance: Very handsome 'leading man' face with high cheekbones and strong dimpled chin. Slim athletic build. Personality: Charismatic, warm and congenial. Happy working alone or with others. Even-tempered. Enjoys reading, music, drawing, running. Born: 1950's Achievements: Outstanding in one of the most competitive areas of mathematics. Named full professor at a major university at a young age. Editor of an internationally recognized professional journal. Music: Proficient performer Athletics: High school state champion long-distance runner. Manual dexterity: Good General health: Excellent Blood type: B + Blood pressure: 130/74 mm Hg (normal) Offspring: Incredible! One son was speaking 6-word sentences at 16 months. Most have straight blond hair. Defects: Red-green color deficiency, embedded third molars, slight dental malocclusion. One parent requires lithium to control bipolar disorder. There is no sign of bipolar disorder in the donor or in his sibling. Comments: This color deficiency cannot be inherited by his sons and their offspring. His daughters face an 8% risk of color deficiency, while sons of his color-vision- normal daughters have a risk of 50%. The estimated excess recurrence risk for embedded third molars is 30%, 19% for dental malocclusion. The estimated excess risk for bipolar disorder is less than 7%. His semen quality appears average, but he has a good conception rate. ================================================= Heredity Choice PO Box 1050 +1 661 944 1222 Pearblossom, CA 93553-1050 stork@qnet.com ARTIFICIAL INSEMINATION AT HOME P. E. Smith Warnings: ! A straw out of liquid nitrogen longer than 20 seconds must not be refrozen! ! All semen supplied by Heredity Choice is washed. It may be dangerous to follow this protocol with unwashed semen. ! Never allow the shipping carton containing the tank to stand upside down. ! If you need to add liquid nitrogen, first remove the tank from the shipping carton. Rev. 99-11 ~ The Vaginal Speculum ~ We stock two widths of vaginal specula; Pedersen (medium width) or Graves (wide). The Pedersen and Graves is each available in two lengths; Large (long) or Medium (shorter). For artificial insemination, the most common size is the large Pedersen. A medium Pedersen is generally preferred by smaller women and those of Asian or Native American ancestry. If the vaginal walls fold in between the blades enough to interfere with seeing the cervix, generally the case for women who have undergone vaginal delivery, then the wider Graves speculum is needed. =========================================== !!Acquaint yourself with the speculum before you need it!! =========================================== Grasp the blades with one hand and work the adjustments with the other. On a metal speculum there are two thumb nuts. The bigger thumb nut, on the handles, is for spreading apart the blades at the handle end, an adjustment not used for artificial insemination. The smaller thumb nut holds the tips of the blades apart. This thumb nut is spun down when the speculum is in place with the tips of the blades spread, after the cervix has been located and positioned. For home insemination the prospective mother should lie on a bed with her knees raised and spread, her feet to the sides, and her bottom at the end of the bed. A firm cushion should be placed under her buttocks to allow the speculum handle to clear the bed. Lubricate the speculum blades with water or baby oil. Carefully insert the speculum, blades closed, part way into the vagina with the handles to one side. Turn the handles down, and then gently push the speculum further in until you reach the cervix. Spread the blade tips about 25 mm (1 inch) by squeezing the handles together. Continue squeezing the handles, and illuminate the vagina with a flashlight or other convenient light source. Look between the speculum blades for the smooth flesh of the cervix. If only the rippled walls of the vagina can be seen and the speculum is fully inserted, a longer speculum may be needed. If the cervix is seen before the speculum is fully inserted, a shorter speculum may be more convenient. The external os, the mouth of the cervix, may be readily seen as a hole in the cervix. If the os is not visible, it may be on the underside of the cervix. Bring it into view by lifting the cervix with the tip of the lower blade. To allow a Makler canula to pass freely into the cervix, you must center the external os. First, point the speculum handle in the direction that the os deviates from center. Next, use the longer blade (that nearest the handles) to move the cervix, centering the os. If the os cannot be centered, it is often helpful to remove the speculum and start again. When the speculum is positioned satisfactorily, spin down the smaller thumb nut to hold the blades open. When finished, loosen the smaller thumb nut to allow the tips of the speculum blades to close before gently removing the speculum. Wash the speculum thoroughly, first in cold water. A metal speculum can be sterilized by boiling for 5 minutes. Any speculum, after washing, can be sterilized by soaking it in a bleach solution, prepared by mixing 2 mL (1/2 teaspoon) of household liquid chlorine bleach per liter (quart) of water. After soaking for ten minutes, rinse the speculum in water. ~ The Timing ~ Successful artificial insemination depends on fertile sperm meeting a fertilizable egg. The serum luteinizing hormone (LH) level surge onset pre- ceeds ovulation by 20 to 36 hours. Convenient home test kits for identifying the urine LH surge onset, called ovulation predictor kits, are available in pharmacies. The best work well for most women, except in a Pergonal/Fertinex cycle. One example of an ovulation predictor kit is "Clearplan Easy." In order to know when the LH surge begins, the testing must start early enough for the first test to be negative. If the first test is positive, we cannot be sure when the LH surge began. Should this happen, perform the first insemination as soon as possible. Test your urine daily following the instructions that come with the ovulation predictor kit. Once the test is clearly positive, there is no benefit from repeating it during that cycle. A few women have a short LH surge and need to test twice daily. If there is still no positive test, there was probably no ovulation. Skillfully performed ultrasound is the 'gold standard' for identifying the time of ovulation, but is more expensive and less convenient than home ovulation predictor kits. If no ultrasound has been performed, inseminate either on the day the ovulation predictor test turns positive or the following morning. When using thawed semen, a second insemination should be done 24 hours after the first. With ultrasound, the optimal time for insemination with thawed semen is the time of ovulation, but better early than late. ~ Liquid Nitrogen Safety ~ A dry shipper tank without loose liquid nitrogen offers no significant hazard, but keep it away from children and pets. ! A 'wet' thermos tank or thermos flask is hazardous if tipped. ! At 77 degrees Kelvin (-320 degrees Fahrenheit) liquid nitrogen must be treated with respect. Splashed drops of liquid nitrogen should not harm bare skin. ! Protect your eyes if you have to pour liquid nitrogen. ! Immediately remove any clothing drenched in liquid nitrogen. ! Remove anything restricting blood flow to the affected area. ! Immerse in or irrigate with body-temperature water and treat for frostbite. ! Nitrogen gas is non-toxic, non-flammable, odorless and invisi- ble, but it can suffocate by displacing oxygen. ! With nitrogen suffocation, symptoms before unconsciousness may include yawning, headache, dizziness or labored breathing. ! It is also possible to experience no warning symptoms before nitrogen asphyxia. ! If liquid nitrogen is spilt, open the windows and doors or leave the room. A tank can safely be emptied on bare ground outside. ! Do not pour liquid nitrogen down a drain. No tank or shipper employed by Heredity Choice is pressurized. ! If you put liquid nitrogen in your own vacuum flask, an unvented neck plug must be left loose to avoid pressure buildup and possible explosion. ~ The Insemination ~ Do not remove a straw until 3 minutes before the actual insemination, but familiarize yourself with the liquid nitrogen shipper beforehand. To open the dry shipper, remove the tape and lift out the foam neck plug. The plastic straws containing the frozen semen are sealed at one end with a steel ball and can be lifted out with the magnet provided. If the magnet picks up more than one straw, drop the extra back immediately. If the magnet fails to pick up a straw, turn the dry shipper upside down over a styrofoam box. After removing a straw, replace the neck plug immediately. Semen in straws begins thawing 20 seconds after leaving the liquid nitrogen and must be used forthwith or discarded. Refrozen semen has poor post-thaw motility. The color bands on the straws indicate the donor. Check these colors to be sure you have the right donor. Fit the tip of a B-D 1.0 mL syringe with a tom cat catheter (Sovereign 8890-703013), the transparent catheter. The catheter must be on tightly enough that no air leaks in while drawing up the semen. Make sure that the tom cat catheter will not turn on the tip of the syringe. Rarely, a tom cat catheter may have too big a base, and not fit tightly when pushed on the syringe tip all the way. When this happens, use sharp scissors to trim 3 mm (1/8") off the tom cat catheter hub. Check that the syringe plunger slides freely and push the plunger in all the way. The end of the straw not sealed with a steel ball is open. Do not cut the straw! Insert the tom cat catheter into the straw and draw the semen out, watching the semen in the straw, not the syringe. When the straw is empty, continue drawing out the plunger until air reaches the tip of the syringe, leaving no semen in the catheter. There will be a 0.2 mL air bubble attached to the tip of the plunger, the volume of the catheter. Do not remove or dislodge this air bubble; during insemination it will push the last of the semen through the Makler cannula and into the cervix. Now discard the tom cat catheter and fit to the tip of the syringe a Makler insemination cannula, the pink catheter supplied, leaving the sterile wrapper opened only at the hub end. Position the prospective mother, the lighting and the vaginal specu- lum. Maneuver the speculum as necessary to center the cervical os, at the same time --if necessary-- lifting the cervix. Discard the cannula wrapper, holding the syringe by the barrel, not the plunger. Try not to allow the cannula to touch the walls of the vagina. Insert the Makler cannula through the cervical os until the cannula hub touches the cervix. Gently pressing the cannula hub against the cervix, slowly push the plunger in all the way. Hold the cannula hub against the cervix for 5 minutes to allow the spermatozoa to get on their way. Remove the syringe and cannula, loosen the smaller thumb nut to collapse the speculum, and remove it carefully. Let the prospective mother rest for a few minutes. ~ Nutrition ~ During the first month after conception, the future baby's neural tube is developing. Take at least 0.4 mg/day of folic acid from green vegetables or vitamin pills, starting at least one month before insemination, to minimize the risk of spina bifida and other neural tube defects. Ascorbic acid (Vitamin C) is essential in the mother's diet, but too much creates a tolerance in the fetus. The baby is then born needing high levels of Vitamin C to prevent scurvy. Do not exceed a supplement of 500 mg daily without your doctor's consent. Supplementary vitamin A is generally not advised. ~ Drugs ~ The only drugs taken should be those prescribed by a physician who knows that the woman is or may be pregnant. Recreational drugs (alcohol, tobacco, cocaine, etc.) are potentially very harmful and must be avoided. Over the counter remedies, health food supplements, and herbal extracts should be approved by your doctor. Caffeine - There are many conflicting studies. Check with your doctor regarding this. ~ Returning the Tank ~ As soon as you finish with the tank, return it with the enclosed magnet in the shipping box in which they arrived. The neck plug must be taped down to avoid damage. Insure the empty tank for $650. A drywall shipper tank contains no loose liquid nitrogen and has been declared nonregulated by the FAA. FedEx and UPS do not impose a dangerous goods surcharge. ================================================= Heredity Choice CONSENT AGREEMENT FOR ARTIFICIAL INSEMINATION The undersigned Applicant [and her Spouse each]* applies to Heredity Choice for the proposed artificial insemination of the Applicant as follows: 1. Donor's Right to Remain Anonymous. The donor of semen provided by Heredity Choice shall under all circumstances have the right to anonymity. The Undersigned [each]* agrees not to attempt to discover the identity of the donor of semen provided by Heredity Choice nor to assist or encourage others to do so. 2. Pledge to Abstain from Harmful Substances. The Applicant understands that consuming tobacco or alcohol or psychoactive or neuroleptic drugs has been shown to have a harmful effect on the fetus. The Applicant pledges not to partake of any of the above during insemination and pregnancy except those drugs prescribed by her physician. 3. No Obligation for Support. The donor of the semen and Heredity Choice have no responsibility for the support of the offspring or of the Applicant [or of her Spouse]* or of any other relative or other party caring for or responsible for the child so conceived. Understanding this, the Undersigned [each]* agrees never to seek from the semen donor, Heredity Choice or any other party associated therewith any form of support or other pay- ments for the offspring or the Applicant or others. 4. Physicians and Nurses are Independent Contractors. Full responsibility for the health and medical well-being of the Applicant and her offspring shall rest with the Applicant [and Spouse]* and her own physicians and nurses. All parties including but not limited to all physicians, nurses and relatives of the Applicant involved in the artificial insemination of the Applicant in whatever capacity are independent contractors and are not acting as employees or agents of Heredity Choice. 5. No Guarantees. The undersigned Applicant [and Spouse each]* acknowledges and agrees that no guarantees or assurances are possible with respect to the quality of the offspring or any aspect of the offspring's genetic, physical, or mental health, or even that there will be offspring or conception. 6. General Release of All Claims. The undersigned Applicant [and Spouse each]* on behalf of self and on behalf of her offspring and on behalf of heirs and executors and admin- istrators and successors and assigns hereby fully releases and discharges Heredity Choice and its successors and assigns and heirs and executors and administrators from all rights and claims and actions that the Applicant and her offspring and their above-mentioned successors now or hereafter may have against Heredity Choice or its affiliated entities and persons and their above-mentioned successors arising out of the artificial insemination of the Applicant. This release is freely and voluntarily executed by the Applicant [and Spouse]* who [each]* executes this release independently of any inducements or promises or representations made by Heredity Choice or any of its affiliated entities or persons. 7. Indemnification. The Applicant [and her Spouse each]* hereby agrees to indemnify and hold harmless Heredity Choice and its affiliated entities and persons and their successors and assigns and heirs and executors and admin- istrators from and against any and all liability in connection with any claim brought by the Applicant [or her Spouse]* or her offspring or any other person or entity in connection with the artificial insemination of the Applicant including without limitation any and all liability resulting from attempts by the Applicant [or her Spouse]* or her offspring or any other family member of the Applicant to discover the identity of the donor of semen provided to the Applicant. 8. Marital Status. The Applicant agrees that if her marital status changes she will not continue receiving the services of Heredity Choice until returning a new Consent Agreement for Artificial Insemination. 9. Parental Rights and Responsibilities. The Applicant [and her Spouse each]* accepts full parental rights and reponsibilities for any offspring resulting from this artificial insemination. Signed at_____________________________|______________ -----------|-------------------City-----------------------------|--State--- on _______________________________1999 -----------------------Applicant----------------------|Spouse/Witness**---- Signature________________________|_______________________ Printed Name___________________________|_______________________ Address__________________________|________________________ ____________________________|________________________ Telephone (_____)__________________|(_____) _________________ E-mail __________________________|_______________________ [ ]* Applies to married women only ** Delete one. If the Applicant is legally married, the Spouse must witness.