Donor Application Process


To be an IRMS egg donor, you must be between 21 – 32 and in presumably good health. You must be able to commute to one of our locations during the week for cycle monitoring and to our Livingston location for the day of Donor Screening, for any weekend monitoring during your cycle and for the actual egg retrieval. Women of all races and ethnicities are encouraged to apply.

To become a Donor at IRMS you must first complete the confidential Online Preliminary Application. Remember to include a photo of yourself. Once received, a member of our OD Team will review it, and if you qualify, will send you an email invite to log on to our Donor Portal to fill out our full donor application. It is also an online application for your convenience. All identifying information received through this application will remain confidential. Questions about the donor process or wish to speak with someone? Email and a member of our Donor Team will contact you or call Cindy Lucus at 973.322.2225

IRMS Preliminary Donor Application


Address (*)

Address Line2


State / Province / Region

Postal / Zip Code


Your Email (*)

Best phone number to reach you

Date of Birth


Current Weight

Weight at 21


What is your ethnic background? (You may use the Please Explain box, if you wish to be more accurate)

Please Explain (i.e. Mom is Italian, Dad is French)

Where were you born?

Where were you raised?

Are you eligible to work in the U.S.?
 Yes No

Highest grade completed?

What do you do for work?

Have you been or applied to be an egg donor before?
 Yes No

If yes, please indicate the number of times and where?

If you have a condition that requires current medical care tell us what it is?

Have you ever had any serious illness? Be Specific.

Are you allergic to latex?
 Yes No

Have you ever had a hysteroscopy, laparoscopy, endometriosis or fertility problems?

Have you ever seen a psychiatrist, psychologist, social worker, counselor, or any other mental health professional for any reason?
 Yes No

If yes, please explain.

What medications have you taken in the past 12 months?

In the past 12 months, have you been exposed to known or suspected HIV, hepatitis B, and/or hepatitis C infected blood through percutaneous inoculation, contact with an open wound, non-intact skin, or mucous membrane?
 Yes No

In the past 12 months, have you had tattooing, ear or body piercing, acupuncture, or electrolysis?
 Yes No

Have you lived or traveled or lived outside of the US for more than 3 months since 1980?
 Yes No

If Yes, where, when and how long?

Did you spend a total of 6 months or more associated with a military base in any of the following countries: Belgium, The Netherlands, Germany, Spain, Portugal, Turkey, Italy or Greece?

In the past 3 years have you been outside the U.S. or Canada. If so where and how long?

Were you born, lived in, or traveled to any African country, such as Cameroon, Central Africa, Chad, Congo, Equatorial New Guinea, Gabon, Niger or Nigeria since 1977?
 Yes No

Will you be available to complete the egg donation in the next 4 – 9 months?

How did you hear about us?

Have you ever been refused or denied as a blood donor?
 Yes No

Do you currently smoke cigarettes and if so, how many per week?

How many alcoholic beverages do you consume per week?

When was the last time you used recreational or illicit drugs?

Have you ever had any problems with the law (ie. DUI, custody issues, lawsuits)?

Are your menstrual periods regular?

Please indicate what form of birth control you use, if any.

Have you ever had an abnormal PAP?
 Yes No

If yes, when.

Number of pregnancies?

Number of miscarriages?

Number of abortions?

Please indicate if you or any family member a carrier of a genetic disease. Be Specific.

Please indicate if you or any family member has a genetic condition. Be Specific.

Please include a current photograph of yourself. (*)