Surrogacy medical screening is the multi-step process clinics use to confirm that a prospective surrogate is physically and emotionally ready to carry a pregnancy for someone else, and it combines a review of medical records, a physical exam, infectious disease and lab testing, and a psychological evaluation. Most candidates can expect tests for HIV, hepatitis, syphilis, and other infections, a uterine cavity check, BMI and vitals review, and a licensed mental health evaluation. The result is either medical clearance to proceed or a deferral with clear next steps.
TL;DR:
- Full clearance usually takes two to six weeks, but missing delivery summaries or cesarean operative reports can delay review while clinics obtain hospital records.
- Programs commonly seek candidates ages 21 to 40 with a prior uncomplicated delivery, but age, BMI, and cesarean limits vary by clinic.
- Treatable chlamydia or gonorrhea usually requires treatment and a retest, while HIV and hepatitis B or C generally exclude candidates under most program policies.
- Clearance includes uterine imaging and a licensed mental health evaluation, while the surrogate retains authority over her care and should have independent legal counsel.
Table of Contents
- Why screening exists and where it fits in your timeline
- Prescreening and application: what gets asked first
- What clinics look for in your medical records
- The in-clinic exam and lab checklist, explained
- Psychological screening: what evaluators actually assess
- Infectious disease standards, genetic screening, and the regulatory backdrop
- Common disqualifiers and how remediation works
- Timeline, costs, and your pre-appointment checklist
- How we support you through screening
- A few things that surprised me about screening
- Ready to start your screening journey with us
- FAQ
- Sources
Why screening exists and where it fits in your timeline
Medical screening protects everyone involved: the surrogate, the pregnancy, and the intended parents who are placing enormous trust in the process. The ASRM committee opinion on gestational carriers recommends infectious disease testing for carriers and, in most cases, for their partners as well, because the goal is to reduce transmission risk and document that every decision was made with full information.
Screening also exists to protect a surrogate's autonomy. The ASRM ethics committee opinion is clear that a gestational carrier retains ultimate authority over her own medical care, and the screening process is partly about documenting informed consent so that decisions around prenatal testing or unexpected findings are planned for in advance, not improvised under stress.
You will typically encounter screening in two phases. The first is a lighter prescreen, done before you are matched with intended parents, meant to catch any obvious disqualifiers early. The second is the full medical clearance, which happens after a match and involves the complete lab panel, uterine evaluation, and psychological assessment. Prescreening exists mainly to save time, both yours and the clinic's, by filtering out candidates who would not pass full clearance before anyone invests further effort.
Prescreening and application: what gets asked first
Before any lab work happens, most programs ask you to complete an application that covers your obstetric history, general health, and background. This step is designed to flag anything that would make full clearance unlikely, so it tends to move quickly.
- You will summarize your delivery history, including how many pregnancies you have carried, delivery method, and any complications.
- You will answer lifestyle and health questions covering smoking, substance use, current medications, and chronic conditions.
- You will consent to a criminal background check, which most agencies require for you and often for your partner.
- You will be asked your age and BMI range, since most programs set baseline thresholds around age (commonly 21 to 40) and a minimum interval since your last delivery.
Programs commonly look for at least one prior uncomplicated pregnancy and delivery, a reasonable gap since that delivery, and a limited number of prior cesarean sections, though thresholds vary by clinic. These thresholds vary by clinic, so a number that disqualifies you at one program will not necessarily disqualify you everywhere.
The best way to speed this stage along is to gather your delivery summaries and any operative reports before you start the application. Clinics move faster when they are not waiting on records from a hospital's medical records department, which can take weeks to respond on its own.
What clinics look for in your medical records
Once you move toward full clearance, your medical team will request detailed records from every pregnancy and any relevant surgery, not just a summary. This is where the real evaluation of your obstetric history happens.
- Delivery records showing whether you delivered vaginally or by cesarean, and any complications during labor.
- Operative reports from cesarean sections or uterine surgeries, including myomectomies or fibroid removals.
- Documentation of serious pregnancy complications such as placenta accreta, severe preeclampsia, or postpartum hemorrhage.
- Pathology reports when a prior pregnancy involved a structural or tissue-related finding.
- Any specialist consult notes, particularly from maternal-fetal medicine.
A history of significant complications does not automatically end your candidacy. Clinics often request a specialist consult, additional uterine imaging, or documented proof of a full recovery interval before deciding. A prior placenta accreta or multiple cesarean sections, for instance, usually triggers a closer look at your uterine anatomy before anyone moves forward.
Pro Tip: Request copies of your delivery summaries and operative reports directly from the hospital's medical records office as soon as you start considering surrogacy. It often takes longer than people expect, and having them ready can shave real time off your clearance timeline.
The in-clinic exam and lab checklist, explained
Your full medical clearance appointment covers a physical exam, a full lab panel, and a uterine assessment, and it is the most detailed part of the process.
The physical exam includes blood pressure, BMI, and a general health check, along with a pelvic exam when indicated. Clinicians also look for physical signs that matter for infectious disease risk, including evidence of recent nonmedical injection use or unsterile piercings or tattoos.
The standard lab panel, as outlined in ASRM's committee opinion, typically includes:
- HIV-1/2 antibody testing
- Hepatitis B surface antigen and core antibody
- Hepatitis C antibody
- Syphilis serology
- NAAT testing for chlamydia and gonorrhea
- A complete blood count and metabolic panel, including blood type
- A urine drug screen
- CMV IgG/IgM when relevant to the intended parents' situation
Your BMI is reviewed using standard clinical categories, and the CDC's adult BMI calculator reflects the same thresholds most clinics reference, though BMI functions as one risk factor among several rather than an automatic cutoff on its own.
Uterine evaluation usually happens through a saline infusion sonogram or transvaginal ultrasound, and ASRM guidance describes this step as highly recommended before any embryo transfer, since cavity shape and scar tissue from prior surgeries can affect implantation.
A reactive result does not always end the process. Positive tests are confirmed before you are notified, and conditions like treated chlamydia typically allow retesting after treatment, while HIV or hepatitis B or C generally exclude candidacy under most program policies, according to the same ASRM committee opinion.
Psychological screening: what evaluators actually assess
The psychological evaluation is not a formality, and most surrogates find it just as thorough as the physical exam. It typically has two parts: a clinical interview with a licensed mental health professional, and a standardized written assessment such as the Personality Assessment Inventory.
- Evaluators ask about your motivation for becoming a surrogate and whether the decision is fully your own.
- They assess emotional stability and how you have handled past stressful life events.
- They look closely at your support system, including your partner's involvement and your children's understanding of the arrangement.
- They explore how you would handle complex decisions during the pregnancy, including unexpected medical findings.
When an evaluator recommends additional counseling, it is usually to work through a specific concern, not to disqualify you outright. Expect the conversation to be confidential, and expect the evaluator to document that you understand your right to independent decision-making throughout the pregnancy.
Pro Tip: Talk through the emotional and logistical realities with your partner and older children before your psychological evaluation. Evaluators are specifically listening for evidence that your household understands and supports the decision, not just that you do.
Infectious disease standards, genetic screening, and the regulatory backdrop
The testing you go through did not emerge arbitrarily. It reflects a mix of professional society recommendations and federal guidance on laboratory standards.
The FDA's guidance on donor eligibility sets expectations for testing standards broadly, including the use of FDA-licensed or FDA-cleared tests and CLIA-certified laboratories for reproductive tissue testing, along with specific timing windows for specimen collection. Gestational carriers are technically classified by the FDA as recipients rather than donors, so these donor-specific mandates do not apply directly to you, but most clinics still follow ASRM's parallel recommendations for carrier and partner testing as a matter of practice.
Genetic and carrier screening typically focuses on the intended parents and any gamete donors rather than the surrogate herself, since the pregnancy's genetic makeup comes from them. The CDC's guidance on family health history notes that carrier screening for conditions like cystic fibrosis and spinal muscular atrophy is commonly offered as part of preconception care, and genetic counseling is typically available when a relevant finding comes up.
- Treatable infections like chlamydia or gonorrhea usually allow a retest after a documented treatment course.
- HIV, hepatitis B, and hepatitis C generally remain exclusionary under most program policies.
- Specimen collection timing follows FDA-referenced windows relative to any planned procedure.
Common disqualifiers and how remediation works
Not every flag on your screening ends your candidacy. Disqualifiers generally fall into two categories: things that exclude you outright, and things that simply require more time or treatment.
- Immediate exclusions typically include active, untreated HIV, uncontrolled hepatitis B or C, and certain unresolved uterine abnormalities that affect pregnancy safety.
- Temporary deferrals cover situations like a recently treated chlamydia or gonorrhea infection, which usually just require a retest after treatment completes.
- Controlled chronic conditions, such as well-managed thyroid disease or diabetes, are evaluated case by case with documentation from your treating physician rather than an automatic no.
- Structural findings, like fibroids or scar tissue found on uterine imaging, sometimes open a path forward through a myomectomy or adhesiolysis followed by specialist clearance and repeat imaging.
A herpes diagnosis managed with antiviral prophylaxis, for example, is often accepted with documented management and informed consent rather than treated as an automatic disqualifier, according to ASRM's guidance. The common thread across all of these situations is documentation: clinics want to see that a condition is controlled, treated, or resolved before moving forward.
Timeline, costs, and your pre-appointment checklist
Prescreening to full medical clearance generally takes two to six weeks, depending on how quickly records arrive and how fast lab results turn around. Some lab tests, imaging, or specialist consults may be billed separately rather than bundled into agency coordination, so it is worth asking early which costs fall on you.
- Bring delivery summaries and operative reports from every prior pregnancy.
- Bring immunization records and a current medication list.
- Bring recent lab results if you have had any in the past year.
- Have contact information ready for your prior OB or midwife.
Pro Tip: Keep a single folder, digital or physical, with every medical document you are asked for. You will likely be asked for the same records more than once across different stages of the process.
How we support you through screening
We coordinate the logistics that make screening less overwhelming to navigate alone: gathering your records, scheduling labs and imaging, and liaising directly with clinics and mental health evaluators so you are not chasing appointments on your own. Our team includes legal and medical professionals who walk you through informed consent and document your autonomy over medical decisions at every stage. We support surrogates across diverse backgrounds and circumstances, and we point you toward educational resources covering the legal process alongside the medical one.
A few things that surprised me about screening
The paperwork request that catches people off guard is usually the operative report from a prior cesarean, not the lab work. Clinics want specifics, not a summary. My advice: over-communicate with both your clinic and the intended parents' team, and never assume a document has arrived just because you sent it.
One more thing worth repeating: you retain full authority over your own medical care throughout this process, and securing your own independent legal counsel, separate from the intended parents' attorney, protects that authority in writing.
— Becca
Ready to start your screening journey with us
We handle the coordination that makes medical screening feel manageable: organizing your records, scheduling your labs and evaluations, and keeping communication clear between you, the clinic, and the intended parents. Our programs support international couples, gay couples, lesbian couples, transgender couples, heterosexual couples, and singles alike.
- We request your delivery summaries, operative reports, and basic health history to begin.
- We schedule your labs, imaging, and psychological evaluation with vetted clinics.
- We provide legal guidance so your rights and autonomy are documented from day one.
Visit our surrogacy page to begin your application and ask any questions about what screening will look like for you.
This article is general information, not a substitute for advice from a qualified doctor. Consult a qualified healthcare professional about your own circumstances before acting on anything here.
FAQ
What medical conditions disqualify you from being a surrogate?
Active, untreated HIV and uncontrolled hepatitis B or C generally exclude candidacy under most program policies, according to ASRM's committee opinion. Treatable infections like chlamydia or gonorrhea typically only cause a temporary deferral until retesting confirms the infection has cleared.
What disqualifies you as a surrogate?
Beyond infectious disease, uncontrolled chronic illness, certain unresolved uterine abnormalities, and recent substance use are common disqualifiers, though controlled conditions are often evaluated individually with physician documentation. A structural finding like fibroids can sometimes be resolved through surgery and repeat imaging rather than ending candidacy outright.
How long does it take to get medically cleared for surrogacy?
Full medical clearance typically takes several weeks from the start of prescreening, depending on how quickly records and lab results come back. Having your delivery summaries and operative reports ready in advance tends to be the biggest factor in moving faster.
What BMI do I have to have to be a surrogate?
Most programs use standard adult BMI categories, the same ones reflected in the CDC's BMI calculator, as one factor in assessing pregnancy-related risk rather than a strict universal cutoff. Thresholds vary by clinic, so it is worth confirming the specific range a program uses before assuming you do or do not qualify.
Sources
- Recommendations for practices using gestational carriers: a committee opinion (ASRM, 2022)
- Eligibility Determination for Donors of Human Cells, Tissues, and Cellular and Tissue-Based Products: Guidance for Industry (FDA)
- Consideration of the gestational carrier: an Ethics Committee opinion (ASRM, 2023)
- Adult BMI calculator (CDC)