The surrogate screening process runs through five connected stages: application and intake, records and laboratory testing, psychological evaluation, background and support checks, and fertility-clinic medical clearance. An agency coordinator, a licensed mental-health professional, a fertility physician, and independent legal counsel each handle a distinct piece, following standards set by the American Society for Reproductive Medicine and the American College of Obstetricians and Gynecologists. Success looks like documented clearance from each professional before embryo transfer, or a clear written list of what remains outstanding.
TL;DR:
- Ask which screening stages must finish before matching or embryo transfer; agencies differ, and records retrieval or confirmatory tests often cause delays.
- Prior cesarean delivery, gestational diabetes, or a hypertensive disorder does not automatically disqualify a candidate; clinics review complete records and whether complications resolved.
- ASRM recommends that a licensed mental health professional assess motivation, coping, support, and coercion before legal counseling, repeating evaluations older than a year.
- Request the physician’s signed medical clearance, lab result summaries, psychological report, and a written list of outstanding items before embryo transfer.
- The surrogate should have independent legal counsel, separate from agency and intended parents’ attorneys, to review and negotiate the contract and consent terms.
Table of Contents
- Quick overview: the five-stage screening workflow
- Application and prescreening: intake questions and documents to prepare
- Medical screening and laboratory testing: specific tests, records review, and uterine checks
- Psychological screening: scope, tests, and timing
- Clinic medical clearance and uterine assessment: the fertility team's responsibilities
- Timing and typical timeline: realistic ranges and common delays
- Questions to ask clinics and agencies: the trust-signal checklist
- What happens after screening: matching, contracts, and next medical steps
- Criteria for surrogate candidate acceptance
- Communication expectations and counseling about the surrogacy journey
- Understanding altruism versus compensation
- Publisher perspective: why rigorous screening matters
- How Colombia Surrogacy Partners supports screening and next steps
- FAQ
- Sources
Quick overview: the five-stage screening workflow
Before diving into any single step, it helps to see the whole sequence. Most programs move through the same five stages, though the order and pace vary depending on the agency and clinic involved.
- Application and intake: initial eligibility questions, identification, and basic health history.
- Records and prior-pregnancy review: obstetric, gynecologic, and mental-health records collected and reviewed.
- Background and lifestyle checks: criminal history, references, and household stability.
- Psychological evaluation: a clinical interview and standardized testing with a licensed mental-health professional.
- Fertility-clinic medical clearance: physical exam, lab work, and uterine assessment ordered by the treating physician.
The ASRM committee opinion on gestational carriers describes a practical screening workflow, though some agencies finish every stage before matching while others complete medical clearance only after a match. Ask directly which steps are already finished before a profile is shared and which ones could still cause delay.
Application and prescreening: intake questions and documents to prepare
The first contact with an agency usually takes the shape of a written application paired with a phone or video screening call. This stage exists to catch obvious disqualifiers early, before anyone invests time in records review or lab work.
Typical intake questions cover age, BMI, number of prior pregnancies and deliveries, current medications, smoking or substance use history, and household stability. Agencies also ask about criminal history, immigration or residency status where relevant, and whether a candidate has carried a healthy pregnancy to term without major complications.
Documents candidates should gather ahead of time include:
- Government-issued identification and proof of address.
- Obstetric and delivery records from every prior pregnancy.
- Immunization history and a recent physical exam summary.
- Proof of current health insurance or a clear statement of coverage gaps.
Prior pregnancy details carry weight because they predict how a body may respond to another pregnancy. A history of cesarean delivery, gestational diabetes, or a hypertensive disorder does not automatically disqualify a candidate, but it does mean the actual delivery records need review rather than a summary from memory. The most efficient approach is to request complete records directly from the delivering hospital early, since retrieval times vary, and to disclose any complication upfront rather than waiting for it to surface during records review.
Medical screening and laboratory testing: specific tests, records review, and uterine checks
Once intake is complete, the fertility clinic takes over medical screening. This is where a prospective surrogate's physical readiness for pregnancy gets confirmed through objective testing rather than self-report.
According to ASRM's recommendations for practices using gestational carriers, commonly recommended infectious-disease screening includes HIV-1 and HIV-2 antibody testing, hepatitis B surface antigen and core antibody, hepatitis C antibody, nucleic acid testing for HIV, hepatitis B, and hepatitis C, syphilis serology, and nucleic acid amplification testing for gonorrhea and chlamydia. Cytomegalovirus IgG and IgM testing is added when relevant to the intended parents' own status. Carrier screening for conditions such as cystic fibrosis and spinal muscular atrophy, along with a complete blood count and screening for thalassemias and hemoglobinopathies, is also part of standard preconception work, as outlined in ACOG guidance on carrier screening. This type of testing identifies inherited-condition risk rather than whether someone can safely carry a pregnancy, and it may prompt genetic counseling when both intended parents carry a relevant variant.
Clinics also pull and review prior obstetric records in detail, looking specifically at how a cesarean delivery was performed, whether gestational diabetes was managed with diet or medication, and whether any hypertensive disorder resolved after delivery. Because medical clearance is case-specific, a prior complication should trigger a closer look at the actual chart rather than an automatic yes or no.
A saline-infusion sonogram or an equivalent uterine-cavity evaluation checks for structural issues like fibroids or scarring that could affect implantation. The fertility physician orders this alongside a standard physical exam. When a test comes back positive or indeterminate, protocol calls for confirmatory testing, counseling about what the result means, and sometimes treatment or a temporary deferral rather than an outright rejection.
For a fuller checklist of what this stage involves and how long it typically takes, our surrogacy medical screening guide walks through the timeline in more detail.
Psychological screening: scope, tests, and timing
A licensed mental-health professional, not the agency or the fertility clinic, conducts this evaluation, and it covers far more ground than a simple pass or fail.
ASRM's 2022 committee opinion recommends a structured clinical interview combined with validated psychometric testing. Two examples commonly cited are the Personality Assessment Inventory and the Minnesota Multiphasic Personality Inventory, both standardized tools used to flag psychiatric risk factors that might complicate a surrogacy arrangement. The evaluation also includes implication counseling, a conversation about what the pregnancy, the relationship with intended parents, and a potential disruption to family life might actually feel like, with a partner or primary support person included in that conversation whenever possible.
The domains assessed go beyond a checklist of diagnoses. Evaluators look at motivation for pursuing surrogacy, coping skills under stress, any psychiatric history including perinatal mood disorders, the strength and availability of social support, and whether there is any sign of coercion, financial, emotional, or otherwise, pushing someone toward this decision. ASRM's ethics guidance is explicit that voluntariness has to be actively discussed, not assumed.
Timing matters here in a way that is easy to overlook. ASRM recommends that this evaluation happen before legal counseling and before any contract is signed, so that psychological clearance is never retrofitted around a deal that is already moving forward. If an evaluation is more than a year old by the time a new contract begins, ASRM recommends repeating it rather than relying on outdated findings.
Clinic medical clearance and uterine assessment: the fertility team's responsibilities
The fertility physician holds final responsibility for medical clearance, and that clearance is always case-specific rather than a generic stamp of approval.
Clearance starts with a close read of obstetric history. A prior cesarean section prompts questions about the surgical technique and healing. A history of gestational diabetes or a hypertensive disorder in a past pregnancy means the physician looks for whether either condition resolved fully or left any lasting risk factor. None of these histories rule someone out automatically, but each one changes what the physician needs to verify before signing off.
The uterine-cavity evaluation, typically a saline-infusion sonogram, checks for fibroids, polyps, or scarring that could interfere with implantation or increase pregnancy risk. Alongside this, the fertility team usually provides preconception counseling that covers topics like the number of embryos to transfer, how a high-order pregnancy would be handled, and what the plan would look like if prenatal testing uncovered a serious finding, consistent with ACOG's guidance on gestational surrogacy. Throughout this counseling, the gestational carrier retains authority over decisions involving her own body and medical care.
Because clearance is formalized by the treating physician rather than the agency, intended parents should expect a direct signed statement, not a secondhand summary, before moving forward with transfer.
Timing and typical timeline: realistic ranges and common delays
Screening does not move at a single fixed pace. Each stage has its own typical window, and delays in one stage ripple into the next.
- Application and intake timing varies from first contact to a completed profile.
- Records retrieval depends on how quickly prior hospitals or clinics respond to requests.
- Laboratory testing timing varies, and confirmatory testing can take longer.
- Psychological evaluation, including the clinical interview and implication counseling, can take time to schedule and complete.
- Medical clearance and matching timing depends on when all records and test results are in hand.
The most common bottlenecks are records that are slow to arrive from outside providers, confirmatory testing triggered by an initial positive or indeterminate lab result, and scheduling conflicts with outside evaluators who are not on the clinic's own staff. Intended parents should confirm early which steps must finish before embryo transfer and which ones, like certain background checks, can wrap up in parallel after a match is made. Our surrogacy timeline guide breaks this scheduling question down further for intended parents starting legal steps before IVF.
Questions to ask clinics and agencies: the trust-signal checklist
A short set of direct questions separates documented clearance from reassurance that sounds good but cannot be verified.
- Who conducted each assessment, and what are their credentials?
- When was each evaluation completed, and is the psychological evaluation still current?
- Which records and lab tests were actually reviewed, not just requested?
- Will the surrogate have independent legal counsel separate from the agency's attorney?
- What specific items, if any, remain outstanding before transfer can be scheduled?
The trust signals worth requesting include a licensed mental-health evaluation report, a physician-signed medical clearance letter, copies or clear summaries of lab results, and written informed-consent documentation that references ASRM or ACOG recommendations by name. Telehealth evaluators, such as those offering psychiatric evaluation services in Arizona, illustrate what a thorough licensed mental-health evaluation typically involves when an in-person specialist is not locally available. For more on asking these questions respectfully, our guide on questions intended parents ask a surrogate covers the tone as well as the substance.
Pro Tip: Ask for scanned copies of each key report along with a one-page summary of what is still outstanding before transfer, so nothing gets lost between providers.
What happens after screening: matching, contracts, and next medical steps
Once screening clears, matching begins with profile review and an introduction call, followed by a period where both sides set expectations before anything becomes official.
Legal agreements come next, and the surrogate's independent legal counsel, separate from any attorney representing the agency or intended parents, reviews and negotiates the contract and the informed-consent terms. Our legal process page outlines this stage in more detail.
After a signed agreement, the clinical team finalizes any remaining medical clearance, schedules additional testing if time has passed since the original labs, and begins uterine preparation ahead of embryo transfer.
Criteria for surrogate candidate acceptance
Most programs apply a consistent set of baseline criteria before a candidate moves forward, though the exact cutoffs vary by clinic.
Age requirements vary by clinic, reflecting pregnancy-related risk. BMI thresholds vary by clinic, though many set an upper limit, since higher BMI is linked to increased pregnancy complications; the NHLBI BMI calculator and CDC's BMI tool are commonly used reference points during intake.
Previous pregnancy history matters as much as current health. Many programs look for a prior pregnancy carried to term without major complications, since that history demonstrates a body's capacity to sustain a healthy pregnancy and gives the clinic real data instead of a theoretical assessment. A candidate who delivered via uncomplicated vaginal birth or an uncomplicated cesarean typically faces fewer questions than one with multiple complicated deliveries, though as covered earlier, a complicated history prompts closer record review rather than automatic exclusion.
Other common criteria include a stable living situation, no active tobacco or substance use, a BMI and overall health profile that supports a safe pregnancy, and the absence of certain chronic conditions that significantly raise pregnancy risk. None of these criteria function as a rigid formula. They work together, and a strong showing in one area, like an excellent obstetric history, can offset a borderline finding elsewhere once the physician reviews the complete picture.
Communication expectations and counseling about the surrogacy journey
Surrogacy runs on communication as much as it runs on medical coordination, and most agencies set expectations for this early rather than leaving it to chance.
Implication counseling, covered earlier in the psychological evaluation stage, is where many of these expectations first get named out loud: how often will the surrogate and intended parents communicate during pregnancy, who attends medical appointments, and how will decisions get made if something unexpected comes up. These conversations work best when they happen before a contract is signed, not after, so that everyone enters the relationship with a shared understanding rather than assumptions that surface later under stress.
Ongoing counseling support matters throughout the pregnancy, not just at the evaluation stage. A surrogate who feels supported through regular check-ins, access to her mental-health evaluator if concerns arise, and a clear channel for raising questions tends to navigate the emotional demands of pregnancy and eventual placement with more stability. Intended parents benefit from this structure too, since clear communication norms reduce the anxiety that comes with being at a physical distance from a pregnancy they care deeply about. Our piece on the emotional side of surrogacy goes further into how to prepare for this part of the journey.
Understanding altruism versus compensation
Part of the psychological evaluation specifically probes why a candidate wants to be a surrogate, and this question exists for good reason.
A surrogate motivated primarily by compensation without a clear understanding of the emotional and physical demands involved may be at higher risk for distress later in the process. ASRM's screening framework asks evaluators to assess motivation directly, distinguishing a candidate who sees compensation as fair recognition for the significant commitment involved from one who may not have fully considered what the experience requires. This is not about disqualifying anyone who benefits financially. Fair compensation for time, risk, and physical demands is a normal and appropriate part of surrogacy.
The goal is clarity rather than judgment. A candidate who can articulate both the altruistic motivation, helping someone build a family, and the practical reality of fair compensation for a significant physical and emotional undertaking, tends to be better prepared for the realities ahead. Evaluators also watch for any sign that financial pressure, rather than informed choice, is driving the decision, since that distinction connects directly back to the coercion-risk assessment built into the psychological evaluation.
Publisher perspective: why rigorous screening matters
Thorough screening protects three parties at once: the surrogate's autonomy and health, the intended parents' ability to trust the process, and the wellbeing of the child. We prioritize medical oversight and legal guidance because shortcuts in these areas shift risk onto people who trusted the process to catch it. Transparent documentation, not reassurance, is what actually protects everyone involved. Reach out to our team directly if you want to see what that documentation looks like before committing to anything.
— Florent Letronne, PhD
How Colombia Surrogacy Partners supports screening and next steps
We coordinate medical oversight and legal guidance in one connected process.
- Psychological evaluations as part of the screening process.
- Medical oversight as part of the screening process.
- Legal guidance throughout the surrogacy process.
- Support programs for international couples, LGBTQ+ couples, and singles.
If you are ready to talk through what screening looks like for your situation, visit our surrogacy page to start the conversation.
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 will disqualify you from being a surrogate?
Common disqualifiers include a BMI outside the clinic's accepted range, no prior successful pregnancy, active substance use, significant unmanaged psychiatric history, or an unstable living situation. Many findings, like a past cesarean or gestational diabetes, prompt closer record review rather than automatic exclusion.
Is the surrogate process painful?
The screening portion itself, lab draws, a physical exam, and a uterine-cavity evaluation, involves only mild, brief discomfort similar to a routine gynecologic visit. Later stages like embryo transfer and pregnancy carry the same physical experience as any pregnancy, with medical support throughout.
How long does a surrogate process take?
Screening duration varies depending on intake, records retrieval, lab testing, psychological evaluation, and medical clearance. Delays most often come from slow records retrieval or confirmatory testing after an initial positive result.
How do they get the sperm for surrogates?
Sperm is collected directly from the intended father or a chosen donor at a fertility clinic or through a certified sperm bank, then used to fertilize eggs in a lab setting before embryo transfer. The surrogate has no direct biological connection to the embryo in a gestational surrogacy arrangement.
Sources
Medical and psychological clearance answer whether someone can carry a pregnancy safely and handle the emotional weight of surrogacy. Background checks answer a different question: does this person have the stable environment a pregnancy and postpartum period require?
Criminal-record checks are standard, though the scope varies: some programs run a basic state-level check, others pull a more comprehensive multi-state or federal history. Professional and personal references, along with in-home interviews or written home-environment reports, round out the picture of household stability and the people who will be supporting a surrogate through the pregnancy.
- Recommendations for practices using gestational carriers: a committee opinion (2022) | American Society for Reproductive Medicine | ASRM
- Recommendations for practices using gestational carriers: a committee opinion
- Pubmed
These factors matter because a pregnancy does not happen in isolation. A candidate with unstable housing, no backup childcare, or a volatile home environment faces real obstacles that no amount of medical fitness can offset.