Surrogate Medical Screening Process: What to Expect

Surrogate medical screening is the comprehensive evaluation process a woman undergoes before being approved to carry a pregnancy for intended parents. It makes sure she is physically, emotionally, and medically prepared for a successful surrogacy journey.

Whether you’re just starting your research or feeling ready to jump into the next steps to become a surrogate at Hatch, it helps to be familiar with the surrogate medical screening process.

Gestational surrogacy is when an incredible person like you carries a baby for loving intended parents through in vitro fertilization (IVF) and an embryo transfer procedure, so that the baby is not genetically related to you. 

The baby you carry may be related to one or both of the intended parents, or they may use an egg and/or sperm donor to create their embryos.

Hatch has been supporting surrogates through every step of their journeys since 1991, and in the 34+ years since our program was founded, we have strived to ensure that each of the selfless women who help others through surrogacy is fully informed of the process before they begin. 

Medical screening is one of several important steps to ensure you are set up for a high rate of success in achieving pregnancy as a surrogate. And have the best chance of a low-risk pregnancy and delivering a healthy baby for your intended parents.

Quick Overview: What Is Surrogate Medical Screening?

Surrogate medical screening includes a blood and urine test to check for drug use, infectious diseases, and other health markers. A physical exam and a pelvic ultrasound are performed to assess your uterus and ovaries. Your partner will also be screened for drug use and infectious diseases. 

These steps verify that you are physically and emotionally ready for a healthy surrogacy journey.

Preliminary Surrogate Requirements

Before getting started, you’ll want to check that you meet the basic requirements to become a surrogate. At Hatch those requirements are:

• Be between the ages of 21-42 
• Reside in a surrogacy-friendly state
• Be emotionally, socially, financially, psychologically and medically stable
• Be a US citizen or possess a green card with 5 years before expiration 
• Not actively using cannabis or tobacco products, and have no history of drug or alcohol abuse 
• Have no violent criminal history for self or partner, no child safety concerns 
• Have given birth to at least 1 child you are raising 
• Have had no more than 3 previous c-sections
• Have had no more than 6 births 
• Have had no more than 2 miscarriages
• Willing to allow the Intended Parents to make medical decisions for their baby

At Hatch, we will help you to feel prepared for your surrogacy journey by getting to know you well, understanding your hopes for this experience, providing education on the process, and supporting you through each step of admissions, matching, and the management of your case. Our mission is to make sure you know what to expect when you’re expecting as a gestational surrogate.

Why is Surrogate Testing & Screening Important?

Surrogate medical screening protects everyone involved (especially the surrogate and baby) by identifying health risks or complications before the journey begins.

One of the biggest keys to success for a surrogacy journey is through rigorous social, psychological, and medical screening. Medical testing and screening help the Reproductive Endocrinologist (your doctor for the IVF process) know that you are a healthy, low-risk candidate for a surrogate pregnancy.

Surrogates are first and foremost moms to their own kids and keeping you healthy and safe for your family is always the priority when you’re choosing to give the ultimate gift to another family.

The Complete Surrogacy Medical Screening Process

Your medical suitability to become a surrogate can be assessed through your medical history. This is a combination of the information you recall and share with us and your detailed medical records, as well as your psychological history and present mental well-being through screening with a Licensed Mental Health Professional (LMHP), and your current physical health through an in-person medical screening and lab work.

IVF doctors are guided by the American Society of Reproductive Medicine (ASRM) standards for surrogacy, which determined many of the medical criteria for surrogates in the U.S.  Surrogacy agencies like Hatch also adhere to further screening guidelines as recommended by the Society for Ethics in Egg Donation and Surrogacy (SEEDS).

Our medical screening process at Hatch is a comprehensive multi-step process that aims to leave no stone unturned. This way, we don’t miss any critical details that could impact your health, safety, or success are missed. 
 

Medical Records Review

One of the first ways we assess that a surrogate pregnancy will be low risk for you is through a meticulous review of your medical records. Our Medical Records team will contact your providers and obtain your full medical records from each pregnancy, delivery, past fertility treatment (when applicable) and well-woman gynecological care. These records are then summarized by our Medical Records Manager and reviewed by our Medical Director who is a licensed, practicing Reproductive Endocrinologist with over 30 years of experience.

Based on this review we sometimes request additional clearance letters from your current medical providers, updated PAPs, updated breast cancer screenings, or additional lab work to check that nothing important is missed for your specific circumstances.

While all surrogate screening is thorough, it's also not one-size-fits-all and your current and past health history informs us of what screening will be needed.

In-Clinic Surrogate Medical Screening

• You will have a consultation with the doctor, and they will go over your medical and reproductive history verbally
• They will check your height and weight to calculate your BMI (Body Mass Index) and check your vital signs like your blood pressure and temperature.
• They will complete a uterine lining check using an internal pelvic ultrasound probe, which you may have experienced in a past pregnancy. This is quick and painless, but some find it mildly uncomfortable like having a PAP exam.
• They will complete a current PAP (if needed)
• They will complete a breast exam
• They will draw some blood work and possibly do urine lab tests as well. The tests will vary by doctor and your medical history. The common things checked are:
  • Your immunity to illnesses commonly vaccinated in childhood such as chicken pox, measles, mumps, rubella
  • A hormone/thyroid panel
  • An STI panel
  • A CBC
  • Vitamin levels to screen for anemia and Vitamin D deficiency
  • Drug and alcohol screening
  • Urine culture to screen for Mycoplasma 

At Hatch, we want to set you up for success and protect your feelings in this process to minimize the risk of disappointment after matching. The most common reason that surrogates do not pass medical screening is due to uterine lining issues such as inadequate/irregular uterine lining, fibroids, cysts, and polyps.

We cover the expenses to have you undergo a uterine lining check with or without mock cycle medications (depending on your obstetrical history) before you match with your Intended Parents and form that special connection. 

Because this step is completed before matching, you can feel confident that you have a strong chance of passing your in-person medical screening with the reproductive endocrinologist.

Psychological Screening

In compliance with SEEDS and ASRM standards, you will undergo a detailed psychological screening. This screening consists of two parts: a video consultation and interview with a Licensed Mental Health Professional (LMHP) specializing in surrogacy for you and your partner (if applicable). And a psychological test for you, typically a PAI (Personality Assessment Inventory), all from the comfort of your own home.

A PAI is a personality test that also screens for serious psychological concerns such as schizophrenia and bipolar disorder.

The LMHP drafts a detailed psychological report, which we provide directly to your Reproductive Endocrinologist for the surrogacy so they can confirm that surrogacy is a good fit for your mental health.

Substance & Drug Screening

We must ensure a surrogate is not taking any medications or controlled substances that could be unsafe for pregnancy.

The first step of surrogate medical screening for drugs (both prescribed and illicit) and controlled substances like cannabis or alcohol is a conversation with you in your admissions process. It is critical to be fully transparent so we can come up with an appropriate plan of action and timeline for your journey.

When it comes to responsible use of cannabis or alcohol within the confines of your state laws, we still need to ensure you are substance-free and do not have any dependencies before proceeding, as these could disqualify you from becoming a surrogate.

Many over-the-counter and prescription medications have not been well-studied in pregnancy so we defer to the Reproductive Endocrinologist you will be working with to determine what can be taken or must be discontinued in a surrogate pregnancy or during your fertility treatment as a surrogate.

The second step is screening for drugs, alcohol, and certain prescription medications through blood and/or urine toxicology tests.

How to Prepare for Your Surrogate Medical Screening

Preparing for medical screening is both exciting and nerve-wracking for many surrogates. Here are some tried and true tips to help you have a successful medical screening:

1. Follow a healthy, balanced diet leading up to your screening to have an optimal BMI, especially if your BMI is close to 30 to start, as clinics do have BMI limits, and this will slow down your journey if you need to reach a BMI goal before proceeding.  You can calculate your current BMI with the BMI tool from the CDC.
2. Limit your salt intake, be adequately hydrated, and minimize stress (take time for some deep breaths) to have optimal blood pressure
3. Be honest and transparent about your medical history and any medications you’re taking throughout the screening process. If you think there are any medical concerns we should know that are not in your medical records please let us know as soon as possible.
4. Bring your list of medical questions (if there is anything you want to specifically ask the Reproductive Endocrinologist)
5. Keep a positive attitude! Sometimes surprises come up and if they do, we will be in touch with you to support you and figure out the next steps. Your Case Manager is an experienced surrogate who is in your corner!
6. Be patient; results from your lab work can take 2-3 weeks to come back sometimes. Your Case Manager is going to make sure you get your results as soon as possible. 

5 Common Reasons a Surrogate May Not Qualify

While many women are eager to help others grow their families through surrogacy, not everyone who applies will meet the medical and psychological requirements to move forward.

1. Health History and Pregnancy Complications

One of the most important factors in surrogacy qualifications is a woman’s pregnancy history. Because surrogates need to demonstrate the ability to carry a healthy pregnancy to term, complications in previous pregnancies may raise red flags.

Some disqualifying conditions include:

• History of preeclampsia or gestational diabetes
• Preterm labor or low birth weight deliveries
• Multiple miscarriages without a known cause
• More than three C-sections or six total births

These conditions don’t automatically disqualify every applicant, but they do require careful evaluation.

2. Medical Conditions and BMI

A surrogate must be in good overall health. Certain medical conditions can interfere with fertility treatment or pose risks during pregnancy.

Common medical disqualifiers include:

• Uncontrolled thyroid disorders
• Autoimmune diseases like lupus
• Diabetes requiring insulin
• High blood pressure
• Certain medications that cannot be safely stopped

Additionally, body mass index (BMI) plays an important role in determining eligibility. Most clinics require a BMI between 19 and 32.

3. Mental Health and Emotional Readiness

Surrogacy isn’t just a physical journey; it’s an emotional one, too. Part of the surrogate screening process includes a thorough psychological evaluation to assess emotional stability and mental health history.

Some psychological disqualifiers include:

• Untreated or recent diagnoses of depression, anxiety, or other mental health conditions
• History of postpartum depression
• Current use of certain psychiatric medications

These assessments aren’t meant to judge. They’re in place to make sure the surrogacy journey is positive and manageable.

4. Lifestyle Factors and Substance Use

Surrogates must be tobacco-free, drug-free, and committed to avoiding alcohol throughout the pregnancy. Recreational drug or alcohol use, even occasionally, may disqualify a candidate.

In some cases, surrogates may also be asked about:

• Commitment to attending appointments
• Willingness to follow medical protocols and communicate openly

5. Lack of a Stable Support System

One factor that’s sometimes overlooked is whether a potential surrogate has a stable and supportive home environment. 

While the physical and emotional demands of pregnancy are significant on their own, the surrogacy journey also comes with appointments, legal paperwork, and ongoing communication with the intended parents.

During the surrogate screening process, agencies and clinics look at:

• Whether the surrogate has dependable emotional and logistical support (from a partner, family, or close friends)
• The surrogate’s ability to balance daily responsibilities with the demands of the process
• Openness and support from those closest to her, especially if she’s in a committed relationship

Why does this matter? 

A strong support system helps the surrogate feel empowered, not overwhelmed, especially during more intensive stages like embryo transfer or late pregnancy.

Become a Surrogate With Hatch Surrogacy

Hatch has over three decades of experience, high success rates, and hundreds of positive journeys for our surrogates and Intended Parents.  

Successful journeys depend upon our comprehensive admissions process, including rigorous medical screening. Safe journeys make for happy and successful ones, and putting the health and safety of our surrogates first is the secret to making that possible.

You can rest assured that you have the best chance of a rewarding and smooth experience when you have undergone our social, medical and psychological screening steps.

We understand that at times it can feel like a lot of hoops to jump through to be able to give the gift of family. But the emotional rewards on the other side are well worth the time and energy you will invest in becoming a surrogate, and our comprehensive and competitive compensation package is a bonus.

Our program is run by experienced surrogates who have completed a collective 50+ surrogacy journeys themselves, and every one of us was once in your shoes just starting our research to decide if surrogacy was right for us.

We are beyond excited to get to know you, prepare you, and support you through your journey if you decide Hatch is the right fit for your needs.

Being a Hatch surrogate means you will never walk alone in your journey. If you want to get started, you can complete your application here to speak with a Surrogate Specialist and learn about giving the gift of family.