Surrogate Medical Screening: What the Process Involves and What to Expect

Surrogate medical screening is the stage where a fertility clinic reviews your records and examines you in person. It confirms whether you can carry a pregnancy safely and whether an embryo transfer is likely to succeed. It usually comes after an agency's pre-screening and before any surrogacy contract is signed. It typically has five parts: a records review, a physical and uterine exam, lab and infectious disease testing, a psychological evaluation, and a decision. The clinic makes that decision, not the agency, and not this site.

You may have already cleared an agency's first round of questions and want to know what the medical part involves before you go further. This guide walks through it in order and covers how long it takes as a general estimate. It also explains what can pause it, so nothing comes as a surprise.

Before You Start: What Medical Screening Is and Who Orders It

Medical screening is ordered by the intended parents' fertility clinic. The clinic sets its own standards. Most clinics use guidance from the American Society for Reproductive Medicine (ASRM), the professional body for fertility medicine in the United States, as a baseline. ASRM guidance is a set of recommendations, not federal law. Each clinic interprets it, and some are stricter than others.

Screening sits in the middle of the larger qualification path. You apply to an agency. The agency pre-screens you and may match you with intended parents. Their clinic then screens you medically. Legal contracts usually follow medical clearance. Our overview of the surrogate screening process covers the agency and legal steps on either side.

Two stages are easy to confuse:

• Preliminary eligibility is an early check of basics such as age, pregnancy history and general health. An agency or an online tool like ours can tell you whether your situation looks likely to fit.
• Medical clearance is a physician's decision after reviewing your records and examining you.

Passing the first does not mean you will pass the second.

The cost of the screening workup is generally the intended parents' responsibility, not yours. Base pay usually starts later, once a contract is in place. Ask your agency in writing who pays for each part of screening and for any travel, and how time off work for appointments is handled.

Step 1: Medical Records Review

The clinic reads your history before it schedules any in-person testing. A reproductive endocrinologist (RE), a physician specialising in fertility, or a nurse coordinator at the clinic usually does this review.

The clinic commonly requests:

• OB/GYN records from every prior pregnancy and delivery, including complications, gestational age at birth and delivery method.
• Records of any cesarean sections. The number of prior C-sections is a common limiting factor. Many clinics set a ceiling, often around two or three, and some assess each case individually. The physician decides based on your records.
• BMI documentation. Many clinics look for a BMI in roughly the 19 to 32 range. Some are narrower and some go higher. This is a common range, not a national rule.
• Mental health history, if you have any treatment or diagnosis on record.
• Prior fertility treatments or reproductive surgeries, such as a D&C, fibroid removal or treatment for endometriosis.

The clinic is looking for anything that could make a pregnancy riskier for you or make a transfer less likely to succeed.

Missing records are one of the most common causes of delay. Delivery records held by a hospital you used years ago can take weeks to arrive.

Step 2: Physical Examination and Uterine Evaluation

This is the centre of medical screening, and it is a hands-on appointment.

It usually takes place at the intended parents' fertility clinic. That may mean travel if the clinic is not near you, sometimes a flight and an overnight stay. Under most arrangements the intended parents cover travel for screening. Confirm how and when you are reimbursed before you book anything.

The visit typically includes:

- A general physical exam: blood pressure, heart rate, height, weight and an overall health assessment. - A gynecological exam, which may include a Pap smear if you are not current. - A transvaginal ultrasound. A probe placed in the vagina shows the uterine lining and the ovaries. - A uterine cavity evaluation, using one of two methods: - Saline infusion sonohysterography (SIS): sterile saline is passed through a thin catheter into the uterus while an ultrasound shows the inside of the cavity. Many women describe cramping during and shortly after. - Hysteroscopy: a thin camera is passed through the cervix to look directly inside the uterus. Depending on the clinic, it may be done in the office or with sedation.

The uterine evaluation looks for fibroids, polyps, a uterine septum (a band of tissue dividing the cavity), adhesions or scarring, and other structural issues that could affect implantation or the pregnancy.

Step 3: Laboratory and Infectious Disease Testing

Several vials of blood and a urine sample usually cover this step, often drawn on the same day as the exam.

Standard labs commonly include:

• Complete blood count (CBC)
• Metabolic panel
• Thyroid function
• Blood type and Rh factor

The infectious disease panel commonly covers HIV 1 and 2, hepatitis B surface antigen and core antibody, hepatitis C antibody, HTLV I/II, syphilis (RPR or VDRL), CMV (cytomegalovirus) IgG and IgM, gonorrhea and chlamydia.

The federal regulation behind much of this is FDA 21 CFR Part 1271. It sets donor eligibility and infectious disease testing rules for human cells and tissues, including the reproductive tissue used to create embryos. Clinics commonly apply a similar panel to gestational carriers alongside ASRM guidance. The exact list can differ by clinic.

Many clinics also run:

• Urine drug screening.
• Nicotine or cotinine testing. Most clinics require non-smoking status, and some test for nicotine specifically.

If you have a partner, they will typically be asked for infectious disease testing too. Some infections can pass within a household. Clinic policy, informed by the federal testing framework, usually extends to the partner for that reason.

Lab turnaround is typically a few days to a few weeks, depending on the lab and the test.

Step 4: Psychological Evaluation

The psychological evaluation is a separate appointment with a licensed mental health professional who has experience in third-party reproduction. This is usually a psychologist or a licensed clinical social worker. ASRM recommends psychological evaluation for all gestational carriers.

It typically includes:

• A clinical interview about your history, motivations, household and how you picture the pregnancy and the handover.
• Standardised psychological testing. The MMPI-2 and the PAI are common examples. Not every evaluator uses the same instrument.

The evaluator is assessing your emotional readiness and your understanding of the arrangement. They also look at your ability to relinquish the baby at birth, the strength of your support system, and whether any significant mental health condition is untreated. If you have a partner or spouse, they are typically included, because their support matters through the pregnancy.

The evaluator sends a written report to the fertility clinic and sometimes to the agency. A finding does not automatically end your candidacy. The evaluator may recommend counselling or more support rather than giving a simple yes or no.

If you live in New York, the state's Department of Health publishes requirements for gestational surrogacy under the Child-Parent Security Act, including a psychological evaluation. The New York State Department of Health is the place to read the state-level detail.

Step 5: Receiving Results and What Happens Next

Results usually reach you through your agency coordinator or the clinic's nurse coordinator. They rarely come directly from the physician.

There are three broad outcomes:

1. Cleared to proceed.
2. Cleared with conditions. For example, a polyp must be removed or a thyroid level managed before transfer.
3. Not cleared.

A "not cleared" result is a medical finding, not a judgment of you. Some findings are disqualifying at most clinics, such as certain uterine anomalies or an active infectious disease. Others depend on the clinic. A woman not cleared at one clinic is not necessarily disqualified everywhere, because standards differ.

If you are cleared, the legal contract phase usually begins next. At most agencies, medical clearance and contracts happen one after the other, not at the same time. An independent attorney reviews your contract before you sign. Before signing, you are generally not committed to continuing. Check whether any agency agreement you have already signed says otherwise.

Some clinics then run a mock cycle before the real transfer cycle. You take the same hormone medications a transfer would use, commonly estrogen and then progesterone. The clinic monitors your uterine lining with ultrasounds and blood draws. Some clinics add endometrial receptivity testing, which takes a small sample of the lining. A mock cycle can last several weeks and involves daily medication and repeated appointments. The surrogacy process for surrogates covers the transfer and pregnancy stages that follow.

When the Process Gets Complicated: Common Findings and How They Are Handled

Findings come up often, and many can be resolved.

• Uterine polyps are common. They are often removed in a minor outpatient procedure called a hysteroscopic polypectomy, after which screening may continue.
• Fibroids depend on location and size. Submucosal fibroids bulge into the uterine cavity and are more likely to affect candidacy. Subserosal fibroids grow on the outside wall and are less likely to matter.
• Prior C-sections are weighed differently by each clinic. Some evaluate the scar on ultrasound as part of the workup.
• A positive CMV IgG result means a past infection, which is common in the general population. Most clinics have protocols for this, often depending on the intended parents' CMV status.
• A positive drug screen is typically disqualifying. Some agencies allow reapplication after a set period.
• A psychological recommendation for counselling is not a disqualification. It means the evaluator wants more support in place first. A disqualification ends that candidacy.
• Thyroid abnormalities are often manageable with medication. The clinic decides whether and how to proceed.

You generally have the right to request copies of your own medical records from screening. It is worth asking for them, especially if you may be screened by another clinic later.

How Long Medical Screening Takes

As a general estimate, the medical portion often runs about four to ten weeks from records request to a clearance decision. It can be faster or much slower. The whole screening path, including agency and legal steps, often takes three to six months.

Common causes of delay:

• Prior delivery records that are slow to arrive
• Clinic scheduling, especially for the uterine evaluation
• Travel arrangements to a distant clinic
• Lab turnaround
• A finding that needs a follow-up procedure, such as polyp removal, plus recovery time
• Scheduling the psychological evaluation for a surrogate and her partner, if applicable

How to Prepare

• Request your OB/GYN and hospital delivery records early, including operative notes for any C-section.
• List your medications, surgeries and any mental health treatment, with dates.
• Talk with your partner about their part: lab testing and joining the psychological evaluation.
• Ask your agency who pays for each screening cost and how travel is reimbursed.
• Ask how far the clinic is and how often you may need to travel there.

When you are comparing programmes, our guide to choosing a surrogacy agency covers questions about escrow, attorney fees and coordinator support.

See Whether You May Qualify

If you want to know where you stand before contacting an agency, Surrogate Compass offers a free, no-obligation eligibility check. It shows whether your situation looks likely to fit common programme criteria and which types of programme may suit you. It also gives you a general sense of how compensation is structured and what you could be paid. It is not medical clearance or approval. Agencies and clinics decide that. You can start with our surrogate eligibility quiz, or contact Surrogate Compass to request a free eligibility review. Come back whenever you are ready. When you decide to move forward, our guide on how to apply to be a surrogate explains what comes next.