The Surrogate Screening Process: What Happens at Each Step

Surrogate screening is the set of checks between your first application and the point where a fertility clinic clears you for an embryo transfer. It usually runs in five stages: an application, an agency interview and background review, medical screening at a fertility clinic, a psychological evaluation, and a legal agreement signed by you and the intended parents. As a general estimate, the whole sequence takes three to six months, sometimes longer. Each stage is decided by a different party, and passing one does not mean you will pass the next.

You may be reading this before you have told anyone. That is common. Most women want to know what the process asks of their body, their calendar and their household before they decide whether to apply at all. This page sets out what happens, in order, so you can judge that for yourself.

A note on who does what. Surrogate Compass is an independent platform. We help you understand whether you are likely to meet common requirements and which programs may fit, and we can connect you with agencies. We do not screen, approve, match, contract with or pay surrogates. Agencies, fertility clinics, mental health professionals and attorneys do that, and the decisions at every step below are theirs.

Before You Start: What Agencies and Clinics Are Actually Looking For

The requirements below are what agencies and clinics commonly look for. They are not a national standard. Programs differ, and for anything medical, a physician reviewing your records makes the call.

• Age. Many agencies accept women from about 21 to 40, and some extend to 42. Clinics may set their own limits.
• A prior pregnancy, and a child you are raising. Agencies generally look for at least one previous pregnancy carried without serious complications, and a child currently in your care. A previous pregnancy shows how your body has handled one. Parenting a child means you already know what it is to bring a baby home, which matters when you will not be doing so this time.
• BMI. Many programs set an upper BMI limit somewhere in the low 30s, and some go higher. These limits are clinical, not cosmetic. Clinics draw on guidance from the American Society for Reproductive Medicine (ASRM) because BMI is linked to pregnancy risks such as gestational diabetes and high blood pressure. If your BMI is near a limit, one program's answer may differ from another's.
• A smoke-free, substance-free household. Agencies typically look for no smoking, vaping or drug use by you, and often by anyone you live with.
• Mental health. Having had therapy, counseling or treatment in the past is different from having an active condition that would complicate a pregnancy and relinquishment. Many women with a treatment history go through screening. What an evaluator looks at is how you are doing now.
• Financial stability. This is not about income or wealth. Agencies look for the absence of financial distress, such as relying on government assistance or facing eviction, so that compensation is not the thing holding your household together.
• Residency. Agencies typically require that you live in the United States. Some require residency in particular states, because surrogacy law varies widely and some states are hostile to compensated gestational surrogacy.

Meeting these on paper is preliminary eligibility. It is not acceptance. Agency, medical and legal screening decide that.

Step 1: The Initial Application

The application is a written form, usually online. It is the first point at which you share details with an agency, and it does not commit you to anything further.

What it typically asks:

• Personal history: age, height and weight, where you live, relationship status.
• Obstetric history: each pregnancy, how you delivered (vaginal or C-section), and any complications such as preeclampsia, gestational diabetes or preterm labor.
• Lifestyle: smoking, alcohol, medications, travel, work schedule.
• Household: who lives with you, including partners and adult family members.

What happens to it. An agency coordinator compares your answers against the agency's written eligibility criteria. That is the whole review at this stage. No medical exam and no psychological evaluation happen yet.

How long it takes. Most agencies respond to a completed application within a few days to a few weeks.

What "preliminary approval" means. It means the agency wants to keep talking. It opens the next steps. It is not an acceptance, and it does not mean a clinic will clear you medically.

Some applicants are declined here, based on written criteria alone. That is not a judgment about you as a person or a mother. It means a particular agency's rules do not fit your current situation, and another program's rules may differ.

Step 2: Agency Interview and Background Review

Here the agency moves from your paperwork to you.

The interview. This is usually a video or phone call with an agency coordinator. Some agencies also arrange a home visit. Expect questions about:

• Why you are considering surrogacy.
• Who supports you day to day: partner, family, friends, childcare.
• Your partner or spouse's view, if you have one, and how involved they plan to be.
• What you understand the role to involve, including injections, appointments and handing the baby to the intended parents at birth.

The agency is also learning how you communicate. Do you answer messages? Are you clear about your schedule? Surrogacy involves a year or more of coordination between you, a clinic, attorneys and the intended parents, so reliability matters as much as the facts on paper.

The background check. This commonly includes:

• Criminal history, because the intended parents are trusting you with their pregnancy.
• A sex offender registry search, because a child will be born into your care before going home with the intended parents.
• Sometimes a financial or credit review, to check for the financial distress described above.

Adults over 18 who live in your home are typically included in these checks.

What ends things here, and what starts a conversation. Certain criminal records, registry results or serious financial instability may lead an agency to decline. Other findings, such as an old minor offense or a household member who has not yet agreed to a check, often lead to a follow-up conversation rather than a decision. Where the line sits varies by agency.

Step 3: Medical Screening

Medical screening is the most physically involved part of the process. It is carried out by the intended parents' fertility clinic and its reproductive endocrinologist (RE), not by the agency. The clinic alone decides whether you are medically cleared.

What it typically includes. Exact tests vary by clinic, but a woman going through medical screening can generally expect:

• A records review. The clinic reads your prior pregnancy and delivery records before or alongside the exams. Gathering these can take time.
• A full physical exam, including blood pressure and BMI.
• A gynecological exam, often with a Pap smear and a transvaginal ultrasound, where a probe is placed in the vagina to view the uterus and ovaries.
• A uterine evaluation. This is usually a saline sonogram, in which a thin catheter passes through the cervix and sterile saline fills the uterus while it is imaged by ultrasound. Some clinics use a hysteroscopy instead, where a thin camera is passed through the cervix. Both can cause cramping, and many women arrange a ride home or time off for that day.
• An infectious disease panel, which typically tests for HIV, hepatitis B and C, syphilis and other conditions.
• A complete blood count and metabolic panel, plus other blood work the clinic orders.
• A drug screen, and sometimes nicotine testing.

Several of these involve blood draws on more than one visit. Some tests have to be timed to a particular point in your menstrual cycle. If the clinic is not near you, you may also need to travel, sometimes overnight.

Why the infectious disease testing is not optional. Part of this panel traces to federal regulation. The FDA's human cells, tissues, and cellular and tissue-based products (HCT/P) regulations at 21 CFR Part 1271 set screening and testing requirements in third-party reproduction. Clinics apply them alongside professional guidance from ASRM, the society whose practice guidelines shape what clinics evaluate in gestational carriers. So this testing is not simply a clinic preference.

The step most likely to find something. The uterine evaluation is where unexpected findings most often appear: fibroids, polyps, or a septum (a band of tissue dividing the uterus). Some of these can be treated, often with a minor procedure, and then re-evaluated. Whether a finding can be treated, and whether treatment leads to clearance, is the clinic's decision based on your case.

How long it takes. Typically one to several weeks, depending on your cycle timing and the clinic's schedule.

Two separate gatekeepers. You can be accepted by an agency and then declined by a clinic. The agency's view of your application has no bearing on the clinic's medical decision.

Step 4: Psychological Evaluation

The psychological evaluation is a standard part of gestational carrier screening, recommended for all carriers in ASRM guidance and addressed in professional guidance from the American College of Obstetricians and Gynecologists (ACOG) on informed consent. It is not a test of whether you are a good person or a good parent.

Who conducts it. A licensed mental health professional with experience in third-party reproduction.

What it involves. Usually two parts:

1. A standardized psychological assessment instrument, such as the MMPI-2 or PAI. These are long written questionnaires. Evaluators vary in which tool they use, and no single instrument is universally required.
2. A clinical interview, a conversation about your history, your household, your motivation and how you handle stress.

What the evaluator is looking at:

• Whether your expectations are realistic, about the medical side, the time involved and the relationship with the intended parents.
• Emotional resilience, and how you have coped with hard things before.
• Your understanding of relinquishment: that the baby is not yours to keep and will go home with the intended parents.
• Whether any active psychiatric condition would complicate the pregnancy or the process.

A history of therapy is not, by itself, disqualifying. The evaluator is assessing your current functioning and your insight into your own situation.

Your partner. If you have a partner or spouse living with you, they are typically included, either in a joint session or a separate interview.

Who decides. The mental health professional writes a report and makes a recommendation to the clinic and the agency. They do not make the final decision alone.

How long it takes. Usually a single session of two to three hours, with a written report following, often within days to a couple of weeks.

Step 5: Legal Screening and the Surrogacy Agreement

The legal stage produces the surrogacy agreement: the contract between you and the intended parents. No embryo transfer happens until it is signed.

Your own attorney. You have independent legal counsel, separate from the attorney who represents the intended parents. Their attorney represents their interests. Yours represents you. This is a professional and ethical standard, and in many arrangements it is also a contractual requirement. Under most agreements, the intended parents pay your attorney's fees.

What the agreement typically covers:

• Compensation and expense reimbursement. How your base compensation, allowances and reimbursements are structured, and when they are paid. Amounts vary by agency, state and individual agreement, which is why this page quotes no figures.
• Medical decision-making. Who decides what during the pregnancy and delivery.
• Selective reduction and termination. What happens in specific medical situations, such as a multiple pregnancy or a serious fetal diagnosis.
• Insurance. Health insurance for the pregnancy and, commonly, life insurance for you.
• Contact and communication. How often you and the intended parents will be in touch during the pregnancy and after the birth.

You read the draft with your attorney, ask questions, and request changes before signing. Legal clearance means both parties have signed.

Where you live matters. Surrogacy law varies enormously from state to state. California is widely regarded as surrogacy-friendly, with established case law supporting pre-birth orders, the court orders that name the intended parents as the legal parents before the baby is born. If you live elsewhere, your attorney will explain how your state handles this. This page cannot tell you what any contract term should say or how a court will rule.

How long it takes. Typically two to six weeks, depending on how quickly both attorneys turn drafts around.

Typical Timeline: How Long the Full Screening Process Takes

These are general estimates. Every journey differs.

If you start in month one, being cleared before month three would be unusual, even when nothing goes wrong.

What slows it down:

• Clinic scheduling, especially for the uterine evaluation.
• Cycle timing. If a test has to happen on a certain cycle day and you miss it, you wait about a month.
• Records. Hospitals can be slow to send delivery records.
• Attorney availability during contract negotiation.

Where matching fits. Agencies handle this in two ways. Some match you with intended parents after your application and interview, so medical screening happens at that family's clinic. Others complete more of your screening first and then match. Either way, the legal agreement comes after the match, because it is signed with specific intended parents.

Delays are common and normal. A slow stretch does not mean something is wrong with your candidacy.

How You Can Prepare

A few things tend to keep screening moving:

• Request your pregnancy and delivery records early. Prenatal records and hospital delivery notes for each birth are usually the first thing a clinic wants.
• Answer requests promptly. Forms, consent signatures and lab orders often sit waiting on whoever has them.
• Flag schedule constraints early: work shifts, childcare, travel limits, and roughly when your cycle runs.
• Talk with your partner before the psychological evaluation and background check, since both usually involve them.
• Think about support. Screening alone can involve months of appointments and invasive procedures. Knowing who can drive you, watch your children or simply listen makes a difference.

When the Screening Process Gets Complicated

Not every screening runs in a straight line. These are the most common reasons it pauses.

Medical findings. A uterine polyp or fibroid, a borderline lab value, or a BMI outside a clinic's range may mean more testing, treatment, or a period of waiting before re-evaluation. None of these is automatically disqualifying everywhere. The clinic will explain what the finding means and whether there is a path forward.

Psychological follow-up. An evaluator may recommend additional sessions, or a waiting period after a major life event, rather than an outright decline.

Legal negotiation. Selective reduction and termination clauses are the most common reason negotiations take longer. These are deeply personal questions, and it is normal for both sides' attorneys to go back and forth. If your views and the intended parents' views cannot be reconciled, the match may not proceed.

Being declined. A decline at one stage does not always mean you cannot be a surrogate anywhere. Some declines are specific to one clinic's criteria, or to timing, such as how recently you gave birth. Others reflect a condition that most programs would treat the same way. The party that declined you can usually explain which kind it is.

Asking about decline rates. It is a reasonable question to ask any agency how many applicants are declined at each stage, and why. An agency's answer tells you something about its criteria and its candor.

What Happens After Screening Is Complete

Once you are medically and psychologically cleared and the agreement is signed, the clinic schedules a transfer cycle. This is where the medication protocol begins. It commonly involves estrogen to prepare the uterine lining and progesterone, often by daily injection, continuing for weeks. It also involves monitoring appointments with blood work and ultrasounds. The clinic sets the protocol and the schedule. Clearance does not guarantee the transfer will result in a pregnancy, and some women go through more than one transfer.

See Whether You May Qualify

If you want to know where you stand before you apply anywhere, you can contact Surrogate Compass to request a free eligibility review. There is no obligation, and nothing is shared with an agency unless you choose to go further. The review looks at your age, pregnancy history, BMI and household. It tells you whether your situation is likely to meet common requirements, which programs may fit, and what compensation could look like for someone in your circumstances. It is not an approval. Agencies, clinics and attorneys make those decisions, as described above. You can take as long as you need, and come back whenever you are ready.