Programmes most often turn candidates away for these reasons:
- a BMI outside the programme's range, often about 19 to 32 or 33
- no prior full-term pregnancy
- three or more C-sections
- serious past pregnancy complications
- uncontrolled chronic illness
- current nicotine or marijuana use
- certain medications
- active untreated mental illness
- a felony record
No single list applies everywhere. Agencies, clinics and physicians set and apply their own standards.
You may be reading this before you have mentioned surrogacy to anyone. Many women start this way, checking quietly whether the idea is even realistic for their body and their household. This page sets out what programmes commonly look at and why each requirement exists. It does not tell you whether you qualify. That decision belongs to an agency, a fertility clinic, a physician reviewing your records and, on the contract, an attorney.
Surrogate Compass is an independent platform for women considering gestational surrogacy in the United States. We explain eligibility, compensation and the process from your side, and we connect candidates with agencies. The agencies do the screening, matching, contracting and paying. California appears in its own section below because our state coverage is deepest there.
Why Surrogacy Eligibility Requirements Exist
The requirements come from three separate places:
- Fertility clinics set medical protocols. These cover your body, your history and your fitness for an IVF transfer and pregnancy.
- Agencies set screening standards. These cover background, household, stability and readiness.
- State law sets the legal conditions for a valid surrogacy contract.
Passing one layer does not mean passing the others.
Most clinics use guidance from the American Society for Reproductive Medicine (ASRM) as a baseline when they set gestational carrier criteria. A baseline is a floor, not a ceiling. Any clinic or agency can apply stricter standards, and many do. That is why two programmes can look at the same candidate and reach different answers.
A short online questionnaire is only a first filter. Passing it is not qualifying. The medical evaluation, the psychological evaluation and the record review come later. They carry far more weight.
These rules can feel like gatekeeping. Most of them exist to protect your health during a pregnancy that is not yours to keep. They also protect the pregnancy itself and the legal soundness of the arrangement. If a rule makes sense to you, it is easier to judge whether it applies to you. Each section below explains the reason behind the rule as well as the rule itself.
Medical Conditions That Typically Disqualify a Surrogate
BMI. Most clinics look for a BMI between about 19 and 32 or 33. Some cap lower and a few go slightly higher. The number matters for three reasons:
- A higher BMI raises the risks around anesthesia, which matters if you need a C-section.
- It raises the risk of gestational diabetes.
- It can lower the chance that an embryo transfer succeeds.
A BMI below the range raises its own concerns about nutrition and pregnancy. The page on surrogate BMI requirements covers how programmes apply the range.
Uterine abnormalities. Some conditions can interfere with implantation or with keeping a pregnancy going:
- fibroids in certain locations
- a uterine septum
- significant scarring inside the uterus, known as Asherman's syndrome
Some of these can be treated and some cannot. Imaging and a physician's review decide which applies.
Chronic conditions. Programmes usually decline candidates with the following:
- uncontrolled diabetes or uncontrolled hypertension
- autoimmune disorders that need immunosuppressant medication
- active cancer or a recent cancer history
The word "uncontrolled" carries weight here. A well-managed condition is assessed differently from one that is not.
Past pregnancy complications. Preeclampsia, placenta previa, placental abruption and preterm labor can each raise the risk in a later pregnancy. The American College of Obstetricians and Gynecologists (ACOG) publishes guidance on these obstetric risk factors. A clinic weighs several things:
- how severe the complication was
- whether it happened once or more than once
- what caused it
- how your other pregnancies went
None of this is automatic in either direction.
Tobacco and vaping. Most programmes want nicotine stopped well before screening. A cessation period of 6 to 12 months is common, though it varies. Nicotine affects how the placenta works and how the baby develops.
Prescription medications. Some medications are not considered safe in pregnancy, and current use can rule a candidate out unless a physician can safely change or stop them. These are your own prescriptions. They are separate from the surrogate medication protocol that the clinic prescribes for the transfer cycle.
Infectious disease. Screening for HIV, hepatitis B and hepatitis C is standard. Some programmes have updated their protocols for certain conditions. Even so, an active infection is typically disqualifying.
Reproductive History Requirements
Most programmes require at least one prior pregnancy carried to term and delivered. That history shows your uterus has carried a pregnancy before. It also gives the medical team a record to evaluate.
Many programmes go further. They require that you are currently raising at least one child, not only that you have given birth. This is partly a psychological safeguard. A woman who is raising her own child knows what pregnancy and parenting involve, and her own family is already formed.
C-sections. Many clinics limit candidates to two prior C-sections. Each additional surgery adds scar tissue, and with three or more the risk of uterine rupture rises enough that many clinics decline. Clinics also look at more than the count: how the scar has healed, and how far apart your deliveries were.
Pregnancy loss. Recurrent miscarriage is usually defined as two or more losses. It may be disqualifying, depending on the cause. A loss with a known, one-off cause is weighed differently from an unexplained pattern.
Tubal ligation. Having your tubes tied is not usually a barrier on its own. In gestational surrogacy, the embryo is placed directly into the uterus through IVF, so your fallopian tubes play no part.
Gestational or traditional. In gestational surrogacy, the embryo is created from the intended parents' or donors' eggs and sperm, and you have no genetic connection to the baby. In traditional surrogacy, the surrogate's own eggs are used. Most agencies and clinics in the US work only with gestational surrogacy. Every requirement on this page assumes that model.
Psychological and Mental Health Factors
Expect a conversation, not a test. A licensed mental health professional evaluates you as a standard part of screening. Nothing about it resembles an IQ test or a personality exam. It looks at four things:
- how ready you are
- why you want to do this
- who supports you
- how well you understand what the process involves
Active, untreated serious mental health conditions are typically disqualifying. Examples include schizophrenia, bipolar I disorder with recent episodes, and active major depression. Programmes also look at current psychotropic medication. If a medication is not considered safe in pregnancy, that can matter.
A history of postpartum depression is weighed by how severe it was. A mild episode is not automatically disqualifying. A severe or psychotic postpartum episode typically is, because the same risk can return after a later delivery.
Motivation is explored openly. Wanting the compensation is normal, and evaluators know that. They are concerned when money is the only reason and the household is in financial crisis. In that situation, the emotional complexity of a year-long process tends to be harder to handle.
Support matters too. Evaluators commonly ask about a partner, family or close friends who know about the plan and back it. The absence of that support is a frequent concern. If you have experienced relinquishment trauma or complicated grief after a pregnancy loss, expect those subjects to be discussed in some depth.