Medical screening is one of the most important safeguards in a gestational-surrogacy journey.
But there is an important distinction that often gets lost online:
Agency pre-screening and fertility-clinic medical screening are not the same thing.
At Simple Surrogacy, potential surrogates go through an initial screening process before they are presented for matching. This includes reviewing pregnancy and delivery records, background screening, psychological evaluation, insurance review, and confirming that the applicant meets our general program requirements.
After a surrogate and intended parents choose one another, the intended parents’ fertility clinic performs a separate medical evaluation. That clinic—not the agency—ultimately decides whether the surrogate is medically cleared to proceed toward embryo transfer.
The exact testing varies by clinic and individual medical history, but professional guidance from the American Society for Reproductive Medicine recommends a comprehensive evaluation that includes medical history, physical examination, infectious-disease testing, preconception testing, uterine-cavity evaluation, psychosocial evaluation, and legal counseling.
Here’s what surrogates and intended parents should expect.
A gestational surrogate is volunteering to undergo fertility treatment and another pregnancy.
Even someone who has had several healthy pregnancies needs to be evaluated again before embryo transfer.
Health changes.
Pregnancy history matters.
Previous deliveries matter.
Medications may change.
New medical conditions can develop.
And fertility treatment itself introduces procedures and medications that were probably not part of the surrogate’s previous pregnancies.
Medical screening is therefore designed to answer a basic question:
Does the fertility clinic believe another pregnancy and embryo-transfer cycle are medically appropriate for this particular woman at this particular time?
It cannot eliminate every pregnancy risk.
No screening process can do that.
Its purpose is to identify foreseeable concerns before treatment begins and reduce avoidable risk for the surrogate and pregnancy.
At Simple Surrogacy, we do not wait until intended parents select a surrogate before looking at whether she appears to meet the basic qualifications.
Our pre-screening process starts much earlier.
A potential surrogate completes an application and interview, signs authorizations allowing us to obtain relevant medical records, and provides information about her previous pregnancies and deliveries.
We review whether she appears to meet our current surrogate requirements, including age, pregnancy history, BMI, lifestyle, support system, and other program criteria.
Background screening, insurance review, and psychological consultation are also part of the process before matching.
You can review our complete Surrogate Requirements guide and our How to Become a Surrogate guide for more information about these initial steps.
The goal is to avoid presenting intended parents with candidates who have not first undergone meaningful pre-screening.
But this initial process is not final medical clearance.
This distinction is important for both surrogates and intended parents.
Agency pre-screening helps determine whether a potential surrogate appears eligible to enter the program and matching process.
At Simple Surrogacy, that can include:
Once a match is established, the intended parents’ fertility clinic performs its own evaluation.
This can include:
The fertility clinic then determines whether it will medically approve the surrogate for treatment.
An agency cannot override that decision.
At Simple Surrogacy, final clinic screening normally occurs after matching.
The surrogate and intended parents first choose each other through the matching process.
Once everyone agrees to move forward, the surrogate is scheduled with the intended parents’ fertility clinic for medical evaluation.
This matters because some older descriptions of surrogacy screening make it sound as though every surrogate receives a complete fertility-clinic evaluation before an intended-parent match exists.
That generally is not how the process works.
The agency completes substantial pre-screening first.
The intended parents’ actual fertility clinic then performs its own final medical assessment after the match.
You can read more about how the parties reach that point in our Surrogate Matching guide.
Previous pregnancy and delivery records are extremely important.
The clinic may review records documenting:
One reason surrogates must have previously carried a pregnancy is that those records give fertility specialists actual evidence of how the potential carrier’s body responded to pregnancy.
ASRM recommends that gestational carriers ideally have experienced at least one uncomplicated term pregnancy. It also recommends that, ideally, a carrier have no more than five previous deliveries or three C-section deliveries.
Those are professional recommendations rather than guarantees that every clinic will apply identical rules.
The clinic evaluates the complete medical picture.
The exact appointment varies by fertility clinic.
A reproductive endocrinologist or other qualified medical professional may review the surrogate’s medical history and perform an appropriate physical and reproductive-health evaluation.
The physician may discuss:
This is also a good opportunity for the surrogate to ask questions about the clinic’s embryo-transfer protocol.
Screening should not simply happen to the surrogate.
She should understand why testing is being done and what the clinic expects from her.
Testing varies by clinic, but professional recommendations commonly include blood type and Rh factor and testing for immunity or susceptibility to certain infections.
The clinic may also order additional bloodwork based on its protocols and the surrogate’s medical history.
One important point: there is no single universal laboratory checklist used by every fertility clinic.
Clinics can establish requirements that go beyond professional minimum recommendations.
So a surrogate who was medically approved by one clinic during a previous journey may still need new testing—and may even encounter different criteria—during a later journey with another clinic.
Infectious-disease screening is an important part of preparing for embryo transfer.
ASRM recommends infectious-disease testing of gestational carriers even though FDA donor-eligibility regulations primarily govern reproductive tissue donors rather than requiring the same screening of the gestational carrier herself.
Common recommended testing can include infections such as:
Testing requirements can also extend to the surrogate’s partner in some circumstances.
The exact laboratory panel depends on clinic protocols, current professional guidance, medical history, and applicable regulations.
Travel, recent tattoos or piercings, sexual-health history, and other potential exposure risks may also be discussed.
The important point is that infectious-disease screening is based on current risk and medical guidance, not simply a decades-old checklist.
Often, yes.
ASRM recommends checking immunity to rubella and varicella as part of preconception evaluation.
If someone is not immune, the fertility clinic may recommend vaccination before pregnancy.
Some vaccines cannot be given during pregnancy, so identifying immunity issues before embryo transfer allows time to address them appropriately.
The clinic determines what is required and how long treatment should be delayed after any necessary vaccination.
It may be.
ASRM’s preconception recommendations include urine drug screening, and fertility clinics may also have policies relating to nicotine, marijuana, alcohol, prescription medication, and other substances.
Simple Surrogacy has its own lifestyle requirements as part of initial eligibility as well.
Surrogates should disclose medications and substance use accurately.
Trying to hide a medication or exposure because you are worried it may affect approval can create a much larger issue later.
Because an embryo will ultimately be transferred into the uterus, fertility clinics want to evaluate the uterine cavity before treatment.
ASRM recommends uterine-cavity evaluation.
One commonly used method is a saline-infusion sonogram, sometimes called a saline sonogram or sonohysterogram.
During this procedure, sterile saline is introduced into the uterine cavity while ultrasound is used to evaluate its shape and look for potential abnormalities.
A clinic may use another appropriate method depending on the circumstances.
The purpose can be to identify conditions such as:
Not every surrogate undergoes exactly the same procedure.
That is why I would avoid an evergreen article stating that every surrogate receives an HSG or hysteroscopy.
The correct statement is that the fertility clinic determines the appropriate method of uterine-cavity evaluation.
This is another place where older information can be misleading.
A gestational surrogate does not contribute the egg used to create the embryo.
Because she is not a genetic contributor, routine genetic-carrier screening of the surrogate for diseases such as cystic fibrosis or sickle-cell disease is not the same central requirement it would be for someone contributing an egg or sperm.
ASRM recommends genetic evaluation of the genetic contributors—the people providing the egg, sperm, or embryo.
A surrogate may still undergo genetic testing if her individual medical history gives the clinic a reason to order it.
But we should not tell readers that broad genetic-carrier screening is universally part of every gestational surrogate’s medical-screening checklist.
For more information about why the surrogate is not genetically related to the baby, see our Gestational Surrogacy vs. Traditional Surrogacy guide.
Usually, ovarian reserve is not the central issue in gestational-surrogate screening because the surrogate is not providing the egg.
Older screening lists sometimes include tests such as cycle-day FSH almost automatically.
That can create confusion.
In a gestational-carrier arrangement, the clinic is primarily evaluating whether the surrogate can safely undergo treatment, receive an embryo, and carry a pregnancy.
The fertility clinic may order additional hormonal testing when medically appropriate, but ovarian-reserve testing should not be presented as though the surrogate were an egg donor or IVF patient using her own eggs.
Group B streptococcus screening is routinely associated with later pregnancy, not generally with deciding whether a woman can initially serve as a gestational carrier.
ACOG recommends routine GBS screening during each pregnancy near the end of gestation so appropriate antibiotics can be given during labor when indicated.
For that reason, we would not include Group B strep as though it were a universal pre-match or pre-transfer surrogate-screening requirement.
It is another example of why old medical-screening checklists should be reviewed rather than copied forward indefinitely.
It is better to think of psychological evaluation as a separate but equally important part of overall surrogate screening.
Simple Surrogacy arranges psychological consultation as part of our pre-match process.
The mental-health professional may discuss:
ASRM recommends psychosocial evaluation and counseling for gestational carriers.
The exact evaluation method is determined by the qualified mental-health professional. Psychological testing may be used when appropriate, but we would not tell applicants that one specific test—such as the MMPI—is universally required in every surrogacy journey.
A spouse or partner can be relevant both medically and psychologically.
ASRM recommends infectious-disease testing of the gestational carrier’s partner in certain circumstances before embryo transfer.
Partners may also participate in psychological screening because a surrogate pregnancy affects the household as a whole.
Their support matters.
There may be appointments, travel, medications, pregnancy symptoms, restrictions, childcare needs, delivery, and postpartum recovery.
A successful journey requires more than the surrogate herself being enthusiastic.
Her home support system needs to be realistic too.
Yes.
Responsible screening should not operate in only one direction.
At Simple Surrogacy, intended parents complete background screening and psychological consultation before matching.
The people contributing eggs or sperm also undergo medical and infectious-disease screening according to the requirements applicable to their fertility treatment.
ASRM recommends medical, infectious-disease, psychological, genetic, and legal considerations for intended parents and genetic contributors as part of a gestational-carrier arrangement.
Surrogates deserve to know that intended parents are being prepared for the relationship too.
The intended parents are responsible for approved costs associated with their surrogacy journey, including the surrogate’s required medical screening.
A surrogate should not be expected to personally pay for travel, medical screening, childcare, or other approved costs required because intended parents need her to attend their fertility clinic.
Those details are handled through the program’s financial arrangements and ultimately the gestational-carrier agreement.
At Simple Surrogacy, funds intended for surrogate expenses and compensation are handled through independent escrow rather than being held as agency operating funds.
Possibly.
The medical screening is generally performed by the intended parents’ fertility clinic.
If that clinic is located in another city or state, travel may be necessary.
Depending on the situation, that can involve:
Approved travel and related expenses should be arranged and funded according to the surrogacy program and eventual agreement.
Finding something during screening does not automatically mean something is seriously wrong.
A test may need to be repeated.
A physician may request additional records.
The clinic may want another specialist’s opinion.
An infection may need treatment.
A uterine finding may need further evaluation.
A medication may need to be reviewed.
Sometimes an issue creates only a delay.
Other findings may mean the clinic does not believe proceeding with pregnancy is appropriate.
The medical professionals—not the agency or intended parents—make the medical-clearance decision.
This is important because screening generally happens after a match has been made.
If the fertility clinic does not approve the surrogate, the embryo-transfer process does not proceed with that candidate.
The next step depends on why she was not approved and whether the issue is temporary or permanent.
A surrogate may be asked to complete additional testing or treatment.
In other circumstances, the match may need to end and the intended parents return to matching.
This can be disappointing for everyone.
But the purpose of screening is not to preserve a match at all costs.
It is to determine whether moving forward is medically appropriate.
No.
This is one of the most important things both surrogates and intended parents need to understand.
Medical clearance means the fertility clinic determined that the surrogate met its criteria to proceed with treatment at that time.
It cannot guarantee:
Pregnancy always involves uncertainty.
Good screening reduces avoidable risk.
It does not eliminate all risk.
There is no universal timeline.
Timing may depend on:
This is why medical-screening timelines should be viewed as estimates rather than guarantees.
Once the fertility clinic issues medical clearance, the journey generally moves into the legal phase.
The intended parents have their attorney.
The surrogate has her own independent attorney.
The gestational-carrier agreement is drafted, reviewed, negotiated as necessary, and signed before treatment proceeds.
You can learn more in our Surrogacy 101 Legal Process guide.
Only after the required legal and financial arrangements are complete does the fertility clinic move toward the medication cycle and embryo transfer.
Our Surrogate Pregnancy Process explains what happens from medications through transfer and pregnancy.
Simple Surrogacy performs extensive pre-screening before matching. Final medical clearance by the intended parents’ fertility clinic occurs after a match is established.
The fertility clinic ultimately determines whether it will medically approve a surrogate for embryo transfer.
Simple Surrogacy uses ASRM guidance as an important professional framework, while individual fertility clinics establish their own medical protocols and may impose additional requirements.
No. There is substantial overlap, but individual clinics can require different testing based on their protocols, the surrogate’s history, current professional guidance, and applicable regulation.
Yes, blood and other laboratory testing are normally part of fertility-clinic screening. The exact tests depend on the clinic.
Yes. Infectious-disease evaluation is an important part of preparing a gestational carrier for embryo transfer.
Potentially. ASRM recommends certain infectious-disease testing of a gestational carrier’s partner as part of the process, and clinic protocols vary.
Not routinely simply because you are the gestational carrier. Genetic-carrier screening primarily concerns the people contributing the egg and sperm. A physician may order additional testing when your personal or family medical history warrants it.
Not necessarily. ASRM recommends evaluation of the uterine cavity, but the fertility clinic determines which method is appropriate. A saline-infusion sonogram or another modality may be used.
You will still need medical evaluation for a new journey. Health changes over time, test results expire, and different clinics have different protocols.
Yes. Previous uncomplicated pregnancy is an important qualification, but it is not the only factor the fertility clinic evaluates.
Medical-clearance decisions belong to the fertility clinic. Intended parents cannot simply waive a clinic’s medical standard because they like a particular surrogate.
Medical screening is sometimes described primarily as something that reassures intended parents.
That is only half the story.
The surrogate is the person whose body will undergo medications, embryo transfer, pregnancy, delivery, and recovery.
Screening should therefore protect her first.
At Simple Surrogacy, we believe a strong program starts by carefully pre-screening women before matching and then respecting the independent medical judgment of the intended parents’ fertility clinic.
No one benefits from rushing a candidate through screening simply because everyone likes the match.
The right question is not:
“How quickly can we get her approved?”
It is:
“Do the professionals involved believe this woman can appropriately move forward with another pregnancy?”
If you are considering becoming a surrogate, start by reviewing our current Surrogate Requirements, our How to Become a Surrogate guide, and the Surrogate Pregnancy Process.
If you are an intended parent, our Surrogacy Process Overview for Intended Parents explains where screening fits into the complete journey.
Good screening takes time.
That time is part of protecting everyone involved.
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