Surrogate Screening: What to Expect at Every Stage

If you are exploring surrogacy, either as a potential surrogate or as an intended parent hoping to match, you have probably heard that the screening process is "thorough" and "comprehensive." What you probably have not heard is what actually happens at each step, how long it takes, and what can trip things up along the way.

I learned a lot of this the hard way. Before I founded The Biggest Ask, my husband and I spent months preparing to journey with a potential surrogate who was, by every measure, a dream candidate. She was a NICU nurse. She was a mother of two healthy kids. She was a family connection. She passed the fertility clinic's initial medical clearance. And then she texted me that she was pregnant with her own baby. Just like that, everything we had built together fell apart.

Here is what I know now that I did not know then: proper screening is not a formality. It is the foundation that holds the entire journey together. A formal screening process, including a psychological evaluation, might have revealed that she was not quite ready to close the door on her own family. It would have saved all three of us a tremendous amount of time and heartache.

Whether you are a surrogate reading this to know what you are signing up for, or an intended parent wanting to understand what the process really looks like, this guide walks you through it honestly.

Why Screening Exists (and Why It Cannot Be Skipped)

Gestational surrogacy places real physical and emotional demands on a woman. The screening process exists to confirm, before anyone's embryo is involved, that a candidate is genuinely ready and medically suited for the journey.

In the United States, the American Society for Reproductive Medicine (ASRM) sets the minimum standards for surrogate screening. Fertility clinics are bound by these guidelines. Surrogacy agencies typically add their own layer on top. What this means in practice is that the fertility clinic, not the agency, has the final word on medical clearance. An agency might approve a surrogate that a specific clinic will not clear, and vice versa. This is important to understand upfront, because it shapes everything.

Most surrogacy agencies and clinics also follow the guidelines set by SEEDS, the Society for Ethics in Egg Donation and Surrogacy, which address psychosocial standards in addition to medical ones. Together, these two frameworks form the backbone of what you will experience during screening.

Phase 1: The Initial Application

The first step is usually a screening form or application. At The Biggest Ask, our initial form covers several key categories:

Personal information including relationship status, employment, and living situation
Health and lifestyle covering weight, cycle regularity, smoking status, alcohol use, medications, and chronic conditions
Pregnancy history including number of pregnancies, delivery types, birth weights, complications, and any experience with postpartum depression
Legal and financial background including criminal history, civil suits, bankruptcy, and whether the applicant receives any government assistance
Insurance status including whether the policy is surrogate-friendly
Surrogacy motivation and preferences covering why she wants to become a surrogate, her feelings about selective reduction, how many transfer cycles she is willing to commit to, and where she would prefer to deliver
Partner information because partners are part of this process too, and their background, support, and readiness matter

This initial form is not just paperwork. It is the beginning of a real conversation. Answering honestly here, even about things that feel uncomfortable, is always better than having a difficult fact surface later in the process.

Phase 2: Confirming the Basic Requirements

Before the deeper screening stages begin, certain baseline requirements must be met. Most clinics follow the ASRM guidelines, which set the following standards for surrogate candidates:

Be between the ages of 21 and 42
Have carried at least one pregnancy to term, with no major complications
Have had no more than three deliveries by C-section
Have a stable home environment with emotional and practical support
Have a body mass index (BMI) under 32 to 33 (though some clinics set a lower limit, and individual clinic requirements vary)
Not smoke, or have anyone in the household who smokes
Not have a history of substance abuse
Not be receiving welfare, Medicaid, public housing, or government cash assistance
Not have a criminal record
Have no active or recent mental health conditions requiring medication, such as antidepressants in the last six months

It is worth noting that some clinics are stricter than others on each of these points. I always tell intended parents to check with their specific clinic early, because a surrogate who would be cleared by one clinic might not be cleared by another. The earlier you know your clinic's specific requirements, the smoother this phase goes.

Phase 3: Medical Records Review

Once a surrogate has cleared the initial application, the next step is a review of her actual medical records. The agency or fertility clinic will request her full obstetric records from her OB/GYN, including documentation of all previous pregnancies, delivery outcomes, blood pressure patterns throughout those pregnancies, and any complications that came up.

Many clinics and agencies will also request a letter directly from the surrogate's primary OB/GYN stating that, in that doctor's assessment, she is fit for pregnancy. This letter is separate from the records themselves and reflects the OB/GYN's current clinical opinion.

What happens during records review is not a rubber-stamp process. A thorough review looks for patterns that might not show up on a screening form: elevated blood pressure across multiple pregnancies, a history of gestational diabetes, preterm labor, or uterine complications. These things do not automatically disqualify a candidate, but they do inform what comes next.

Phase 4: The In-Person Medical Examination

If the records review looks good, the surrogate will move to an in-person medical examination at the fertility clinic. This is usually scheduled after the intended parents and surrogate have matched, because it is done at the IPs' clinic.

At this appointment, the surrogate can expect:

Physical exam and vital signs

Height, weight, BMI, and blood pressure are measured. The doctor will conduct a general physical examination.

Pelvic ultrasound

An internal pelvic ultrasound is performed to evaluate the uterine lining and look for any issues such as fibroids, cysts, or polyps. This is the most common point where surrogates encounter obstacles. Issues like an irregular uterine lining or the presence of a polyp can delay the journey, though most of these situations are treatable. The fertility clinic will advise on next steps if something comes up.

Bloodwork panel

A comprehensive blood panel is drawn, which typically includes:

Complete blood count (CBC)
Hormone and thyroid panel
Infectious disease and STI screening (for both the surrogate and her partner, if applicable)
Immunity panel (measles, mumps, rubella, varicella)
Vitamin levels including Vitamin D
Drug and alcohol toxicology

Results from the bloodwork typically take about two weeks to return, which is why the final medical clearance timeline is usually two to three weeks from the appointment date.

PAP smear

If the surrogate is due for one or has not had a recent clear result, a PAP smear will be completed.

Most surrogates pass the in-person medical examination. When something does come up, it is usually addressable. Fertility clinics are experienced with these situations and will walk both the surrogate and the intended parents through what the next steps look like.

Phase 5: The Psychological Evaluation

This is the part of screening that I feel most strongly about, because it is also the part most likely to be skipped or rushed, especially in independent journeys.

Most fertility clinics require both the surrogate and the intended parents to complete a psychological evaluation before proceeding to a transfer. At The Biggest Ask, we require it regardless, and I am emphatic about why. As I said on our YouTube channel: only a professional can truly assess whether someone is mentally ready to start a surrogacy journey. A potential surrogate might answer every question perfectly and still not be ready for what the experience actually asks of you.

The psychological evaluation for surrogates typically has two components:

Personality Assessment Inventory (PAI)

This is a standardized psychometric test that takes about 30 to 45 minutes to complete. It assesses personality traits and screens for clinically significant concerns. It is not something you study for. The goal is to get an accurate picture of where you are emotionally and psychologically.

Clinical interview with a licensed mental health professional

A licensed therapist or psychologist who specializes in reproductive mental health will conduct a structured interview. She or he will want to understand your motivations for pursuing surrogacy, your support system at home, how you plan to handle the emotional aspects of the journey (including the postpartum period and handing the baby over), and your relationship dynamics if you have a partner. Your partner or spouse may be asked to participate in part of this interview as well.

This evaluation is not designed to disqualify people. It is designed to surface anything that might make the journey harder than it needs to be, and to give both the surrogate and the intended parents a chance to address it before the embryo transfer happens.

The timing of the psychological evaluation depends on the path. Agency surrogates often complete their psych eval before they are ever matched, sometimes before they have even met a potential IP. Independent surrogates typically complete it after medical records review, often around the time of or after the in-person medical examination.

The IPs also complete a psychological evaluation, though it is typically less intensive than the surrogate's. An IPs evaluation focuses on their emotional readiness for the journey and the relationship dynamics they bring to the match.

Phase 6: Background Checks and Lifestyle Review

Background checks run for the surrogate and, in most cases, all adult members of her household. This includes criminal history screening and, depending on the agency or clinic, financial background checks as well. At The Biggest Ask, we verify this during the application process and consent is confirmed on the initial screening form.

Beyond the formal background check, the lifestyle review covers housing stability, financial independence, the practical support system the surrogate has at home (especially if bedrest becomes necessary), and her overall readiness for the months ahead. This is not about judgment. It is about making sure the conditions exist for a safe and well-supported pregnancy.

What Happens If Something Comes Up

Finding a flag during screening does not always mean the journey is over. Here are some of the most common situations and how they typically play out:

Uterine polyp or fibroid: Often treatable with a minor outpatient procedure before the transfer. The surrogate may need to wait a cycle or two, but many continue successfully.
Elevated blood pressure: The clinic will want to monitor this and may require a note from the surrogate's physician. Situational blood pressure spikes from stress are different from chronic hypertension.
BMI just above the clinic's limit: Some clinics will work with a surrogate who is close to their limit. Others will not. Knowing the clinic's specific cutoff early prevents surprises.
Mental health history: This is case-by-case. Some clinics accept surrogates who take antidepressants; others do not. A history of successfully treated depression, with no current symptoms, is evaluated differently than active treatment. The psych evaluator's report carries significant weight here.
Partner flags: If a partner's background check or STI panel raises something, the clinic will advise on next steps. Partners are part of the surrogacy team, and their health and legal standing matter.

Key Takeaways

The fertility clinic has final say on medical clearance, not the agency. Always confirm your clinic's specific requirements early in the process.
Screening happens in stages: application, records review, in-person medical exam, psychological evaluation, and background check. Each stage builds on the last.
The psychological evaluation is not optional, even in independent journeys. Skipping it is one of the most common and costly mistakes both surrogates and intended parents make.
Most surrogates who reach the in-person medical exam pass it. When something comes up, it is usually addressable with time and the right medical guidance.
Being honest at every stage, especially on the initial application, protects everyone involved. Information that surfaces late is always harder to manage.

How The Biggest Ask Approaches Screening

At The Biggest Ask, our screening process is built around the belief that the right match and the right preparation make the journey. When we work with potential surrogates, we walk through the initial application together and make sure you know exactly what to expect at each phase. For intended parents, we help you understand what your fertility clinic requires and how to evaluate the surrogates you meet.

If you are considering becoming a surrogate or are an intended parent trying to understand whether a potential match is truly ready, our matching program and our free surrogacy guide are good starting points. This journey is deeply personal, and it deserves to be done right.

Have questions about the screening process? Reach out at hello@thebiggestask.com or visit thebiggestask.com to learn more about our matching and education programs.

If you want to go deeper, you can also read Surrogate Requirements: Who Qualifies to Become a Surrogate in 2025-2026, Independent Surrogacy: Pros, Cons, and How to Do It on Your Terms, and How Much Do Surrogates Get Paid? A Real Compensation Breakdown.