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A Surrogate’s Ultimate Guide: The Medical Pre-screening Process

Gestational surrogacy is on the rise as hopeful parents who are unable to carry a pregnancy themselves seek out this option to complete their families. Gestational surrogacy is not new. What was once deemed an option only for the wealthy, changes in law, regulation, and insurance have made gestational surrogacy more accessible than ever before. While there are many hopeful parents, there are far fewer surrogates, and often, that’s due to barriers or fear of the medical pre-screening process potential surrogates must undergo to qualify.

What is gestational surrogacy? 

Gestational Surrogacy is a method of assisted reproduction in which a surrogate mother carries a baby to term on behalf of the intended parents. Unlike traditional surrogacy, where the gestational carrier’s eggs are used, gestational surrogacy only requires the surrogate mother’s uterus, and the baby has no relation to the surrogate whatsoever. 

Instead, an embryo created through in vitro fertilization (IVF) using the eggs and sperm of the intended parents or donors is transferred to the surrogate’s uterus. This method allows individuals or couples to become parents despite fertility issues or medical conditions. 

However, before a surrogate can make an intended parent’s dreams of a family come true, they must undergo a series of screenings – both medical and psychological. These screenings are required of anyone serving as a surrogate in assisted reproduction.

Why is Medical Screening Necessary? 

Medical screening plays a crucial role in the surrogacy journey to ensure the health and well-being of all parties involved. Intended parents are often investing not just money but emotions as well, and pre-screening a surrogate provides peace of mind and the best chance of success at the end of the journey – a beautiful, healthy baby. 

The screening process is rigorous and comprehensive and aims to identify any risks and physical or psychological conditions. While the terms “rigorous” and “comprehensive” can make you feel like you need to start practicing to run a marathon, don’t let it scare you. One of our surrogates, Maile, describes the process as “easy” and “super smooth.”

Up next in our “Ultimate Guide” series, we’ll break down the components of the medical screening process for those seeking to serve as gestational surrogates. In this blog, we’ll share what it’s like to undergo screening from a clinical and the gestational surrogate’s perspective.

The Medical Screening Process

Initial Consultation and Medical History Review

The first step in the gestational surrogacy medical screening process is an initial consultation with a fertility specialist or reproductive endocrinologist. During this consultation, the surrogate will meet with the medical team to discuss their medical history and expectations for the surrogacy journey.  

Once you’ve completed a ton (and we do mean “a ton”) of paperwork, you’ll meet with a clinician to review your medical history. You’ll be asked about prior pregnancies, deliveries, miscarriages, complications, medical conditions, etc.  The medical team will also explain what happens during the surrogacy cycle, including the medications that will be taken and any associated risks.  The purpose of the initial consultation is to lay the foundation for a healthy working relationship with the medical team and establish trust and good communication. 

Physical Exam and Bloodwork

Once you’ve completed the medical review and it’s been determined your medical history doesn’t contain any disqualifiers such as high blood pressure or diabetes, you’ll complete a physical exam and bloodwork. The physical exam is very similar to a routine Gynecological exam. The doctor will measure your weight and height and complete a pelvic exam. 

Bloodwork can only be done one way… via blood draw. The tests they’ll perform are for infectious diseases, hormone levels, blood type, Rh factor, vitamin and mineral levels, and immunity to certain diseases.  Blood screening ensures you’re healthy and free from any potential risks that could affect the pregnancy or the baby. 

Ultrasound or Hysteroscopy

Following the physical exam and bloodwork, the doctor will perform an ultrasound to assess your uterus. Evaluating your uterus is an essential component of the medical screening process. This involves a vaginal ultrasound to examine the uterus and assess its shape, size, and overall condition.  

Sometimes, a clinic will also perform a hysteroscopy.  An anesthetic is often used, and surrogates can also be placed under light sedation for their comfort.  A thin scope is inserted vaginally, which allows the physician to evaluate your uterus and also remove any tiny polyps or check on scar tissue (perhaps from a prior c-section).  The procedure is quick – 30 minutes or less.  And most surrogates resume normal activities the same day.

Hormone Assessment

Hormone balance is critical for a successful pregnancy. Therefore, hormonal assessments are done during the medical screening. Your estrogen and progesterone are measured at specific times during your menstrual cycle to ensure they’re within the optimal range for successful embryo implantation and development of the pregnancy.  Your thyroid is also checked because thyroid hormones influence how your body metabolizes estrogen (which surrogates take in certain doses to prepare for embryo transfer) and the receptivity of your endometrium (how welcoming of an environment your uterus may be for that embryo).

“That’s a lot of tests! How long will this take?” 

We felt it best to use Maile’s words to describe her medical screening experience here:

“Medical screening was super smooth. It was semi-local (about 100 miles away). I made it into a girl’s day trip with my best friend.

Regarding preparation, I didn’t have to change anything as I live a healthy and active lifestyle. The appointment took about an hour.

The clinic was so friendly and professional. They allowed my IM (Intended Mother) to join me. I was cleared in about a week as my bloodwork was reviewed. Everything came back great! I was a bit low on Vitamin D (it was Winter), so they just recommended I supplement with a daily vitamin. They wrote me a prescription for their preferred prenatal, and I began those ASAP. I was so happy to be able to start planning our transfer date!”


The gestational surrogacy medical screening process is a comprehensive and vital part of the surrogacy journey. It ensures the health and well-being of the intended parents, surrogate, and the unborn baby. From medical history evaluations to infectious disease screening, psychological evaluations, and hormone assessments, each step holds significant importance in determining the suitability and success of the surrogacy process. 

By understanding the medical screening process, you and the intended parents can embark on the journey with confidence, knowing that they have taken all necessary steps to ensure a healthy and successful pregnancy and birth.

If you or someone you know is considering giving the gift of family, our agency is here to help navigate the surrogacy journey and answer any questions you have. Reach out to us today!

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