What Screenings Are Required for Gestational Surrogacy?

Any woman who wants to be a gestational carrier has a big heart, loves pregnancy (and is good at it), and enjoys giving birth. But is that enough? How else do agencies and fertility centers determine whether or not a woman is a good candidate to be a gestational carrier?

For intended parents looking for someone to carry a baby for them, a lot of attention is paid to who might be a perfect “match.” This is a critical step, of course – all parties must feel a genuine connection to one another and want to spend the next year or so working together in pursuit of a baby.  But beyond the basic personality match, a potential gestational carrier must pass many other screenings before being cleared to carry a baby.

If a woman is working through a surrogacy agency to find a couple to carry for, the agency will conduct their own initial screening process even before accepting her into their program to be considered for a match. Each agency is different (so there is no one universal screening process), but the screening process for most agencies include:

A written application form that covers topics including physical and mental health background, educational and work history, pregnancy history, family descriptions and living arrangements, motivations and expectations for surrogacy, and more. Many agencies request potential surrogates to submit photos of herself and her family, and some request photos of her home.

An extensive interview with a member of the agency, which may be done in person if feasible, or via telephone or video chat if distance is an issue. During this interview the agency will follow up on any questions from the application as well as go into more details about the surrogacy process, ensuring that the woman has a thorough understanding of the requirements and responsibilities for a gestational carrier.

A psychological screening with a licensed mental health professional. Some agencies do this as part of their initial screening process, while others wait until there’s a potential match with intended parents. In most cases a psychologist will administer a written tool that assesses various personality traits and evaluates basic mental health, and issue a report back to the surrogacy agency.

References and a background check.  Some agencies may conduct these as part of their own screening process, some wait until the gestational carrier and intended parents are matched, and some merely offer the intended parents the option for these screening if they wish for them to be performed.

Once a match is made between a gestational carrier and intended parents, the potential carrier must then undergo medical screenings by the fertility center they plan to use. This is important because the requirements between fertility centers vary, and sometimes they can even vary between individual doctors within a fertility center. If distance allows, the potential surrogate should meet with the doctor in person, but some consultations can be done over the phone with test results sent in for review. The doctor will expect the following tests to be completed prior to approving her to be a carrier:

  • Height, weight, and BMI
  • Blood tests measuring thyroid and other hormone levels, and possible blood sugar level
  • Drug and alcohol use screening
  • Sexually transmitted diseases
  • Other blood-borne diseases such as Hepatitis or Zika
  • HIV testing
  • Pelvic ultrasound of the uterus, ovaries and cervix
  • Hysterosalpingogram (or HSG -  a dye-contrast x-ray exam of the uterus and fallopian tubes)

Once the carrier has successfully completed these screenings, the doctor will approve her to move forward in the process. Some fertility centers require that the intended parents, gestational carrier, and her partner all meet together with a social worker to ensure that everyone's expectations align – though not all centers have this requirement.

The good news is that if your gestational carrier is cleared this far, it’s highly likely that she’ll be an excellent candidate to carry for you, There are just a few final steps left!

If your gestational carrier is married or in a serious relationship, her partner will need to have blood tests done to ensure there’s nothing communicable that she might be exposed to. And although some might consider it part of the cycling process and not the screening process, it’s worth mentioning the mock cycle, since it can disqualify a woman from being a gestational carrier (though that is not common, usually any irregularities can be fixed).

A mock cycle is just what it sounds like – it’s a chance for the gestational carrier to use all of the medications in her protocol to see how her body responds. The doctor will check on her hormone levels during the cycle and measure the thickness of her uterine lining to make sure the medications are doing their job. At the conclusion of the cycle, the doctor may perform what’s called a “mock transfer,” which allows the doctor to visualize the uterus and plan the best way to transfer the embryos during the real cycle. Once this is complete, everyone is on their way to the real cycle and the actual embryo transfer!

Should you decide to pursue an independent match rather than working through an agency, it’s important to note that much of the background and mental health screening will not be performed – it will be up to you to decide if there are any screenings you’d like a potential carrier to undergo. She’ll still have to complete all of the fertility center’s medical prerequisites, but the psychological screening requirements may be minimal, so that’s something to take into consideration.

It may seem like a lot of hoops to jump through for anyone to become a gestational carrier, but each of the screenings has a purpose – to protect the carrier, to protect you, or to protect you both. And once your carrier has successfully completed all the screenings, you can be assured that you have the best possibly chance of enjoying a successful surrogacy experience.