Surrogacy Screening Process: Screening and Selecting a Surrogate
Have you found a potential surrogacy match or are you deciding between potential candidates?
There are several important factors to consider as you’re looking for the right surrogate. It’s important to be on the same page before you finalize a match. Ask a lot of questions on the front end; this will prevent headaches down the road.
You’ll want to determine:
Prior Surrogacy Experience
Experienced surrogates are usually more desired because they know the process and their body has a track record of responding well to the medical and hormonal aspects of surrogacy. Surrogates that have successfully delivered healthy surro babies sometimes request higher levels of compensation for subsequent journeys. This is important to keep in mind if you’re an Intended Parent on a small budget. For those doing independent journeys without a surrogacy agency, an experienced surrogate can provide direct answers to questions you may have, Your fertility clinic and attorney are there for guidance as well. An experienced surrogate knows the drill since she’s been through it all before.
This does not mean you can’t have a successful journey with a first-time surrogate. A Reproductive Endocrinologist looks at a first-time surrogate’s medical history to determine the likelihood of a healthy full-term pregnancy. He/she monitors how a surrogate responds to hormonal medications to make sure they are excellent candidates for an embryo transfer. If a fertility clinic signs off on a potential surrogate, whether experienced or brand-new to surrogacy, there’s a good likelihood of a successful outcome.
If you are discussing a match with an experienced surrogate, you may want to ask them if they are comfortable with you reaching out to their former Intended Parents as references. You can learn a lot from others who have worked with your surrogate on prior surrogacy pregnancies.
Location of the Surrogate
There are legal and ethical requirements that must be followed in places where commercial surrogacy is practiced. Laws governing surrogacy vary widely across the United States and around the world. Jurisdiction instructs how surrogacy arrangements are structured. In some places, only compensation-less (altruistic) surrogacy is permitted. Other locations prohibit all forms of surrogacy. In many US states, given the absence of local laws, surrogacy is conducted under a framework of ethical standards established from decades of commercial surrogacy. Other states have surrogacy-specific laws that must be followed for all surrogacy arrangements.
Many Intended Parents will look to “surrogacy-friendly” states when choosing their surrogate. Surrogacy-friendly states offer a clear path for establishing parentage, protect the rights of all parties involved, permit commercial surrogacy, and provide access to emergency reproductive healthcare when needed. For an overview of local laws, please see our surrogacy-by-state resources page.
Surrogacy is very expensive. The only optional expense is a surrogacy agency which can be avoided using a self-matching site like SurrogacyPlace.com. Experienced surrogates tend to charge more than first-time surrogates. Surrogates in desired locations (e.g. California, Nevada) often charge more than surrogates in less-friendly states. Some surrogates are willing to do compensation-less journeys where only their medical, legal pregnancy, and living expenses are covered. Some surrogates with existing health insurance plans without surrogacy exclusions may charge a premium for their services given the enormous savings to Intended Parents and the peace of mind that comes with surrogacy coverage. Surrogacy compensation may also vary widely depending on personal preference. Surrogacy compensation can range from altruistic, to around $25,000-$40,000, to over $100,000.
There are hard expenses that must be covered, though expenses like maternity clothes can be negotiated. For a detailed discussion on all the expenses Intended Parents should expect when deciding to pursue surrogacy, check out our surrogacy budget page.
Pregnancy and Medical History
During the surrogacy screening process, a fertility clinic will assess potential surrogates for suitability. They will examine medical history, pregnancy and childbirth history, and body mass index/current overall health. Comprehensive medical evaluations are done to ensure that a surrogate is not likely to experience pregnancy complications and risks to her health. If she’s had any significant pregnancy complications in her medical history, she is not likely to be approved as a surrogate. A woman who has never been pregnant or given birth is not qualified to be a surrogate. A surrogate must not have a chronic health condition that may affect pregnancy or fetal development, or a condition managed by medications incompatible with pregnancy. A woman should never go off of necessary medications to become a surrogate, including medications necessary for managing mental health conditions.
It’s important that a surrogate’s emotional stability and well being is evaluated prior to beginning a surrogacy arrangement. Most surrogates will undergo a psychological screening to evaluate if she is going into surrogacy for the right reasons, is ready for surrogacy, considers her own family complete, and has the appropriate support network to lean on throughout the process.
If a surrogate has known mental health disorders such as chronic depression or anxiety, schizophrenia, bipolar disorder, Borderline Personality Disorder (BPD), or a condition that requires medication to manage, she is not a good candidate for surrogacy.
Personal and Lifestyle History
During the surrogacy screening process, surrogates should be evaluated by age, occupation, and general lifestyle. If a surrogate has a chaotic lifestyle, she may not be a good fit for surrogacy. If she has a dangerous job or is regularly exposed to chemicals known to harm fetuses, she is not a good candidate for surrogacy. If she is younger than 21 or older than 42 (though age on the older side can vary depending on individual circumstance), she is not a good candidate. She must have had at least one biological child of her own that she is raising or has raised to adulthood.
A surrogate must not be a recreational drug user or use alcohol or tobacco/marijuana products during pregnancy. She must be willing to abstain from risky activities such as sports, certain exercises and leisure activities, and any substances that an OB-GYN would generally advice against during pregnancy.
A potential surrogate must have a secure home and stable finances. Surrogates must not depend on surrogacy for basic income needs. If a surrogate is on government assistance of any kind, including Section 8 housing and food assistance, she is disqualified from surrogacy.
Surrogacy Journey Expectations
Are you looking for a traditional or gestational carrier or open to either? Do you have shared views on pregnancy protocols including agreement on prohibited activities and travel restrictions? Do you agree on vaccine requirements including non-Covid inoculations such as Whooping Cough and yearly flu shots? Do you share similar ethical views? Are you and your surrogate on the same page in terms of the desired birth plan including hospital location (or home birth), medicated vs. natural delivery, etc.
Shared Ethics and Religious Considerations
Do you have shared views on termination or multifetal pregnancy reduction? Are you or your surrogate members of the LGBTQ+ community? Does your faith dictate certain lifestyle or dietary requirements? Although it can be uncomfortable to have conversations about religion or politics, it’s imperative you broach these conversational topics as they may have an impact on your surrogacy needs and expectations.
Health and Life Insurance
If your potential surrogate doesn’t have a health plan that covers surrogacy, you’ll need to provide insurance for her to cover the pregnancy-related medical expenses. Your own health plan will not cover your surrogate’s pregnancy, you will need specific health insurance for surrogacy.
Some Intended Parents strongly prefer to match with surrogates that have verified surrogacy coverage in their existing health plan. This is a match point that should be discussed during the vetting process. Unless a surrogate has recently used their health plan for surrogacy-related medical expenses, it’s a good idea to get her health plan professionally evaluated for surrogacy coverage using an organization like ARTrisk.
You will also need to provide life insurance to protect her family in the event of rare and unexpected fatal pregnancy complications. The desired coverage varies depending on preference and need. Life insurance expectations should be discussed during matching or during the legal negotiations phase.
Motivations for Becoming a Surrogate
Understanding why a surrogate is choosing to carry a pregnancy on behalf of others can tell you a lot about their level of commitment to the process. It’s a great idea to have a direct and honest conversation about why you and they are seeking a surrogacy arrangement. If you are interested in surrogacy for a non-medical or biological reason, it’s important to disclose that to potential matches. Surrogates deserve to make informed decisions during the matching process. Be honest with yourself and your potential matches.
Knowing why a surrogate has decided to become a surrogate or do another journey can reveal how committed they will be to the process from start to finish. It’s also an opportunity to establish a personal connection which is the cornerstone of building trust. You will want a positive relationship throughout the process and, if desired, after the birth of your child(ren).
Communication Style and Personal Involvement
Do you want to be in touch regularly, or only in emergencies? Do you and the surrogate agree on whether or not you should attend milestone appointments in-person? If you’re an International Intended Parent, is the surrogate okay with working with foreigners who may experience travel related delays or visa restrictions? What type of relationship do you want to have with the surrogate following the birth of your child(ren)? Do you want the surrogate to be involved in your child(ren)’s life in some small way?
At the end of the day, irrespective of how you found your surrogate, you are responsible for your own due diligence. During the surrogacy screening process, especially if you’re unsure if you’ve found an ideal match, you should interview multiple surrogate candidates. A Qualified Assisted Reproduction attorney and Reproductive Endocrinologist/fertility clinic staff can guide you with the most important considerations when evaluating potential matches. Pay attention to possible red flags and move forward only when you feel ready and comfortable.