What Actually Disqualifies You From Being a Surrogate

Most applicants decide what disqualifies them from being a surrogate before they ever speak to an agency. A past C-section, a slightly elevated BMI, a history of managed depression: they scan a requirements list, find one item that doesn’t fit, and close the tab.

The problem: most agencies use rigid checklists built by coordinators, not physicians, to determine what disqualifies you. A checkbox says yes or no. A board-certified OB/GYN says “let me look at your specific situation.”

At Physician’s Surrogacy, every application goes to our physician team — not an automated filter. That distinction — hard disqualifiers versus conditions that get individual physician review — is exactly what this guide covers.

The Baseline Requirements Every Surrogate Must Meet

Before getting into specific conditions, the non-negotiable foundations apply at our agency and at every ASRM-aligned program in the U.S.

Age: 20.5–40.5 years old. Age outside this window disqualifies applicants outright. The lower limit reflects legal contract requirements and the maturity this commitment demands.

The upper limit follows obstetric risk data — pregnancies after 40.5 carry elevated rates of gestational hypertension, preterm delivery, and fetal growth restriction. See our surrogate age requirements guide for the full breakdown.

• Prior pregnancy required. You must have carried and delivered at least one child without major complications. IVF clinics need this to verify your uterus responds to pregnancy. Without it, there’s no clinical baseline to evaluate. See why the prior pregnancy requirement matters medically.
• BMI below 35. Surrogates with a BMI between 35–37 may apply and are reviewed individually by our physician team. Above 37, anesthesia risk in a potential C-section makes clearance unlikely at most partner clinics. See our BMI requirements for surrogacy guide.
• U.S. citizen or permanent resident in one of 41 eligible states. PS accepts applicants from 41 states across three compensation tiers. Non-smoker and no active drug use — confirmed at intake before any medical review begins.

Hard Disqualifications: What Rules You Out at Any Reputable Agency

These conditions are not evaluated case-by-case. They disqualify a candidate regardless of history, management, or circumstance — because the medical risk they present cannot be safely managed in a surrogate pregnancy.

• HIV, Hepatitis B, or Hepatitis C. All three carry documented perinatal transmission risk. The ASRM’s 2022 guidelines and the CDC identify these as disqualifying in all carrier arrangements.
• Active cancer or treatment within two years. Chemotherapy and radiation are incompatible with pregnancy. Post-remission candidates need at least two years cancer-free before being considered. See our article on surrogacy after cancer.
• No prior pregnancies. At least one successful full-term delivery is required at every reputable agency — directly per ASRM guidelines and IVF clinic protocols.
• Active substance use disorder. Current illegal drug use, prescription misuse, or active alcohol dependency disqualifies a candidate. A documented history of addiction in sustained remission is evaluated differently.
• Untreated serious psychiatric illness. Active psychosis, untreated bipolar disorder with recent hospitalization, or schizophrenia on antipsychotic medication are hard disqualifiers. These medications cannot safely be discontinued for a pregnancy.
• Uterine rupture or eclampsia history. Both carry serious recurrence risk per ACOG. Eclampsia — convulsions from severe preeclampsia — is a hard stop. Preeclampsia alone is evaluated case-by-case.
• Four or more prior C-sections. Three is case-by-case review. Four is a firm threshold at most IVF clinics due to cumulative placenta accreta risk from uterine scar tissue.

20 Conditions That Are Evaluated — Not Automatically Disqualifying

This is where most “can I be a surrogate if” questions land. For every condition below, the answer depends on the specifics — and a physician review, not a checklist, is what determines the outcome.

1. C-Section History

One or two prior C-sections are common among our surrogates and rarely present an obstacle. Three C-sections enters case-by-case territory — our OB team reviews uterine scar tissue integrity, delivery spacing, and any complications.

The clinical concern is placenta accreta, which becomes more likely after multiple C-sections. Read more about C-section history and surrogate eligibility.

2. Depression and Antidepressant History

A past history of depression does not automatically disqualify you. Current medication status and psychological stability matter far more than past diagnosis alone. Most IVF clinics require surrogates to be off psychiatric medication for at least 12 months before embryo transfer.

If you’re currently on antidepressants and stable, the timing may still work depending on your projected transfer date. Our psychological evaluation assesses current readiness — not just what’s in your records. See the full guide on surrogacy and depression.

3. Anxiety Disorder History

Anxiety follows the same framework as depression: current status matters far more than past diagnosis. Many of our surrogates have managed anxiety at some point in their lives.

The psychological evaluation looks at your current readiness, support system, and ability to handle the emotional realities of the journey. For a broader view, see our guide on emotional readiness for surrogacy.

4. ADHD and ADHD Medication

An ADHD diagnosis alone does not disqualify you. The issue is stimulant medication. Adderall, Vyvanse, and Ritalin are classified as Category C medications — not recommended during pregnancy, per CHADD’s pregnancy guidance. A 2023 ADHD study found a possible modest increase in preeclampsia risk with stimulant use in pregnancy.

If you’re currently on stimulant medication for ADHD, you’d need to discontinue it before transfer — under your prescribing doctor’s supervision. ADHD managed without medication or with non-stimulant alternatives is generally not an obstacle.

5. HPV

A history of HPV does not disqualify you — read our full HPV eligibility guide. HPV is the most common STI in the U.S., and past detection — including a prior abnormal Pap smear — is not grounds for rejection. What matters is your current cervical health. Prior LEEP or cone biopsy procedures are reviewed individually for any effect on cervical competency.

6. Herpes (HSV-1 and HSV-2)

Herpes does not disqualify you from being a surrogate — see our herpes eligibility guide. HSV-1 has no impact on a surrogate pregnancy. HSV-2 is managed with antiviral suppression in the final weeks of pregnancy. If an active outbreak occurs near your delivery date, your OB may recommend a C-section as a precaution. Full disclosure during medical history review is required.

7. PCOS (Polycystic Ovary Syndrome)

PCOS doesn’t disqualify you. Gestational surrogacy uses the intended parents’ embryo — not your eggs — so PCOS’s effect on ovulation isn’t the concern. The clinical flag is complication risk: women with PCOS have elevated rates of gestational diabetes and preeclampsia. Well-controlled PCOS with uncomplicated prior deliveries typically doesn’t prevent candidacy.

8. Endometriosis

Severity determines everything with endometriosis — see our endometriosis eligibility guide. Mild to moderate cases that have been treated are often compatible with serving as a surrogate.

The IVF clinic’s reproductive endocrinologist reviews uterine lining receptivity, whether surgery has been performed, and imaging of the current cavity. Severe endometriosis affecting uterine structure is more likely to raise obstacles — but always determined on individual review.

9. Uterine Fibroids

Fibroids are common and most don’t affect eligibility. Location determines what matters clinically. Submucosal fibroids — inside the uterine cavity — can interfere with embryo implantation and are the ones our physicians evaluate most carefully.

Intramural and subserosal fibroids are generally not disqualifying. A 2024 fibroid study found fibroids associated with elevated rates of hypertensive disorders and preterm labor — factors weighed alongside location and size on imaging.

10. Preeclampsia History

Preeclampsia history requires careful physician review — but history alone doesn’t rule you out. One mild episode resolved at full term is treated very differently than severe preeclampsia at 28 weeks or a case involving HELLP syndrome. ACOG’s preeclampsia guidance distinguishes how severity and gestational timing affect recurrence risk — the same framework our OB team applies.

11. Gestational Diabetes History

Prior gestational diabetes that developed during a prior pregnancy and fully resolved after delivery is not automatically disqualifying. It signals elevated recurrence risk, which a managing OB monitors closely.

Managed without serious complications and without recurrence in subsequent pregnancies, it’s typically compatible with our program. Current, uncontrolled Type 2 diabetes is a different situation — that generally disqualifies an applicant.

12. Thyroid Disorders (Hypothyroidism and Hyperthyroidism)

Thyroid conditions don’t automatically disqualify you. Well-managed thyroid conditions are frequently compatible with serving as a surrogate. Uncontrolled thyroid dysfunction is the concern — ACOG and multiple studies link unmanaged thyroid disease to preterm delivery, hypertensive disorders, and neural tube defects.

If your TSH levels are stable on medication and prior pregnancies were uncomplicated, thyroid disease typically doesn’t prevent candidacy. Your current labs are reviewed during medical screening.

13. Autoimmune Conditions (Lupus, Rheumatoid Arthritis, Hashimoto’s)

Autoimmune conditions vary widely in their effect on surrogate eligibility. Research published in 2025 found that lupus, rheumatoid arthritis, and Hashimoto’s thyroiditis are associated with increased risks of preeclampsia, preterm birth, and miscarriage.

Active lupus with frequent flares is generally disqualifying. Lupus in stable, documented remission is evaluated individually. Well-managed Hashimoto’s with controlled thyroid function is typically not an obstacle. Rheumatoid arthritis depends heavily on which medications are involved and whether they’re pregnancy-safe.

14. Chronic Hypertension

Chronic hypertension alone doesn’t automatically disqualify you, but it requires careful physician review. Chronic high blood pressure — pre-existing, not gestational — raises the risk of preeclampsia, intrauterine growth restriction, and placental abruption during pregnancy.

Well-controlled mild hypertension on a pregnancy-safe medication with an uncomplicated prior delivery is often reviewable. Severe, poorly controlled hypertension generally disqualifies an applicant. This is one of the clearer cases where “managed” carries real clinical weight.

15. Prior Preterm Delivery

A preterm delivery triggers physician review — but the cause matters more than the fact of it. Spontaneous preterm labor with no identifiable cause is reviewed differently than an indicated preterm delivery driven by a specific, non-recurring factor.

ACOG distinguishes these two categories — our OB team applies that same framework when reviewing your actual delivery records, not just a form summary.

16. Multiple Miscarriages

One miscarriage rarely disqualifies you. A single miscarriage is common and rarely affects eligibility. Multiple miscarriages — typically three or more — raise a clinical question about recurrent pregnancy loss that our physicians investigate. They look for an identifiable cause: chromosomal, anatomical, immunological, or thrombophilic.

An identified and treated cause is very different from unexplained recurrent loss. Recurrent unexplained loss, particularly if your most recent pregnancy ended in miscarriage, receives close scrutiny during IVF clinic medical screening.

17. Blood Clotting Disorders (Thrombophilia)

Thrombophilia doesn’t automatically disqualify you, but it requires IVF clinic coordination. Hereditary thrombophilias — Factor V Leiden, antiphospholipid syndrome, and MTHFR mutations — affect how blood clots and can increase pregnancy risk. Eligibility depends on the specific condition, its severity, and whether prior pregnancies involved clotting complications.

Many surrogates with managed thrombophilia are cleared after IVF clinic review, often with a low-molecular-weight heparin protocol during the pregnancy. Antiphospholipid syndrome with prior clotting events or pregnancy losses is reviewed more carefully. Our physician team coordinates directly with the IVF clinic on these cases.

18. GLP-1 Medications (Ozempic, Wegovy, Mounjaro)

Taking GLP-1 medications doesn’t disqualify you. You’ll be asked to discontinue them at least two months before embryo transfer so the medication has time to clear your system. If you’re currently on a GLP-1, the timeline works — you’d stop the medication as your transfer date approaches, under your prescribing doctor’s guidance.

19. Tubal Ligation (Tubes Tied)

Tubal ligation has no effect on surrogate eligibility. Gestational surrogacy uses IVF embryo transfer — the embryo goes directly into the uterus, bypassing the fallopian tubes entirely. This is one of the clearest “can I be a surrogate if” questions: the answer is simply yes. The same applies to women who’ve had their tubes tied after completing their own families.

20. Tattoos and Recent Piercings

Tattoos and piercings don’t disqualify you from being a surrogate. Timing matters for recent procedures — tattoos or piercings received within 12 months before your medical screening may require a bloodborne pathogen panel. Fully healed tattoos have no bearing on eligibility whatsoever.

Lifestyle Factors That Affect Eligibility

These aren’t medical conditions. Each can disqualify you from being a surrogate just as effectively as a clinical diagnosis — and unlike medical findings, most are within your control before you apply.

• Active smoking or vaping. The CDC directly links nicotine use in pregnancy to preterm birth, low birth weight, and placental complications. Recent cessation doesn’t automatically disqualify you, but it is documented during intake.
• Alcohol use. Full abstinence is required throughout the medical process and pregnancy. Per CDC guidance, there’s no known safe level of alcohol during pregnancy.
• Criminal history. Background checks are standard. Felony convictions — particularly those involving violence, fraud, or child welfare — may disqualify a candidate, assessed case-by-case based on the nature and timing of the conviction.
• Financial instability. Candidates must be financially stable without depending on surrogate compensation to cover basic living expenses. This protects both parties from financial pressure creating undue influence on the arrangement.
• No support system. Surrogacy requires at least one reliable support person throughout the process. A partner or co-habitant actively opposed to the surrogacy is a flag evaluated during the psycho-social interview.

Psychological Disqualifications: What the Evaluation Actually Looks For

The psychological evaluation is the most misunderstood part of surrogate screening. It’s not designed to catch you out — it’s designed to confirm you’re genuinely prepared for what surrogacy involves.

A licensed psychologist conducts a clinical interview with you and, if applicable, your partner. The evaluation covers your mental health history, motivations, support system, and emotional readiness to hand the baby to the intended parents at delivery.

Conditions that typically disqualify at this stage: active, unstable mental health conditions that are untreated or recently diagnosed; severe postpartum depression that was poorly managed; current major life stressors suggesting the timing isn’t right; or a support system actively opposed to the surrogacy.

None of these are permanent disqualifications — and temporary circumstances don’t mean you’re disqualified from being a surrogate forever. “Not right now” is genuinely different from “never.”

Women who reapply after resolving a temporary stressor often become excellent candidates. Many women who assume they’re disqualified turn out to be strong candidates once a physician has reviewed their records and a psychologist has assessed their current readiness.

What to Do If Something in Your History Concerns You

Your History Doesn’t Disqualify You — a Physician’s Review Does

A checklist is a blunt instrument. It can’t weigh severity, context, or whether a past complication is relevant to a future pregnancy. What disqualifies you from being a surrogate should rest on clinical judgment — not a form that checks boxes.

Our physician team reviews every application with that framework. They sometimes approve candidates that other agencies’ checklists disqualify. They also sometimes identify risks a clean checklist would miss. Both outcomes protect you.

If you’ve been turned down by another agency, that rejection was almost certainly a checklist decision. Our physicians may reach a different conclusion. Our surrogate requirements page covers what we look for in detail, and our screening process guide walks through exactly what happens after you apply.

Frequently Asked Questions About Surrogacy Disqualifications

Julianna Nikolic

Chief Strategy Officer Julianna Nikolic leads strategic initiatives, focusing on growth, innovation, and patient-centered solutions in the reproductive sciences sector. With 26+ years of management experience and a strong entrepreneurial background, she brings deep expertise to advancing reproductive healthcare.