The Surrogate Screening Process: What Agencies Actually Look For (and Why)
Every surrogacy agency describes their surrogate screening process with the same three words. “Rigorous.” “Comprehensive.” “Thorough.” None of that tells you what actually happens — or why the outcome at one agency is meaningfully different from another.
The difference isn’t the number of steps. Most agencies run the same basic sequence through their surrogate screening process: application, phone interview, background check, physical, psych eval. The difference is who runs each step, what they’re looking for, and what they do with what they find.
At Physician’s Surrogacy, that difference is structural. Onsite board-certified OB/GYNs design and oversee the medical components of screening — not coordinators with checklists. That single fact changes what the surrogate screening process can catch, what it can clear, and what it means for the women who go through it.
Key Takeaways
Why the Surrogate Screening Process Exists
Gestational surrogacy places real physiological and psychological demands on a woman’s body and mind. The surrogate screening process exists to confirm a candidate can meet those demands safely and successfully. Without it, there is no way to know before someone else’s baby is involved.
The ASRM’s 2022 guidelines require all gestational carrier candidates to complete a full medical evaluation and psychosocial consultation before acceptance into any surrogate screening process. That’s the floor.
At Physician’s Surrogacy, our OB/GYNs identified additional risk factors that standard checklist-based screening misses. Blood pressure patterns across multiple pregnancies. Recovery timelines after prior C-sections. Gestational diabetes screening results that a coordinator marks “negative” without knowing what to ask next. These are the things that decide whether a pregnancy goes well.
That’s why our preterm birth rate is 50% below the national average.
Quick Answer
The surrogate screening process covers medical history review, physical screening, psychological evaluation, background checks, and IVF clinic compatibility review. At Physician’s Surrogacy, onsite board-certified OB/GYNs run the medical components. The physician-led model changes what gets caught, what gets cleared, and who gets approved.
The 8-Step Surrogate Screening Process at Physician’s Surrogacy
Here is what happens inside each step — and what a physician-led process finds that a coordinator-run process typically misses.
1. Initial Application
A 10-minute form covering personal info, pregnancy history, health status, and lifestyle. It immediately confirms state eligibility, which matters more than most applicants expect.
2. Coordinator Phone Interview
A 30–45 minute call that goes deeper into your surrogate screening process history than a form can. Health history, motivation, family situation — plus a real opportunity to ask about compensation, timelines, and what happens if something goes wrong.
3. Background Checks
Criminal and financial screening for the candidate and all adults in the household. Red flags are reviewed in context rather than used as automatic disqualifiers.
4. Medical Records Review
Our OB/GYNs read your actual OB/GYN records. Delivery outcomes, labor progression, blood pressure patterns, placental health — the full clinical picture. This is where the surrogate screening process diverges most sharply from how other agencies work.
5. Physical Screening
Arranged near your home. No travel required. The physical surrogate medical screening includes a full bloodwork panel, urinalysis, infectious disease testing, and BMI review. Our physician team goes beyond ASRM minimums on every bloodwork panel.
6. Psychological Evaluation
A licensed mental health professional conducts a structured interview as part of the surrogate screening process. It covers mental health history, motivations, support system, and readiness to hand the baby over. Partners participate. The evaluator is looking for readiness, not reasons to disqualify.
7. IVF Clinic Compatibility
Every fertility clinic has its own gestational carrier requirements. Our physicians handle this review directly with the clinic before matching. You’re never cleared by us, paired with intended parents, and then rejected by the IVF team.
8. Lifestyle and Support Review
Housing stability, financial independence, household support, personal network. This final stage of the surrogate screening process confirms whether the conditions exist for a safe, successful pregnancy.
What the Medical Records Review Actually Reveals
Step 4 is where the surrogate screening process separates physician-led agencies from coordinator-run ones. The entire surrogate medical screening lives or dies on what happens in this step.
A coordinator sees “C-section delivery” and checks a box. A physician sees “C-section at 38 weeks due to breech presentation, uncomplicated recovery, well-healed uterine incision, four-year interval since last pregnancy.” Those are not the same data point. One produces a pass/fail. The other produces a clinical judgment.
Our OB/GYNs review delivery outcomes, labor progression, placental health, blood pressure patterns across multiple pregnancies, gestational diabetes screening results, and recovery timelines. They’re reading the same records they’d review in their own obstetric practices. They are the same physicians.
If Your Obstetric History Is Complicated
A history of preeclampsia, one or two prior C-sections, or gestational diabetes doesn’t mean automatic rejection. Our OB/GYNs don’t ask “did this happen?” They ask “what does this mean for a future pregnancy, and what does the full clinical picture show?” Those are very different questions. Only a physician can answer them.
What the Physical Screening Measures — and Why BMI Isn’t the Whole Story
The physical component of the surrogate screening process is arranged near your home — no travel required. It includes a physical examination, full bloodwork panel (CBC, metabolic panel, thyroid function, infectious disease), urinalysis, and baseline health metrics including BMI.
BMI is part of the picture, but it isn’t the whole story. Research consistently shows that BMI above 35 at embryo transfer correlates with higher rates of gestational diabetes, preeclampsia, and cesarean delivery. That’s why our threshold is below 35 at application, with case-by-case evaluation for 35–37.
Infectious disease testing follows FDA and ASRM requirements. HIV and hepatitis B or C are absolute disqualifications. There are no exceptions and no retesting pathways for these conditions.
The Psychological Evaluation: A Conversation, Not a Test
Surrogate medical screening doesn’t stop at bloodwork. Every candidate must also complete a psychological evaluation with a licensed mental health professional. Partners participate too. A surrogacy pregnancy puts real demands on a whole household — sleeping schedules, childcare, finances during bed rest. A partner who isn’t genuinely on board will make that felt long before anyone sees it coming.
GC psychological screening research, published in Fertility and Sterility, confirms that ASRM recommends all candidates complete a psychosocial consultation as part of the surrogate screening process, and that the field continues to refine which protocols work best.
The evaluation covers mental health history, motivations, emotional readiness, support system, and the candidate’s understanding of what it means to relinquish the baby at delivery.
A history of depression or anxiety doesn’t automatically disqualify a candidate. Our physicians and licensed evaluators look at where someone is right now — current stability, current support system, current readiness. For more on how mental health history is handled, see our article on surrogacy with depression.
Research published in Human Fertility found that common tools like the MMPI-2 and Personality Assessment Inventory (PAI) are widely used in surrogate evaluation, though practitioners note they sometimes yield overly positive profiles. Our evaluators use clinical interviews alongside standardized assessments to get a fuller picture.
The IVF Clinic Compatibility Review: The Step Most Agencies Skip
This step is often missing from explanations of the surrogate screening process, but it’s essential to the gestational surrogacy process. It’s also one of the most practically consequential.
Every IVF clinic has its own requirements for gestational carriers. Some set stricter BMI limits. Some require additional infectious disease panels. Some need specific testing our surrogate screening process hasn’t already covered at that point.
Our physicians handle this compatibility review directly with the fertility clinic before matching. That means a surrogate is never cleared by us, paired with intended parents, and then rejected by the IVF clinic during their own medical review. That sequence causes real harm: to the surrogate, to the intended parents, and to a match that took time and trust to build.
Catching compatibility issues at this stage, before matching, is a structural protection our process provides that coordinator-run agencies can’t replicate. See how it fits into the broader one-week matching process for more context.
What the Lifestyle and Support Review Actually Evaluates
The gestational surrogacy process doesn’t end with medical tests. The surrogate screening process also evaluates the broader picture of a candidate’s life. The 2022 ASRM guidelines state that carriers must have a stable family environment with adequate support to cope with the added demands of pregnancy. ASRM doesn’t say this to be invasive. They say it because the data on surrogate outcomes bears it out.
What the 92% Rejection Rate Actually Means
Fewer than 8% of applicants pass Physician’s Surrogacy’s full surrogate screening process. That number surprises people. It shouldn’t.
It doesn’t mean most applicants are unsuitable. Surrogacy has genuine clinical thresholds. The surrogate screening process at Physician’s Surrogacy enforces them consistently rather than letting borderline cases through for the sake of a larger pool.
The acceptance rate is also the reason we can match intended parents in an average of one week. Every surrogate in our pool has already been fully physician-cleared. Intended parents aren’t waiting months for post-match screening. That work is already done. For more on what surrogate qualifications look like in full, see our complete surrogate requirements guide.
Clear Before You Match. Not After.
Candidates in our Medically Cleared Program complete the full surrogate screening process before being matched with intended parents. That eliminates the 3–5 week post-match screening delay common at other agencies. Your profile goes in front of intended parents the moment you’re cleared.
Same rigorous physician-designed screening. Smarter order.
Learn more about becoming a surrogate and how the Medically Cleared path works.
What Happens After You Complete the Surrogate Screening Process
Clearing Physician’s Surrogacy’s surrogate screening process means an onsite OB/GYN has reviewed your records, evaluated your history, and confirmed you’re medically appropriate for a gestational surrogacy pregnancy.
Once you complete the surrogate screening process and are cleared, your profile becomes visible to intended parents whose needs match your profile. Our coordinators manage the matching process with both parties in active communication, factoring in medical compatibility, personal preferences, geographic considerations, and the kind of relationship both sides want during and after the pregnancy.
For a full breakdown of what surrogates earn once matched, see our surrogate pay guide. For an overview of the full journey from start to finish, see our guide to how surrogacy works.
Ready to See Where You Stand in the Surrogate Screening Process?
The surrogate screening process at Physician’s Surrogacy isn’t a bureaucratic obstacle. It’s what produces outcomes 50% better than the national average on preterm delivery. It works because the people running it can read a medical record and act on what they find.
If you’re wondering whether you’d pass the surrogate screening process, the fastest way to find out is to apply. Our application takes about 10 minutes, immediately confirms your state eligibility, and gets your history in front of the only agency in the country where OB/GYNs personally review every candidate.
The only agency where OB/GYNs review every surrogate application.
Apply in 10 minutes. Our physicians evaluate every history individually — with the same clinical judgment they apply in practice.
Over 1,500 babies born. Preterm rate 50% below the national average.
What physician-led screening produces, from application to delivery.
Frequently Asked Questions About Surrogate Screening
Frequently Asked Questions
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.
