The Surrogate Screening Process: What Agencies Actually Look For (and Why)

The surrogate screening process is the part most agencies describe in the vaguest possible terms. “Rigorous.” “Comprehensive.” “Thorough.” None of that tells you what actually happens — or why some women pass while others don’t.

This article covers the full picture: every step in the surrogate screening process, the medical and psychological research that justifies each one, and what it means that Physician’s Surrogacy’s screening is designed and run by OB/GYNs instead of coordinators.

Gestational surrogacy is one of the most medically sophisticated ways a family can be built — and one of the most human. The screening process exists to protect both.

Why the Surrogate Screening Process Exists

Gestational surrogacy places specific physiological and psychological demands on a woman’s body and mind. Screening identifies whether a candidate is prepared to meet those demands — safely and successfully.

The ASRM’s 2022 guidelines require all gestational carrier candidates to undergo a complete medical evaluation and psychosocial consultation before acceptance into any surrogacy program. These are the floor, not the ceiling.

At Physician’s Surrogacy, our physician-designed screening goes beyond ASRM minimums. Our OB/GYNs identified additional risk factors that standard checklist-based screening misses — factors that show up in delivery outcomes, not just application forms. That’s why our preterm birth rate is 50% below the national average.

The 8 Steps of Surrogate Screening at Physician’s Surrogacy

Here is what the process looks like from application to full clearance — and why each step matters.

Step 1: Initial Application and Eligibility Review

The process starts with a short application covering personal information, pregnancy history, health status, and lifestyle. At Physician’s Surrogacy, this takes about 10 minutes and immediately confirms state eligibility.

State eligibility matters more than most applicants realize. Surrogacy law varies by state — some states, including Michigan, Louisiana, and Nebraska, restrict compensated surrogacy by statute. We work only in states where surrogacy contracts are legally enforceable and where pre-birth parentage orders can be obtained.

After the application is submitted, a coordinator reviews the basic criteria: age, prior pregnancies, BMI, lifestyle, and state. If the initial picture looks right, the candidate moves to a phone interview.

Step 2: The Coordinator Phone Interview

A 30–45 minute call covers health history in more depth, motivation, family situation, and any open questions the candidate has. This conversation has two purposes.

First, it gives our team a fuller picture of the candidate than a form can capture. A coordinator can follow a thread — ask why, ask what happened next — in ways that a questionnaire can’t.

Second, it gives the candidate something equally important: clarity. Most women who apply to become a surrogate have done research but still have unanswered questions about compensation, timelines, medical steps, and what happens if something goes wrong. This call addresses those directly.

Step 3: Background Checks

Criminal and financial background screening covers the candidate and any adults in her household. This step protects the intended parents, the surrogate herself, and the integrity of the legal contract that governs the entire journey.

Red flags in a criminal background — felony charges, restraining orders, certain financial patterns — don’t automatically disqualify a candidate, but they do require review and discussion. Transparency here protects everyone involved.

The ASRM’s 2023 ethics opinion stresses that GCs must have independent legal counsel and that all parties require informed consent throughout the process. Background screening is part of establishing that informed baseline.

Step 4: Medical Records Review — Where Our Process Diverges

This is the step that separates physician-led screening from coordinator-run screening most clearly.

We request your pregnancy and delivery records from your OB/GYN. Our in-house physicians read those records — not a coordinator summarizing them. They review delivery outcomes, labor progression, placental health, blood pressure patterns across pregnancies, gestational diabetes screening results, and recovery timelines.

A coordinator sees “C-section delivery.” A physician sees “C-section at 38 weeks due to breech presentation, uncomplicated recovery, well-healed incision, four-year interval since last pregnancy.” Those are entirely different levels of information. One produces a binary pass/fail. The other produces a clinical judgment.

This is the reason we catch risks that other agencies miss — and approve candidates that other agencies’ checklists would reject without review.

Step 5: Physical Screening

Physical screening is arranged near your home, so you don’t need to travel. It includes a physical examination, bloodwork (including a complete blood count, metabolic panel, thyroid function, and infectious disease panel), urinalysis, and baseline health metrics including BMI.

The BMI component matters because research on gestational carrier outcomes shows that higher BMI at embryo transfer is linked to increased risk of gestational diabetes, preeclampsia, and cesarean delivery.

Our BMI threshold is below 35 at application, with a maximum of 37 at embryo transfer. Candidates with a BMI between 35 and 37 are reviewed individually by our physician team.

Infectious disease testing at this stage follows FDA and ASRM requirements. Conditions including HIV and hepatitis B or C are absolute disqualifications — they can be transmitted to the baby during pregnancy or delivery.

Step 6: Psychological Evaluation

Every gestational carrier candidate must complete a psychological evaluation with a licensed mental health professional. If the candidate has a partner or spouse, they participate too.

Research on GC psychological assessment, published in Fertility and Sterility, confirms that ASRM recommends all candidates complete a psychosocial consultation — and that the field is still refining which testing protocols work best.

What’s consistent across programs: the evaluation covers mental health history, motivations, emotional readiness, support system, and the candidate’s understanding of what relinquishing the baby involves.

The psychological evaluation isn’t a pass/fail test. It’s a structured conversation designed to surface anything that might create difficulty down the road — and to ensure the candidate enters the journey with clear expectations, not assumptions.

Research published in Human Fertility found that common psychological screening tools like the MMPI-2 and the Personality Assessment Inventory (PAI) are widely used in surrogate psychological evaluation, though practitioners note these tools sometimes yield overly positive profiles. Our licensed evaluators use clinical interviews alongside standardized assessments to capture a fuller picture.

Partners matter here too. A surrogacy pregnancy affects an entire household — sleeping arrangements, schedules, childcare, finances during bed rest. A partner who isn’t genuinely on board creates risk that surfaces months into the journey, not on a questionnaire.

Step 7: IVF Clinic Compatibility Review

This step is often overlooked in explanations of surrogacy screening — but it’s one of the most practically important.

Every IVF clinic that works with intended parents has its own specific requirements for gestational carriers. Some are stricter on BMI. Some have additional infectious disease screening. Some require specific testing our initial physical screening hasn’t covered.

Our physicians handle this compatibility review directly with the fertility clinic. That means you’re not matched with an intended parent, go through legal, and then get rejected by the IVF clinic during medical review — a sequence that causes real harm to everyone involved.

Catching compatibility issues at this stage, before matching, is one of the structural protections our process provides that checklist-based agencies can’t replicate.

What the Psychological and Lifestyle Review Actually Evaluates

Beyond the formal psychological evaluation, our screening looks at 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 help cope with the added stress of pregnancy. That’s a clinical recommendation rooted in outcome data.

What “More Than 90% Screened Out” Actually Means

Fewer than 8% of women who apply to become a surrogate at Physician’s Surrogacy are accepted into the program. That figure surprises people. It shouldn’t.

It doesn’t mean most applicants are unsuitable people. It means surrogacy has genuine clinical thresholds — and that our screening is designed to enforce them consistently rather than let borderline cases slide through for the sake of a larger surrogate pool.

The rigorous acceptance rate is also the reason we can match intended parents in an average of one week from consultation. Every surrogate in our pool has already been fully cleared. Intended parents aren’t waiting months for a surrogate to complete screening post-match — the screening is already done.

For intended parents, that speed comes from physician-designed screening that identifies the most qualified surrogates upfront — not from lowering the bar.

The Matching Step: What Happens After You’re Cleared

Once cleared, your profile becomes visible to intended parents whose needs match your profile. At Physician’s Surrogacy, intended parents can see your profile and initiate a match — sometimes within days of clearance.

The matching process considers medical compatibility, personal preferences, geographic considerations, and the type of relationship both the surrogate and the intended parents are looking for during and after the journey. Our coordinators manage this process with both parties in ongoing communication.

For more on surrogate qualifications, see our guide to becoming a surrogate. For a full breakdown of surrogate compensation, see our surrogate compensation page.

Ready to Find Out Where You Stand?

The surrogate screening process is thorough because it has to be. A physician-designed screening isn’t bureaucracy — it’s the reason our surrogates have consistently safer outcomes than the industry average.

If you’re wondering whether you’d pass, the only way to find out is to apply. Our application takes about 10 minutes. It immediately confirms your state eligibility, and it puts your history in front of our physician team — the only agency in the country where OB/GYNs personally review every candidate.

Start your application and find out where you stand — we review every candidate individually.

Frequently Asked Questions About Surrogate Screening

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.