What are the Surrogacy Requirements?

 A Surrogate mother is a generous woman who carries a pregnancy for a couple or a single person. There are different reasons why intended parents may decide to turn to Surrogacy to make their dream of having a child come true. Heterosexual couples may have difficulties in becoming a parent for different medical reasons. A single parent or LGBTQ+ couple may also need an egg donor or sperm donor to achieve the pregnancy. Thus, as a Surrogate Mother, you will not be biologically related to the baby that you will be carrying for the Intended Parents. For becoming an intended parent you need to know the surrogate requirement.

If you are considering helping a family to make their dream of having a child come true, knowing the requirements for surrogate mothers and gathering information is the best way to be ready to apply. We have prepared this article with all the requirements for surrogate mothers from the general criteria to the more specific surrogacy requirements.

What are the criteria for being a surrogate?

The basic requirements for becoming a surrogate with Physician’s Surrogacy are:

• Having a minimum age of 20.5 years and a maximum age of 37 years
• Being a parent of at least one child
• You should have a BMI under 32
• Applicants must be US citizens or permanent residents of states that encourage surrogacy

Why Surrogate requirements are in place?

Surrogate requirements are in place for the safety of both the surrogate and the baby conceived through surrogacy. These surrogacy requirements are established by experts in the field, each focusing on their areas of expertise. 

Generally, the surrogate requirements are based on a combination of the IVF center’s qualification requirements, the legislation in each state, individual surrogacy agency requirements, and guidance from the American Society of Reproductive Medicine (ASRM) and the American College of Gynecology (ACOG).

Surrogacy Requirements

1. Age

The age requirements stem from a combination of state laws, ACOG, and ASRM guidelines. The minimum age of 21 is based on state laws. Although some states will allow surrogates to be under the age of 21, most require a woman to be 21 years of age to engage in a surrogacy contract legally. The minimum age requirement is in place to ensure the surrogate candidate has the maturity to undertake the responsibility of becoming a surrogacy journey.

The goal for surrogacy pregnancies is to create the lowest risk environment, supporting the safety of the surrogate and the child. While a few agencies will accept surrogates above the age of 37, many IVF centers prefer to approve surrogate surrogates under the age of 37.

In exceptional circumstances, typically with compassionate surrogacy (unpaid), they will make exceptions for surrogates of advanced age. This discrepancy can create frustration for surrogates older than 37 as a surrogacy agency may accept them to the program. Still, it can be difficult for that surrogate to be selected by intended parents with lower age-based risk alternatives.

Additionally, even if these surrogates are accepted and matched, they can run into issues regarding screening if the IVF center has an internal age limit for compensated surrogacy. The IVF physician has worked very hard to help these families create quality embryos, which can be a long and emotional journey. Ultimately, they want to ensure the parents have the best opportunity for success and to reduce the likelihood of complications.

2. Have at least one child of your own

Surrogate candidates must have at least one child of their own. This requirement has been set forth by ASRM and supported by professional psychologists specializing in Third Party Reproduction. 

This requirement is in place for two reasons:

• Safety. An agency and IVF center must establish that the surrogate candidate had uncomplicated pregnancies and deliveries to ensure it is safe for her to carry a surrogacy pregnancy. Specific complications in one pregnancy can lead to increased risk in future pregnancies, and this must be identified for all candidates. 

• Psychological well-being of the surrogate. In gestational surrogacy, the surrogate has no biological relationship with the baby. The delivery of the child is the most significant milestone of the surrogacy journey. It’s a moment of unmatched joy for the new parent(s) and the surrogate, celebrating her most generous gift. Once delivery occurs, the baby will leave the hospital with the Intended Parents, and the Surrogate returns home from the hospital to her family and her loving child or children. From the psychological perspective, a Surrogate returning home to her children reduces the likelihood of postpartum depression or attachment issues during the pregnancy. All surrogates will undergo a psychological evaluation to ensure their emotional readiness for the journey.

3. Be a US Citizen or US Permanent Resident

To enter into a surrogacy contract; a surrogate must legally be a US citizen or US permanent resident. This status ensures the surrogate can enter into and conclude their contract without concerns of losing their visa status or being deported from the country during their journey. 

While intended parents can work with surrogates abroad in countries where it is permissible, it’s advised against as they have less control over the surrogacy process and limited recourse.

4. Residing in a Surrogacy-Friendly US State

Surrogacy laws in the United States vary from state to state. Believe it or not, the surrogacy laws are not consistent from state to state. So the selected states focus on states that do not pose significant legal hurdles for parents or surrogates.

Some states, such as Michigan, Louisiana, and Nebraska, completely ban compensated surrogacy. In these states, there are either statutes or historical case law that prohibit compensated surrogacy agreements (Louisiana) or other obstacles that prevent both parents from being able to be named on the birth certificate.

There are other states where surrogacy is regularly practiced, and courts have issued orders for parentage. Still, surrogacy contracts themselves are unenforceable by statute and therefore void. In these cases, it’s possible to proceed but vital to use extreme caution. One opportunity in the case of these states, is to match a surrogate from one of the states with parents in surrogacy-friendly states, it will allow the embryo transfer and surrogacy contract to occur in a state where surrogacy is permitted. This type of arrangement offers both the surrogate and parents an opportunity to work with Surrogacy friendly state laws.

Finally, there are permissible surrogacy states; however, even in those states, the results will depend on certain factors for the county where the contract is created. For example, some States require a post-birth legal procedure where after the birth, the intended parents are added to the birth certificate through a post-birth adoption. The parentage will be spelled out in the contract; however it is an additional step. In addition to this issue, state-by-state statutes may also indicate surrogacy requirements for the intended parents’ residency, marital, and citizenship status and place restrictions around whether donor eggs, sperm or both can be used.

Finally, we have surrogacy-friendly states where surrogacy is permitted and allowed for all parents. Pre-birth orders will be granted, allowing both parents to be named on the birth certificate instead of the surrogate’s name. For both surrogates and intended parents, these are ideal states. They include California, Colorado, Connecticut, DC, Delaware, Maine, New Hampshire, New Jersey, Nevada, Vermont, and Washington. These laws frequently change, so more states become a surrogate friendly and permit surrogacy yearly.

5. BMI Surrogate Requirements

The BMI requirements are established by the American Society for Reproductive Medicine (ASRM). The guidelines state that a surrogate must be below a 34 BMI at the time of embryo transfer. Currently, many agencies set the requirement for applicants at 32 and many are even moving to a maximum BMI of 30 for a candidate to apply. 

The maximum BMI provision is in place for surrogate safety. Many published studies reflect a higher incidence of gestational diabetes and other pregnancy complications for surrogates with higher BMIs. These complications pose a risk to both the surrogate and the baby. Therefore this guideline has been put into place. 

The reason for the allowance between the BMI at application and the BMI at embryo transfer is to allow for any weight gain that may occur due to taking the medications in preparation for the embryo transfer. While not all surrogates gain weight between application and embryo transfer, it provides a buffer so the surrogate is not stressed about trying to maintain their weight and is within the allowed BMI range for embryo transfer.

Most agencies will not allow you to apply until your weight is within their established range. Other agencies, such as ours, will accept surrogates with a BMI up to 34, and we will provide support from an outside nutritionist to assist with weight loss to get their BMI below 32

6. Background Screening and No Criminal History

As you can probably imagine, intended parents entrusting a surrogate with their most precious dream requires to beome a parent to know that the home environment will be safe and free of disruption. This is the reason it is a requirement for a prospective surrogate to undergo and pass a background screening. The screening will disclose any past criminal activity and ensure the candidate doesn’t have any pending legal issues. 

It is essential that intended parents are confident the home and environment the surrogate will be in during her pregnancy are safe, and that the surrogate isn’t facing the possibility of incarceration or other legal restrictions that would interfere with the surrogacy journey.

7. Not on antidepressants or anti-anxiety medications

A woman is typically advised to discontinue medication and supplements during pregnancy. While it’s common to have situational depression and anxiety, those with long-term conditions requiring treatment with medications are not candidates for surrogacy. 

If there is a past history of a transient condition, that should not pose an issue in applying. Essentially, we need to ensure that anyone currently on medication for these conditions is not tempted to discontinue them to pursue a surrogacy journey as we understand that continued use of medication is a requirement for some. 

In fact, there is less concern for a natural pregnancy as the mother and her treating physicians will make the decision to take medications during pregnancy.

8. Non-smoker and no drug use – Surrogacy Requirements

It has been well established that smoking and drug use during pregnancy can cause congenital disabilities and other issues for the unborn child. For this reason, candidates who smoke or use recreational or prescription drugs are not qualified for surrogacy.

9. No significant complications during pregnancy

Pregnancy is a natural process, and it is not unusual for mild issues to arise. When applying to be a surrogate, the agency and the IVF center must obtain, review and approve the records for her past pregnancies and deliveries. This record review ensures no past conditions or events could lead to complications for the surrogate in a future surrogacy pregnancy. The primary goal is to ensure the safety of the surrogate applicant and the baby she will carry. Common complications include the following:

• Placental Abruption
• Intrauterine growth restriction (IUGR)
• Pre-Eclampsia and Eclampsia
• Gestational Diabetes (requiring medication such as Glyburide or Insulin)
• Pre-Term delivery (with unavoidable cause)
• Chronic Hypertension (requiring medication)
• Premature rupture of membranes before 36 weeks
• HELLP syndrome
• Complete Placenta Previa
• Oligohydramnios 
• Incompetent Cervix
• Conditions requiring medication not deemed safe for pregnancy

Becoming a Surrogate is one of the greatest experiences you can have as you will be giving Intended Parents the best gift they could wish for. As it is a complex process, it is important to follow all the established surrogacy requirements.

At Physician’s Surrogacy, your safety is our top priority. Our one-of-a-kind physician and OB-managed model will give you peace of mind because you will be in the best hands and you will get the highest quality care you need during your surrogacy journey. If you have further questions or would like to know more, we are here to help.