What Are the Medical Requirements to Become a Surrogate Mother? A Doctor’s Perspective

By Dr. Naman Arya, MD, MPH, MSHCM

Reproductive Endocrinology and Infertility Division at Surrogacy4All.

Introduction

As a physician deeply involved in reproductive health and surrogacy programs, I often meet women who feel called to help others build a family by becoming a surrogate. It’s an incredibly generous act, but also a deeply personal and medical journey. For those considering it, one of the most important things to understand is the medical screening process.

Surrogacy isn’t for everyone. To ensure the health and safety of both the surrogate and the baby, there are specific medical requirements you must meet before you can be approved. These requirements are based on the guidelines of two key regulatory bodies: the American Society for Reproductive Medicine (ASRM) and the U.S. Food and Drug Administration (FDA).

This article will walk you through the medical eligibility criteria, the reasoning behind each step, and what to expect if you’re thinking about becoming a surrogate mother.

Why Medical Requirements Matter

Carrying a child for someone else is a physically demanding process. To ensure a successful, safe pregnancy and delivery, it’s critical that surrogates meet specific medical standards. These guidelines are not just bureaucratic hurdles, they are in place to protect your health, the baby’s health, and the emotional well-being of everyone involved.

When we follow ASRM and FDA recommendations, we significantly improve the chances of a healthy pregnancy and reduce risks for complications. Let’s dive into what these requirements are and why they matter.

1. Age and Reproductive History

• Age Range: According to ASRM, ideal surrogate candidates are between 21 and 45 years old. Some agencies prefer a maximum age of 40 to reduce pregnancy-related risks.
• Previous Successful Pregnancy: You must have had at least one uncomplicated pregnancy and delivery.
• Raising a Child: Many clinics and agencies also require that you are currently raising at least one biological child. This demonstrates that you understand pregnancy and parenting from experience.

Why It Matters: A history of a full-term, healthy pregnancy is one of the best indicators that your body can handle another. It also shows you understand the emotional and physical responsibilities that come with carrying a child.

2. General Physical Health

Before you can become a surrogate, you’ll undergo comprehensive health screening. This includes:

• A complete physical exam
• Lab work to rule out infections or chronic illnesses
• Evaluation of your reproductive organs via ultrasound
• Pap smear and pelvic exam
• Body Mass Index (BMI) check, typically requiring a BMI under 35 (some clinics prefer under 30)

Why It Matters: Surrogates must be in good physical health to carry a pregnancy safely. High BMI, unmanaged chronic conditions, or a history of complicated pregnancies could increase risks during the process.

3. Psychological Evaluation

Surrogacy is as much an emotional journey as it is a medical one. You’ll need to undergo a psychological assessment with a licensed mental health professional who specializes in third-party reproduction.

The evaluation typically covers:

• Emotional readiness
• Support systems (partner, family, friends)
• Understanding of commitment and potential risks
• Motivation for becoming a surrogate

Why It Matters: Pregnancy, especially on behalf of someone else, can bring up intense emotions. Ensuring you’re emotionally prepared helps minimize stress and supports a positive experience for everyone.

4. Lifestyle and Environmental Factors

FDA regulations and best practices from ASRM also look at your lifestyle:

• Non-smoker and no exposure to secondhand smoke
• No drug or alcohol abuse
• Safe home environment
• Financially stable, so you’re not motivated solely by compensation
• Reliable transportation to attend appointments

Why It Matters: A stable, healthy environment reduces risks to the baby and supports your own health during pregnancy.

5. Infectious Disease Screening (FDA Requirements)

If you are participating in an IVF cycle, you will be screened under FDA regulations for communicable diseases such as:

• HIV
• Hepatitis B and C
• Syphilis
• Gonorrhea and Chlamydia
• CMV (Cytomegalovirus)

You’ll also be tested for immunity to rubella and varicella.

Why It Matters: These screenings help ensure the safety of the embryo transfer and pregnancy. If a surrogate is a carrier of certain diseases, it could impact both the embryo and the outcome of the pregnancy.

6. Uterine Evaluation

Doctors will perform tests to confirm that your uterus is healthy and able to support a pregnancy. This may include:

• Hysteroscopy or Sonohysterogram: Imaging tests that allow us to view the inside of your uterus
• Endometrial biopsy (in some cases): Checks the lining of the uterus for abnormalities

Why It Matters: A healthy uterus increases the likelihood of embryo implantation and carrying the baby to full term.

Step-by-Step: What the Medical Screening Process Looks Like

1. Initial Consultation: You’ll speak with a surrogacy coordinator or medical professional to go over basic qualifications.
2. Application & Background Check: Includes your medical history, lifestyle, and family support.
3. Medical Exam: Blood work, infectious disease testing, uterine evaluation, and general physical.
4. Psychological Evaluation: Mental health screening with a licensed therapist.
5. Approval & Legal Steps: Once medically cleared, you’ll move on to matching and legal agreements.

Real Voices: Testimonials from Surrogates

Laura, 34, Texas “I didn’t expect the screening to be so thorough, but I’m glad it was. It gave me peace of mind and helped me feel supported throughout the pregnancy. As a mom myself, I knew what to expect, but this experience felt even more purposeful.”

Maya, 29, California “When I passed my medical screening, I felt empowered. The doctors explained everything to me. I knew I was in good hands. I wasn’t just doing this for the intended parents—I was doing it the right way for me too.”

Common Reasons Applicants May Be Declined

• History of multiple miscarriages
• Uterine abnormalities
• Active mental health conditions (e.g., untreated depression)
• High-risk pregnancies in the past
• Smoking or substance use
• Financial or emotional instability

If you’re turned down, don’t be discouraged. Sometimes changes in lifestyle or health can allow you to reapply in the future.

Final Thoughts from a Doctor

If you’re thinking about becoming a surrogate, you’re considering one of the most generous and life-changing decisions you can make. But it’s not something to take lightly. As a physician, I believe that strong medical screening isn’t just about checking boxes, it’s about ensuring that your surrogacy journey is safe, successful, and supported from start to finish.

We owe it to you, the child, and the intended parents to take every precaution. And in my experience, when all the right measures are taken, the result is not just a healthy baby, it’s a beautiful story of hope fulfilled.