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Surrogate medical screening: the gauntlet between match and transfer

You’ve matched—now nothing else can start until the surrogate is medically cleared. Screening is a sequence of gates, not a single appointment, and each gate can add weeks. Here’s the actual order of operations, based on going through it ourselves.

Educational only—not medical advice. Requirements vary by IVF clinic (the clinic, not the agency, sets the medical bar); your clinic’s protocol is the one that counts.

1. 1

   Step 1 — Records pre-approval: the paper screen

   Before any appointment is booked, the clinic reviews her on paper:

   • She submits complete medical records—especially OB records from every prior pregnancy and delivery. Retrieving these from hospitals and old providers can itself take weeks; start immediately.
   • The clinic checks hard eligibility criteria: age, number of prior deliveries and C-sections, pregnancy complications, and BMI. Most clinics require BMI under roughly 30–33 (each clinic sets its own cutoff).
   • If a criterion isn’t met, this is where the journey pauses: in our case, our surrogate had to lose weight to reach the clinic’s BMI range before the process could continue—plan for this possibility rather than being blindsided.
   • Only after records pass this review does the clinic invest anyone’s time (and your money) in the steps below.
2. 2

   Step 2 — Psychological screening

   A licensed mental-health professional experienced in third-party reproduction conducts:

   • A clinical interview covering motivation, support system, expectations about the relationship with you, and how she’d handle hard scenarios (reduction, loss, bed rest).
   • Standardized psychological testing (commonly PAI or MMPI)—routine, not adversarial.
   • Her spouse or partner typically participates in part of the evaluation too, since the journey affects the whole household.
3. 3

   Step 3 — Getting exam-ready: the small prerequisites that gate the big visit

   Before the clinic will schedule the in-person screening, routine health items must be current:

   • An up-to-date pap smear is required—if hers wasn’t current, it has to be done and results returned before the medical screening can be scheduled. A small item that can quietly cost two or three weeks.
   • Any conditions flagged in records review (blood pressure, thyroid, BMI target) need documentation that they’re resolved or managed.
   • Routine labs or a physical from her own doctor may be requested, depending on the clinic.
4. 4

   Step 4 — The clinic screening visit: timed to her cycle

   The centerpiece—and the step with the least scheduling freedom:

   • The uterine evaluation (saline sonogram or hysteroscopy plus ultrasound) must happen early in her cycle—so once her period starts, she needs to travel to the clinic almost immediately. This was one of the biggest surprises of our journey: pre-approval done, then everything waits on day one of a cycle.
   • Same visit: bloodwork and hormone panels, an infectious-disease panel (FDA-required for gestational carriers), and typically a drug screen.
   • Her partner usually needs infectious-disease testing as well—coordinate their schedule too.
   • If the cycle window is missed—travel conflict, clinic backlog, illness—the visit slips a full month. This single constraint explains most screening-stage delays.
5. 5

   Step 5 — Clearance, and what it unlocks

   The clinic issues medical clearance once everything is reviewed:

   • Medical clearance is the green light for the legal phase—contracts are typically drafted only after she’s cleared, since nobody wants to pay attorneys for a match that fails screening.
   • Legal clearance then unlocks escrow funding, and escrow funding unlocks her medication start for the transfer cycle—each gate feeds the next.
   • Screening results are generally valid for a limited period (often 6–12 months depending on the test), so long gaps before transfer can force re-testing.