Surrogacy agencies and fertility clinics screen candidates across several categories: age, physical health, reproductive history, mental health, lifestyle, finances, and legal eligibility. Failing to meet the requirements in any one of these areas can disqualify you. Some disqualifiers are permanent, while others are temporary and fixable with time or lifestyle changes.
Age and BMI Requirements
Most agencies require surrogates to be between 21 and 45 years old, though many prefer candidates between 21 and 39. The lower limit exists because agencies want candidates with established pregnancies behind them and the emotional maturity to handle the process. The upper limit reflects the increased pregnancy risks that come with age.
Body mass index is another early screening criterion. Most agencies set the ceiling at a BMI of 33. If your BMI falls below 19, that can also be disqualifying, since women at very low body weight can take up to four times longer to conceive. The BMI requirement isn’t arbitrary. The fertility medications used in IVF work best within a specific weight range, and a higher BMI is associated with greater risk of cycle cancellation and lower rates of ongoing pregnancy.
Pregnancy and Delivery History
You must have carried at least one pregnancy to term and be currently raising at least one child. This is a universal requirement across agencies and clinics. It proves your body can sustain a healthy pregnancy, and it means you already understand what pregnancy demands physically and emotionally.
Complications in your past pregnancies can disqualify you. A history of preeclampsia, placenta previa, cervical incompetence, or preterm birth raises concerns about recurrence. Gestational diabetes in a prior pregnancy may or may not be disqualifying depending on the agency and how it was managed.
The number of previous cesarean sections matters too. Most agencies cap it at two or three prior C-sections. Medical authorities generally recommend a maximum of three C-sections total, because the risk of serious complications like abnormal placenta attachment and surgical adhesions climbs sharply after the third. If you’ve already had three, most clinics won’t approve you. The total number of previous deliveries (vaginal and cesarean combined) is also evaluated, with many agencies setting an upper limit of five.
Medical Conditions That Disqualify
Certain chronic health conditions will prevent you from becoming a surrogate because they make pregnancy dangerous for you, the baby, or both. These include:
- Heart disease or significant cardiac conditions
- Clotting disorders that increase the risk of blood clots during pregnancy
- Autoimmune diseases like lupus, particularly if they require immunosuppressive medications
- Uncontrolled hypertension
- Kidney disease
- Uterine abnormalities such as a bicornuate uterus or significant fibroids
- HIV, hepatitis B, or hepatitis C
The American Society for Reproductive Medicine (ASRM) guidelines also call for a thorough physical exam that screens for signs of sexually transmitted infections, evidence of intravenous drug use (including checking for needle tracks that might be concealed by tattoos), and signs of liver disease like unexplained jaundice. Any tattoo, piercing, or body piercing done within the past 12 months without verified sterile technique is also flagged as a concern.
Mental Health Screening
Every surrogacy arrangement requires a psychological evaluation, typically conducted by a licensed mental health professional who specializes in reproductive psychology. This evaluation assesses your emotional readiness, your motivations, and your ability to handle the unique stresses of carrying a pregnancy for someone else.
Active, untreated mental health conditions are disqualifying. This includes unmanaged depression, anxiety disorders, bipolar disorder, and any condition requiring psychiatric hospitalization within the recent past. Being on certain psychiatric medications can also be a barrier, since many of these drugs carry risks during pregnancy. A stable mental health history with well-managed conditions may not automatically disqualify you, but the evaluating psychologist and the fertility clinic will make that judgment case by case.
A history of postpartum depression is evaluated carefully. If it was mild and resolved with treatment, some agencies will still consider you. If it was severe or recurrent, it typically results in disqualification.
Substance Use and Lifestyle Factors
Any current use of recreational drugs, including marijuana, is an automatic disqualifier. You’ll be drug tested during the screening process and throughout the pregnancy. Smoking cigarettes or using nicotine products (vapes, patches, chewing tobacco) also disqualifies you. Most agencies require that you’ve been nicotine-free for at least one year, sometimes longer.
Alcohol use during pregnancy is obviously prohibited, but a history of alcohol abuse or addiction, even if you’re currently sober, will usually disqualify you unless you can demonstrate a sustained period of recovery, often at least several years.
A criminal record can be disqualifying depending on the nature of the offense. Felony convictions, drug-related offenses, and any history of child abuse or neglect will almost certainly prevent you from being approved. Some agencies run background checks on both you and any adults living in your household.
Financial Stability Requirements
This one surprises many applicants. If you’re currently receiving government assistance like food stamps (SNAP), Medicaid, or other welfare programs, most agencies will disqualify you. The concern isn’t about judging your financial situation. It’s a safeguard against a scenario where someone feels pressured or coerced into surrogacy primarily for the compensation.
ASRM guidelines specifically stress the importance of financial stability to prevent women from entering surrogacy out of financial desperation. Agencies typically evaluate whether you can support your family on your current income, whether you’re free from government assistance, and whether you’ve avoided bankruptcy within the past year. The goal is to ensure that surrogacy is a genuine choice rather than a financial necessity.
Where You Live
Your state of residence can be a dealbreaker. Surrogacy laws vary dramatically across the United States, and some states make the process legally risky or impossible.
Arizona expressly prohibits surrogacy under state statute, making surrogacy contracts unenforceable. Indiana’s law voids gestational and traditional surrogacy contracts if they contain certain provisions. Nebraska declares surrogacy contracts void and unenforceable, though not technically illegal. In these states, even a willing and medically qualified candidate may not be able to serve as a surrogate because there’s no legal framework to protect anyone involved.
Other states fall somewhere in the middle, with limited or unclear legal protections. Agencies strongly prefer candidates who live in states with clear, surrogacy-friendly laws because it simplifies the legal process for establishing parental rights after birth. If you live in a restrictive state, some agencies may still work with you but require you to deliver in a different state, which adds significant complexity and cost.
Relationship and Household Stability
If you have a spouse or partner, most agencies require their consent and involvement in the psychological screening. A partner who is unsupportive or opposed to the surrogacy will typically result in disqualification, because the emotional and physical demands of the process require a stable support system at home.
Living in an unstable or unsafe household environment is also a concern. Agencies want to see that you have reliable housing, a support network, and the practical ability to attend frequent medical appointments throughout the pregnancy. If you’re in the middle of a divorce, a custody dispute, or another major life upheaval, you’ll likely be asked to reapply once things settle.
Temporary vs. Permanent Disqualifiers
Not every disqualifier is final. A BMI that’s too high or too low can change. Nicotine use can be quit. A recent tattoo or piercing just needs time to clear the 12-month window. Financial instability can improve. If you’re told you don’t qualify right now, it’s worth asking whether reapplying later is an option.
Permanent disqualifiers are the ones rooted in your medical history that can’t be reversed: serious pregnancy complications, certain chronic diseases, too many prior C-sections, or a history of substance abuse that agencies consider too recent or too severe. Even here, different agencies have slightly different thresholds, so a rejection from one doesn’t necessarily mean a rejection from all.