Becoming a surrogate mother, or gestational carrier, requires a rigorous, multi-stage screening process. This comprehensive evaluation ensures the health and safety of the surrogate, the developing fetus, and the success of the pregnancy. Fertility clinics follow standard protocols, often mandated by medical bodies like the American Society for Reproductive Medicine (ASRM). The process systematically reviews physical health, psychological readiness, and verification of a stable home environment to confirm the candidate is prepared for the unique demands of surrogacy.
Initial Comprehensive Medical Screening
The initial medical screening evaluates the candidate’s physical and reproductive history to establish fitness for pregnancy. A reproductive endocrinologist conducts a full physical examination, including a Pap smear. General health metrics, such as blood pressure and Body Mass Index (BMI), are reviewed; BMI is usually required to be below 30 or 32 to minimize complications. Blood work determines the candidate’s blood type and Rhesus (Rh) factor, which is necessary for managing potential pregnancy complications.
Infectious disease screening is a major focus, protecting the surrogate, the embryo, and the intended parents. Comprehensive testing is performed for sexually transmitted infections (STIs) and other communicable diseases. These include HIV, Hepatitis B and C, Syphilis, Gonorrhea, Chlamydia, and Cytomegalovirus (CMV). These tests must often be repeated periodically to maintain clearance. Candidates must also provide a detailed obstetric history, demonstrating a successful, uncomplicated pregnancy and delivery of their own child to prove uterine function.
The reproductive assessment focuses specifically on the uterus. Imaging tests, such as a transvaginal ultrasound, examine the uterine cavity, ovaries, and cervix. A saline sonogram (sonohysterogram) is often performed. This involves injecting sterile saline solution into the uterus to expand the cavity, allowing for a clearer image of the lining. This procedure checks for structural abnormalities, such as fibroids, polyps, or intrauterine scarring, that could interfere with embryo implantation.
A hysteroscopy may also be ordered, inserting a thin, lighted scope through the cervix to visually inspect the uterine cavity for subtle issues missed by ultrasound. These detailed assessments ensure the uterus is structurally healthy and receptive to the embryo. The combination of general health checks, infectious disease clearance, and a proven history of healthy pregnancies confirms the candidate’s physical ability to safely carry a gestation to term.
Psychological Assessment and Counseling
Following medical clearance, candidates undergo a thorough psychological evaluation to ensure emotional preparedness for surrogacy. This assessment is conducted by a licensed mental health professional specializing in third-party reproduction, adhering to ASRM guidelines. The evaluation includes a structured clinical interview and may involve standardized psychological testing tools, such as the Personality Assessment Inventory (PAI). These tools assess emotional stability and coping mechanisms.
The primary goal of this counseling is to confirm the candidate understands the emotional complexities of carrying a genetically unrelated child. Discussions focus on the potential for emotional attachment during pregnancy and the need for emotional separation after delivery. This ensures the surrogate is prepared for the non-parental role. The evaluation also explores the candidate’s motivation, ensuring it is altruistic and not influenced by financial coercion or undue pressure.
The mental health professional also reviews the candidate’s personal support system, including the stability and support of a spouse, partner, and immediate family members. This ensures the candidate has a stable home environment and a network that supports the emotional and physical commitment of the surrogacy journey. A final report confirms the candidate is psychologically stable and fit to proceed before medical treatment begins.
Lifestyle and Eligibility Requirements
Beyond the medical and psychological evaluations, candidates must satisfy non-clinical eligibility and lifestyle requirements. A criminal background check is mandatory for the candidate and often for other adults living in the household. This verifies a clean record and a safe living situation, ensuring stability for the gestation.
Substance screening is a continuous requirement. Candidates must be non-smokers and drug-free, often for a significant period before and throughout the process. Nicotine and illicit drug use are serious disqualifiers due to the risks they pose to fetal development. Candidates are also required to demonstrate financial independence, meaning they do not rely on surrogacy compensation as their primary source of income.
The candidate must commit to the logistical demands of the process. This includes traveling for appointments, undergoing frequent monitoring, and strictly adhering to the medical protocols prescribed by the fertility clinic. These requirements establish reliability and responsibility, ensuring the candidate can comply with the demanding schedule required for a successful surrogacy pregnancy.
Final Pre-Embryo Transfer Testing
In the lead-up to the embryo transfer, a final, time-sensitive round of testing ensures the uterus is optimally receptive for implantation. This preparation is guided by a hormone replacement therapy (HRT) protocol, using medications like estrogen and progesterone. Detailed transvaginal ultrasounds measure the endometrial lining thickness. The lining must reach a specific measurement, typically 7 millimeters or more, and display a “trilaminar” or three-layered pattern, indicating peak receptivity.
Frequent blood tests monitor precise levels of hormones like estrogen and progesterone, allowing the clinic to pinpoint the optimal day for transfer. The timing is highly dependent on these hormone levels, mimicking the natural window of implantation. Some clinics perform a “mock cycle” before the actual transfer. During this cycle, the candidate takes HRT without an embryo, allowing the medical team to fine-tune dosages and confirm the uterine lining responds correctly.
A trial transfer, sometimes performed during a mock cycle, involves passing a soft catheter through the cervix into the uterus without an embryo. This measures the exact path and depth needed for the actual procedure. This final preparation ensures that on the day of the frozen embryo transfer (FET), the uterine environment is conditioned, and the procedure is executed with maximum precision.