Can I Be a Surrogate with Medical History?

Picture this: You’ve just finished reading a heartfelt story about a couple who finally held their baby after years of infertility struggles, made possible by a generous surrogate. Your heart swells with the idea of giving such an incredible gift. But then doubt creeps in. You had gestational diabetes with your second pregnancy. Or maybe you’ve had three C-sections. Perhaps you take medication for anxiety. The question weighs heavy: Can I still become a surrogate?

You’re not alone in this concern. Many women who feel called to surrogacy worry that their medical history might close the door before it even opens. The truth is more nuanced and hopeful than you might think. The surrogacy screening process is undeniably thorough—designed to protect all parties-surrogate, the intended parents, and the future baby. However, having a medical history doesn’t automatically disqualify you from becoming a surrogate and experiencing this life-changing journey.

Medical screening exists not as a gatekeeping exercise, but as a careful evaluation to ensure everyone’s safety and to maximize the chances of a healthy, successful pregnancy. Some conditions require additional medical clearance. Others may genuinely be disqualifying. But many common medical histories that prospective surrogates worry about don’t eliminate them from consideration at all.

The decision to become a surrogate is one of the most generous acts imaginable. Medical screening exists to protect that gift—for you, the intended parents, and the baby you’ll help bring into the world.

At Pathways to Parenthood, we believe in transparency from day one. We understand that deciding to become a surrogate is deeply personal, and you deserve honest, compassionate guidance about what the medical evaluation process entails and how your individual health history factors into eligibility. This article will walk you through the foundational health requirements, explain each phase of the comprehensive screening process, address specific medical conditions and their impact on eligibility, and provide practical guidance on preparing for success. By the end, you’ll have a clear understanding of whether surrogacy might be the right path for you—and what steps to take next.

Key Takeaways

• The surrogacy screening process is rigorous but designed to protect everyone’s health and wellbeing, not to exclude unnecessarily
• A history of successful, uncomplicated pregnancies is required, with limits on previous births and C-sections
• Many common medical concerns don’t automatically disqualify candidates—conditions are evaluated individually with medical clearance requirements
• BMI, lifestyle factors (smoking, substance use), and current medications are critical screening components
• Complete honesty about your medical history from the beginning provides the best possible outcome and prevents disappointment later in the process

Understanding Basic Surrogate Medical Requirements

Before the in-depth screening begins, prospective surrogates must meet foundational health and lifestyle criteria. These requirements aren’t arbitrary—they’re established based on medical research and guidelines from organizations like the American Society for Reproductive Medicine (ASRM) to optimize pregnancy success and minimize risks.

Age matters significantly in surrogacy. Most agencies, including Pathways to Parenthood, require surrogates to be between 21 and 40 years old. This range represents the sweet spot where women are mature enough to make informed decisions while their bodies are optimally prepared for pregnancy without age-related complications. Younger candidates may lack the emotional maturity and life experience needed, while those over 40 face increased pregnancy risks.

Your pregnancy history serves as the most important predictor of your ability to carry another successful pregnancy. You must have given birth to at least one child whom you’re currently raising. This requirement serves two purposes: it confirms your body can carry a pregnancy to term, and it makes certain you understand the physical and emotional realities of pregnancy and childbirth.

Additionally, your previous pregnancies should have been relatively uncomplicated. Most agencies set limits—typically:

• No more than five previous births
• No more than three previous Cesarean sections

These limits exist because multiple C-sections and vaginal deliveries compromise uterine integrity, increasing risks in subsequent pregnancies.

Body Mass Index (BMI) requirements reflect medical necessity, not judgment. A BMI generally under 33 is required because fertility treatments are significantly less effective in women with higher BMIs, and pregnancy complications like gestational diabetes and preeclampsia increase substantially. Achieving and maintaining a healthy weight before screening improves your chances of qualifying and having a healthy pregnancy.

Lifestyle Factors and Requirements

Lifestyle factors are non-negotiable when it comes to surrogate health requirements:

• No smoking: You must be a non-smoker with no use of tobacco, vaping products, or e-cigarettes. Smoking during pregnancy causes serious harm to developing babies.
• No substance use: You must abstain from alcohol, cannabis (even in states where it’s legal), and all illicit drugs. These substances cross the placenta and can cause developmental problems.
• Financial stability: Compensation should improve your life, not serve as essential income. You shouldn’t be reliant on government assistance programs. This requirement makes certain you’re pursuing surrogacy for the right reasons—the desire to help a family—rather than out of financial desperation.

Finally, comprehensive background checks are conducted on both you and your partner or spouse. Any history of violent crimes, felony convictions, or child safety concerns will disqualify a candidate.

The Complete Surrogacy Screening Process: What to Expect

Understanding the full scope of the surrogate screening process helps you prepare mentally and practically for what lies ahead. While the thoroughness might feel intimidating, remember that every requirement exists to protect your health, increase the likelihood of success, and make certain you’re fully prepared for this commitment.

Phase 1: Initial Application, Medical Records Review, Background Check

First comes the initial application, where you provide basic information about your health, pregnancy history, and lifestyle. If you meet preliminary requirements, the process moves to a more extensive medical records review. We’ll obtain comprehensive documentation from all relevant healthcare providers to review:

• Obstetric records from every previous pregnancy and delivery
• Gynecological records
• Medical clearance from current Ob/Gyn
• Any fertility treatment documentation
• Criminal and child abuse background checks

Our team will review these records for any complications or red flags, and if necessary, we may request additional documentation, such as updated screenings or clearance letters from your current providers. This behind-the-scenes review can take two to four weeks but serves as an important filter before you invest time in further screening.

Phase 2: Psychological Evaluation

Simultaneously or shortly after, you’ll go through a psychological evaluation with a Licensed Mental Health Professional specializing in third-party reproduction. This assessment includes both a clinical interview and standardized personality testing. The purpose of the evaluation is to ensure that you and your partner/spouse are psychologically and emotionally prepared for the special challenges of you carrying a baby for someone else.

Phase 3: In-Person Medical Screening

Once you have completed the agency screening process and you’re matched with intended parents, you’ll attend an in-person medical screening at the intended parent’s chosen fertility clinic.  This comprehensive evaluation includes consultations, physical examinations, possibly imaging, and extensive laboratory testing including drug and nicotine testing. Results from this appointment can take another two to four weeks to finalize.

This holistic evaluation confirms you have a stable, supportive environment for the pregnancy.

Throughout this entire process, Pathways to Parenthood is here to guide you through each step, answers questions, and provide reassurance. The timeline from initial application to final medical clearance typically spans six to twelve weeks, though it can vary based on clinic scheduling and how quickly medical records are obtained.

Medical Records Review and Pre-Screening

The medical records review happens largely behind the scenes, but it’s one of the most critical phases of the surrogate medical evaluation. After you’ve submitted your initial application and self-disclosed your medical history, our team formally requests comprehensive records from your healthcare providers. We’ll analyze the documents, looking for patterns of successful, uncomplicated pregnancies and identifying any potential concerns. We specifically look for complications like:

• Preterm labor
• Preeclampsia
• Gestational diabetes
• Placental problems
• Postpartum hemorrhage

We’ll also verify the number of previous deliveries and C-sections to make certain you’re within safe limits.

In-Person Medical Evaluation and Testing

After your medical records are approved, the in-person screening at the fertility clinic is where the most comprehensive medical clearance for surrogacy evaluation takes place. This appointment is scheduled after you’ve been matched with intended parents, making it an exciting milestone in your experience.

The surrogacy medical tests conducted during this appointment are extensive. You’ll need to provide blood and urine samples for a comprehensive panel:

• Infectious disease screening: HIV, Hepatitis B and C, other STDs
• Hormone and thyroid panels: Making certain your levels are optimal for supporting a pregnancy
• Immunity screening: Checking protection against rubella, measles, mumps, and chickenpox
• Complete Blood Count (CBC): Screening for anemia and other blood disorders
• Vitamin levels: Particularly Vitamin D, which plays a role in pregnancy health
• Comprehensive toxicology screening: Via blood and urine tests confirming you are substance-free

Lab results can take two to three weeks to be finalized and reviewed by the Reproductive Endocrinologist. Once all results are in and assessed, the doctor provides final medical clearance—the green light that you’re physically ready to proceed.

Common Medical Conditions and Their Impact on Surrogacy Eligibility

This is likely the question weighing heaviest on your mind: Will my specific medical condition disqualify me? The honest answer is: it depends. Surrogacy eligibility with medical conditions is evaluated on a case-by-case basis. Some conditions are absolute disqualifiers because they pose significant risks during pregnancy. Others may require additional medical clearance but don’t necessarily eliminate you from consideration. Still others, particularly conditions that have fully resolved, may have no impact on your eligibility at all.

What matters most is complete transparency. Being upfront about your entire medical history—even conditions that don’t appear in your medical records—allows the medical team to make informed assessments and, if necessary, request appropriate clearances from specialists. Hiding or downplaying medical issues creates risks for everyone and will likely be discovered during the thorough screening process anyway.

Let’s address the most common medical concerns that prospective surrogates bring to their initial consultations and explore how each typically impacts eligibility.

Pregnancy-Related Conditions

If you experienced complications in a previous pregnancy, you might worry those issues will repeat themselves or disqualify you from surrogacy. The reality is nuanced and depends heavily on the specific condition and its severity.

Gestational Diabetes

This condition, where blood sugar levels become elevated during pregnancy but typically resolve after delivery, doesn’t automatically disqualify you. However, it does require medical clearance. Your Reproductive Endocrinologist will want:

• Documentation confirming the gestational diabetes was pregnancy-specific and resolved after you gave birth
• Current lab work showing normal fasting glucose and hemoglobin A1C levels

If gestational diabetes occurred in multiple pregnancies, or if you’ve since developed pre-diabetes or Type 2 diabetes, disqualification becomes more likely because the risks of recurrence and complications increase substantially.

Preeclampsia

A history of preeclampsia requires careful evaluation. Mild preeclampsia that developed late in pregnancy and resolved without complications may be acceptable, particularly if it occurred only once. However, severe preeclampsia, especially if it developed early in pregnancy or required preterm delivery, is often disqualifying due to high recurrence risk and serious maternal health dangers.

Previous C-Sections

The number of previous C-sections directly impacts your eligibility. Most agencies and fertility clinics set a maximum of three prior Cesarean deliveries. Each C-section creates scar tissue on the uterus, and with multiple surgeries, the risk of serious complications like uterine rupture, placenta accreta (where the placenta grows too deeply into the uterine wall), and hemorrhage increases significantly.

Preterm Labor, Placental Issues, or Postpartum Hemorrhage

A history of preterm labor, placental complications (such as placenta previa or placental abruption), or postpartum hemorrhage doesn’t automatically exclude you—but it does trigger a closer look. The reviewing physician will assess how early the preterm birth occurred, whether it was spontaneous or medically indicated, and whether complications could recur. Candidates with mild or resolved issues may be approved with specialist clearance, while severe or recurrent events may lead to disqualification for safety reasons.

Multiple Miscarriages

Most agencies require a record of healthy, full-term pregnancies. Having one miscarriage doesn’t typically affect eligibility, but a history of two or more consecutive miscarriages raises concerns about underlying reproductive or hormonal issues. Depending on your medical evaluation and testing results, this may disqualify you or require further review before proceeding.

Chronic Health Conditions

Ongoing health conditions are evaluated individually. Some can be managed safely during a surrogate pregnancy, while others pose unacceptable risks. Controlled hypothyroidism is often acceptable if your thyroid levels are stable with medication and monitored regularly. In contrast, Type 1 or Type 2 diabetes is generally disqualifying because it increases risks for both surrogate and baby.

Autoimmune disorders can vary — well-controlled conditions may be permitted, while conditions like lupus or multiple sclerosis typically are not. Hypertension (high blood pressure), even when controlled by medication, often excludes candidates because of heightened pregnancy risks.

Mental health is also reviewed carefully. A history of mild anxiety or depression may be acceptable with documented stability and no recent medication changes, but ongoing or severe mental health conditions usually require a longer period of demonstrated stability before approval.

Lifestyle and Medication Considerations

Lifestyle and prescription habits play an important role in medical clearance. Many prescription medications—especially antidepressants, mood stabilizers, and blood pressure drugs—aren’t considered safe during pregnancy and may need to be discontinued for several months before screening. Candidates must show they can remain healthy and stable without them.

A history of substance abuse typically requires at least two years of documented sobriety. Smoking and vaping are automatic disqualifiers, and agencies require full abstinence before application. Maintaining a healthy lifestyle—including balanced nutrition, regular exercise, and stress management—strengthens your eligibility and helps ensure a positive pregnancy outcome.

Why Medical Screening Is So Thorough: Protecting Everyone’s Journey

It’s natural to feel nervous about such an in-depth process, but thorough medical screening protects everyone involved. The primary goal is your health and safety—ensuring you can safely complete the pregnancy and return home healthy to your own family.

The process also safeguards the intended parents’ emotional and financial investment, verifying that every surrogate is physically and emotionally ready for the responsibility. By identifying potential risks early, doctors can make informed decisions, reducing complications later.

At Pathways to Parenthood, screening isn’t about exclusion—it’s about ensuring the foundation of a safe, rewarding journey for everyone.

Beyond Medical Health: Psychological and Social Screening Components

Surrogacy is both a medical and emotional commitment. Beyond physical health, you’ll complete a psychological evaluation with a Licensed Mental Health Professional who specializes in third-party reproduction. This ensures emotional readiness and evaluates your motivations, coping skills, and support network.

How to Prepare for Successful Medical Screening

• Physical Health Optimization: Aim for a healthy BMI, stay active, and maintain balanced nutrition. Complete any overdue medical checkups, such as a Pap smear or dental cleaning, and begin prenatal vitamins early to boost nutrient levels.
• Documentation and Transparency: Gather your medical records in advance and be honest about every condition or medication. Full transparency allows for smoother processing and prevents delays.
• Mental and Emotional Preparation: Discuss your decision with your family, make sure you have their full support, and approach the process with patience—thoroughness takes time, but it ensures success.

What Happens If Medical Issues Are Identified During Screening

If screening reveals potential concerns, don’t lose hope. Some findings—like elevated BMI or vitamin deficiencies—are temporary disqualifiers that can be corrected with lifestyle changes or treatment. Others, like certain chronic illnesses or uterine abnormalities, may be permanent exclusions for your safety.

Even if surrogacy isn’t possible right now, Pathways to Parenthood helps candidates explore options for reapplying or supporting the surrogacy community in other ways. Every step taken shows your generosity and commitment to helping families grow.

Pathways to Parenthood’s Approach to Medical Screening

At Pathways to Parenthood, transparency and compassion define our screening process. From our first conversation, we’ll be here to help guide you through each step of the process, explaining results, and answering every question.

We partner with respected fertility clinics and Reproductive Endocrinologists across the Midwest to ensure safe, evidence-based care. Our proactive approach minimizes disappointment and respects your time and emotional investment.

You’re never alone in this process. From application to approval and beyond, our team is committed to making your experience supportive, empowering, and rewarding.

Conclusion

Becoming a surrogate is an extraordinary act of compassion and courage. While the surrogacy screening process is detailed and sometimes daunting, it exists to protect your wellbeing and the success of the intended parents’ dream.

Many women with prior medical conditions discover that they still qualify once evaluated honestly and individually. The key is transparency, patience, and guidance from a trusted agency like Pathways to Parenthood.

If you’re ready to explore whether surrogacy is right for you, contact Pathways to Parenthood today to start a confidential conversation. Your story could help create a family’s future.

Frequently Asked Questions

1. Can I be a surrogate if I had gestational diabetes?
   Yes—if it was pregnancy-specific, resolved postpartum, and your current bloodwork shows normal glucose levels. Recurrent gestational diabetes or pre-diabetes may disqualify you.
2. What medical conditions automatically disqualify someone?
   Conditions such as Type 1 or 2 diabetes, uncontrolled hypertension, severe autoimmune diseases, or significant uterine abnormalities typically disqualify candidates. Each case is reviewed individually.
3. How long does the medical screening process take?
   Initial agency screening is 4-8 weeks. Fertility clinic medical screening typically takes 6-8 after matching. It includes medical records review, an in-person exam, lab work and final clearance from the fertility specialist.
4. Who pays for the medical screening?
   All costs related to surrogacy medical evaluations are covered by the intended parents, not the surrogate.
5. Can I apply if I’m taking prescription medication?
   It depends on the medication. Some must be discontinued before pregnancy, with stability demonstrated off treatment. Always disclose medications early for proper guidance.