Guide to the Surrogacy Medical Screening Process
Surrogates are most known for their role of carrying a pregnancy to term for an intended parent(s). The pregnancy is initiated through the transfer of an embryo from a culture dish in an IVF lab to the surrogate’s uterus.
This guide serves as an overview of the surrogacy medical screening process, which ensures that a potential surrogate meets specific physical requirements that allow her to safely carry a healthy pregnancy to term.
Keep in mind that surrogacy medical screening processes are often performed at IVF clinics, and each clinic may have its own protocols and policies. Below you’ll find the most standard and expected process to medically screen and approve surrogates.
It undoubtedly takes a very special person to be a surrogate. By saying this, I mean that surrogacy requires a lot of dedication and willingness to be patient through the long process. But I mean this literally, as well.
In order to be accepted into a surrogacy agency’s program, a woman must complete an application process, which begins with the submission of any or all of the following documents to the agency:
- An official application
- Self-disclosed forms regarding her social and medical history
- Her official medical records from previous pregnancies
- Permission to perform a background check
If all of these items are approved, the potential surrogate must successfully complete medical and psychological screening evaluations. Though these processes are extensive, each step is essential for the safety of the surrogate, fetus, and intended parent(s).
Traveling to the Fertility Clinic for Medical Screening
Many surrogates don’t live near their intended parents or assigned fertility clinic. I myself live in Sacramento and I traveled to Las Vegas for my medical screening. You can watch my medical screening travel diary here!Medical screening is usually a one-day trip, unless you live across country and you need to stay overnight.
Tracking Your Period Prior to Medical Screening
Your medical screening appointment will be scheduled around your period. The protocol is that you tell your fertility clinic exactly when you start your period (first day of bright red bleed). They will then schedule your appointment usually in about 2 weeks, because they want you to be in a specific phase of your cycle. This does not give you much time for planning travel, so be prepared to make work and childcare arrangements on the fly.
What to Expect at Surrogacy Medical Screening
The medical screening process usually consists of a complete physical examination. In addition, some diagnostic procedures, blood tests, and urine cultures may also be required.
Common medical screening diagnostic procedures that are performed are:
- A Pelvic Exam: a physical exam of the external reproductive organs (cervix, vagina, and vulva). Abnormalities may include lesions or abnormal cells.
- During this exam, the following may also be performed:
- Pap Smear
- Endocervical Culture: a sample of cervical cells are tested for infections such as gonorrhea and chlamydia
- Pelvic Ultrasound: a machine uses sound waves to view the reproductive structures inside the pelvis (uterus, cervix, Fallopian tubes, ovaries). Abnormalities may include an ovarian cyst or abnormally-shaped uterus.
- Hysteroscopy: a small camera is inserted through the cervix and into the uterus to observe the uterine lining (endometrium). Abnormalities may include the presence of polyps, fibroids, adhesions (scarring), or septa. These abnormalities may interfere with embryo implantation and fetal development.
- Saline Sonohysterogram (SHG): a saline solution is injected into the uterus and an ultrasound is used to visualize the uterine cavity. The saline also flushes out the uterine cavity. Possible abnormalities include an abnormally-shaped uterine cavity and the same conditions listed for the hysteroscopy procedure.
Surrogacy Screening Blood Tests
Multiple blood tests are often performed at medical screening. These tests serve to:
- Measure fertility hormone levels to ensure that they are within normal ranges (examples include estradiol (E2), testosterone (T4), and progesterone (P4)). Keep in mind that these levels fluctuate depending what stage of the menstrual cycle you are at when the blood is drawn.
- Screen for infectious or communicable diseases that can be transmitted to the fetus in utero (examples include HIV, hepatitis B and C, cytomegalovirus (CMV), and RPR).
- Measure thyroid hormone levels.
- Confirm that the surrogate is immune to measles, CMV, rubella, and chicken pox.
- Determine the surrogate’s blood type and Rh factor.
- Ensure that the surrogate is healthy enough to safely carry a pregnancy to term (examples include a complete blood count and basic metabolic panel).
*Note, with my own blood tests, the results came back that I was slightly anemic. It is common for results to come back with deficiencies such as iron, vitamin A, vitamin D or thyroid levels to be off. In this scenario, the surrogate takes supplements or medication for 30 days, and then does a blood re-test. If she is able to get her correct levels, she will be medically cleared.
To avoid this kind of delay, I suggest to start taking prenatal vitamins as soon as you begin the surrogate application process. If I had been taking a prenatal with iron earlier, my journey wouldn’t have been delayed a month.
Urine Tests for Surrogates
Finally, a urine culture is often obtained. The urine culture may test for:
- The presence of recreational drugs
- Sexually transmitted infections including chlamydia and gonorrhea
- A current pregnancy
The surrogacy medical screening process is a complex (yet vital) step in determining if a woman should be accepted into an agency’s surrogacy program. This process confirms that the potential surrogate is physically healthy enough to carry a pregnancy to term without causing physical harm to the pregnancy.
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