Luckily, there are some incredible women who feel that their own family is complete, had easy pregnancies (and loved being pregnant!), want to change other people’s lives to allow them to experience the joy of parenthood, and are willing to take the inherent medical risks of any pregnancy, including the fact that any pregnancy could be their last. The American Society for Reproductive Medicine (ASRM) has created countless resources for surrogacy professionals and intended parents, and guidelines for screening gestational surrogates (referred to in legal jargon as gestational carriers). Surrogacy agencies and IVF clinics use these resources as just that, guidelines. In fact, many top agencies and IVF clinics impose even stricter requirements for their GC candidates.
What are the requirements that all gestational surrogates must meet?
A potential surrogate candidate must meet the following criteria:
Be between the ages of 21 and 42
•ASRM guidelines allow for a surrogate to be up to 45-years-old; however, most IVF clinics require that a first-time surrogate deliver before she turns 44. Some clinics require her to be a bit younger than that.
•When looking to make a match, it is important to ask whether the intended parents are interested in a sibling journey. If yes, it would necessitate matching them to a GC candidate who is open to the possibility of a second, sibling journey. To this end, the age limit should be lower, typically 40, to give her time to do a repeat, sibling journey if all works out well during the first journey -- without aging out.
Had at least one healthy pregnancy and delivery (and no more than 5 prior pregnancies)
•Exceptions have been made for repeat surrogates on a case-by-case basis.
•Again, if a sibling journey is desired, then when making a match, it is preferable to back down the number of prior deliveries, limiting it to 4.
•Had no more than 3 prior C-sections
- Note: Some clinics limit to no more than 2 prior C-sections, but there are many clinics that accept 3 prior C-sections.
Had full-term, complication-free prior pregnancies
•No delivery of a singleton before 35 weeks
•No delivery of multiples before 32 weeks
•The best predictor of a safe, full-term pregnancy are prior pregnancies.
- Note: The specific requirements vary by IVF clinic.
Have a BMI between 18% and 32%
•Some clinics will consider 33% on a case-by-case basis.
•Some clinics cap the top limit lower.
Be financially stable
•Not receiving government assistance, i.e., GC candidate is not receiving food stamps or Medicaid health insurance.
•Surrogate candidates are not required to have their own health insurance policy, so long as she takes care of her health, and many existing health insurance policies exclude maternity care for a gestational surrogate. Interestingly, in early 2019, Nevada was the first state to pass legislation that prohibits “an insurer from denying certain coverage for maternity care because the insured acts as a gestational carrier…” Go Nevada!
Reside in a surrogacy-friendly state
•GC candidate cannot live in a state in which compensated surrogacy is prohibited. In 2020, those states include Louisiana, New York, Michigan, and Nebraska. Effective February 15, 2021, New York will no longer prohibit compensated surrogacy; however, there are many requirements for surrogacy to take place in NY. Visit our US Surrogacy Map for more details about any state and for the most up-to-date information.
No history of gestational diabetes requiring medication
•If a surrogate candidate was able to manage her gestational diabetes with dietary restrictions alone, she can still qualify as a surrogate.
No history of a psychiatric diagnosis such as major depression, bipolar disorder, schizophrenia, psychosis, or a significant anxiety disorder and no current use or dependency on psychiatric medications, including all SSRIs
•A GC candidate must be off all SSRIs for at least 3 to 6 months (varies by clinic) with prescriber approval before medical and psych screening occurs.
No history of drug or alcohol abuse
•Note: History of nicotine and marijuana use when not pregnant is considered on a case-by-case basis
•It is typically required that a surrogate candidate be smoke-free for at least 1 year before applying to be a surrogate. Vaping nicotine must be discontinued 3-6 months before medical screening – This policy varies by IVF clinic. A candidate with a history of infrequent marijuana use when not pregnant may be approved on a case-by-case basis depending on the IVF clinic; matching will depend on the perspective of the intended parents
What about Intended Parents’ additional preferences for a surrogate?
It’s completely normal to have other preferences about your surrogate that go beyond the basic requirements! Those preferences deserve a clear and careful conversation -- first with your partner (if applicable) and then your surrogacy agency. Many surrogacy agencies work with surrogates of all different personalities, races, ethnicities, sexual orientations, gender identifications, religions, relationship statuses, and more. We value the importance of inclusivity and diversity, but there may be some preferences to consider for the kind of person you want your surrogate to be. Depending how strong your views are, you may have requirements or preferences for the agency to consider in finding the right person to be your surrogate. This is part of the matching process.
Examples of preferences that relate to your match could include geographic location, compatibility on issues such as termination and selective reduction, and the number of embryos to be transferred. If you are international parents, the surrogate’s marital status may be very important to your ease in gaining citizenship for your child after returning home; e.g., for parents from Germany and The Netherlands, an agency will match you to an unmarried surrogate.
In sum, your agency should match you to a GC candidate who meets your IVF Center’s qualifications, who meets your preferences, and who – importantly – is someone who gives you a sense of trust. After all, she will be carrying and caring for your child in utero.