Agency Screening
Reputable agencies screen surrogate applicants before adding them to their active pool. Agency-level screening typically includes: review of prior obstetric records (number of pregnancies, complications, delivery type), health history questionnaire, BMI assessment, lifestyle factors (no smoking, substance use), criminal background check, financial stability check, home study or home visit, and a preliminary psychological screening interview. Surrogates who do not meet agency criteria are declined before they are ever presented to intended parents.
Psychological Evaluation
A licensed mental health professional (typically a psychologist or clinical social worker with third-party reproduction experience) conducts an in-depth psychological evaluation of the surrogate and, separately, of her partner or spouse if she has one. This evaluation assesses: understanding of the surrogacy process and ability to relinquish the baby, absence of unresolved attachment issues, emotional stability, social support system, motivations for becoming a surrogate, and views on sensitive GCA topics. The psychological evaluation is required by fertility clinics and is separate from the agency's preliminary screening.
Medical Evaluation at the Fertility Clinic
After matching and GCA execution, the fertility clinic conducts its own comprehensive medical evaluation. This is more thorough than the agency's initial health review and includes: uterine assessment (saline sonogram or hysteroscopy to check for polyps, fibroids, or other abnormalities), full hormone panel, complete blood count and metabolic panel, infectious disease screening (HIV, hepatitis B and C, syphilis, gonorrhea, chlamydia), and review of all prior obstetric and medical records. The REI (reproductive endocrinologist) makes the final medical clearance decision. A surrogate who passed agency screening may still be declined at the clinic level.
Background Check
Background checks cover criminal history at the county, state, and federal level. Most agencies and fertility clinics also run background checks on the surrogate's spouse or partner who lives in the home.
The fertility clinic's medical evaluation is independent of the agency's screening. Don't assume agency approval equals clinic clearance — the clinic makes its own determination based on direct medical assessment.