Before a surrogate can be matched to you, your agency or clinic must admit the surrogate to their program. Screening potential surrogates is a very important step that affect the likelihood that embryo transfer and pregnancy will be successful. Not all women who are young and motivated to help intended parents are fit to become a surrogate. Surrogacy agencies and clinics have to consider a wide range of factors that make a candidate suitable or unsuitable for becoming a surrogate. If you choose a surrogate who is medically, mentally, or socially unprepared to carry your child for 9 months, the chance of success in surrogacy is reduced. I’ve heard many disastrous stories due to poor selection from surrogates, from canceling embryo transfer at the last minute due to the surrogate living with a violent boyfriend to miscarriage due to stress in her job.
Surrogate screening process is typically broken down into two steps: initial screening and medical screening. Initial screening is when your agency reviews the information provided by the surrogate candidate and follows up with the candidate to see if she is eligible for surrogacy. Most clinics in the US uses the guideline published by American Society of Reproductive Medicine. Some surrogacy agencies in Mexico also follow these guidelines. Understand what they are and check to see if your agency is following this guideline.
Surrogacy Requirements (ASRM Guideline)
1) The surrogate is between 21 years of age to 45 years of age
The surrogate must be at least 21 years old because she should have had a child already and she should be emotionally mature to understand what it takes to be a surrogate mother for intended parents. Being at least 21 years of age also ensures that the surrogate has physically matured.
The surrogate should be younger than 45 years of age, and ideally younger than 40 years of age. Pregnancy over the age of 40 comes with increased risks to the woman and the fetus, such as:
- Premature birth
- Miscarriage
- Low birthweight
- Preeclampsia
This doesn’t necessarily mean younger the surrogate mother, the better. Many surrogates between ages 35 and 40 have carried fetus to term successfully. As intended parents, you just have to make sure the surrogates are between 21 and 40.
2) The surrogate has a healthy BMI (Body-Mass Index)
Body-Mass Index (BMI) can be used to classify whether a person is underweight, normal weight, overweight, or obese. A person with a BMI of 30 or more is considered obese (though, there are some controversy surrounding this classification). Many surrogacy agencies require their surrogates to have a BMI of less than 30 – 33. Obesity is known to be associated with increased obstetric and neonatal risk as well as a higher risk of miscarriage.
3) The surrogate does not smoke or use drugs
Smoking and using illicit drugs are known to have large detrimental effects on fetus development and may lead to stillbirth.
4) The surrogate is not on welfare
This requirement is to ensure that the surrogate does not rely on compensation from her surrogacy as her primary source of income.
5) The surrogate has had at least one successful previous pregnancy and has not had more than 5 vaginal births or 3 C-section births
The surrogate should be proven to be able to carry pregnancy to term successfully. In the US, most agencies and clinics don’t allow women who have never given birth to become a surrogate. This is to ensure that the surrogate’s body has a proven ability to carry a fetus to term. Also, the surrogate should not have more than 5 births as multiple pregnancies can put significant strain on a woman’s uterus. For example, uterine atony, which is when uterus fails to contract after childbirth, increases after a woman has had more than 5 babies.
6) The surrogate is currently raising a child in her home
7) The surrogate has had no major complications in previous pregnancies
8) The surrogate has no history of postpartum depression and has not used antidepressants or antianxiety medications for 12 months
The requirements 7 and 8 are to ensure that the surrogate is in good mental and physical conditions to become pregnant with your fetus.
9) The surrogate is able to travel to medical appointments
The surrogate should be living in an area that is not too far from the clinic. She also should have the means to travel to appointments in the clinic for regular prenatal checkups by her OBGYN. Some agencies in Mexico help their surrogates by accompanying them to the appointments.
10) The surrogate should have a stable home life and support system
The surrogate should be living at home and has friends and family that can help her during pregnancy. Her spouse and/or family should know that she will be a surrogate for an intended parent and they should support her decision. If her family doesn’t support her decision to be a surrogate, she would be encouraged to talk to her family before becoming a surrogate.
In addition, a surrogate should not be living in a collective living facility for surrogates set up by an agency, away from her home. This used to be a common type of exploitation for women as it takes away their autonomy and support system, but it is rarely practiced nowadays in Mexico.
Follow-up for surrogates who passed initial screening
After the surrogate candidates pass the initial screening, an agency would typically investigates further the suitability of the candidates. This may involve the following:
1) Background check
An agency in Mexico may conduct a background check to make sure that the surrogate candidate and/or her spouse has not been convicted of a felony.
2) Psychological evaluation
A mental health professional will talk to the surrogate candidate about what surrogacy will entails. He or she will also assess whether the candidate is emotionally ready to carry someone else’s child for 9 months. It takes a lot of commitment to complete a surrogacy process, so the surrogate candidate has to be prepared for the potential emotional complications involved in surrogacy. In general, the surrogate candidate should be emotional mature, stable, and have the right motivation to be a surrogate. An ideal surrogate would want to help intended parents have a baby that they have longed for, is willing to put the wellbeing of the fetus first, and is not just “in it” for money.
3) Medical screening
A surrogate will complete medical screening to make sure she is medically fit to become a surrogate in Mexico. There are several tests and examinations that fertility doctors will perform, such as:
- Pap smear to check for any evidence of cervical cancer
- Physical examination
- Blood test done on the surrogate candidate and/or her partner to screen for sexually transmitted diseases and other infectious diseases
- Urine test to check for any presence of drugs
- Hysteroscopy or ultrasound to check the health of the uterus
4) Social and medical history
The surrogate candidate’s social and medical history may be collected and evaluated by a health professional.
5) In-home assessment or video consultation
A surrogacy professional from your agency may visit the home of the surrogate candidate and talk to her family members to make sure that the home environment is stable and healthy for pregnancy. The professional will assess whether all her family members are aware that she wants to become a surrogate and that they are supportive of her decision. Some agencies may conduct assessment over Zoom in lieu of home visit.
Final Thoughts
Many intended parents are eager to get matched with a surrogate. Because there is currently a smaller number of surrogates than intended parents in Mexico, some intended parents may feel the screening process is too strict. They might jump at an agency offering immediate match. However, there is a real cost to using a surrogate who is not suitable for surrogacy. She might be emotionally unprepared, physically not fit, or live in an unstable home environment with unsupportive spouse. If an intended parent goes with a surrogate who is not properly vetted, they may experience repeated embryo transfer failure or worse yet, miscarriage after many months of pregnancy. The emotional toll would be devastating. It is important for intended parents to choose an agency that properly screens surrogates and carefully examine the profile of the surrogate presented to them by their agency.