Prospective surrogates usually complete a detailed medical screening before they are approved for an embryo transfer. The exact list varies by fertility clinic, country, personal history and how recently earlier tests were performed.
Screening commonly includes review of previous pregnancy records, a physical examination, blood and urine tests, infectious-disease screening and an assessment of the uterus. A clinic may also request cervical screening, a drug screen, an ultrasound, a saline sonogram or hysteroscopy, and tests for a spouse or partner.
This process is designed to protect the prospective surrogate, the pregnancy and the intended parents. It is not a guarantee that treatment will work or that a pregnancy will have no complications.
The short answer
A surrogate may have tests covering four broad areas: her general health, previous pregnancies, possible infections and the condition of her uterus. Clinics also assess emotional readiness and review lifestyle factors, although psychological screening is not a medical test.
No online checklist can confirm eligibility. The fertility clinic must decide which tests are appropriate and interpret the results in context.
Why do surrogates need medical screening?
Gestational surrogacy involves medication, embryo transfer, pregnancy and birth. Screening helps the clinical team identify conditions that could make treatment or pregnancy less safe.
It can also uncover an infection that needs treatment, show whether immunity or vaccination should be discussed, and identify a uterine issue that may affect implantation. Sometimes a result simply means that more information or a specialist opinion is needed.
Review of medical and pregnancy records
The process often starts before any new blood is taken. The clinic may ask for primary-care records, prenatal notes, delivery summaries, C-section operative reports and records of pregnancy complications.
Clinicians look at previous full-term pregnancies and consider issues such as pre-eclampsia, gestational diabetes, preterm birth, haemorrhage, placental problems, severe tearing and postpartum mental health. They may also review miscarriages, ectopic pregnancies and gynaecological surgery.
Accurate records matter even when a previous pregnancy felt straightforward. For applicants with caesarean births, see Can You Become a Surrogate After a C-Section?.
General physical examination
A clinician may record height, weight, blood pressure, pulse and other basic observations. The examination and health questionnaire may cover the heart, lungs, abdomen, reproductive health, current medication, allergies and previous operations.
The purpose is not to expect a perfect medical history. It is to decide whether known conditions are controlled, whether pregnancy could worsen them and whether another clinician should be consulted.
What blood tests might be requested?
The precise blood panel is clinic-specific. Common possibilities include a complete blood count to look for anaemia or other abnormalities, blood group and Rh type, and tests related to kidney, liver, thyroid or glucose function when clinically appropriate.
A result outside the reference range does not automatically mean rejection. It may need repeating, treating or interpreting alongside symptoms and medical history.
Infectious-disease screening
Clinics generally screen for infections that could affect the surrogate, pregnancy, baby or people involved in treatment. Depending on the clinic and jurisdiction, the panel may include HIV, hepatitis B, hepatitis C, syphilis, gonorrhoea and chlamydia. Cytomegalovirus and other tests may also be considered.
Requirements and timing differ, and names on a standard panel can change. The clinic should provide its current written list and explain which results need confirmation or treatment.
A spouse or sexual partner may also be asked to complete infectious-disease testing. This is a health precaution, not a judgement about a relationship.
Immunity and vaccination review
Blood tests may check immunity to infections such as rubella or varicella. The clinic may also review vaccination records and current public-health recommendations.
Some vaccines cannot be given during pregnancy and may require a waiting period before embryo transfer. A prospective surrogate should not arrange a vaccine or change the timing of treatment without advice from the fertility clinic or her own healthcare professional.
Urine tests and drug screening
A urine sample may be used for pregnancy testing, infection checks, general health assessment or a drug screen. Some programmes also test for nicotine or request alcohol and substance-use information.
Applicants should disclose prescribed, over-the-counter and recreational substances honestly. A positive result can have different explanations, and the clinic should confirm unexpected findings before making a decision.
Cervical screening and sexual-health checks
A clinic may require evidence that cervical screening is up to date under local guidance. It may request a new test if one is due, a previous result needs follow-up or records are unavailable.
This is different from checking the uterine cavity. Cervical screening looks for changes in cells of the cervix, while uterine assessment examines the space where an embryo would be placed.
Transvaginal ultrasound
A transvaginal ultrasound can show the uterus, uterine lining and ovaries. It may help identify fibroids, polyps, ovarian cysts or other findings that require discussion.
The person performing the scan places a covered ultrasound probe in the vagina. Clinics should explain the procedure, obtain consent and offer appropriate privacy and support.
Saline sonogram
A saline infusion sonogram, also called sonohysterography, gives a clearer view of the inside of the uterus. A clinician passes a thin catheter through the cervix, introduces sterile fluid and uses ultrasound to inspect the cavity.
It may reveal a polyp, fibroid, scar tissue or an unusual cavity shape. Temporary cramping or spotting can occur, and the clinic should explain risks, preparation and aftercare.
Hysteroscopy
Some clinics use hysteroscopy instead of, or after, a saline sonogram. A slim camera is passed through the cervix so the clinician can view the uterine cavity directly.
Whether it is performed routinely or only after another test depends on the programme and medical history. Diagnostic and operative hysteroscopy are not identical, so applicants should ask what is proposed and why.
Mock embryo transfer
A mock transfer allows the clinician to practise passing a soft catheter through the cervix and map the route into the uterus without transferring an embryo. It may help the team plan catheter choice and placement.
Not every clinic performs one as a separate appointment. Our guide What Happens During an Embryo Transfer to a Surrogate? explains the treatment-day procedure.
Hormone tests and lining checks
Blood tests for hormones are not identical for every applicant. A clinic may check particular hormone levels when investigating menstrual cycles, confirming baseline status or monitoring medication.
Once a transfer cycle begins, blood tests and ultrasound scans may be used to monitor the endometrium and determine whether medication and timing are appropriate. These cycle-monitoring appointments are separate from initial eligibility screening.
Do surrogates have genetic testing?
In gestational surrogacy, the carrier does not provide the egg and is not genetically related to the baby. Genetic testing of the people providing the egg and sperm therefore addresses a different question from the carrier’s medical fitness for pregnancy.
A carrier may still be offered or required specific genetic tests because of her own health history, ancestry, local rules or clinic policy. Ask what each test can show and whose health it is intended to assess.
Learn more in Does a Surrogate Mother Use Her Own Egg?.
Psychological screening is also important
Psychological assessment is not a blood test or scan, but it is a standard part of many surrogacy programmes. It can explore expectations, motivation, communication, support, boundaries and the emotional implications of pregnancy for another family.
A spouse or partner may be included because the journey affects household routines and relationships. Independent legal advice is another separate safeguard and should not be replaced by counselling or medical consent.
Are all tests completed at one appointment?
Usually not. Records may be reviewed first, followed by a consultation, laboratory work and uterine assessment. Some tests must occur at a particular point in the menstrual cycle.
Screening can also pause while records are obtained, an infection is treated or a specialist provides clearance. Applicants should ask which appointments are local, which require travel and when results are expected.
Will any tests be repeated?
Yes, they may be. Clinics can require infectious-disease or pregnancy testing within a defined period before treatment. A result may expire if matching or legal preparation takes longer than expected.
Tests may also be repeated to confirm an unexpected result, after treatment or before a later transfer attempt. A surrogate beginning another journey should expect a fresh review rather than assuming earlier clearance remains valid.
What happens if a result is abnormal?
An abnormal result does not always end the process. The clinic may repeat the test, request primary-care or specialist assessment, recommend treatment or postpone transfer until an issue is resolved.
Some findings do create a level of pregnancy risk that a clinic will not accept. The applicant should receive a clear explanation, a copy of relevant results and advice about any follow-up needed for her own health.
Who pays for surrogate screening?
Payment arrangements depend on the country, programme and agreement. Intended parents or an agency may cover approved screening costs, travel and related expenses, but this should be confirmed in writing before appointments are booked.
Applicants should ask how unexpected follow-up care is handled, whether insurance is involved and who receives invoices. Medical privacy should be respected even when another person pays.
How to prepare for medical screening
- Collect complete records for every pregnancy and delivery.
- List medication, supplements, allergies and previous procedures.
- Bring vaccination and cervical-screening records if available.
- Ask whether fasting or cycle-day timing is required.
- Disclose health and substance-use information accurately.
- Write down questions about discomfort, consent, costs and results.
Do not stop prescribed medication or make a health decision simply to meet eligibility criteria. Discuss changes with the prescribing professional and fertility clinic.
Questions to ask the fertility clinic
- Which tests are required, and which are optional?
- Why is each test being performed?
- How long will each result remain valid?
- Who can see the results?
- What happens if follow-up is needed?
- Who pays for testing, travel and treatment?
- When is final medical clearance given?
You can explore fertility clinics, browse intended-parent profiles or create a SurrogateFinder profile. Matching should never replace independent medical, psychological and legal screening.
Frequently asked questions
Do surrogates have to pass a blood test?
Blood testing is commonly part of screening. The panel varies but may assess blood group, general health, immunity and infectious diseases.
Are surrogates tested for drugs?
Many clinics or programmes use urine, blood or other testing for drugs, nicotine or alcohol exposure. Policies, consent procedures and confirmation of unexpected results vary.
Do surrogates get tested for STIs?
Infectious-disease screening commonly includes sexually transmitted infections that could affect treatment or pregnancy. The exact infections and timing depend on local and clinic requirements.
Does a surrogate need an ultrasound?
Many prospective gestational carriers have a transvaginal ultrasound or another form of uterine assessment. The clinic decides which imaging is appropriate.
Is a saline sonogram painful?
Experiences differ. Some people report mild or moderate cramping and temporary spotting. The clinic should explain pain relief, risks and when to seek advice afterward.
Can a health condition disqualify a surrogate?
Some conditions may make pregnancy or fertility treatment too risky, while others can be reviewed or managed. Eligibility is an individual clinical decision, not a diagnosis made from a checklist.
How long does medical clearance take?
It may take several weeks, but timing varies with record collection, menstrual-cycle scheduling, laboratory turnaround and any follow-up assessment.
Can medical clearance expire?
Yes. Clinics may repeat time-sensitive tests if transfer is delayed or require a new assessment before another journey.
The bottom line
Surrogate medical screening usually combines records, examination, laboratory testing and assessment of the uterus. It is thorough because approval affects the health of more than one person, but the exact protocol is not universal.
Ask the treating fertility clinic for its current requirements and a plain-language explanation of every test. This article provides general information and is not a substitute for individual medical advice.