Surrogacy requirements apply to both the person carrying the pregnancy and the intended parents, covering physical health, psychological readiness, legal standing, and lifestyle factors. Most surrogacy agencies and fertility clinics follow similar baseline criteria, though specific cutoffs can vary. Here’s what both sides need to qualify.
Age and BMI Requirements for Surrogates
Surrogates generally need to be between 21 and 43 years old. The American Society for Reproductive Medicine (ASRM) allows surrogates up to age 45, but most IVF clinics require a first-time surrogate to deliver before turning 44. The lower limit of 21 reflects both legal contracting age considerations and the preference for candidates with established pregnancy histories.
BMI requirements typically fall between 18 and 35, though many clinics cap the upper limit at 32. A small number of clinics will evaluate candidates with a BMI up to 35 on a case-by-case basis, but a BMI outside the accepted range is one of the most common disqualifiers.
Pregnancy History
Prior successful pregnancies are considered the best predictor of a safe surrogacy outcome. Most programs require at least one previous full-term delivery but no more than five total pregnancies. The delivery history should be free of significant complications. Candidates who’ve had more than three cesarean sections are typically disqualified, though some agencies will consider three C-sections if the pregnancies were otherwise uncomplicated and the candidate passes additional uterine evaluation.
If you’ve recently given birth, expect a mandatory waiting period: at least six months after a vaginal delivery and roughly a year after a C-section before you can begin a new surrogacy transfer.
Disqualifying Medical Conditions
Several health conditions will rule out a surrogacy candidate, even if she meets age, BMI, and pregnancy history criteria:
- Preeclampsia in a prior pregnancy
- Type 1 diabetes
- Gestational diabetes that required insulin or medication (gestational diabetes managed through diet alone may not disqualify you)
- Polycystic ovary syndrome (PCOS)
- Endometriosis
- Active cancer treatment or conditions requiring medications that aren’t safe during pregnancy
A history of preterm delivery (before 32 weeks) is also disqualifying in most cases, with one exception: if you later had a full-term singleton pregnancy (37 weeks or beyond), some programs will still consider you.
Medical Screening Process
Candidates who pass the initial eligibility criteria move on to a thorough medical screening. This includes blood and urine testing that covers immunity to common childhood illnesses (chickenpox, measles, mumps, rubella), thyroid and hormone levels, a full panel for sexually transmitted infections, a complete blood count, vitamin levels (particularly checking for anemia and vitamin D deficiency), and drug and alcohol screening. A urine culture screens for certain bacterial infections.
Your partner or spouse living in the household will also be screened for drug use and infectious diseases. Beyond bloodwork, the clinic performs an internal pelvic ultrasound to evaluate the uterine lining. Depending on your obstetric history, this may be done with or without a round of preparatory medications to simulate a transfer cycle.
Psychological Evaluation
Every surrogate candidate undergoes a psychological evaluation conducted by a mental health professional. This involves standardized personality assessments, such as the Minnesota Multiphasic Personality Inventory or the Personality Assessment Inventory, combined with an in-depth clinical interview.
The interview covers a wide range of topics: your family background, current relationships and support system, employment stability, history of trauma or abuse, legal history (including bankruptcy, custody disputes, or involvement with child welfare services), current life stressors, and your general personality traits like maturity, empathy, and assertiveness. Evaluators are looking for a stable home environment with enough emotional support to handle the added demands of carrying a pregnancy for someone else.
Factors that can lead to rejection include current relationship instability, an insufficient support network, a chaotic or highly stressful lifestyle, excessively demanding family circumstances, or a pattern of difficulty maintaining respectful relationships with others.
Lifestyle and Substance Use
Any history of drug or alcohol abuse is a disqualifier at virtually every agency. Candidates are screened for substance use during the medical evaluation, and ongoing testing continues throughout the pregnancy. Nicotine use is similarly restricted, as smoking and vaping carry well-documented pregnancy risks. Programs expect surrogates to remain substance-free from the start of fertility medications through the postpartum period.
Requirements for Intended Parents
Surrogacy requirements aren’t one-sided. Intended parents go through their own screening process. Most programs set a maximum age of 55 for intended parents. If one partner is over 60, the other typically needs to be under 50. Single men, gay couples, and individuals biologically unable to carry a pregnancy are presumed to have a medical need for surrogacy. For intended mothers, a licensed physician must confirm that carrying a pregnancy would be medically unsafe or impossible, whether due to physical conditions, a history of failed IVF transfers, recurrent miscarriage, or psychological factors documented by a mental health professional.
Intended parents also undergo background checks. A history of violent offenses, assault, domestic violence, or armed incidents is disqualifying. Most programs require intended parents to complete a psychological preparedness evaluation with a therapist specializing in assisted reproduction, who then provides a letter confirming readiness. Some programs also require at least two genetically tested embryos before matching with a surrogate, and expect intended parents to maintain at least weekly contact with their surrogate throughout the pregnancy.
Legal Requirements Vary by State
Surrogacy law in the United States is a patchwork. There is no single federal law governing surrogacy, so requirements depend entirely on which state the surrogate lives in and where the birth takes place. Some states, like Arizona, expressly prohibit surrogacy contracts and make them legally unenforceable. New York allows gestational surrogacy but bans traditional surrogacy (where the surrogate is also the egg donor). Kansas permits compensated traditional surrogacy but requires additional legal steps like confirmatory adoptions and donor agreements, with criminal penalties for noncompliance.
Other states are highly surrogacy-friendly with clear legal frameworks that allow pre-birth parentage orders, making the intended parents the legal parents before the baby is even born. Because of this variation, both surrogates and intended parents need legal representation from attorneys experienced in reproductive law in the relevant state. The legal contract between the parties establishes everything from compensation to medical decision-making to what happens in the event of complications.
Insurance and Financial Considerations
Health insurance for the surrogate is a critical logistical requirement. Some surrogates have existing health insurance policies that cover pregnancy regardless of whether it’s a surrogacy arrangement, but many policies exclude surrogacy or contain specific limitations. In those cases, intended parents typically purchase a dedicated surrogacy insurance policy or a supplemental rider to cover maternity care, delivery, and any complications.
For surrogates who are TRICARE beneficiaries (military insurance), coverage works differently. TRICARE acts as secondary insurance, meaning the medical expenses outlined in the surrogacy contract must be exhausted first. Without a formal contract in place, TRICARE won’t cover surrogacy-related maternity services at all.
Surrogate compensation in the United States averages $50,000 to $75,000 for a single pregnancy as of 2025. Experienced surrogates who have completed a previous surrogacy journey can earn an additional $5,000 to $10,000. This base pay is separate from reimbursements for medical expenses, maternity clothing, travel, lost wages, and other costs typically covered by the intended parents.