To become a surrogate in the United States, you generally need to be between 21 and 45 years old, have delivered at least one child without major complications, pass medical and psychological screenings, maintain a healthy BMI, be free of nicotine and recreational drugs, and be financially stable. The exact criteria vary by agency and fertility clinic, but these baseline requirements are remarkably consistent across the industry, largely because most programs follow guidelines from the American Society for Reproductive Medicine (ASRM).
Previous Pregnancy and Birth History
This is the single most non-negotiable requirement. You must have previously given birth to at least one child and be currently raising that child. Reputable fertility clinics automatically disqualify candidates without a prior birth. The reasoning is straightforward: a successful pregnancy proves your body can carry to term, and the experience prepares you for the physical and emotional realities of doing it for someone else.
Most agencies also look at how your pregnancies went. If you had severe complications like preeclampsia, placenta previa, or preterm delivery, those can be disqualifying. The number of prior cesarean sections matters too. While one or two C-sections won’t necessarily rule you out, agencies are cautious because each additional cesarean increases surgical risk in future pregnancies. Programs typically cap the total number of pregnancies (including surrogacy births) at around five or six.
Age Range
Most surrogacy agencies require candidates to be between 21 and 40, though some clinics accept surrogates up to 45. The lower limit exists partly for legal reasons (contract enforceability) and partly because ASRM guidelines emphasize emotional maturity and the ability to give fully informed consent. The upper limit reflects the increased pregnancy risks that come with age, including gestational diabetes, high blood pressure, and preterm labor.
Physical Health and BMI
You’ll need to be in overall good health with no chronic conditions that could complicate pregnancy. Most agencies require a BMI between 19 and 33, though some clinics set the cutoff at 30 or 32. A higher BMI is associated with lower embryo transfer success rates and greater pregnancy complications, so this threshold is both a safety measure and a practical one. You’ll undergo a full medical evaluation, including bloodwork, a uterine assessment, and screening for infectious diseases like HIV, hepatitis B and C, syphilis, chlamydia, and gonorrhea. While the FDA does not technically require surrogates to undergo these tests (it classifies surrogates as recipients rather than donors), fertility clinics run them as standard practice.
Psychological Evaluation
ASRM guidelines recommend that all surrogate candidates undergo a psychosocial consultation and, when appropriate, psychological testing. In practice, this is a requirement at virtually every reputable agency. The evaluation typically involves a clinical interview and a standardized personality inventory, a self-report questionnaire designed to flag conditions like depression, anxiety, or personality disorders that could affect the surrogacy experience.
The screening isn’t just about diagnosing mental illness. It assesses your motivations for becoming a surrogate, your understanding of what you’re committing to, your ability to set boundaries with intended parents, and how you’ve handled emotional challenges in the past. If you have a history of a mental health condition that’s well-managed and in your past, that doesn’t automatically disqualify you. But active, untreated conditions will.
Medications and Mental Health Treatment
This is where the process gets more restrictive than many applicants expect. ASRM guidelines support screening out surrogates who are currently taking prescribed psychiatric medications. Intended parents are typically unwilling to accept any medication that might interfere with the embryo transfer protocol or pose a risk during pregnancy, and clinics reinforce this position. In practical terms, there is very little flexibility around taking supplemental medication during the transfer and pregnancy.
This creates a difficult situation for women managing conditions like clinical depression with medication. Discontinuing an antidepressant can cause severe mood instability and raises the risk of postpartum depression after delivery. Some applicants underplay or hide their medication use to get matched, which puts everyone at risk. If you currently rely on psychiatric medication to function well in daily life, most programs will not accept you as a candidate, not as a judgment on your fitness as a person, but as a precaution given the medical stakes involved.
Substance Use and Lifestyle
You must be a non-smoker and free from recreational drug use. Most agencies require that you’ve been nicotine-free for at least one year before applying, and some test for nicotine during screening. Any history of drug or alcohol abuse is disqualifying, though the specific lookback period varies. You’ll undergo drug screening during the application process and may be tested randomly throughout the pregnancy.
Alcohol use must stop completely once the surrogacy process begins, starting before the embryo transfer. Marijuana is treated the same as other drugs regardless of its legal status in your state, because it remains a concern during pregnancy.
Financial Stability
Agencies evaluate your financial situation, and this surprises many applicants. The requirement exists to ensure that no one enters surrogacy out of financial desperation, which ASRM guidelines specifically flag as a coercion risk. You need to be supporting yourself and your family without relying on surrogacy compensation as essential income.
Receiving government assistance like food stamps or Medicaid-funded insurance can be disqualifying. A recent bankruptcy (typically within the past year) may also rule you out. Agencies evaluate financial eligibility by asking whether you can support your family independently, whether you’re currently free from government assistance, and whether you’ve avoided recent bankruptcy. The goal is to confirm you’re pursuing surrogacy from a stable foundation, not under financial pressure.
Legal Considerations by State
Surrogacy laws vary dramatically across the United States. States like California, Connecticut, and Illinois expressly permit and regulate surrogacy, making the legal process relatively straightforward. Other states, like Arizona and Nebraska, treat surrogacy contracts as void or unenforceable. Several states, including Alaska and Minnesota, have no specific statutes or case law on surrogacy at all, creating legal gray areas.
Where you live affects not just whether you can be a surrogate but how the legal process works for establishing the intended parents’ rights. Some agencies will work with surrogates in less favorable states by arranging for the birth to take place in a surrogacy-friendly jurisdiction, but this adds complexity. If you live in a state where surrogacy contracts are unenforceable, you may have fewer agency options or face additional legal steps.
Support System at Home
Agencies want to know that you have a reliable support network. Surrogacy involves fertility medications, medical appointments, potential bed rest, and the physical demands of pregnancy on top of your existing responsibilities. You’ll need people around you who can help with childcare, transportation, and daily life, especially during the later stages of pregnancy or if complications arise.
If you have a spouse or partner, they’re typically included in the screening process. They’ll participate in the psychological evaluation and may need to sign legal documents consenting to the arrangement. A partner who is unsupportive or uncomfortable with surrogacy can be a disqualifying factor, because conflict at home directly affects the pregnancy and the surrogate’s wellbeing. Single surrogates aren’t excluded, but they’ll need to demonstrate they have other reliable support in place.