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Becoming a gestational surrogate is one of the most profound commitments a woman can make. It is a path guided by compassion and responsibility and it is also regulated by clear medical and legal standards. Many women applying for the first time are surprised to learn that something like past C-sections or a higher BMI can affect eligibility. Understanding why these rules exist helps them see that disqualification is not a rejection, but a safeguard for their health. Most agencies follow the guidelines established by the American Society for Reproductive Medicine (ASRM) to make sure that surrogacy is safe for both the surrogate and the intended parents.
This article explores in depth what may lead to disqualification for surrogacy, why these requirements exist, and how women can assess their own eligibility before applying.
Why Surrogacy Qualifications Are Essential
Surrogate qualifications are not simply boxes to check. They are safeguards designed to protect the health of the surrogate and the baby, while also ensuring intended parents can begin their journey with confidence. These requirements follow the best practices set by the fertility specialist and are carefully implemented by experienced medical professionals, including registered nurses.
Candidates must meet specific standards such as being between 21 and 45 years old, having at least one prior uncomplicated pregnancy and delivery, maintaining a healthy BMI between 18 and 35, and living in a stable environment with strong support from family or friends. Surrogates must also be U.S. citizens or permanent residents, refrain from smoking, alcohol, drugs and be willing to follow medical protocols including appointments, travel and taking injectable medications.
These health and safety criteria are not barriers but protections. They exist to minimize health risks, create a secure legal framework and provide the foundation for a safe and successful surrogacy experience. By setting clear expectations from the start, we ensure that every surrogate who joins our program is fully prepared for the responsibility of carrying a child on behalf of intended parents.
The Most Common Disqualifications for Surrogacy
Certain factors may disqualify a candidate from surrogacy. These are not meant to discourage women but to protect their safety and ensure a successful outcome for intended parents.
Age Requirements for Surrogacy
The ASRM guidelines exist to protect the health of the surrogate and the baby. ASRM guidelines are as follows: “Carriers must be of legal age, and preferably between the ages of 21 and 45 years. Certain situations may dictate the use of a carrier older than 45 years, but all parties involved must be informed about the potential risks of pregnancy with advancing maternal age.” The goal is always to create the best chance for a healthy pregnancy.
2. Previous Pregnancy History
ASRM guidelines require that every surrogate candidate must have experienced at least one healthy pregnancy and live birth. This ensures two things:
● The surrogate’s body has already demonstrated the ability to carry a pregnancy to term
● She understands the physical and emotional aspects of pregnancy
Women with no birth history are automatically disqualified. One surrogate we spoke with said that having already carried her own children gave her confidence when applying. She explained that she knew what to expect physically, and that reassurance helped both her and the intended parents feel secure.
3. BMI Restrictions for Surrogacy
ASRM guidelines provide overall health and safety recommendations for third-party reproduction, including that surrogates must be in good physical health and free from medical conditions that increase pregnancy risks. They do not set a strict universal BMI number. Instead, they leave it to fertility professionals to apply BMI thresholds in line with medical best practice.
Most programs apply a BMI range of 18–35, based on ASRM’s broader health and safety criteria. We make sure to follow the best industry practice, and we carefully review BMI as part of the gestational carrier assessment.
4. Medical Conditions Disqualifying Surrogates
Certain health conditions may create risks during pregnancy and can lead to disqualification for surrogacy. Specific criteria vary from agencies and clinics. These include:
● Polycystic Ovary Syndrome (PCOS)
● Preeclampsia in prior pregnancies
● Gestational diabetes requiring insulin
● Type 1 diabetes
● More than three prior C-section
● More than 5 deliveries
The ASRM guidelines emphasize that surrogates should be free of underlying health conditions that could complicate pregnancy.
5. Psychological Evaluations for Surrogates
Candidates with a history of psychiatric illness or who are currently on antidepressants are not eligible. Every surrogate undergoes a psychological health assessment with a psychologist to ensure emotional readiness prior to being introduced and matched with Intended Parents.
6. Lifestyle and Residency Requirements
Lifestyle plays a critical role in eligibility. A candidate may be disqualified if she has a drug use history, smokes, abuses alcohol or lives in an unhealthy living environment, like being exposed to secondhand smoke.
Residency is another key factor:
● Candidates must have legal residency and meet citizenship requirements for surrogates
● They must live in surrogacy-friendly states
Agencies typically work closely with legal experts to ensure compliance with all surrogacy legal considerations and to remain up to date with changing state laws.
7. Financial Stability and Support System
Candidates who rely heavily on government assistance may not qualify, as financial stability is an important factor in the screening process. In addition to financial stability, most agencies underline the importance of a strong surrogate support system. Many surrogates share that the encouragement of a partner, parent or close friend made all the difference during their journey. Even simple thing likes, like offering to help with childcare during appointments, can strongly impact the experience. Strong support systems are essential. Many agencies also encourage candidates to connect with peer groups, where surrogates can share experiences and provide mutual encouragement.
The Surrogate Screening Process
The surrogate screening process is designed to protect both the surrogate and the intended parents. This includes:
● Medical history review for surrogates with previous pregnancy history
● psychological evaluations for surrogates
● Lifestyle verification: no smoking, drug-free, safe living conditions
● Legal residency verification
Only women who meet all these surrogacy program requirements move forward in the process.
How Previous Pregnancy Outcomes Impact Eligibility
A healthy birth history strengthens eligibility, while repeated complications may lead to disqualification. A registered nurse carefully reviews pregnancy histories to ensure they align with the intended parents’ clinic requirements.
Examples include:
● Severe preeclampsia in past pregnancies
● Uncontrolled gestational diabetes
● Multiple C-sections or emergency deliveries
Every case is reviewed individually. Some women may still qualify if risks are minimal and approved by an IVF clinic.
Surrogacy Legal Considerations
Surrogacy laws differ by state. Some states fully support gestational surrogacy, while others restrict or ban it.
To qualify, candidates must:
● Live in surrogacy-friendly states
● Meet citizenship requirements for surrogates
● Have the ability to sign a legally binding surrogate contract agreement
All surrogates live in states where laws support the process.
Is There Flexibility in the Requirements?
While many disqualifications are strict, there is sometimes flexibility. A woman with a history of diet-controlled gestational diabetes may still be eligible. Candidates with four C-sections may be accepted if previous recoveries were uncomplicated. However, conditions like active drug use, lack of legal residency or untreated mental illness are final disqualifiers.
Support Beyond Eligibility
Surrogacy is more than meeting requirements. Ongoing support is also important, including:
● Surrogacy journey support from dedicated coordinators
● Transparent surrogate compensation packages
● Emotional counseling and wellness checks
● Legal guidance throughout the process
Frequently Asked Questions
Q1. What are the most common reasons for disqualification from surrogacy?
living in non-surrogacy-friendly states, age outside the accepted range, no previous pregnancy, BMI outside 19–35, medical conditions such as PCOS or preeclampsia, smoking or drug use
Q2. What medical conditions can disqualify a surrogate applicant?
Preeclampsia, PCOS, gestational diabetes requiring insulin, Type 1 diabetes and other severe conditions.
Q3. What lifestyle factors lead to disqualification?
Smoking, drug use, excessive alcohol, unsafe living conditions, and lack of a reliable support system.
Q4. Are there age or family requirements?
Yes, candidates must be 21–45 years old and have at least one healthy prior pregnancy.
Q5. What are the legal residency requirements?
Surrogates must be legal residents or citizens of the United States and live in states with surrogacy-friendly laws.
Q6. How do previous pregnancy outcomes affect eligibility?
Healthy pregnancies strengthen eligibility. Complications like preeclampsia or multiple C-sections may disqualify.
Q7. Can you be a surrogate with your tubes tied?
Yes. Having your tubes tied (tubal ligation) does not disqualify you. Since embryos are created through IVF and transferred directly to the uterus, tubal ligation has no impact on the ability to carry a pregnancy.
Q8. Is there any flexibility in the requirements?
Some, but only when medical risks are minimal and approved by fertility specialists.
Conclusion: Understanding Your Path to Surrogacy
Disqualification for surrogacy is never about rejection. It is about ensuring safety and giving intended parents the best chance at welcoming a healthy baby. ASRM guidelines help ensure surrogacy programs remain safe, ethical and supportive.
If you are considering surrogacy, the best first step is to begin the screening process. This will clarify medical, legal, and emotional factors so you can know with certainty whether surrogacy is right for you. You can take our quiz here.
