The requirements for becoming a surrogate fall into six buckets: age and prior pregnancy history, physical health, mental health, lifestyle and background, insurance and legal paperwork, and the law of the state you live in. Most of these standards come from the American Society for Reproductive Medicine (ASRM) and individual agency policies rather than any single federal statute, so exact cutoffs shift a little between clinics. The shape of the screening, though, is consistent nearly everywhere.
Age and Prior Pregnancies
ASRM recommends gestational carriers be between 21 and 45 years old, with some room above the upper limit if additional screening supports it.1ASRM. Recommendations for Practices Using Gestational Carriers – A Committee Opinion 2022 The floor exists so the carrier can give fully informed consent and has already completed a pregnancy of her own. The ceiling reflects the climbing risk of gestational diabetes, hypertension, and other complications in pregnancies after 45.
Prior pregnancy history is just as important as age. ASRM guidance says the carrier should ideally have had at least one uncomplicated, full-term pregnancy before carrying for someone else.2Fertility and Sterility. Recommendations for Practices Utilizing Gestational Carriers That gives the medical team obstetric records to review for warning signs like preeclampsia, placenta previa, or preterm labor. Many agencies add a rule of their own: the candidate must be actively parenting the child she delivered. That requirement isn’t in the ASRM criteria, but it is common, and the reasoning is that parenting experience shows the candidate understands what she is helping someone else take on.
Medical Screening
Every candidate goes through a full medical workup before being cleared for embryo transfer. The exam covers reproductive health, general physical condition, and a careful look at past pregnancies.
Body mass index matters. Published reproductive medicine research points to an optimal BMI below 30, and while some agencies will accept candidates up to a BMI of 32 or 33, higher weight raises the risk of gestational diabetes, hypertension, and cesarean delivery. Each clinic sets its own cutoff based on how much risk it is willing to carry.
Substance use is a hard disqualifier. Candidates must be non-smokers, free of illegal drug use, and without a history of alcohol abuse. These rules are about fetal development, but they are also about reliability over a nine-month commitment.
Infectious disease testing is standard. The panel typically includes HIV (types 1 and 2), hepatitis B and C, syphilis, chlamydia, and gonorrhea. That panel mirrors the FDA’s required screening for anyone donating reproductive cells or tissue.3eCFR. 21 CFR 1271.85 – What Donor Testing Is Required for Different Types of Cells and Tissues Technically the FDA treats the gestational carrier as a tissue recipient rather than a donor,4Food and Drug Administration. Reproductive Donor Workshop but in practice fertility clinics run the full panel on surrogates as a matter of routine care.
Expect travel restrictions once you are matched. Contracts commonly limit travel to regions with active infectious disease outbreaks, especially places with Zika transmission risk, because Zika can cause severe birth defects. The CDC maintains a list of countries considered at risk based on current or past transmission.5CDC. Countries and Territories at Risk for Zika International travel during the pregnancy usually requires written approval.
Psychological Evaluation
ASRM recommends every candidate complete a psychosocial consultation and, where appropriate, standardized psychological testing.1ASRM. Recommendations for Practices Using Gestational Carriers – A Committee Opinion 2022 This is where many medically qualified candidates get screened out.
The evaluation is normally a clinical interview with a licensed mental health professional, paired with a personality inventory. The evaluator looks at motivation for carrying, emotional readiness for handing the baby to the intended parents, and the plan for managing the relationship with them during and after the pregnancy. A spouse, partner, or close family support system is part of the picture. Candidates whose primary driver appears to be financial pressure, or who show signs of unresolved grief from a prior loss, are likely to be flagged.
Background, Finances, and Government Assistance
Agencies run a criminal background check on the candidate, her spouse or partner, and other adults in the household. Felony convictions, particularly for drugs or violence, usually disqualify.
Financial stability is part of the review. The point is to make sure a candidate isn’t entering surrogacy out of economic desperation, which raises coercion concerns. Agencies generally want to see household income sufficient to meet basic needs without the surrogacy compensation.
Receiving means-tested government benefits like Medicaid, SNAP, or housing assistance disqualifies candidates at nearly every agency. First-time carrier base pay commonly runs $60,000 to $75,000 in 2026, which has to be reported as income and will almost certainly push the surrogate off those programs. Failing to report it is fraud. Medicaid creates a separate issue: it does not cover prenatal care tied to a commercial surrogacy, and using it that way can expose both the carrier and the intended parents to legal consequences. The disqualification isn’t permanent. Someone previously on assistance who has since become financially self-sufficient can apply again.
U.S. citizenship or permanent legal residency is another standard agency requirement. It isn’t a medical standard. It exists to keep the legal and insurance side of the arrangement workable.
Health and Life Insurance
Insurance is one of the parts of qualifying that catches people off guard. Your existing health plan gets reviewed early. Many employer-sponsored plans contain language excluding coverage for pregnancies carried as a gestational surrogate, sometimes called “third-party reproduction” exclusions.
Plans that don’t exclude surrogacy outright can still cause problems. Some contain lien clauses letting the insurer recoup costs from the surrogate’s compensation once the arrangement is discovered. Others have narrow networks that leave out the fertility clinic or delivery hospital the intended parents want to use. When the existing plan won’t work, the intended parents typically purchase a surrogacy-specific policy for the carrier.
A life insurance policy on the carrier, paid for by the intended parents, is also standard. It protects the surrogate’s family in the event of a fatal pregnancy complication, and the policy usually has to be active and fully paid before the embryo transfer.
The Contract and Your Own Attorney
No embryo transfer happens without a signed surrogacy agreement. The contract establishes how legal parentage will be handled, what happens if medical complications arise (including decisions about intervention and termination), and the full compensation structure: base pay, monthly allowances, reimbursement for pregnancy-related expenses, and extra payments for things like a cesarean or carrying multiples.
Reputable agencies have the surrogate represented by her own attorney, separate from the intended parents’ lawyer, with the intended parents paying for that representation. Independent counsel isn’t legally mandated in every state, but it is close to universal in professionally managed surrogacies. The surrogate’s attorney reviews the agreement to confirm the compensation is fair, her rights are protected, and she understands what she is signing. Skipping this step is one of the fastest ways for an arrangement to fall apart.
Where You Live
Where you live can matter as much as whether you meet the medical criteria. There is no federal surrogacy law. Each state sets its own rules, and they vary widely.
Roughly a dozen states plus the District of Columbia have clear legal frameworks permitting gestational surrogacy for all intended parents and allowing pre-birth parentage orders. Most other states permit surrogacy with conditions, such as requiring at least one intended parent to have a genetic link to the child, or only issuing parentage orders after birth. A smaller group poses real obstacles: in a few states surrogacy contracts are statutorily void and unenforceable, and at least one state treats compensated surrogacy as a criminal offense in most circumstances. Several more have inconsistent case law that makes outcomes depend on the specific judge or county.
The state where the baby is born usually controls the parentage process, which is why experienced local counsel is essential. Check your state’s status before you start the medical screening, because meeting every other requirement won’t help if your state’s law makes the arrangement unworkable.
Taxes on Your Compensation
Surrogate compensation is taxable income. There is no special exemption in the federal tax code for money earned through surrogacy. The IRS generally treats these payments like other nonemployee compensation, and many surrogates receive a Form 1099-NEC at year-end. Even without a 1099, the income is reportable.
Because the money is often classified as nonemployee income, it can trigger self-employment tax for Social Security and Medicare in addition to regular income tax. The combined bill surprises people. Financial professionals who work with surrogates commonly suggest setting aside 25 to 30 percent of compensation for taxes. Reimbursements for actual out-of-pocket expenses, such as maternity clothing or mileage to medical appointments, may be treated differently than base pay, but that distinction depends on careful documentation. Talk to a tax professional familiar with surrogacy before you sign the contract, not after the 1099 shows up.