When is medical screening scheduled?
Medical screening happens after your match is confirmed. It is a one-day visit to the intended parents' fertility clinic, usually scheduled for day 5 to 12 of your menstrual cycle. Day 1 is the first day of full bleeding.
The timing matters because two of the tests look at your uterus. Early in your cycle, after your period and before you ovulate, the uterine lining is thin. That gives the doctor the clearest view of the uterine cavity and the most accurate count of the small follicles in your ovaries.
When you get your period, you tell your case manager. Your case manager and the clinic then set the date, and PLS books your travel. If your cycle is irregular, the clinic may adjust the plan.
By the time you reach the clinic, the doctors already know a great deal about you. Mark Silverberg, DDS, MD, has read your prenatal and delivery records and written a physician medical summary for the clinic. See the records review. Screening confirms, in person, that your body is ready for a transfer now.
What tests are done and why
Expect a full day with several short appointments. Most of it is blood draws, ultrasound and conversation.
- Physical exam, with a Pap test if you are due for one.
- Transvaginal ultrasound. This counts your antral follicles and measures your uterine lining.
- Saline sonogram, also called a saline infusion sonohysterogram. This checks the inside of your uterus for polyps, fibroids or scarring.
- Infectious disease blood work: HIV, hepatitis B and C, syphilis, gonorrhea, chlamydia, and CMV.
- Blood type, thyroid and prolactin.
- Nicotine and drug screen.
- Consult with the reproductive endocrinologist, the fertility doctor who will manage your cycle and do your transfer.
| Test | Purpose | How it is done | Result turnaround | What a problem result means |
|---|---|---|---|---|
| Physical exam and Pap | General health and cervical screening | Office exam | Pap results with the rest of your labs | An abnormal Pap may need follow-up before the cycle |
| Transvaginal ultrasound | Counts antral follicles and measures the lining | Small probe in the vagina; a few minutes | At the visit | Usually nothing; findings are discussed with the doctor |
| Saline sonogram | Checks the uterine cavity for polyps, fibroids or scarring | Saline through a thin catheter during ultrasound | At the visit | A polyp or fibroid is usually removed in a minor procedure first |
| Infectious disease panel | Protects you, the embryo and the intended parents | Blood draw | Within about two weeks | Follow-up with the clinic; some results affect eligibility |
| Blood type, thyroid and prolactin | Planning for pregnancy; hormone balance | Blood draw | Within about two weeks | A thyroid result may mean medication before the cycle |
| Nicotine and drug screen | Confirms you meet the non-smoker requirement | Urine or blood | Within about two weeks | Discussed with the clinic and PLS; PLS surrogates must be non-smokers |
| Reproductive endocrinologist consult | Reviews your history and the plan | Conversation | At the visit | Questions may lead to more tests |
Results and clearance usually come within two weeks.
The test list follows the screening practice the American Society for Reproductive Medicine (ASRM) and the FDA set for gestational carriers. Individual clinics may add tests.
What is a saline sonogram like?
A saline sonogram is the part of screening most surrogates ask about. It is short.
You lie on the exam table as you would for a Pap. The doctor places a speculum, passes a thin, soft catheter through your cervix, and fills your uterus with a small amount of sterile saline. Then the doctor scans with a transvaginal ultrasound. The saline gently opens the uterine cavity so the doctor can see its walls clearly.
It causes cramping similar to a period, for a few minutes. Many surrogates take an over-the-counter pain reliever beforehand. Ask the clinic which one, and when, before your visit. You can drive or walk around afterward, and you may have some watery discharge for the rest of the day.
Why bother? An embryo needs a smooth, healthy uterine lining to implant. A small polyp or a band of scar tissue can lower the chance of a transfer working. Finding it before the cycle means it can be fixed before the cycle.
Does your partner get screened?
Yes. If you have a partner, your partner has infectious disease blood work too. It is a blood draw, usually done at the same clinic visit or at a lab near your home.
The reason is simple. You and your partner share a household and a bed. The clinic needs to know that nothing transmissible could affect you during the pregnancy. Your partner's lost wages are reimbursed, as yours are. Your partner's travel, if your partner comes with you, is paid in the same way as yours.
What can delay clearance?
Most surrogates clear on schedule. These are the usual reasons for a delay:
- A polyp, fibroid or scar tissue. The clinic usually removes it in a minor procedure before the cycle. The intended parents pay. You heal for a few weeks, and then the cycle can go ahead.
- A lab result that needs a recheck. For example, a thyroid level that needs medication, or a borderline infection result.
- An abnormal Pap test. You may need follow-up with your own doctor first.
- Cycle timing. If your period does not come when expected, the visit moves.
- Records still missing. If something from your earlier pregnancies has not arrived, the clinic may wait for it.
Your case manager follows up with the clinic so you are not left waiting without news.
What happens after clearance
Once the clinic clears you, three things come together before any medication starts:
- The contract is signed. You and the intended parents each have your own attorney.
- Escrow is funded. The intended parents have deposited $10,000 at match and fund the balance before medications start.
- The clinic writes your calendar. Some clinics run a mock cycle first, to see how your lining responds to medication. Others go straight to the transfer cycle.
Nothing medical starts until the contract is signed and escrow is funded. That rule protects you.
From here, monitoring moves close to home. Your first and last appointments in the cycle are at the intended parents' clinic: screening now, and the embryo transfer later. Monitoring in between, mainly blood work and ultrasounds, is done at a clinic near you.
Travel, time off and what is reimbursed
PLS coordinates your travel, and the intended parents pay for it. That includes flights or mileage, a hotel if the visit needs an overnight stay, and ground transport. Read how travel for screening and transfer works.
You do not pay for screening. The tests, the visit and any procedure the clinic needs before the cycle are paid by the intended parents.
You are reimbursed for:
- Travel costs not booked directly for you, with receipts.
- Your lost wages for the screening day and travel days.
- Your partner's lost wages, if your partner travels with you.
Childcare during screening travel is reimbursed under the terms of your contract.
Submit receipts and lost wage documentation to your case manager. Payments come from the independent escrow account, not from PLS.
If you have not started yet, the first step is the prescreen: see if you qualify. For the order of every step, see the surrogate process overview.
Sources
- American Society for Reproductive Medicine (ASRM), recommendations for practices using gestational carriers. https://www.asrm.org
- US Food and Drug Administration (FDA), donor eligibility screening for reproductive tissue.
- Centers for Disease Control and Prevention (CDC), assisted reproductive technology. https://www.cdc.gov