Which complications are reviewed and which are disqualifying?
It depends on the complication and how it resolved. Private Label Surrogacy requires that your prior pregnancies were healthy, but "healthy" is a medical judgment, not a checkbox. Mark Silverberg, DDS, MD, makes it from your records.
The question behind every decision is recurrence. Some complications happen once, for a reason that will not come back. Others are likely to return in the next pregnancy, often in a more serious form. A surrogate pregnancy should not be the one that tests that risk, because the risk is to you.
| Condition | Usually acceptable | Case by case | Disqualifying | Why, and source |
|---|---|---|---|---|
| Gestational diabetes | Diet-controlled, one pregnancy, normal postpartum glucose test | Diet-controlled in more than one pregnancy | Needed insulin, or type 2 diabetes diagnosed afterward | Tends to recur and can progress to type 2 diabetes (ACOG) |
| Preeclampsia | None | Mild, late-onset, at term, resolved after delivery | Severe preeclampsia, HELLP syndrome or eclampsia | High recurrence risk, often earlier and more severe (ACOG) |
| Chronic high blood pressure | None | Controlled without medication, reviewed with the clinic | Needs medication, at most clinics | Raises preeclampsia and placental risk (ACOG) |
| Preterm birth | Medically indicated early delivery, for a reason that will not recur | Medically indicated early delivery, other reasons | Spontaneous preterm birth before 34 weeks | Spontaneous preterm birth tends to recur (ACOG) |
| Cervical insufficiency | None | Reviewed individually | Usually disqualifying | Tends to recur in the next pregnancy (ACOG) |
| Placenta previa | Resolved before delivery, no other risk factors | Reviewed individually | None by default | Risk rises with prior cesareans (ACOG) |
| Placenta accreta | None | Reviewed individually | Usually disqualifying | Risk of severe bleeding in the next pregnancy (ACOG) |
| Postpartum hemorrhage needing transfusion | None | Reviewed individually | None by default | Depends on the cause (ACOG) |
Gestational diabetes
Gestational diabetes is high blood sugar that starts in pregnancy and usually ends after delivery. It is common, and on its own it is not a mark against you.
Gestational diabetes controlled by diet in one pregnancy is usually acceptable, if your postpartum glucose test was normal. Insulin-dependent gestational diabetes, or a diagnosis of type 2 diabetes afterward, is not. Needing insulin means your body had more trouble managing blood sugar in pregnancy, and that tends to recur and to get harder each time.
If you had gestational diabetes, find your postpartum glucose test result. It is one of the first things the review looks for.
Preeclampsia, HELLP and high blood pressure
Preeclampsia is high blood pressure in pregnancy with signs that other organs are affected, such as protein in the urine. It can become dangerous quickly.
Mild preeclampsia at term that resolved after delivery is reviewed case by case. Severe preeclampsia, HELLP syndrome or eclampsia is disqualifying, because the recurrence risk is high and the next episode often comes earlier and harder. HELLP is a severe form that affects the blood and the liver. Eclampsia is preeclampsia with seizures.
Chronic high blood pressure, meaning blood pressure that is high outside pregnancy, is a separate question. Chronic hypertension that needs medication is disqualifying at most clinics.
Preterm birth and cervical insufficiency
A full-term birth is 37 weeks or later. What matters in an earlier birth is why it happened.
A spontaneous preterm birth before 34 weeks is disqualifying. Spontaneous means labor started early, or your water broke early, on its own. That tends to recur. A medically indicated early delivery, where your doctors chose to deliver early for a specific reason, may not be disqualifying, depending on the reason.
Cervical insufficiency means the cervix opens too early in pregnancy, without contractions. It is reviewed individually. Because it tends to recur, it usually rules a candidate out.
Placenta previa, accreta and hemorrhage
Placenta previa means the placenta implanted low in the uterus, over or near the cervix. Placenta accreta means it grew too deeply into the uterine wall. Postpartum hemorrhage is heavy bleeding after delivery. Each of these is reviewed individually, and so is any hemorrhage that required a transfusion.
The review looks at the cause. Prior C-sections raise the risk of previa and accreta, so your cesarean history is read alongside them. See surrogacy after a C-section.
Why Dr. Silverberg reads the records before the clinic
Dr. Silverberg personally reads every candidate's prenatal and delivery records and writes a physician medical summary that goes to the intended parents' fertility clinic. He is an anesthesiologist with more than 30 years of medical practice, including many obstetric and gynecologic cases.
Reading records first protects you. A complication that would stop you at the clinic is usually found weeks earlier, before you are matched with a family and before anyone has made plans around you. Your own memory of a delivery is not always what the chart says, and the chart is what the clinic will read. See the records review.
What the clinic may add after our review
The clinic's reproductive endocrinologist makes the final medical decision. After reading Dr. Silverberg's summary, the clinic may add:
- An early glucose test, for a history of gestational diabetes.
- A blood pressure review or a cardiac workup, for a history of high blood pressure.
- An ultrasound or a saline test of your uterus, for a history of previa, accreta or surgery.
- A consultation with a maternal-fetal medicine specialist, an OB who focuses on higher-risk pregnancies.
If you are cleared, the clinic or your OB may recommend specific care during the pregnancy, such as low-dose aspirin for a past history of preeclampsia.
If you are unsure where your history falls, ask it free on SurrogacyHotline, PLS's sister site, which answers within 24 to 48 hours. Read what disqualifies a surrogate for the full list. If your history fits, start at See if I qualify.
Sources
- ACOG (American College of Obstetricians and Gynecologists), practice bulletins on gestational diabetes, gestational hypertension and preeclampsia, preterm birth, and placenta accreta spectrum. acog.org
- ASRM (American Society for Reproductive Medicine), recommendations for practices using gestational carriers. asrm.org