What records are reviewed, and from how many pregnancies?
Every pregnancy she has carried. A surrogate candidate's prior pregnancies are the best evidence of how a surrogate pregnancy is likely to go, so the review covers all of them, not only the most recent.
For each pregnancy, the records include:
- Prenatal records from her OB or midwife: visit notes, blood pressure readings, weight, lab results, glucose screening and ultrasound reports.
- Delivery records from the hospital: how labor started, how long it lasted, the mode of delivery, the reason for any cesarean, blood loss and any complications.
- Postpartum notes, where they exist.
The candidate signs releases, and the PLS administrative team requests the records from each provider. Formal medical clearance from her own healthcare provider is also required to proceed.
What does the physician look for?
The question behind every finding is the same: did anything in a past pregnancy make the next one riskier for her, or for your baby?
The review looks for preterm birth, hypertensive disorders, gestational diabetes, the number of cesareans and any complications, postpartum hemorrhage, and anything that ASRM guidance on gestational carriers treats as a reason for caution.
| Condition in a prior pregnancy | Why it matters for a surrogate pregnancy | Typical outcome of review |
|---|---|---|
| Preterm birth | A past preterm birth raises the chance of another | Single late preterm birth with a known cause: proceed with clinic note. Repeated preterm birth: decline. |
| Hypertensive disorders, such as preeclampsia | Can recur, and can be serious for her and the baby | Mild, late, resolved: proceed with clinic note. Serious hypertensive disease: decline. |
| Gestational diabetes | Can recur, and affects monitoring and the baby's growth | Diet-controlled: proceed with clinic note. Requiring medication: case by case. |
| Cesarean deliveries | Each one adds risk to placement of the placenta and to the uterus | One or two uncomplicated: proceed. More, or with complications: case by case or decline. |
| Postpartum hemorrhage | Can recur, and can be life-threatening | Single, managed without surgery: proceed with clinic note. Severe or repeated: decline. |
| Placental problems, such as previa or abruption | Can recur and can cause bleeding | Case by case, with clinic note. |
ASRM recommends that a gestational carrier have had no more than five prior deliveries or three cesarean deliveries. Confirm against the current ASRM guidance.
What is in the physician medical summary your clinic receives?
A short, plain document addressed to your clinic's reproductive endocrinologist. It sets out:
- Her obstetric history, pregnancy by pregnancy.
- Any complications, and how they were managed.
- The mode of each delivery.
- Findings that need the clinic's attention.
- A recommendation to the reproductive endocrinologist.
The clinic receives the summary before it screens her. It knows what to look for, and does not discover it at the medical screening visit.
How is this different from a coordinator checklist?
A checklist asks yes-or-no questions: Was the pregnancy full-term? Was the baby healthy? A coordinator ticks the boxes from what the candidate reports or from a discharge summary.
A physician reads the record itself. He sees that a "healthy full-term pregnancy" ended in an induction for rising blood pressure at 37 weeks. He sees the blood loss figure in the delivery note. He knows which finding is routine and which one should change a decision.
That is the difference between screening for eligibility and reviewing for risk. Private Label Surrogacy (PLS) does both. The agency agreement defines the step as review by a board-certified physician. State Dr. Silverberg's board certification exactly as the agency agreement defines it; confirm wording.
Who is Mark Silverberg, MD?
Mark Silverberg, DDS, MD, is Executive Director of PLS. He has more than 30 years of medical practice. He is an anesthesiologist in Chicago-area operating facilities, where his work includes many obstetric and gynecologic cases. He holds four patents.
He personally reads every surrogate candidate's prenatal and delivery records and writes the physician medical summary that goes to the intended parents' fertility clinic. He works alongside the founder, Nancy Block, RN, a former OB/GYN and fertility nurse. See what nurse-led means.
What happens when the review finds a concern?
One of three things.
- Proceed. The finding is minor or resolved, and nothing needs special attention.
- Proceed with a clinic note. The candidate can go forward. The summary flags the finding so the clinic can look at it closely during its own screening.
- Decline. Findings such as repeated preterm birth or serious hypertensive disease stop a candidate before any parent sees her profile.
A decline is about risk, not about her as a person. The candidate is told why, in plain terms, so she can take the information to her own doctor.
Because the review is complete before any profile is shown, you never become attached to a surrogate who cannot go forward. It is one reason surrogates arrive at match fully screened. See what it means to be matched.
Does the clinic still do its own screening?
Yes. The physician review does not replace the clinic's screening. It prepares the clinic for it.
After match, your fertility clinic performs its own medical screening of the surrogate, following ASRM guidance for gestational carriers. That typically includes a medical history, a physical exam, bloodwork and infectious disease testing, and an evaluation of her uterus. The clinic makes the final decision on medical clearance.
The clinic uses the physician summary as a starting point. See surrogate medical screening. For how twin pregnancies change the picture, see twins and multiples.
Sources
- ASRM (American Society for Reproductive Medicine), recommendations for practices using gestational carriers. https://www.asrm.org
- ACOG (American College of Obstetricians and Gynecologists), guidance on preterm birth, hypertensive disorders of pregnancy and gestational diabetes. https://www.acog.org