Which vaccines are recommended in pregnancy, and by whom?
In the US, two bodies set the reference point for vaccines in pregnancy: ACOG (the American College of Obstetricians and Gynecologists) and the CDC (the Centers for Disease Control and Prevention). A surrogate's OB works from their guidance, and so does the fertility clinic.
Four vaccines come up in almost every gestational carrier agreement:
- Influenza. The flu shot is recommended for anyone who is pregnant during flu season, in any trimester. Flu hits harder in pregnancy, and the antibodies the surrogate makes pass to the baby, who is too young to be vaccinated in the first months of life.
- Tdap. Tetanus, diphtheria and pertussis (whooping cough). ACOG and the CDC recommend it in every pregnancy, early in the third trimester, so antibodies reach the baby before birth.
- RSV. A single dose of the maternal RSV vaccine is recommended at 32 to 36 weeks for pregnancies that reach that window during RSV season, usually September through January. The alternative is an antibody shot for the baby after birth, which the intended parents decide with their pediatrician.
- COVID-19. ACOG recommends COVID-19 vaccination during pregnancy. CDC guidance on COVID-19 vaccination in pregnancy changed in 2025, so check the current recommendation on the date the agreement is signed.
Vaccines made from live virus, such as MMR and chickenpox (varicella), are not given during pregnancy. The clinic usually checks immunity to rubella and chickenpox at medical screening, and a surrogate who is not immune is vaccinated and waits before transfer.
Recommendations on this page were checked against ACOG and CDC guidance on [DATE].
| Vaccine | ACOG and CDC position in pregnancy | Typical clause treatment | Matching impact |
|---|---|---|---|
| Influenza | Recommended during flu season, any trimester | Surrogate agrees to receive it in season | Rarely a matching issue |
| Tdap | Recommended in every pregnancy, early third trimester | Surrogate agrees to receive it | Rarely a matching issue |
| RSV | Recommended at 32 to 36 weeks in season, or infant antibody shot instead | Clause states which option the parties chose | Rarely a matching issue; most parents accept either option |
| COVID-19 | Recommended by ACOG; CDC position to be checked on the publish date | Clause states whether she is vaccinated, will be, or declines | One of the most common matching criteria since 2021 |
What does a vaccine clause typically say?
A vaccine clause is a short section of the gestational carrier agreement. It usually records:
- Which vaccines the surrogate has already had and which she agrees to receive during the journey.
- Roughly when, tied to the pregnancy or to the season.
- That she shares vaccination records with the clinic and her OB.
- What happens if she later declines a vaccine she agreed to. The attorneys for each side negotiate that consequence.
Vaccine costs are usually covered by the surrogate's health insurance, with anything left over reimbursed by the intended parents.
Like the termination and selective reduction clauses, a vaccine clause cannot compel anyone. It records what both sides agreed before the match, so the question never comes up for the first time in the middle of a pregnancy. The surrogate and the intended parents each have their own attorney, and the intended parents pay for both. See legal contracts in surrogacy.
Can intended parents require a surrogate to be vaccinated?
As a matching criterion, yes. As a procedure, no.
If you are intended parents, you can match only with a surrogate who agrees to the vaccines you want. The agreement then records that she agreed. It cannot force a medical procedure on her, and nothing in a contract changes that. The surrogate keeps the right to make decisions about her own body throughout the journey.
If you are a surrogate, the same rule protects you. You will be introduced only to intended parents whose position matches yours, so you are never asked to change your mind to get a match.
Do fertility clinics have their own vaccine requirements?
Yes, and they apply regardless of the contract. The clinic that performs the transfer sets its own medical rules, and those can include COVID-19 vaccination.
PLS works with 14 partner fertility centers, including Kindbody, Shady Grove Fertility, Fertility Centers of Illinois and Oregon Reproductive Medicine. Their requirements are not identical. If the intended parents' clinic requires a vaccine and the surrogate declines it, that clinic will not transfer. PLS checks the clinic's vaccine rules before it introduces a surrogate to the intended parents.
How does vaccination status affect matching and wait time?
Since 2021, vaccination has become one of the most common matching criteria. More intended parents ask for a vaccinated surrogate than ask for the reverse. So a surrogate who is vaccinated, or willing to be, matches faster with parents who require it. An unvaccinated surrogate matches with parents who do not, and that pool is smaller, so the wait is often longer.
Matching at PLS takes about six months today, and signing to surrogate introduction takes about nine. Nancy Block, RN, PLS's founder, runs matching herself. See how matching works and surrogacy wait times.
What about travel, exposure and illness clauses?
Vaccine clauses usually sit next to three related ones:
- Travel. The surrogate travels to the intended parents' clinic for the transfer. Agreements commonly limit other travel late in pregnancy and to areas under a public health travel advisory.
- Exposure. Agreements commonly ask the surrogate to avoid known exposure to contagious illness and hazardous substances where she reasonably can.
- Illness. The surrogate tells her case manager and her OB when she is sick. A fever near the transfer date can lead the clinic to postpone it.
How to state your position at intake
State it early and exactly.
If you are a surrogate, tell your case manager which vaccines you have had and, for each one, whether you would receive it during a pregnancy. "Flu and Tdap yes, COVID no" is a complete answer. PLS records each surrogate's vaccination status and willingness at screening. If you meet the requirements, start at See if I qualify.
If you are intended parents, say at your first consultation which vaccines you require and which you only prefer. A preference leaves more surrogates in your pool than a requirement does. Start at Plan my journey.
Sources
- ACOG (American College of Obstetricians and Gynecologists), guidance on immunization during pregnancy. acog.org
- CDC (Centers for Disease Control and Prevention), vaccine recommendations for pregnant people. cdc.gov
- ASRM (American Society for Reproductive Medicine), recommendations for practices using gestational carriers. asrm.org