What are the seven screening steps and in what order?
A gestational surrogate at Private Label Surrogacy (PLS) passes seven screening steps before she carries for you. The first six happen before her profile is shown to any intended parents. The seventh, the fertility clinic's own medical screening, happens after match.
- Application. She confirms the basic criteria and gives her medical, pregnancy and family history.
- Interview. A PLS team member talks with her about her reasons for carrying, her family, her support system, and her views on the decisions that drive matching.
- Records review. Mark Silverberg, DDS, MD, reads her prenatal and delivery records and writes a physician medical summary.
- Background check. A criminal background check.
- Insurance review. A review of her health plan for surrogacy exclusions.
- Psychological evaluation. By an independent licensed mental-health professional.
- Clinic medical screening. By your fertility clinic, after match, following ASRM guidance for gestational carriers.
| Step | Who performs it | What it checks | When | Cost and who pays |
|---|---|---|---|---|
| Application | The candidate, reviewed by PLS | Eligibility criteria and history | First | No charge to you |
| Interview | PLS | Motivation, support system, matching views | After the application | No charge to you |
| Records review | Mark Silverberg, DDS, MD | Prenatal and delivery records | Before any profile is shown | Part of the PLS program |
| Background check | Background-check provider | Criminal history | Before match | Third-party cost, paid by you [timing of billing to confirm] |
| Insurance review | Independent insurance reviewer | Surrogacy exclusions in her plan | Before match | Third-party cost, paid by you [timing of billing to confirm] |
| Psychological evaluation | Independent licensed mental-health professional | Readiness, support, understanding of the commitment | Before match | Third-party cost, paid by you [timing of billing to confirm] |
| Clinic medical screening | Your fertility clinic | Uterus, infectious disease, drug screen, overall health | After match | Billed by your clinic |
The PLS eligibility criteria are: age 21 to 43; US citizen or permanent resident; BMI under 33; at least one healthy full-term pregnancy and currently parenting; non-smoker; no government assistance; stable home. No current antidepressant use is a PLS criterion on the current site; confirm it is still current policy.
What does the physician record review look for?
Mark Silverberg, DDS, MD, reads every candidate's prenatal and delivery records himself and writes a physician medical summary. The summary goes to your fertility clinic, so the clinic's physician starts with her full obstetric history rather than her own recollection of it. The PLS agency agreement defines this step as review by a board-certified physician. More on why PLS does this is on the physician record review page.
Dr. Silverberg is the Executive Director of PLS. He has practiced medicine for more than 30 years as an anesthesiologist in Chicago-area operating facilities, with many obstetric and gynecologic cases. The records show how her previous pregnancies actually went, which is the most direct evidence of how the next one is likely to go.
Why records and not a questionnaire? A candidate can tell you she had "a normal pregnancy" in good faith and still have had a blood pressure reading, a lab result or a delivery note that matters to a physician. The records are the source. Reading them before her profile is shown means a concern surfaces at the start, not after you have met her and grown attached to the match.
What the review looks for, in plain terms:
- Whether her pregnancies were full term and her babies healthy.
- Blood pressure in pregnancy, including any diagnosis of preeclampsia or gestational hypertension.
- Blood sugar, including any gestational diabetes and how it was managed.
- How she delivered, vaginally or by cesarean, and how many cesareans.
- Complications at delivery, such as heavy bleeding, placental problems or a difficult recovery.
- Preterm labor or delivery in any pregnancy.
- Her general health between pregnancies, and any conditions or medications that matter in pregnancy.
The summary states what the records show and flags anything the clinic should look at closely. It is written for physicians, but you can ask your clinic to walk you through it.
What is in the psychological evaluation?
The psychological evaluation is performed by an independent licensed mental-health professional, not by a PLS employee. PLS does not employ psychologists on purpose. An evaluator employed by the agency would be assessing candidates the agency needs to place. An independent evaluator has no stake in the result.
The evaluation typically includes a clinical interview and may include standardized written testing. It often involves her partner, if she has one. It looks at:
- Why she wants to carry for another family, and whether she understands what that involves.
- Her support system at home: her partner, family, and who helps with her children during appointments and recovery.
- How she handles stress, and her history of mental-health care.
- Her understanding of the decisions in the agreement, including transfer number, termination and selective reduction.
- How she expects to feel about the relationship with you and about saying goodbye to the baby.
The evaluator reports whether she is ready to proceed. ASRM guidance recommends psychological evaluation and counseling for gestational carriers. During the pregnancy, PLS surrogates also have access to mental-health support through independent licensed professionals.
What does the background check cover?
A criminal background check is run on the candidate before match. It may also cover other adults in her household; confirm the scope of the PLS background check.
The background check protects you and protects the integrity of the program. It is one reason the PLS criteria include a stable home. The check is performed by an outside provider and is part of your third-party costs.
What does the fertility clinic test after match?
Once you are matched, your fertility clinic performs its own medical screening, following ASRM guidance for gestational carriers. Clinics differ in detail, but the screening generally includes:
- A uterine evaluation to check that her uterus is ready for an embryo, for example by a saline ultrasound or hysteroscopy.
- An infectious disease panel of blood tests.
- A drug screen.
- A general health check, with bloodwork and a review of Dr. Silverberg's summary.
The clinic may test her partner as well. The clinic's physician gives the final medical clearance. No medications start until that clearance, a signed agreement and funded escrow are all in place. For what comes next, see IVF and embryo transfer.
What disqualifies a candidate?
A candidate does not proceed if:
- She falls outside the eligibility criteria: age, citizenship or residency, BMI, pregnancy history, smoking, government assistance, or a stable home.
- Her records show a pregnancy history that makes another pregnancy a higher risk, such as serious complications in a previous delivery.
- The background check raises a concern.
- The independent psychological evaluation finds she is not ready.
- The clinic does not clear her medically.
An insurance exclusion does not disqualify her. It means you will need a dedicated surrogate health policy, which costs $5,000 to $40,000. PLS's review tells you this before you commit.
Screening a candidate out is a decision about the safety of one more pregnancy, for her and for your baby. It is not a judgment of her as a person or a mother.
How many applicants pass?
Of candidates who apply to PLS, [PLS_SCREEN_PASS_RATE] complete screening and are presented to intended parents.
PLS reports this figure only as a real PLS number. If you are comparing agencies, ask each one for the same figure and how it is defined: as a share of applications started, of candidates interviewed, or of candidates whose records were reviewed. The definitions produce very different numbers. Screening is complete before any profile reaches you, so every surrogate you are introduced to has already passed the first six steps. That is also why matching takes time: about 6 months on average. For how screening fits into matching, see how matching is defined.
Sources
- ASRM (American Society for Reproductive Medicine), guidance on the evaluation of gestational carriers. https://www.asrm.org
- SEEDS, Society for Ethics in Egg Donation and Surrogacy.