Thinking about becoming a surrogate (or using one)?
There’s one step prior to embryo transfer that often surprises people. It’s nothing like bloodwork or ultrasounds.
It’s the psychological evaluation.
Most imagine an interrogation style interview on a leather couch. The reality is far less dramatic. It’s a friendly, well organized chat that safeguards everyone involved:
- The surrogate
- The intended parents
- The baby
Here’s how it works…
Inside This Guide:
- Why The Psych Evaluation Exists
- How Many Times Can You Be A Surrogate?
- The Evaluation Process Step-By-Step
- What To Expect On The Day
Why The Psych Evaluation Exists
IVF and infertility are emotional roller coasters. Hormones. Waiting. Financial concerns. Family drama. It can all become overwhelming quickly.
The psychological screening ensures you are mentally prepared for the journey ahead of you. Administered by a licensed mental health professional, specializing in third-party reproduction (egg donation, sperm donation and surrogacy).
The goal isn’t to “catch you out.”
It’s to:
- Evaluate your support system: Who will run errands with your kids, make you meals and be there for the tough days when you are pregnant?
- Confirm informed consent: Do you really know the risks, the time frame and the postpartum events?
- Identify red flags early: Untreated depression, partner pressure. Easier to address sooner rather than later.
Pretty sensible, right?
How Many Times Can You Be A Surrogate?
This is probably one of the questions asked most often by surrogates. And the answer lies directly in screening.
There are no hard legal limits in most US states. Clinics do have to abide by medical guidelines set forth by the ASRM. Usually a surrogate has had 5x or less total deliveries AND 3x or less c-sections including her own children. Candidates are typically between the ages of 21-45.
How many times can you be a surrogate if you already have three children? Well realistically probably only once or twice more. So it’s in your best interest to know the ASRM-aligned surrogacy requirements before you decide to apply again.
Why does this matter? At one clinic, about 20% of carriers failed to meet ASRM criteria. Another study found deviations from those guidelines resulted in more premature births and newborn complications.
Screening isn’t red tape. It’s protection.
The Evaluation Process Step-By-Step
Clinics all have their own variations. However, most evaluations are basically the same.
The Clinical Interview
The main meeting. You will usually sit down (virtually or physically) with a counsellor for an hour or two. They will ask you questions about your childhood, relationships, previous pregnancies and your motivations for wanting to help.
If you’re married or in a partnership, your spouse/partner will be involved as well. After all, surrogacy is not just something that involves one person in the household.
The Personality Test
Next is a written exam. The most widely used written exam is the MMPI-3 which consists of 335x true-or-false questions. It takes about 25-50 minutes to complete.
Don’t overthink it!
There aren’t any “correct” answers. The test is designed to identify those who try to appear flawless… Being truthful is your best approach.
The Joint Session
Many programs conclude with a surrogate meeting with the intended parents. The tough issues are addressed face to face:
- How much contact you’ll have during pregnancy
- How you’ll handle tough medical decisions
- What the relationship looks like after the birth
Getting everyone on the same page early avoids a ton of stress later.
Intended Parents Get Evaluated Too.
Here’s something most people don’t realise…
The psych eval is for surrogates, but the ASRM highly recommends intended parents seeing a therapist too.
Why? Because they have their own stuff to deal with as well. Most couples have endured years of infertility, pregnancy loss or failed IVF treatments. The counsellor assists them in working through that grief and preparing to entrust another person with their pregnancy.
It also assists with the day-to-day things like what to say and when to explain to their child their birth story.
What To Expect On The Day
Feeling nervous? That’s completely normal.
Here are a few tips to make the day go smoothly:
- Tell the truth: Baby blues won’t automatically disqualify you. Lies might.
- Prep your partner: Make sure they’re ready to join and answer questions openly.
- Understand your “why”: Have a reason BEFORE you step foot in the door.
- Ask questions: This is your chance to learn too.
And the good news?
Studies show that Surrogates experience long term emotional stability. Researchers in the UK interviewed surrogate mothers 20 years after pregnancy. From those who followed up with mental health screenings, none showed signs of depression.
That’s a great result. And good screening plays a big part in it.
The Final Word
The psychological assessment is one of the most crucial steps in the fertility process. It ensures the safety of surrogates, intended parents and babies by confirming everyone is emotionally prepared before the medical process begins.
To quickly recap:
- A licensed counsellor runs the evaluation
- It includes an interview, a personality test and often a joint session
- Intended parents are usually evaluated too
- Every new journey needs a fresh evaluation
Oh and by the way if you’re wondering how many kids you can carry as a surrogate.. Think ASRM guidelines of 5x total deliveries and 3x c- sections. Be Honest. Be Safe. You’ll do great!
Frequently Asked Questions
How many times can you be a surrogate?
Clinics usually go by ASRM guidelines which recommend a surrogate have no more than 5 deliveries total (or 3 c-sections). Your own kids count toward that total, so it depends on your pregnancy history.
Can you fail a surrogacy psychological evaluation?
Yes. Mental illness that hasn’t been treated, unstable home environment or indications that someone is being coerced can all be reasons for a “no.” However many applicants with previous mental health issues will pass if they are stable and have good support.
Is the psychological evaluation the same for everyone?
Not quite. Each party (surrogates, intended parents and their partners) receive questions that are specific to their situation. However, all parties complete a clinical interview with a certified counselor.
Do you need a new evaluation for every surrogacy journey?
Generally speaking, yes. Things change from adventure to adventure in your life, and clinics like to have a current picture before proceeding.
