Reading a Surrogate's Profile: What Is Checked, What Is Sales

In most United States programs the document you receive about a carrier is a few paragraphs: her age, whether she has been pregnant, whether she has delivered by caesarean, sometimes a photograph and a short account of why she wants to carry. It is what most of the choosing gets done on, and it is the only carrier-side paper most intended parents are ever handed.

The guidance US reproductive medicine publishes for programs working with surrogates is considerably longer than that profile. Reading the two against each other is worth an hour before you commit to anyone. What follows is that comparison: what the guidance expects to have happened, which parts of it are a recommendation rather than a rule, and what the profile stays silent about even when the program is careful.

What the guidance expects to have happened first

The ASRM committee opinion for practices using gestational carriers sets out the screening an arrangement should rest on. Three items concern her reproductive history: she must be of legal age and preferably between 21 and 45, she should ideally have had at least one full-term, uncomplicated pregnancy, and she should ideally not have had more than five deliveries in total or three by caesarean section. The separate ethics opinion is what states the reasoning: giving true informed consent without having been through a pregnancy and a delivery is treated as problematic because the experience is prolonged, intense and unlike anything else.

The remainder is a workup rather than a form.

• A medical evaluation with preconception counselling, plus an assessment of the uterine cavity by saline-infusion sonogram or another method, which the guidance calls highly recommended.
• Preconception testing: blood type and Rh factor, cervical cancer screening, a mammogram, varicella and rubella titres, and a urine drug screen.
• Infectious disease testing of her, and of her partner where there is one, covering HIV, hepatitis B and C, syphilis, and gonorrhoea and chlamydia.
• A psychological evaluation by a qualified professional using standardised instruments alongside a clinical interview, with a fresh evaluation expected whenever the previous one is more than a year old at the start of a new contract.
• Implication counselling that covers her understanding of the protocol and her attitude toward prenatal testing, reduction of a multiple pregnancy, pregnancy loss and termination.

Her spouse or partner is expected to be evaluated and to consent as well. And the guidance is explicit that the same psychological evaluation applies whether she was recruited through an agency or is someone you already know.

A recommendation, not a licence

Two facts decide how much weight a profile can carry.

First, United States federal requirements do not oblige any of this for the carrier. The guidance states plainly that the FDA does not require screening or testing of the surrogate, that ASRM recommends it, and that individual state rules may be stricter than the federal floor. There is no licence that compels a program to have completed the workup above, and no certificate that would tell you it was.

Second, the guidance is written for the United States and says so. It notes that because the prevalence of infections and genetic conditions differs elsewhere, its recommendations may not be appropriate in other countries, or for people travelling to the US for treatment. A program in another destination is not measuring her against this list at all.

So the useful question is not whether she is screened. It is which standard was applied where she was screened, and whether you can see the record.

“Ineligible” is not a refusal

The guidance uses a term that reads like a hard line and is not one. It defines ineligible as not meaning excluded, but acceptable with appropriate informed consent.

The consequences are worth knowing before you read a profile. A person providing egg or sperm who shows identified risk factors is ineligible for non-identified donation, the category that used to be called anonymous. Yet the same document records that, under current FDA rules, embryos created by such a person may still be transferred to a carrier, provided the tissue is labelled to show the associated increased risk and both the intended parents and the carrier are aware of the risk and have consented to the transfer verbally.

Verbally. And ASRM’s own stronger position, that these embryos should only go to a carrier who has been adequately informed and counselled, exists precisely because the federal rules do not require the carrier to be told the screening results at all.

Two items of the same shape follow.

Quarantine of embryos. Federal rules do not require embryos to be quarantined before use in a carrier. ASRM recommends that carriers be offered the option of freezing the embryos created from the genetic contributors for 35 days and releasing them only once each contributor has been retested with confirmed negative results. Whether that option was offered to you is a question about your own arrangement, and nothing on a profile answers it.

Vaccination. Clinics are advised to consider strongly requiring vaccination of carriers, and intended parents are advised to write the requirement into their contract. That makes it a contractual term rather than a screening outcome, which is why it will not appear on the document you were handed.

What the profile does not say

The parts of the workup likeliest to shape your experience are the parts you will not be shown, because the guidance treats them as confidential. Programs are told to assure participants that their medical information is protected so far as federal and local law allow.

Three examples follow from that.

Coercion. The required clinical interview includes an assessment for financial coercion, covering her primary source of income and whether she receives government assistance, alongside personal, familial and dual-relationship pressure, such as being employed by the party commissioning the pregnancy. A program that screened her properly has an answer to whether anything was flagged. The profile does not carry it.

Whether you were the one rejected. Disagreement about prenatal testing, reduction, induction of labour, caesarean birth or termination is a stated ground for rejecting a proposed match. If an earlier match did not proceed, this may be why, and the assessment sits with a mental health professional rather than with you.

Her own children. Carriers are counselled to consider the effect of the arrangement on their own children and what those children will be told. A profile lists children as a fact about her, not as a decision she has worked through.

One structural safeguard is worth knowing because it is easy to miss. The guidance states that no owner, operator, laboratory director or employee of a practice may serve as a carrier or as an intended parent in that practice. If the person offering you a carrier has an interest in the outcome beyond their fee, that is a question to ask out loud.

Four questions to put in writing

Ask these of the program, and keep the written answers with the documents in the signing sequence.

1. Which standard did you apply to her: ASRM recommendations, a state requirement, or your own protocol? Name it.
2. Is her psychological evaluation current for this contract, given that the guidance asks for a new one when the previous evaluation is more than a year old?
3. Were we offered the 35-day quarantine option for these embryos, and if not, why not?
4. Who holds her screening records, for how long, and what happens to them if the arrangement ends without a birth?

The fourth matters more than it looks. Federal rules require records on each genetic contributor to be kept for at least ten years, while ASRM’s position is that a permanent record should be kept, with a mechanism to serve as a future medical resource for any child produced. Those are two different promises about your file, and it is worth knowing which one you sit under.

What a profile cannot settle

A profile is evidence that a process was run, not proof of what the process found. It does not decide whether a contract is enforceable where you signed it, who is a legal parent at birth, or what happens to money already committed if the arrangement stops.

It also does not describe the position she holds while pregnant. The guide to these choices covers that, including the point on which US professional guidance is unambiguous: authority over procedures performed on her own body stays with her, whatever the contract says. If you want the profile tested against a written standard rather than a summary, the agency question checklist sends these four questions out as one message.