Intended Parents' Surrogacy Requirements

Introduction

Surrogacy is a deeply personal and life-changing journey. For intended parents in the United States, the process is also structured and guided by both medical necessity and legal standards. Whether you’re a couple facing infertility, a cancer survivor, a member of the LGBTQ+ community, or a single individual, understanding the requirements for becoming an intended parent is crucial.

This article breaks down what is expected from intended parents, particularly the medical aspects, the documentation involved, and how agencies assess readiness for the surrogacy process.

Must Intended Parents Have a Medical Need for Surrogacy?

In most gestational surrogacy cases, yes—a medical need is typically required. This requirement is not just a formality. It is a safeguard to ensure that surrogacy is used appropriately and ethically, and it aligns with most clinics’ and agencies’ internal policies.

Medical need often refers to the inability to safely carry a pregnancy, but definitions can vary slightly depending on the agency, the fertility clinic, and the state’s legal framework.

What Qualifies as a Medical Need for Surrogacy?

Medical need can take many forms. It’s not limited to infertility or cancer. The following conditions are commonly recognized:

• Recurrent pregnancy loss or failed IVF cycles
• Hysterectomy or uterine malformation
• Cardiac or autoimmune conditions that make pregnancy dangerous
• Cancer treatment (past or ongoing) that impacts reproductive health
• Genetic disorders that make carrying a child risky

Men in same-sex partnerships and single men pursuing fatherhood will also require surrogacy, but their medical need is considered "anatomical." Many clinics and agencies accept this as valid justification.

Why Do I Have to Have a Medical Need for Surrogacy?

The requirement for a medical need exists for three main reasons:

1. Ethical Responsibility
   Surrogacy should not be seen as a convenience option. Agencies and clinics strive to ensure that the process is reserved for those who truly need it.
2. Surrogate Consideration
   Surrogates often choose to carry for someone who cannot carry a child themselves. This builds trust and emotional connection, and it supports the surrogate's motivation.
3. IVF Clinic Policies
   Fertility clinics may require documentation of medical need before approving embryo transfer. They often follow guidelines laid out by the Centers for Disease Control and Prevention and National Institutes of Health when establishing protocols.

Do I Need a Letter From My Doctor About a Medical Need?

Yes, in most cases, a letter from your physician or reproductive endocrinologist is required. This letter typically includes:

• Confirmation of diagnosis (e.g., uterine factor infertility)
• A statement that pregnancy is not recommended or is not possible
• If applicable, history of failed IVF or recurrent miscarriage

The letter should be on official letterhead, signed by your doctor, and dated. Some agencies may have specific templates or wording requirements.

You may also be asked to provide this letter to your attorney during the legal portion of your surrogacy journey.

According to MedlinePlus, this kind of documentation is often used to support treatment planning and to establish a medically necessary path forward.

How Important is Embryo Quality?

Embryo quality plays a crucial role in the success of a surrogacy journey. While surrogacy removes the physical limitations of pregnancy, it does not solve underlying embryo quality issues.

Factors That Matter:

• Embryo grading: Clinics assess embryos based on development speed and structure.
• PGT-A testing: Genetic testing of embryos (optional) to check for chromosomal abnormalities.
• Embryo age: Embryos created from older eggs or sperm may have lower implantation potential.

Your fertility clinic will help evaluate your embryos and may recommend creating new ones if needed. Agencies want to see that you have at least one or more viable embryos before matching with a surrogate.

The U.S. Department of Health & Human Services offers an overview of assisted reproductive technologies at hhs.gov.

Surrogacy Agency Guidelines

Every surrogacy agency in the U.S. has its own internal checklist for evaluating intended parents. While there is variation, most agencies follow these common principles:

1. Medical Readiness
   Fertility evaluation completed
   Embryos created or in the process
   Medical letter confirming need for surrogacy
2. Psychological Readiness
   Psychological evaluation of all intended parents
   Counseling available throughout the journey
3. Financial Preparedness
   Surrogacy costs range from $100,000 to $160,000+
   Proof of financial stability is often required
4. Legal Preparedness
   Willingness to work with a licensed surrogacy attorney
   Understanding of your state’s surrogacy laws (some states prohibit or limit it)

Agencies may also have minimum and maximum age limits, relationship status policies, and other considerations.

Conclusion

Becoming a parent through surrogacy is a powerful and deeply personal decision. Understanding the requirements—particularly the medical documentation, embryo quality, and agency standards—will help you move forward with clarity and confidence.

While it may seem overwhelming at first, know that thousands of parents have walked this path before you. With the right support system, careful planning, and emotional readiness, your journey to parenthood is absolutely possible. If you meet the requirements and are ready to take the next step, a reputable agency will be there to guide you every step of the way.