Understanding Disqualifications – What You Need to Know

The word “disqualification” can make anyone feel like it’s a harsh or discouraging word. The reason the word “disqualification” is used is to make it easier for you to understand as many surrogacy programmes you will come across will follow strict surrogate mother criteria in order to make sure there will be a safe pregnancy, and a healthy baby, as well as having the correct legal protection included for all the parties during the journey.

Each eligibility criteria has a qualifying list of criteria, and a disqualifying list of criteria that must be followed usually for the health and safety of everyone involved, and sometimes the criteria is up to the law in the country that surrogacy is taking place.

We want you to know that these potential disqualifications are not judgements against you, but they are safeguards that have been carefully put in place to make sure the surrogate mother and the baby are looked after appropriately, whether that is mentally or physically.

In many cases, a woman may not be eligible to be a surrogate mother, right now, due to multiple reasons like their basic health, untreated conditions, or a temporary lifestyle situation. So, even if you fall under the disqualifications at this moment in time, you may still qualify in the future. If not, there could be other options for you to help someone build a family.

Here, we are going to explore the most common reasons for surrogate disqualifications based on the medical, psychological, and lifestyle a woman is leading.

Basic Health Reasons

There are basic health reasons that are required to be a surrogate and there are many physical and emotional demands that come along with the responsibility of becoming a surrogate mother. Surrogacy agencies assess potential surrogate mothers’ full medical history, health screening results, and their overall fitness. Some factors can disqualify a woman from being a gestational mother.

In this section, we are going to look at the health factors for a surrogate mother, these are guidelines based on medical evidence and previous outcomes and contribute to the safest, and healthiest journey.

Under or Over Childbearing Age

The surrogacy programmes usually accept applicants between the ages of 21 and 40. This age range is considered important as it takes into account a woman’s reproductive health, hormonal stability, and their physical resilience during pregnancy. Scientifically, this age range gives pregnancies a higher chance of being successful.

There have been cases where some clinics have increased the age limit to 42 or even 45 years old, but only in exceptional circumstances such as the woman not having any complicated pregnancies previously, having a full-term birth, and have maintained excellent overall health.

Women under the age of 21 are usually seen to not be physically or emotionally developed or ready for this kind of journey, suggesting that they would not yet fully understand the responsibilities of being a surrogate.

At the maximum age limit, being over 40 can increase the risks that come with pregnancy causing complications such as gestational diabetes, hypertension, and chromosomal abnormalities in the fetus. The older the age in pregnancy the more it can affect the recovery of a woman’s body after the delivery of the baby, especially after multiple births or C-sections.

The age related criteria is therefore based not just on numbers but on the biological and medical evidence that supports the safety of the gestational surrogacy for both the surrogate mother and the baby.

Pregnancy History and Experience

Another criteria that people must meet is to have previously given birth to at least one healthy child. The clinics and surrogacy agencies rely on a woman’s pregnancy history to confirm that their body can carry a pregnancy without any major complications arising. It also shows that the woman is aware of the emotional and physical aspect that comes with pregnancy and childbirth, including being able to separate emotionally from the baby once they are born, this is key for surrogacy.

The detailed history of a pregnancy helps medical professionals look at any patterns in the labour duration, birth weight, type of birth (vaginal or C-section), and the recovery. If a woman has experienced any serious complications like premature labour, stillbirth, delivery prior to 34 weeks, or conditions like preeclampsia or Intrauterine growth restriction (IUGR) it can make her ineligible or concerns are raised for further evaluation.

When a woman has a strong history of a full-term, healthy pregnancy where there have been no interventions or postpartum complications, it is seen as a major strength in her application. It reassures the clinics and agencies that she is physically and emotionally prepared for the surrogacy process.

Health Conditions That May Disqualify You

There are health conditions that can permanently disqualify a woman, while there are others that are reviewed on a case by case basis. The clinics and agencies look very closely at the reproductive and systemic health for a woman, even more so when there have been a pattern of problems in previous pregnancies.

Reproductive-Related Medical Conditions

There are multiple reproductive related medical conditions that can directly impact a pregnancy or the uterus. Some of these are polycystic ovary syndrome (PCOS), preeclampsia, gestational diabetes, caesarean section (C-section), endometriosis, and miscarriage.

In this section we are going to look at each of these medical conditions in more detail and whether it will affect you being a surrogate mother.

Polycystic Ovary Syndrome (PCOS)

Having PCOS doesn’t always disqualify a woman from being a surrogate. There are many women who live with this condition and go on to have successful pregnancies which in turn assists them in becoming a gestational carrier. There are, however, circumstances in PCOS that could raise questions for a woman who wants to be a surrogate. These circumstances are when PCOS has resulted in irregular ovulation, hormone imbalance, or difficulty maintaining a previous pregnancy. The clinics and agencies will assess if the condition has been managed well, such as checking whether the medication like Metformin has been effective and whether the menstrual cycles have been and are stable. The same can be said if PCOS has caused a miscarriage, gestational diabetes, or increased the weight gain of a woman in a past pregnancy, these can reduce the chance of being approved. Although, with the correct hormonal control and a healthy BMI, many women with PCOS can still safely participate in the surrogacy programmes.

Preeclampsia

The medical condition preeclampsia is a serious gestational complication and it is usually one of the leading reasons for being disqualified as a surrogate mother. This type of medical condition comes with high blood pressure, protein in the urine, and higher risks to the surrogate mother and the baby. If a woman has experienced this medical condition plus she’s had additional complications such as IUGR, preemie delivery before 37 weeks, or an emergency C-section, her application is very likely to be declined.

Some clinics and agencies may also choose to refuse a woman who had borderline gestational hypertension if they were hospitalised or on medication. Preeclampsia is a condition that can return in women, therefore, the medical programmes really do prioritise the safety of a pregnancy and review any applications carefully.

Gestational Diabetes

Another medical condition to consider is gestational diabetes, this doesn’t always end in a surrogate not being approved, but it is something that is taken seriously. If a woman has previously had gestational diabetes, and it was successfully managed with only changes to their diet and lifestyle, clinics or agencies may consider the applicant. However, where insulin injections were needed, or there were complications for the baby such as macrosomia (excessive birth weight) or neonatal intensive care unit (NICU) stay, this could cause questions as to whether she should be accepted.

The risk of this returning in another pregnancy can also play a role, and clinics or agencies will carefully review how early a woman was diagnosed in their pregnancy and if her glucose levels were stable at all times. If the condition was mild or came on at a later date with no unfavourable outcomes, this may be viewed as an advantage.

C-Section

Caesarean sections (C-sections) do not jeopardise a woman from being a surrogate mother. Many women are approved and have delivered a baby through C-section. Women are generally considered even if they have had one or two C-sections.

The reason it can be a health risk is the problems that can arise when there is evidence of poor healing, excessive scar tissue, uterine thinning, or complications such as placenta accreta in other pregnancies.

Each time a woman has a C-section, it increases the risk of a uterine rupture or difficulties in implanting an embryo. If a potential surrogate has had three or more C-sections, the surrogacy programmes may request more imaging of the uterine wall before she is approved. The imaging can be done through a hysteroscopy or an ultrasound. The safety of the surrogate mother and the baby is the highest concern, and once the imaging has taken place the medical professionals will decide if the woman will be safe to carry another pregnancy and give birth.

Endometriosis

The medical condition, endometriosis, is when the tissue, similar to the uterine lining, groups outside of the uterus which in turn causes inflammation, pain, and occasionally, infertility. The severity of the condition is key for surrogates. It doesn’t always mean the woman will be disqualified as there have been instances where the condition has been mild or asymptomatic, or they have had a full-term pregnancy before, which is an advantage when a woman applies to be a surrogate.

However, if there has been scarring of the uterus, a blocked fallopian tube or tubes, recurrent miscarriage, most clinics or agencies will see these risks as too high, causing disqualification. The high chance of implantation failure, early loss, or complications during gestation increases the possibility of severe endometriosis, and this is why any women with the issues mentioned about are not usually accepted.

Miscarriage

If a woman has had a miscarriage, this doesn’t prevent a woman from being a surrogate. Many surrogacy programmes accept a number of women who have previously experienced one or two early miscarriages, especially if they have any successful pregnancies afterwards.

Although, if there have been repetitive miscarriages it can raise concerns. Clinics and agencies will look at the time the miscarriage took place during the pregnancy, check for any causes for it, and if treatment was involved or pursued. If the miscarriage took place during the second-trimester or the woman had a stillbirth, it is seen as a much higher risk. In the long run, the aim is to have surrogate mothers with a strong history of full-term, healthy births to make sure they have the best possible outcomes for themselves and the baby.

Mental Health Considerations

A woman who is stable, mentally and emotionally, is highly important in surrogacy. The conditions where women are unlikely to be considered are major depression, bipolar disorder, schizophrenia, and PTSD, especially in cases where they are unmedicated or untreated. The surrogacy programmes will also screen for past trauma or unresolved grief following a loss of pregnancy.

HIV and Other STDs

Surrogate mothers must not have active or chronic infections like HIV, hepatitis B or C, or any untreated STDs. If a surrogate mother has been infected or is infected with any of these, it is highly likely there will be additional screenings. It would be a good idea to have tests prior to applying to make sure that you do not have any active infections, and if you do, take the relevant medication to remove the infection.

Weight and BMI Requirements

Most of the agencies and clinics set the BMI criteria to be between 19 and 30. If a woman is significantly underweight or obese, it can increase the risks during pregnancy. The height, weight, and past pregnancy results are all looked at during the evaluation of a woman.

Hypothyroidism

Hypothyroidism, also known as underactive thyroid, is a condition that causes the thyroid gland not to produce enough thyroid hormones. These are particularly important in surrogacy as they regulate the various bodily functions like metabolism, heart rate, and energy levels in a person and when it is underactive, these functions slow down and lead to a range of health issues. However, this type of condition doesn’t always make a woman disqualified from surrogacy, if her hormone levels are stable and monitored on a regular basis, she may still be eligible whilst having the condition.

Lifestyle and Behavioural Disqualifications

The lifestyle and behavioural choices a woman makes can also affect if they can become surrogate mothers. These types of choices are smoking, substance abuse, her financial stability, support systems, living conditions, environment, and disagreements between the surrogate and her partner or family.

Let’s take a look at these choices that can be made in more detail below.

Smoking and Substance Abuse

If a woman is a smoker, recent quitter, user of recreational drugs, or previous use of recreational drugs, they will not be considered for surrogacy. Secondhand smoke exposure can be of high concern also. It’s also considered that a woman with alcohol dependency or taking certain prescription drugs without the correct medical clearance will lead to a woman being disqualified.

Financial Stability and Support Systems

Potential surrogate mothers who do not have stable housing, income that is consistent, or emotional support could potentially be disqualified. It’s important that a surrogate has a calm, reliable personal life during the surrogacy journey. If the woman intends to rely on the surrogacy compensation for an income, it is highly likely this will raise concerns for clinics or agencies.

Living Conditions and Environment

The living conditions for a surrogate mother is very important, if they are living in an unsafe or unsanitary home, it may prevent her from being a surrogate. In some surrogacy programmes, the agencies or clinics will conduct home visits to evaluate her living situation. The types of things they would look out for is the exposure to mold, lead or any instability in the household, these would lead to being ineligible.

Disagreement Between Surrogate and Her Partner

It’s important to think about the people in the potential surrogate mother’s life. If her partner, spouse, or even family are unaware, unhappy, or disagree with the woman taking part in surrogacy, clinics or agencies are unlikely to move forward due to the lack of emotional support. Without a supportive system for the surrogate, her mental health could suffer during the gestational surrogacy and increases the risks for postpartum complications.

Frequently Asked Questions About Surrogate Health Requirements

Now that we have explained the surrogate disqualifications, we understand that you may still have some questions. Therefore, we have put together a small group of questions to answer for you, but if you still feel that you want to know more about what disqualifies you from being a surrogate or what are the surrogate disqualifications, please contact us and we will happily assist you further with your queries.

Can I be a surrogate if I have health issues?

This is a question that can’t be answered with a simple yes or no. It highly depends on the condition a surrogate has. Some conditions like asthma or hypothyroidism that are managed extremely well may be accepted. Other conditions like preeclampsia or severe depression, would not allow a woman to be a surrogate. A woman should disclose their full medical history during their screening.

How many times can I be a surrogate?

Most surrogacy agencies or clinics tend to limit surrogate mothers to only three or four full-term births in total which includes their own personal pregnancies. If a woman has had multiple C-sections or any complications during the recovery after a birth, it can reduce this number.

What if I am currently breastfeeding?

If you are breastfeeding, it will delay the start of any surrogacy programme. It’s highly important for a woman to wait until their menstrual cycle comes back to a 28 to 30 days cycle, and her hormone levels are back to normal, this usually happens three to six months after weaning the baby off breastfeeding.

Can you be a surrogate after ablation?

Endometrial ablation is a surgery that destroys the lining of the uterus to essentially stop or reduce menstrual bleeding. This usually determines that a woman cannot be a surrogate mother due to not having a functional endometrium, embryo transferring and implantation will not be possible.

Can you be a surrogate if you had gestational diabetes?

Yes it is possible to be a surrogate mother if you have previously had gestational diabetes. It must be noted that you can only be a surrogate if the condition was managed with the correct diet and no major complications happened. Surrogates who required insulin or had severe side effects could be ineligible.

What Should Potential Surrogates Do if They Have Questions About Disqualifications?

If you are a woman who is looking at becoming a surrogate, and you’re unsure if a condition or circumstance doesn’t allow you to apply, then the most common way to find out is to contact a surrogacy agency, or even just try applying, but make sure you are honest in your application.

The surrogacy agencies or clinics conduct thorough screenings that will look at any potential disqualifications for surrogacy, and will explain your options clearly. You should keep in mind that if you are currently under the criteria that disqualifies you now, you might still qualify at a later date after addressing particular health concerns or waiting for a number of months since you last had a baby.

Understanding what can disqualify a woman from being a surrogate can feel overwhelming, but please be aware that the disqualifications aren’t there to discriminate against women. All the surrogacy programmes are designed to protect the surrogate mothers and the baby. If a disqualification was to be missed or ignored, it can be detrimental to the pregnancy and surrogacy journey.

If you would like further information or to understand what may make you ineligible, then please contact us, we are here to help.