| Layer | Purpose | What it does not replace |
|---|---|---|
| Professional guidance | A framework for screening, counselling and risk management | It is not a country's law or a universal clinic threshold |
| Clinic or programme policy | Acceptance criteria based on staffing, laboratory, obstetric referral and insurance capacity | It must not be presented as an ASRM or worldwide rule |
| Individual medical assessment | Review of the complete history by reproductive, obstetric, medical or mental-health professionals | It cannot be replaced by one BMI, TSH result, drug name or test |
| Legal review | Eligibility, consent, agreement, parentage and birth-registration procedure | Medical clearance is not legal eligibility or approval of cross-border documents |
ASRM recommends that a gestational carrier be of legal age and preferably 21–45, ideally have had at least one term uncomplicated pregnancy, ideally have had no more than five previous deliveries or three cesarean deliveries, and have a stable support environment. “Preferably” and “ideally” are guidance terms, not worldwide statutory qualifications.
ASRM also states that its infection-screening recommendations apply to U.S. practice and may not fit other countries. A cross-border programme therefore needs separate review of local law, licensed-clinic requirements and obstetric acceptance.
A qualified professional should review pregnancy and delivery history, surgery, chronic conditions, medication, physical examination, uterine-cavity evaluation, cervical screening, blood type and Rh status, immunity, infection testing and any necessary obstetric consultation. An agency's one-page “pass” label is not a substitute for source reports and the clinician's reasoning.
ASRM recommends risk history and testing of a potential carrier and relevant partner before transfer, with abnormal results confirmed. HIV, hepatitis B or hepatitis C generally preclude serving as a carrier, but an exception requires careful counselling, informed consent and documentation. Treatable infections such as syphilis, gonorrhoea or chlamydia call for treatment, retesting and deferral until treatment is documented and the person is no longer infectious before reconsideration. Pathogen, activity, treatment and local law must not be collapsed into “every positive result means permanent exclusion.”
BMI is associated with some pregnancy risks, but the ASRM carrier opinion does not establish 18.5–32 as a universal threshold. Thyroid results must be interpreted against the relevant preconception or pregnancy reference range, symptoms, antibodies and treatment status; TSH 0.5–2.5 is not a universal pass line.
Prior cesareans require obstetric review of the number and operative records, placental risk, previous complications and current findings. ASRM says a carrier ideally should not have had more than three cesarean deliveries; it does not call two cesareans a universal relative contraindication and does not specify a 3 mm scar rule.
Current antidepressant, anxiolytic or mood-stabiliser use should not be turned into an automatic website exclusion. A qualified mental-health professional and the obstetric/reproductive team should review diagnosis, stability, drug and dose, relapse risk if treatment changes, pregnancy risk and alternatives. A candidate should not stop medication abruptly for screening.
ASRM recommends psychoeducation and evaluation by a qualified mental-health professional familiar with third-party reproduction, using a clinical interview and testing when appropriate. The review should cover voluntary decision-making, understanding of medical risk and role boundaries, coping, support, expectations with intended parents, plans around delivery and possible coercion. DSM-5 may support clinical diagnosis, but ASRM does not mandate it as a universal programme pass/fail test.
Intended parents should normally receive only an appropriate summary within the carrier's consent and privacy rules, not unrestricted access to complete medical or psychological records.
Medical and psychosocial clearance does not itself establish legal eligibility, nor does an agreement automatically create intended-parent status. Capacity, relationship or partner consent, independent counsel, contract form, medical autonomy, birth registration and parentage procedure depend on applicable law.
Reliable screening is a documented process, not a marketing scorecard. Professional guidance, clinic policy, individual clinical judgment and law should each have a clear source and responsible professional. An abnormal result must not be ignored, but a webpage should not turn it into a permanent conclusion without confirmation and specialist review.
For a specific case, collect the clinic policy, source reports and destination-law advice before review by the relevant licensed professionals.
Primary sources:
Medical and legal wording reviewed August 2, 2026. This page is informational and does not replace an individual opinion from a physician, qualified mental-health professional or independent lawyer.