What physical examinations are required for applying for surrogacy in the United States?
1.Basic Health Assessment
Age and reproductive history verification
Legal age requirement: The surrogate mother must be at least 21 years old, and some states require a minimum age of 45 years old to ensure physiological fitness for pregnancy needs.
• Verification of reproductive history: Medical records of at least one full-term pregnancy and successful delivery must be provided to demonstrate the physiological basis for a healthy pregnancy.
Body Mass Index (BMI) monitoring
• Standard range: BMI should be lower than 30. Overweight may lead to complications such as pregnancy diabetes and hypertension, affecting the safety of mothers and infants.
Adjustment measures: If BMI exceeds the standard, it needs to be reduced to a reasonable range through dietary control and exercise plan before entering the surrogacy process.
Infectious disease screening
• Required inspection items:
Sexually transmitted diseases: HIV, syphilis, gonorrhea, chlamydia, mycoplasma.
O Viral hepatitis: hepatitis B surface antigen (HBsAg), hepatitis C antibody (HCV Ab).
• Handling principle: Positive results must be treated and turned negative before continuing the surrogacy process to ensure no risk of vertical transmission.
Chronic disease management
Cardiovascular system: Blood pressure monitoring, electrocardiogram (ECG) evaluation of cardiac function.
• Metabolic diseases: fasting blood glucose, glycosylated hemoglobin (HbA1c) screening for diabetes; The risk of atherosclerosis was assessed by lipid profile analysis.
Immune related diseases, such as systemic lupus erythematosus (SLE) and antiphospholipid syndrome, require specialized evaluation for disease stability.
2. Specialized examination of the reproductive system
Morphological evaluation of uterus and adnexa
• Ultrasonic examination:
Transvaginal ultrasound: Evaluate uterine muscle echo and uterine cavity morphology, exclude fibroids, polyps, and congenital malformations (such as bicornuate uterus).
3D ultrasound: Accurately measure the thickness and volume of the endometrium to confirm that the embryo implantation environment is suitable.
Hysteroscopy (if necessary): For patients with repeated implantation failures or suspected intrauterine adhesions, directly observe the intrauterine environment.
Hormone levels and ovarian function assessment
• Basic hormone testing (2-4 days of menstruation):
Follicle stimulating hormone (FSH):>10 IU/L indicates decreased ovarian reserve.
Luteinizing hormone (LH): A ratio greater than 2 to FSH may indicate polycystic ovary syndrome (PCOS).
Estradiol (E2):>80 pg/mL indicates ovarian hyperfunction.
Anti-M ü llerian hormone (AMH):<1 ng/mL indicates extremely low ovarian reserve and requires adjustment of ovulation induction protocol.
Ovulation function confirmation
Serum progesterone test: On the 21st day of menstruation, progesterone levels greater than 3 ng/mL indicate ovulation.
Basal body temperature (BBT) monitoring: Record continuously for 3 cycles, and the biphasic curve indicates regular ovulation.
3.Genetics and genetic screening
Carrier Screening
• Routine items: cystic fibrosis (CFTR), spinal muscular atrophy (SMN1), thalassemia (HBB), fragile X syndrome (FMR1).
• Expanded screening: Increase testing for rare diseases such as Tay Sachs disease (HEXA) and sickle cell anemia based on racial background (such as Jewish, African American).
Chromosome karyotype analysis
Objective: To eliminate chromosomal number or structural abnormalities (such as balanced translocation) and reduce the risk of embryonic aneuploidy.
• Technology: G-banding karyotype analysis with a resolution of ≥ 550 bands.
Pre implantation genetic screening (PGS/PGT-A)
Applicable scenarios: Elderly surrogate mothers (>35 years old) or those with a history of recurrent miscarriage.
• Technology: Next generation sequencing (NGS) detects 23 pairs of chromosomal aneuploidy in embryos and selects normal embryos for transplantation.
4. Psychological and Lifestyle Assessment
Psychological health screening
Standardized scales: Edinburgh Postnatal Depression Scale (EPDS) and Symptom Checklist-90 (SCL-90) assess anxiety and depression tendencies.
Psychological counseling: Confirm that there are no incurable psychological disorders and that no psychotropic drugs (such as lithium salts and sodium valproate) that affect fetal development have been taken.
Lifestyle review
• Substance use: Urinary drug screening (marijuana, cocaine, methamphetamine), alcohol metabolite testing.
Environmental exposure: Questionnaire survey to assess occupational or living environmental risks such as exposure to radiation, heavy metals, organic solvents, etc.
5. Special inspection items
Cytomegalovirus (CMV) activity detection
Serological testing: CMV IgG/IgM antibody typing, IgM positivity requires confirmation of active infection through viral load PCR.
Intervention measures: Active carriers need to delay surrogacy until IgM becomes negative and viral load is undetectable.
TORCH comprehensive screening
• Projects: Toxoplasma gondii, Rubella virus, Cytomegalovirus (CMV), Herpes simplex virus (HSV-1/2).
Meaning: To prevent fetal malformations or miscarriage caused by congenital infections.
6. Additional Requirements for Pregnancy Surrogacy
Compatibility assessment of embryo transfer
Immunological examination: natural killer cell (NK cell) activity, antiphospholipid antibodies (APA), and antinuclear antibodies (ANA) exclude the risk of immune rejection.
Endometrial receptivity: Endometrial blood flow (PI/RI values) and molecular markers (such as integrin β 3) are evaluated by ultrasound to predict implantation window.
Analysis of past history of pregnancy complications
• History of premature birth: Cervical length measurement (transvaginal ultrasound),<25mm requires cervical cerclage for prevention.
• Gestational diabetes history: oral glucose tolerance test (OGTT) is used to screen abnormal glucose metabolism and formulate diet/insulin intervention program.
7.Check the process and timeline
Initial screening stage (before signing): Basic health assessment, infectious disease screening, reproductive system ultrasound.
Deep evaluation stage (after matching): hormone testing, genetic screening, psychological evaluation.
Pre transplant stage (before cycle initiation): endometrial preparation, immunological examination, TORCH review.
8.Data support and standard basis
ASRM guidelines require surrogate mothers to pass FDA mandated donor screening criteria, including testing for infectious and genetic diseases.
FDA regulation: 21 CFR Part 1271 requires infectious disease screening and laboratory testing for human cells, tissues, and cell and tissue based products (HCT/Ps).
• Clinical data: The risk of preterm delivery of surrogate mothers with high BMI (>30) increased by 2.3 times (OR=2.3, 95% CI 1.8-3.1), and the incidence of diabetes in pregnancy increased by 1.8 times (OR=1.8, 95% CI 1.5-2.2).
9.Conclusion
The American surrogacy medical examination system focuses on reducing the risk of maternal and infant complications, and ensures that the surrogate mother's physiological and psychological state is suitable for pregnancy needs through multi-level and interdisciplinary evaluation methods. The above inspection items strictly follow ASRM and FDA guidelines, eliminate legal and ethical disputes, and focus on medical safety and process standardization.
