Surrogate Psychological Screening Explained

Why psychological screening exists

Surrogacy is uniquely demanding. You're committing to 12–24 months of medical protocols, hormone treatments, and pregnancy for someone else's child. Psychological screening exists to make sure you're prepared for it — not to find something "wrong" with you.

The goal is to confirm three things:

1. You understand what surrogacy actually involves
2. Your motivations are sustainable through the hard parts
3. Your support system can handle the commitment with you

Who conducts the screening

Screening is done by a licensed psychologist or other mental-health professional with experience in reproductive medicine and surrogacy. ASRM recommends this evaluation for every gestational carrier, and agencies and clinics require it; a few states, like Illinois, write it into their surrogacy statute. Evaluators are usually contracted by the clinic or agency, but they answer to their own professional standards. Their job is to assess your readiness honestly, not to hit an approval target.

Most clinics work with specific psychologists who have years of experience evaluating surrogate candidates. That experience matters — general psychologists sometimes miss surrogacy-specific concerns.

The two components of the psychological evaluation

1. Standardized personality assessment (MMPI-2 or PAI)

You'll take either a version of the Minnesota Multiphasic Personality Inventory (MMPI) or the Personality Assessment Inventory (PAI). Both are well-established psychological tests used in many settings.

What they look like: a long series of true/false or rating questions, taken on a computer or tablet at the clinic or psychologist's office. The MMPI-2 has 567 items; the shorter MMPI-2-RF has 338 and the MMPI-3 has 335; the PAI has 344. Plan on 60–90 minutes either way.

What they measure:

• Emotional stability
• Coping patterns under stress
• Depression and anxiety levels
• Relationship patterns
• Risk factors for mental health issues
• Validity scales (whether you're answering consistently and honestly)

How to take it: Answer honestly. The tests have built-in validity scales that flag when people are trying to look either "too good" or "too bad." Overly positive answers can actually raise concerns about guardedness. Be yourself.

2. Clinical interview

The clinical interview is a 1-2 hour conversation with the psychologist. Your partner will usually be invited to part of the interview if you're married or in a long-term relationship.

Topics covered:

• Your motivation for becoming a surrogate
• How you first learned about surrogacy
• What you know about the medical process and timeline
• Your understanding of emotional challenges
• Your partner's feelings about the decision
• Your support system
• How you handled stress in the past
• Financial situation (not to judge — to assess stability)
• Any history of depression, anxiety, or mental health treatment
• Your prior pregnancies and how you felt about them
• Your feelings about the baby at handoff
• Expectations for the relationship with intended parents
• Backup plans if something goes wrong

What psychologists look for

They're looking for specific things that predict a steady surrogate journey. The signals and flags below are the ones evaluators and surrogates describe most often; they aren't a scoring rubric.

Why some applicants don't clear psychological screening

Not everyone clears on the first pass. We don't have a reliable published number for how many don't — figures you'll see elsewhere are unsourced, so we don't repeat them. What evaluators and surrogates consistently describe is this: when someone doesn't clear, it's rarely because of a mental illness. It's usually external factors:

Unsupportive partner

The reason screeners mention most often. If your partner isn't fully on board — not just "okay with it" but actively supportive — the psychologist will raise concerns. Surrogacy affects your whole household. An unsupportive partner makes the journey much harder and creates stress that affects your pregnancy.

High current life stress

Recent major life changes (divorce, job loss, death, move) within the past 6 months are typically reasons to pause. The psychologist may recommend waiting 6-12 months for life to stabilize before reapplying.

Unclear motivation

"I just want to help" without specifics can be a concern. So can "I need the money" with no other motivation. The psychologist is looking for a nuanced, realistic motivation that you've thought through.

Misunderstanding the process

If you think surrogacy is going to be easy, fast, or uncomplicated, the psychologist will recommend more education before clearance. This is usually fixable — read, talk to other surrogates, and reapply after you have a clearer picture.

History of postpartum depression

Severe postpartum depression in prior pregnancies can raise concerns. Mild PPD that was treated and resolved is usually fine. Severe PPD or postpartum psychosis may be disqualifying — the evaluator decides case by case. For the broader list of health and history factors agencies screen, see what disqualifies you from surrogacy.

Current medication for serious mental illness

Active treatment for severe depression, bipolar disorder, or PTSD may pause screening until you and your treatment team agree you're in a stable enough place.

How to prepare for psychological screening

• Have a frank conversation with your partner first. Make sure they're truly on board. The psychologist will ask them directly.
• Read about the process in detail. Our full guide and process breakdown cover the realities, and medical screening explains the clinic side.
• Think through your motivations. Write them down. What specifically draws you to surrogacy? What concerns you?
• Be honest about past mental health treatment. Previous therapy or treatment isn't disqualifying. Hiding it is.
• Don't try to "pass" the test. Answer the MMPI or PAI honestly. The validity scales will catch coached answers anyway.
• Ask questions. If you don't understand something, ask the psychologist. Their job is partly to educate you.

Agency-side surrogate requirements come before any of this; the evaluation is about readiness, not eligibility.

What happens after screening

The psychologist provides a report to the agency and the fertility clinic. Possible outcomes:

• Cleared for surrogacy. You proceed to matching. Most applicants end up here.
• Cleared with recommendations. You're approved but with specific recommendations like "ensure ongoing counseling during the journey" or "have partner attend monthly sessions."
• Delayed with conditions. Not cleared right now, but specific things you can do to be cleared later (e.g., wait 6 months, complete couples counseling, resolve a specific concern).
• Not cleared. Psychological factors make surrogacy not advisable at this time. Sometimes this is temporary, sometimes permanent.

From first appointment to finished report, plan on 2–4 weeks in total.

Frequently asked questions