Quick answer: Medical coordination in surrogacy is the process of moving a gestational surrogate from agency qualification through the fertility clinic’s independent evaluation and final medical clearance while keeping records, clinic requirements, appointments, communication, and next steps organized. The agency coordinates the process. The fertility clinic makes the medical decision.
At Egg Donor & Surrogacy Institute (EDSI), qualification begins before a surrogate candidate is presented to intended parents. EDSI reviews the candidate’s pregnancy and delivery history, relevant medical records, current health and medications, basic eligibility, support system, readiness, preliminary insurance considerations, and compatibility factors. Required psychological evaluation and background screening are also completed as part of the EDSI Ready for Matching qualification process.
After a mutual match, the intended parents’ fertility clinic independently reviews the candidate and determines what additional records, examinations, laboratory testing, imaging, or specialist review may be required. The fertility clinic makes the final medical clearance decision. EDSI does not medically clear surrogates.
98% of EDSI surrogate candidates presented for fertility clinic medical evaluation are accepted by the clinic. This figure applies to candidates who reach clinic evaluation after completing the required EDSI qualification process. It is not a guarantee that every candidate will receive medical clearance, and it does not replace the independent judgment of the fertility physician.
On This Page
- What Does Medical Coordination Mean in a Surrogacy Journey?
- Who Is Responsible for Each Part of Surrogacy Medical Coordination?
- Why Does Medical Coordination Begin Before a Surrogate Visits the Fertility Clinic?
- What Happens After Intended Parents and a Surrogate Mutually Match?
- Why Can Different Fertility Clinics Reach Different Decisions About the Same Surrogate?
- What Does EDSI’s 98% Fertility Clinic Acceptance Rate Actually Mean?
- What Happens If the Fertility Clinic Requests More Information?
- What Happens If a Surrogate Does Not Receive Medical Clearance?
- What Should Intended Parents Expect From Clinical Coordination in Surrogacy?
- What Are Best Practices for Medical Coordination in Surrogacy Programs?
- What Happens After Fertility Clinic Medical Clearance?
- How Is Medical Coordination Different for Intended Parents Who Already Have Embryos?
- What Should First Time Intended Parents Ask About Medical Coordination?
- Frequently Asked Questions About Medical Coordination in Surrogacy
What Does Medical Coordination Mean in a Surrogacy Journey?
Medical coordination does not mean that a surrogacy agency practices medicine. It means organizing the information, people, requirements, and timing surrounding the medical portions of a journey so the licensed professionals responsible for medical decisions have what they need.
In a gestational surrogacy journey, several parties may be involved at the same time. Intended parents may already have a fertility clinic and frozen embryos. The surrogate may live in another state. Medical records may come from several hospitals or obstetric practices. The fertility clinic may have its own gestational carrier requirements. Insurance, psychological evaluation, legal clearance, medications, travel, and transfer scheduling may also need to occur in a particular sequence.
A strong coordination process makes it clear who is collecting records, whether known clinic requirements have been considered, what the clinic is still waiting for, who is responsible for the next action, and whether final medical clearance has actually been issued.
For the broader sequence from consultation through birth, see EDSI’s surrogacy process for intended parents.
Who Is Responsible for Each Part of Surrogacy Medical Coordination?
A safe and understandable process keeps professional roles separate. Coordination connects the professionals. It does not transfer their authority to the agency.
| Stage | Primary responsibility | What it means |
|---|---|---|
| Agency qualification | EDSI | Reviews required candidate information and determines whether the candidate may be presented under EDSI’s qualification standards. |
| Psychological evaluation | Qualified independent mental health professional | Evaluates psychological readiness, expectations, support, and relevant emotional considerations. |
| Medical record review before presentation | EDSI qualification process | Identifies history and documentation that should be understood before intended parents consider a candidate. |
| Fertility clinic review | Intended parents’ fertility clinic | Independently reviews the candidate’s records and determines what further medical evaluation is required. |
| Medical examination and testing | Fertility clinic and licensed medical professionals | Evaluates medical suitability according to the clinic’s protocol. |
| Final medical clearance | Intended parents’ fertility clinic | Determines whether the clinic will approve the surrogate for treatment. |
| Insurance review | Qualified insurance professional | Reviews coverage, exclusions, and potential additional coverage requirements. |
| Legal work | Independent reproductive attorneys | Advise each party and complete required agreements and legal clearance. |
| Journey funds | Independent third party bonded escrow provider | Holds and disburses authorized funds according to the applicable agreement. |
| Journey coordination | EDSI shared coordination team | Tracks communication, documentation, milestones, scheduling, and professional handoffs without replacing the professionals responsible for their decisions. |
Why Does Medical Coordination Begin Before a Surrogate Visits the Fertility Clinic?
The fertility clinic appointment should not be the first time important questions about a candidate are being investigated. Clinic evaluation requires time, medical resources, scheduling, and often travel. Intended parents may also have already formed an emotional connection with the proposed surrogate.
Meaningful qualification before presentation can identify foreseeable concerns earlier. At EDSI, preliminary qualification includes pregnancy and delivery records, current health and medications, basic program eligibility, previous pregnancy outcomes, readiness, support, preliminary insurance considerations, psychological evaluation, background screening, and matching factors.
The objective is not to predict what the fertility physician will decide. The objective is to present a well documented candidate whose history has already been meaningfully reviewed before the fertility clinic is asked to perform its independent evaluation.
Step 1: Understand the Intended Parents’ Fertility Plan
Medical coordination should begin by identifying where the intended parents are in their fertility journey. Important questions include whether embryos already exist, where they are stored, which clinic is expected to perform the transfer, whether that clinic accepts gestational carrier cases, and whether the clinic has specific surrogate criteria that should be considered during matching.
When EDSI knows the intended parents’ clinic, the team can consider known clinic requirements during candidate review where possible. That does not guarantee acceptance. The clinic still conducts its independent review.
Step 2: Review the Surrogate Candidate Before Presentation
A surrogate candidate should be evaluated using more than an application and a short interview. EDSI’s preliminary qualification process considers information such as:
- Pregnancy and delivery history
- Available pregnancy and delivery medical records
- Current health conditions and medications
- Prior pregnancy complications
- Prior cesarean deliveries
- Current BMI
- Smoking and substance use
- Recent pregnancy or breastfeeding when relevant
- Support system and practical readiness
- Preliminary insurance considerations
- Communication and matching expectations
Required psychological evaluation and background screening are also part of EDSI’s Ready for Matching qualification process before presentation. For the detailed pre match standard, see how EDSI screens surrogates before matching.
Step 3: Consider Basic Eligibility and Clinic Compatibility
EDSI’s current general surrogate eligibility guidelines include age 21 through 39, United States citizenship or permanent residency, nonsmoking status, at least one prior full term pregnancy and delivery, no major pregnancy complications that make another pregnancy inappropriate, and a BMI of 32 or below. A successful pregnancy and delivery within the previous 10 years may also be required by the fertility clinic.
Meeting general criteria does not equal medical clearance. A clinic may have narrower requirements based on the candidate’s complete history, physician judgment, treatment protocol, number of prior deliveries or cesarean sections, medications, previous complications, uterine findings, infectious disease testing, or other clinical considerations.
What Happens After Intended Parents and a Surrogate Mutually Match?
A mutual match is a major transition point. Before the match, EDSI is determining whether a candidate has completed the required qualification process and whether an introduction appears appropriate. After both the intended parents and surrogate decide they want to proceed together, the proposed surrogate can move into the intended parents’ fertility clinic review process.
This is where medical coordination becomes clinic specific. Intended parents who are still evaluating candidates may also find EDSI’s guide on how to find a qualified surrogate useful.
Step 4: Organize the Medical File for Fertility Clinic Review
The clinic needs sufficient information to decide whether it is willing to evaluate the proposed surrogate. Depending on the clinic and candidate, relevant documentation may include prior prenatal records, delivery records, hospital discharge summaries, operative reports from cesarean deliveries, postpartum information, current health documentation, cervical screening records, OB clearance, or specialist records.
The clinic may ask for records beyond what the agency originally required. EDSI helps organize communication and documentation so requests can be identified and routed to the appropriate person. A complete and organized record set can prevent avoidable delays caused by missing documents or unanswered questions.
Step 5: The Fertility Clinic Conducts Its Own Record Review
Agency qualification does not bind the fertility clinic. The clinic reviews the proposed surrogate under its own medical standards and the physician’s independent judgment.
The clinic may accept the records for the next stage, request additional records, ask for an updated examination or screening result, request clarification from an obstetrician, request maternal fetal medicine or other specialist review, ask about a medication or diagnosis, request additional laboratory testing, or determine that the candidate does not meet its requirements.
The agency’s role is to help keep the request and response process organized. The medical conclusion belongs to the clinic.
Step 6: The Surrogate Completes the Fertility Clinic Medical Evaluation
The exact evaluation differs by fertility clinic. The American Society for Reproductive Medicine identifies medical evaluation, infectious disease screening and testing, preconception testing, psychosocial evaluation, uterine cavity evaluation, and legal counseling as distinct considerations in gestational carrier arrangements. See the ASRM gestational carrier committee opinion.
A fertility clinic evaluation may include review of medical and pregnancy history, physical examination, bloodwork, infectious disease testing, blood type and Rh factor review, immunity testing, cervical screening, urine or substance testing when required, uterine cavity evaluation, ultrasound or saline sonogram, review of prior cesarean deliveries, medication review, OB clearance, specialist clearance when indicated, and testing of a spouse or partner when required by clinic protocol.
The specific tests and decisions must come from the fertility clinic. An agency should not promise that every clinic follows an identical protocol.
Step 7: The Fertility Clinic Makes the Final Medical Clearance Decision
Final medical clearance is the clinic’s decision that the proposed gestational surrogate meets its requirements to proceed toward treatment. That decision is different from agency approval, Ready for Matching status, a surrogate profile being presented, a mutual match, psychological evaluation, background screening, insurance review, or legal clearance.
A surrogate can therefore complete an agency’s qualification process and still be declined by the fertility clinic. Likewise, a clinic may request additional information without permanently declining the candidate.
Intended parents should ask their agency to use precise terminology rather than describing a candidate as simply “fully cleared” when important independent approvals are still pending.
Why Can Different Fertility Clinics Reach Different Decisions About the Same Surrogate?
Gestational carrier criteria are not identical across fertility clinics. A candidate may satisfy an agency’s eligibility standards but encounter a clinic requirement involving age, BMI, time since the most recent pregnancy, number of previous pregnancies, number of previous cesarean deliveries, a prior pregnancy complication, a medication, mental health history, recent breastfeeding, uterine findings, vaccination requirements, specialist clearance, infectious disease results, or another medical consideration.
This does not necessarily mean that one clinic is correct and another is wrong. Fertility clinics develop protocols using physician judgment, clinical experience, institutional policies, medical risk considerations, and the circumstances of the individual candidate.
A useful agency selection question is: Does the agency understand our fertility clinic’s requirements before presenting surrogate candidates? Early alignment cannot eliminate every unexpected clinic decision, but it can reduce situations in which a clearly incompatible candidate progresses too far before an issue is identified.
What Does EDSI’s 98% Fertility Clinic Acceptance Rate Actually Mean?
98% of EDSI surrogate candidates presented for fertility clinic medical evaluation are accepted by the clinic.
The denominator matters. This does not mean that 98% of people who apply to become surrogates qualify. It does not mean EDSI medically clears 98% of surrogates. It does not mean every surrogate will be accepted by every fertility clinic.
It means that among EDSI candidates who complete the agency’s qualification process and are presented for fertility clinic medical evaluation, 98% are accepted by the clinic.
EDSI attributes that result to the work completed before clinic presentation, including records review, pregnancy and delivery history review, current health and medication review, psychological evaluation, background screening, readiness and support review, preliminary insurance considerations, and attention to known clinic requirements where possible.
The statistic is most useful as a measure of the relationship between preliminary qualification and subsequent clinic acceptance, not as a promise about pregnancy or treatment outcome. The fertility clinic retains final medical authority in every case.
What Happens If the Fertility Clinic Requests More Information?
A request for more information is not necessarily a rejection. A fertility physician may need additional context before deciding whether to clear a candidate.
The clinic might request an operative report from a previous cesarean delivery, records relating to a prior pregnancy complication, an updated Pap test, current OB clearance, a maternal fetal medicine consultation, cardiology or other specialist review, updated laboratory testing, clarification regarding medication use, additional imaging, or more recent medical records.
Medical coordination during this stage means identifying exactly what is missing, determining who can provide it, tracking the request, and making sure the clinic receives the documentation. The clinic then decides whether the additional information is sufficient.
What Happens If a Surrogate Does Not Receive Medical Clearance?
The next step depends on the reason. A temporary issue may require more information, updated testing, recovery time, treatment, or specialist evaluation. Other findings may mean the fertility clinic will not approve the candidate.
Possible outcomes can include providing missing records, repeating an inconclusive test, obtaining updated OB clearance, waiting until an appropriate medical interval has passed, receiving specialist review, pausing the proposed match, ending the proposed match, or beginning a rematch process.
An agency should never pressure a surrogate or intended parents to override a safety based medical decision in order to preserve a match. When a fertility clinic declines a proposed surrogate, the clinic’s medical decision should remain separate from the agency’s responsibility to help the parties understand the next administrative step.
What Should Intended Parents Expect From Clinical Coordination in Surrogacy?
Intended parents should expect the coordination team to know what stage the case is in, what remains outstanding, who is responsible for the next action, and whether an independent professional has actually issued the required clearance.
Good clinical coordination should also help intended parents avoid having to personally chase every record, appointment, request, and status update among multiple professionals.
At EDSI, the shared coordination team helps organize communication across surrogate qualification, fertility clinic review, independent professional evaluations, insurance, legal preparation, escrow, treatment milestones, pregnancy support, and delivery preparation. Medical instructions and medical decisions remain between the surrogate and her licensed healthcare providers.
What Are Best Practices for Medical Coordination in Surrogacy Programs?
Separate Agency Qualification From Clinic Clearance
The agency should clearly explain what it has reviewed and what still requires independent medical evaluation. Terms such as “approved,” “screened,” and “cleared” should not be used interchangeably.
Review Important Records Before Emotional Commitment
A proposed match is stronger when meaningful pregnancy and delivery information has already been collected and reviewed before intended parents are asked to consider the candidate.
Identify Known Clinic Requirements Early
When intended parents already have a fertility clinic, known gestational carrier requirements should be considered during candidate qualification and matching when possible.
Maintain Clear Ownership of the Next Step
The coordination team should be able to answer what is outstanding, who requested it, who is responsible for obtaining it, whether it has been sent, whether the clinic is waiting on anything else, and whether formal clearance has been issued.
Keep Independent Professional Roles Intact
Fertility clinics make medical decisions. Mental health professionals perform psychological evaluations. Attorneys provide legal advice and representation. Insurance professionals evaluate coverage. Independent escrow providers manage funds. The agency coordinates rather than replacing these professionals.
Do Not Treat Medical Clearance as the End of Preparation
Clinic clearance is a major milestone, but it is not the same as being ready for embryo transfer. Legal, insurance, escrow, and clinic requirements must also be completed in the sequence applicable to the case before treatment advances. For more on insurance, see EDSI’s guide to surrogacy insurance.
What Happens After Fertility Clinic Medical Clearance?
After the surrogate receives medical clearance, the journey moves into the remaining preparation required before embryo transfer. That generally involves coordination among the intended parents, surrogate, fertility clinic, separate reproductive attorneys, insurance professionals, escrow provider, and agency team.
The appropriate attorneys complete the gestational carrier agreement and issue any required legal clearance. Insurance requirements are confirmed. Required journey funds are established with the independent third party bonded escrow provider according to the applicable agreement. The fertility clinic then controls the medical treatment schedule, including medications, monitoring, and embryo transfer preparation.
Medical clearance therefore represents an important handoff point. The clinic has determined that the surrogate may proceed medically. The remaining professionals must complete their own responsibilities before treatment can move forward.
How Is Medical Coordination Different for Intended Parents Who Already Have Embryos?
Intended parents who already have frozen embryos often enter surrogacy at a different starting point. Their first coordination questions usually involve where the embryos are stored, whether the current fertility clinic performs gestational carrier transfers, whether they want to continue with that clinic, the clinic’s gestational carrier requirements, how a surrogate will be submitted for review, whether embryo transport may be required, and what medical, legal, insurance, and escrow steps remain before transfer.
Having embryos ready does not remove the surrogate qualification or clinic clearance process. It can, however, allow the agency and fertility clinic to define the medical pathway earlier because the transfer clinic and embryo status may already be known. See EDSI’s guide to surrogacy with embryos already created.
What Should First Time Intended Parents Ask About Medical Coordination?
Before choosing a surrogacy program, intended parents should ask:
- What screening is completed before I see a surrogate profile?
- Are pregnancy and delivery records reviewed before presentation?
- Who performs psychological evaluation?
- When are background checks completed?
- If I already have a fertility clinic, do you review its known surrogate requirements?
- Who sends the surrogate’s records to the clinic?
- Who tracks additional clinic requests?
- Who schedules the medical evaluation?
- Who makes final medical clearance?
- What happens if the clinic asks for a specialist consultation?
- What happens if the surrogate is not medically cleared?
- Who coordinates the transition from medical clearance to legal clearance, insurance, escrow, medications, and embryo transfer?
The quality of the answers can reveal whether medical coordination is a defined operational process or simply a general promise of support.
Why Medical Coordination Matters
Surrogacy involves far more than matching an intended parent with someone willing to carry a pregnancy. A proposed surrogate must move through a series of distinct reviews and professional decisions before an embryo transfer can occur.
The purpose of medical coordination is to keep those stages organized while preserving the independence of the people responsible for them.
EDSI has worked in third party reproduction for more than 25 years and has supported more than 3,000 births. Its role in medical coordination is not to make clinical decisions. It is to help intended parents and surrogates move through qualification, clinic communication, independent evaluation, medical clearance, and the professional steps that follow with a clear understanding of what has been completed and what comes next.
Learn more about how intended parents should evaluate a surrogacy agency and EDSI’s broader surrogacy process.
Frequently Asked Questions About Medical Coordination in Surrogacy
The intended parents’ fertility clinic gives the gestational surrogate final medical clearance. A surrogacy agency may review records, pregnancy history, medications, eligibility, and other qualification information before presenting a candidate, but the agency does not replace the fertility clinic’s independent medical evaluation or final decision.
Surrogate screening is the broader qualification process that reviews factors such as pregnancy and delivery history, relevant medical records, current health and medications, eligibility, psychological readiness, background, support, and insurance considerations. Fertility clinic medical clearance is the clinic’s independent decision that the proposed surrogate satisfies its medical requirements to proceed toward treatment.
No. EDSI completes its required Ready for Matching qualification process before a surrogate candidate is presented to intended parents. After a mutual match, the intended parents’ fertility clinic performs its own medical evaluation and makes the final medical clearance decision.
Before presentation, EDSI reviews required pregnancy and delivery records, pregnancy history, current health and medications, basic eligibility, readiness, support, preliminary insurance considerations, and matching compatibility. Required psychological evaluation and background screening are also completed as part of the EDSI Ready for Matching qualification process.
98% of EDSI surrogate candidates presented for fertility clinic medical evaluation are accepted by the clinic. This figure applies specifically to EDSI candidates who reach fertility clinic medical evaluation after completing the required EDSI qualification process. It does not mean that 98% of surrogate applicants qualify, and it does not mean that EDSI provides medical clearance. The fertility clinic always retains final medical clearance authority.
Yes. Fertility clinics use their own medical protocols and physician judgment. A candidate can satisfy an agency’s qualification standards and still be declined because of a clinic specific requirement, a medical record finding, a test result, a previous pregnancy complication, medication history, or another clinical consideration.
Fertility clinics establish their own protocols based on physician judgment, medical risk considerations, institutional policies, and the circumstances of the individual candidate. Requirements involving age, BMI, prior pregnancies, cesarean deliveries, medications, previous complications, testing, or specialist clearance can therefore differ among clinics.
The exact evaluation depends on the fertility clinic. It may include review of pregnancy and medical history, physical examination, laboratory testing, infectious disease testing, uterine cavity evaluation, medication review, previous pregnancy and delivery records, and additional testing or specialist consultation when indicated. The fertility clinic determines which evaluations are required.
A request for additional information does not automatically mean that the surrogate has been declined. The clinic may request additional pregnancy records, an operative report, updated OB clearance, laboratory testing, specialist review, imaging, or clarification of a medication or medical history item. Medical coordination includes identifying what the clinic needs, helping organize the requested information, and tracking the request until the clinic can make its decision.
The next step depends on the reason. A clinic may request additional information or testing, recommend waiting for a medical interval to pass, require specialist review, or determine that the candidate cannot proceed. If the clinic ultimately declines the candidate, the proposed match may end and the intended parents may need to begin a rematch process.
Medical clearance is an important milestone, but it does not mean the surrogate is immediately ready for embryo transfer. The remaining legal, insurance, escrow, and clinic requirements must be completed in the appropriate sequence. Separate reproductive attorneys handle the legal process, insurance professionals review coverage, an independent third party bonded escrow provider manages journey funds, and the fertility clinic controls medications, monitoring, and embryo transfer preparation.
Yes. Intended parents can come to EDSI with an existing fertility clinic and with embryos already created. When the fertility clinic is known, EDSI can consider known clinic requirements during candidate qualification and coordinate the proposed surrogate’s transition into the clinic’s review process. The fertility clinic still performs its own evaluation and makes the final medical clearance decision.
Understand the Medical Coordination Before You Match
If you are considering surrogacy, already have embryos, or are working with a fertility clinic, EDSI can help you understand what should be completed before a surrogate is presented and what happens between matching and final fertility clinic clearance.
Egg Donor & Surrogacy Institute coordinates surrogacy journeys for intended parents throughout the United States and internationally while fertility clinics, mental health professionals, attorneys, insurance professionals, and independent escrow providers retain responsibility for their respective professional decisions.
Tell us where you are in the process, including whether you already have embryos and which fertility clinic you are using.
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About the author: Parham Zar is Founder and Managing Director of Egg Donor & Surrogacy Institute in Beverly Hills, California. He has worked in surrogacy, egg donation, and third party reproduction for more than 25 years. His work focuses on intended parent guidance, surrogate qualification and matching, fertility clinic coordination, ethical agency practices, and structured coordination among the independent professionals involved in family building.
