The medical screening overview
Medical screening is the step between agency approval and entering the matching pool. It happens at the intended parents' fertility clinic — not your regular OB's office. The clinic may be in another state, which means you'll need to travel. Travel costs are reimbursed.
Typical duration: 1-2 months total from first appointment to final clearance. Some tests can be done in one visit; others require follow-ups.
What gets screened
| Test | Purpose |
|---|---|
| Comprehensive bloodwork | Infectious diseases, hormones, genetic markers |
| Physical exam | General health, blood pressure, weight, BMI verification |
| Uterine evaluation (SHG or hysteroscopy) | Uterine cavity shape, fibroids, polyps |
| Pap smear and STI testing | Cervical health, HPV, chlamydia, gonorrhea, syphilis |
| HIV and Hepatitis panel | Transmissible infections |
| Drug screening | Nicotine, marijuana, recreational drugs |
| Pregnancy history review | Prior pregnancies, deliveries, complications |
| Partner screening (if married) | Infectious diseases, especially HIV |
Comprehensive bloodwork — what they check for
Bloodwork is the biggest part of medical screening. Expect multiple vials drawn, and sometimes multiple visits. Tests include:
Infectious disease panel
- HIV 1 and 2 — disqualifying if positive
- Hepatitis B surface antigen — disqualifying if active infection
- Hepatitis C antibodies — disqualifying if active
- Syphilis (RPR) — treatable; not automatically disqualifying
- Chlamydia and gonorrhea — treatable; requires treatment before clearance
- Rubella immunity — you need immunity or MMR booster
- Varicella (chicken pox) immunity — immunity required
- CMV status — informational, not disqualifying
Hormone and fertility markers
- Thyroid (TSH, T3, T4) — needs to be well-controlled
- Progesterone baseline — for cycle timing
- Estradiol baseline — for cycle timing
- Prolactin — elevated levels can indicate issues
- FSH and LH — basic reproductive health
General health markers
- Complete blood count (CBC) — checks for anemia, infection
- Comprehensive metabolic panel — kidney function, liver function, glucose
- Hemoglobin A1C — diabetes screening
- Blood type and Rh — for pregnancy planning
- Antibody screen — for potential Rh incompatibility
Genetic screening
Some clinics run a genetic carrier screen to check for common recessive conditions. This isn't about disqualifying you — it's about informing the intended parents of any potential genetic considerations for the embryo.
Uterine evaluation — the SHG or hysteroscopy
The clinic needs to confirm your uterus can successfully carry an embryo. This is done through one of two procedures:
Sonohysterogram (SHG)
A saline-infusion ultrasound. A thin catheter is inserted through your cervix and saline is injected into your uterine cavity while an ultrasound probe images the uterus. The saline expands the cavity so the clinic can see any fibroids, polyps, scar tissue, or structural issues clearly. Takes about 15 minutes. Mildly uncomfortable but not usually painful.
Hysteroscopy
A small camera on a flexible tube is inserted through your cervix to visually examine your uterine cavity. Takes about 20-30 minutes. Performed in the office or sometimes a surgical suite. Some clinics prefer this over SHG for a clearer view.
What they're looking for
- Normal uterine cavity shape
- No significant fibroids (small ones are usually fine)
- No polyps (if found, usually removed before clearance)
- No scar tissue (from C-sections or prior procedures)
- Adequate endometrial lining development
Want to see if you'd pass medical screening?
Our quiz checks the biggest medical disqualifiers — BMI, health history, smoking, medications.
Check eligibility →STI testing and pap smear
Standard STI panel: chlamydia, gonorrhea, syphilis, HIV, Hep B, Hep C. Any treatable STI found must be treated and confirmed cleared before you can proceed. HIV and active Hepatitis infections are disqualifying.
Pap smear checks cervical health and HPV status. Abnormal pap results may require colposcopy or additional follow-up. A normal pap is required for clearance.
Drug screening
Urine drug screen checks for nicotine (cotinine), marijuana (THC), cocaine, methamphetamine, opioids, and other drugs. Any positive result disqualifies you from the current cycle. Most agencies require 6-12 months clean before you can reapply after a failed drug screen.
Nicotine testing catches smoking, vaping, and chewing tobacco. Second-hand smoke exposure from a spouse who smokes in the home can occasionally trigger a positive — some agencies consider this during review.
Marijuana remains a disqualifier even in states where it's recreationally legal. THC stays in your system for 30-90 days depending on usage frequency. If you've used recently, you'll fail the screen.
Physical exam
The physical exam confirms general health. Height, weight, and BMI are re-verified — if you were on the borderline for BMI at application, this is where it gets checked against the clinic's actual scale. Blood pressure is measured. Any visible signs of health issues are noted.
Heart and lung auscultation, abdominal exam, and standard physical check. Nothing surprising.
Pregnancy history review
The clinic wants your full pregnancy records. Expect to provide:
- Prenatal records from all prior pregnancies
- Delivery records (vaginal, C-section, complications)
- Any hospitalization records related to pregnancy
- Records of miscarriages or losses
The clinic is looking for patterns — were your pregnancies healthy? Any concerning complications? History of preterm labor? Gestational diabetes? Preeclampsia? Placenta previa?
Minor complications don't usually disqualify you. Severe complications (eclampsia, HELLP, placental abruption) may.
Partner screening (if married)
If you're married or in a long-term relationship, your partner will also be screened for HIV and Hepatitis. This is because a pregnancy means sexual activity during the medical protocol could theoretically expose the embryo to an infection. A positive on your partner's screening doesn't disqualify you directly but changes the protocol.
What causes medical screening failures
Most common reasons women fail medical screening:
- BMI on arrival is higher than reported — most common fixable failure
- Uterine fibroids or polyps requiring removal — fixable with minor procedure
- Positive drug screen — 6-12 month wait required
- Thyroid not well-controlled — adjust meds and retest
- HIV or active Hepatitis — permanent disqualification
- Uterine anomalies — depends on severity
- Abnormal pap requiring follow-up — delays but usually not disqualifying
- Genetic carrier for serious recessive condition — informs matching but usually doesn't disqualify
How to prepare for medical screening
- Gather all medical records beforehand. Prenatal, delivery, hospitalization, and primary care records.
- Stop using any drugs or alcohol 90+ days before. Marijuana especially — THC stays in your system longer than most people realize.
- Get to your target BMI before the visit. Borderline BMI is the #1 fixable reason screening fails.
- Schedule the visit for a time when you're well-rested and healthy. Don't show up with a cold — it can delay the process.
- Bring your partner if you're married. Partner screening is easier when it's done at the same visit.
- Drink plenty of water before bloodwork. Makes the draw easier.