Why psychological screening exists
Surrogacy is uniquely demanding. You're committing to 14-24 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:
- You understand what surrogacy actually involves
- Your motivations are sustainable through the hard parts
- Your support system can handle the commitment with you
Who conducts the screening
Screening is done by a licensed psychologist or mental health professional with specific experience in reproductive medicine and surrogacy. They're not working for the agency — they're independent evaluators. Their role is to assess your readiness honestly, not to approve or reject you based on agency pressure.
Most clinics work with specific psychologists who have years of experience evaluating surrogate candidates. This experience matters — general psychologists sometimes miss surrogacy-specific concerns.
The two components of psych screening
1. Standardized personality assessment (MMPI-2 or PAI)
You'll take either the Minnesota Multiphasic Personality Inventory (MMPI-2) or the Personality Assessment Inventory (PAI). Both are well-established psychological tests used in many contexts.
What they look like: 300-344 true/false or rating questions, typically taken on a computer or iPad at the clinic or psychologist's office. Takes 60-90 minutes to complete.
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 honestly)
How to take it: Answer honestly. The tests have built-in validity scales that detect when people are trying to look either "too good" or "too bad." Overly positive answers can actually trigger 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 successful surrogate journeys:
Positive signals
- Clear and specific motivation. "I love being pregnant and want to help someone who can't have kids" is stronger than "I want the money."
- Realistic expectations. You understand the process is hard, the relationship with IPs is complex, and postpartum emotions are real.
- Strong support system. Your partner is on board. Your family knows. You have people to lean on.
- Prior pregnancy satisfaction. You enjoyed (or at least tolerated well) your own pregnancies.
- Mental health stability. You're in a good place right now, not in crisis.
- Independence. You're doing this by choice, not under pressure from a partner or family member.
Yellow and red flags
- Money as the only motivation. Financial motivation is fine, but it shouldn't be the only reason.
- Unrealistic expectations about the process. Expecting it to be easy, or not understanding the emotional demands.
- Unsupportive partner. This is the #1 reason for psychological screening concerns.
- Current mental health crisis. Active depression, anxiety, or trauma requires stabilization first.
- Recent major life stress. Job loss, divorce, death in the family, or move within the past 6 months.
- Rescuing someone else's dream. Doing it to please a family member or friend.
- Past difficult pregnancy. If your own pregnancies were traumatic, carrying another could be difficult.
Prepare for psych screening with our quiz
Our quiz checks if you're in a good place for surrogacy emotionally and practically — before you spend time with a psychologist.
Start the quiz →Why 10-15% of applicants don't clear psychological screening
About 10-15% of women who start psychological screening don't make it through. It's almost never because they have a mental illness. It's because of external factors:
Unsupportive partner
The most common reason. 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 psychosis may be disqualifying.
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.
- 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-2 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.
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 couple's counseling, resolve a specific concern).
- Not cleared. Psychological factors make surrogacy not advisable at this time. Sometimes this is temporary, sometimes permanent.