Surrogate medical screening usually includes a review of your pregnancy history, a physical exam, blood and urine tests, and a look inside the uterus1. These checks help the clinic understand your health now and whether your body is ready for another pregnancy. If you’re applying with LittleBee and have passed the first application checks, you may still have questions about the appointment—or a result that has appeared on your phone. Here’s what the tests are looking for and how to understand the next step.
What does the clinic check in my history and exam?
Your clinic reviews your previous pregnancies, births, health conditions and medicines alongside a physical exam. Your previous births tell the doctor how pregnancy went for you; the visit also looks at your current health before another pregnancy1. A medical and social questionnaire2 may be part of this review.
The doctor looks at how your pregnancies and deliveries went, including any complications, C-sections or other procedures. Your blood pressure and any ongoing health conditions matter because they can affect the care you would need during pregnancy. Prepregnancy care also includes reviewing prescriptions, over-the-counter medicines, vitamins, supplements and herbs3. Something you started after your last birth belongs in that conversation, even if it feels unrelated to fertility. Mention any allergies, too.
I’d mention a new diagnosis or prescription as soon as you know about it. You don’t need to decide whether it matters before telling the clinic. Telling the doctor now can save you another round of questions after the visit. If the clinic needs an OB’s or another specialist’s opinion about a past complication, the follow-up section below explains how to make that request specific.
You may also be asked about routine cervical or breast screening. The clinic will check whether you’re due for a Pap test or mammogram under the screening guidelines that apply to you1. Ask whether you’re due for a particular test or whether a report you already have will meet the request.
For how prior births, C-sections, recent delivery or breastfeeding affect applying, see pregnancy and delivery history requirements. Age and BMI are covered in the surrogate requirements. This appointment goes further into your own history and current health. If the next request is for a missing report, the screening-process guide covers which records to ask for and what to do when a file is hard to find.
What does the uterine test show, and what does it feel like?
A uterine-cavity test looks for polyps, fibroids, scarring or shape differences that could affect implantation or pregnancy. A saline infusion sonogram, also called an SIS or sonohysterogram, uses a little saline to make the inside of the uterus easier to see on ultrasound4. Evaluating the uterine cavity with a saline scan or another method is highly recommended for gestational carriers1.
During an SIS, you lie on an examination table. The clinician uses a speculum, passes a thin catheter through the cervix and adds saline while viewing the uterus with a vaginal ultrasound probe. Inserting the catheter can pinch or cause cramps, and the saline can cause cramping too4. Some people find it mildly uncomfortable; others find it painful5. Tell the clinician if it hurts, rather than trying to get through it silently.
The scan usually takes less than 30 minutes4. Allow more time for the whole visit, including the conversation and any other checks. That distinction matters if someone is covering a school pickup or you’ve only taken a short break from work.
I’d raise a previous painful pelvic exam or a worry about the catheter before the appointment. Call ahead so you can discuss comfort options and arrange any help you need. Ask what pain relief is appropriate for you and how to tell the clinician you need a pause.
After an uncomplicated SIS, you can generally return to normal activities. Many people can drive themselves, but arranging a ride is reasonable if you feel unwell afterward6. A little cramping, spotting or fluid leakage may follow the test; follow the clinic’s aftercare instructions. Fever, severe pain or a change in vaginal discharge needs a call to your clinician4.
A scan that needs a closer look may lead to a hysteroscopy, which uses a small camera inside the uterus and can sometimes include treatment. An office hysteroscopy may use local anesthesia or no anesthesia; other procedures use sedation or anesthesia7. If you’ll receive sedation, arrange someone to drive you home8. Confirm which procedure is booked before deciding whether to drive yourself or ask someone to come with you.
What are the blood and urine tests looking for?
Blood and urine tests check your health, immunity and substance exposure to help the doctor plan for pregnancy. What matters is what each result means for this pregnancy and whether you need to do anything before the sample is taken.
Preconception tests include blood type and Rh factor, rubella and varicella immunity testing, and a urine drug screen1. Blood type and Rh help with pregnancy planning; Rh-related differences can need preventive care or closer attention9. Immunity testing asks whether you already have protection against certain infections. For example, rubella IgG is used to check immunity10. A low immunity result may lead to a conversation about vaccination before pregnancy. Get the required waiting period and the next appointment date together.
For the urine drug screen, tell the testing team about medicines and supplements that could affect the result11. The clinic may order other blood tests based on your health or its process. If a blood count or thyroid test is requested, it helps the doctor look into blood-cell health12 or thyroid function13. You don’t need to arrive expecting every possible test. The clinic’s actual order tells you what is being checked.
| Before the test | What to confirm | Why it matters |
|---|---|---|
| Blood draw | Fasting instructions for the tests ordered | Some tests need fasting; many do not |
| Hormone test, if ordered | Cycle day or time of day | Timing can affect interpretation |
| Blood or urine sample | Medicines and supplements to report | They can affect some results |
| Leaving the appointment | Notification method and a contact | You know where to get an explanation |
Don’t fast unless you’ve been told to. The preparation depends on the particular test ordered14. If you ate when you were meant to fast, tell the lab before it takes the sample. For a hormone test, ask whether it needs a particular day or time; some tests, such as FSH, are timed to your menstrual cycle15.
I’d get those instructions before rearranging breakfast, childcare or a work shift. Tell the clinic about birth control and other medicines, and don’t stop them on your own to prepare for testing16. If you’ve donated eggs before, this is a different role: you’ll be carrying an embryo17. Ovarian-reserve testing concerns the eggs18, while the uterine check looks at where the pregnancy would develop. If another hormone test is ordered, ask what the doctor wants to learn from it.
Infectious-disease testing and partner testing are covered in the infection-screening guide. Before you leave, ask whether results will come by phone, portal message or an appointment, and whom to contact19. Check that the clinic has your current contact details so it can reach you about results. If something needs attention, the next section shows what to ask about the follow-up.
What if one result needs follow-up?
A result that needs follow-up can mean treatment and another review, more information, or a reason you cannot continue. An abnormal flag on your phone doesn’t tell you which of those applies. A value outside the report’s reference range20 may or may not mean a health problem21.
Results can appear in a portal before the clinician has reviewed them22. The explanation may follow as a comment, a message or a follow-up appointment23. If unexplained flags tend to make you anxious, it’s okay to wait for the clinician’s explanation before opening the report. If you do look first, write down your questions for that conversation. Use the report and the clinical explanation together to understand what happens next.
| What the clinic tells you | Your next step | Who to contact |
|---|---|---|
| Treat or wait, then review again | Get the plan, recheck date and condition for another review | Clinician managing the finding; screening nurse for scheduling |
| More information or testing is needed | Get the exact missing item and where it should go | Person who requested it; clinician or records office providing it |
| You cannot continue | Ask which finding led to the decision and whether later review is possible | Reviewing clinic’s medical team |
For treatment or a pause, find out what needs to change before the next review. The clinician may want a condition treated, more time for recovery or evidence that your health is stable. A treatment plan and a date to reassess give you something concrete to arrange. Ask who will read the new result when it arrives. If the issue is a recent birth or breastfeeding, the pregnancy-history guide covers the waiting questions.
For more information, ask for the request in plain language: a repeat sample, another look at the uterine cavity, a missing report or an opinion about a condition or medicine. If it follows the scan discussed above, get the exact name of the additional test. A specialist may need to explain how a past pregnancy complication affects the present plan. Confirm who asked for the item and where to send it. Keep your question, the reply and its date together so you can see what has been answered. Missing paperwork and a medical finding call for different actions. Nicotine-related questions have their own smoking and vaping guide.
If you’re told you cannot continue, it can hurt after the time you’ve already put into applying. I’d want you to hear the reason in words you understand, beyond that short message. The decision concerns the expected risk of another pregnancy, not how caring or capable you are. Ask whether the concern is an ongoing pregnancy risk, a requirement of that clinic, or something it could reconsider after follow-up. Take a little time to gather your thoughts before that conversation if you need it. Share the full history and the previous decision if another clinic later reviews you. A different clinic may have different requirements; it still needs the complete picture.
When am I medically cleared, and what happens next?
You are medically cleared when the reviewing fertility clinic has the information it needs and confirms its medical acceptance. That decision follows the required records, examination and test results24; completing the evaluation comes before acceptance1. Screening is the work of gathering that information. Clearance is the medical decision after it has been reviewed.
Your fertility-clinic physician or medical team reviews the current information about you. An OB’s or an MFM specialist’s opinion can help explain a particular risk25, while the fertility clinic may still need its own medical checks26. Being approved for an agency profile or having an appointment on the calendar doesn’t mean this review is finished.
Finishing the appointment can feel like the end of the medical part. Kiara’s next request shows why a file may still need one more piece. Kiara completed her ultrasound and blood tests and left thinking she was done. The next day, the clinic asked for the operative report from an old C-section and a note about a prescription. The tests weren’t the problem; the doctor needed enough history to interpret them. Once the records arrived and the doctor reviewed them, she received her medical-clearance notice.
Kiara kept a one-page cover sheet listing every pregnancy, delivery date, hospital, C-section or other procedure, current medicine and record-request status. It helped her see what was missing without rereading long email threads. She felt better when “pending” became one specific record request. For your own file, the records section of the screening-process guide explains what to gather and how to track a request. I’d focus on the named item and the person waiting for it, so you can follow up without starting the whole conversation again.
How long until the answer? Getting records, waiting for results, finding an appointment and arranging another medical opinion can all affect the wait. Ask, “What is still outstanding, who is handling it, and when should I follow up?” Then ask whether matching or other work can continue while that item is pending. A list of what’s still missing helps you follow up without keeping every day free for a possible answer.
Medical acceptance, matching and legal clearance are separate steps. An accepted medical file doesn’t promise you a match, and an insurance-review delay can still hold up the next part. For where these fit together, see the surrogacy timeline.
A new symptom, new medicine or another pregnancy can also change what needs to be checked. Prepregnancy care considers your current health and medicines3. After a long delay or a change of clinic, ask which reports are still usable and whether anything needs to be repeated. Tell the coordinator about changes as they happen so that an older notice doesn’t leave the team working from an out-of-date picture.
Once the needed medical and other steps are complete, follow your own treatment instructions. Surrogacy medications explains that part, and the embryo-transfer guide covers the next procedure. Before booking an extra test or trip, ask your coordinator who pays, what needs approval first and who handles a bill for care of your own health.
Already applying with us? I’m Vivi, your initial contact at LittleBee. Tell me which check you’re having, what message you’ve received and what is still unclear. I can help you identify the next person to contact. If you’re just getting started, start your LittleBee surrogate application.
You can also browse our For Surrogates guides.
References
- Recommendations for practices using gestational carriers: a committee opinion (2022) — asrm.org
- Gestational Carrier | URochester Medicine — urmc.rochester.edu
- Prepregnancy Counseling — acog.org
- Sonohysterography | Johns Hopkins Medicine — hopkinsmedicine.org, accessed 2026-10-09
- Sonohysterogram: Procedure, Fertility, Pain & Side Effects — my.clevelandclinic.org, 2025-05-23
- Sonohysterogram — texaschildrens.org
- Hysteroscopy | Johns Hopkins Medicine — hopkinsmedicine.org
- Hysteroscopy: Minimally Invasive Gynecologic Surgery — healthcare.utah.edu, accessed 2022-09-08
- The Rh Factor: How It Can Affect Your Pregnancy — acog.org, accessed 2026-10-09
- Serology Testing for Rubella | Rubella — cdc.gov, accessed 2026-10-09
- Drug Testing: MedlinePlus Medical Test — medlineplus.gov
- Complete Blood Count (CBC): MedlinePlus Medical Test — medlineplus.gov, accessed 2026-10-09
- TSH (Thyroid-stimulating hormone) Test: MedlinePlus Medical Test — medlineplus.gov
- Fasting for a Blood Test: MedlinePlus Medical Test — medlineplus.gov
- Follicle-Stimulating Hormone (FSH) Levels Test: MedlinePlus Medical Test — medlineplus.gov
- Estrogen Levels Test: MedlinePlus Medical Test — medlineplus.gov
- Fertility evaluation of infertile women: a committee opinion (2021) — asrm.org
- Anti-Müllerian Hormone Test: MedlinePlus Medical Test — medlineplus.gov
- Blood Test — hopkinsmedicine.org
- How to Understand Your Lab Results: MedlinePlus Medical Test — medlineplus.gov, accessed 2026-10-09
- Test Results Procedures — my.clevelandclinic.org
- Frequently Asked Questions — hopkinsmedicine.org
- MyChart Frequently Asked Questions — my.clevelandclinic.org
- What to Expect During Gestational Carrier Screening – A Guide From FCLV — fertilitycenterlv.com
- MFM Clearance for Surrogacy and IVF — oumahealth.com, 2026-05-13
- Gestational Carrier Program — columbiadoctors.org, 2022-11-07
About this guide
I’m Vivi, a LittleBee client manager for surrogate applicants. The medical recommendations and source documents are listed in References, alongside Kiara’s screening experience. Last reviewed: October 10, 2026.