Surrogacy BMI Management

Increase your agency's candidate pool by helping surrogates achieve BMI requirements.

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The True Cost of Declining Overweight Surrogate Candidates And What To Do About It

Surrogacy is a miracle of modern reproductive science where a healthy woman, called gestational carrier or gestational surrogate, carries a pregnancy to term for another woman, couple or individual (the intended parents) to help them become parents. A crucial requirement of this arrangement is that the surrogate is physically healthy.

Unfortunately, many surrogacy agencies end up declining potential candidates due to the strict health criteria. This creates a challenge for the agencies to maintain a ample pool of qualified surrogates and thus suffer from time and resource losses.

BMI Criteria and Surrogacy

One of the main reasons why many women interested in becoming surrogates are turned down is due to their excess weight.

Body mass index (or BMI) is widely used to determine a healthy weight. A woman whose BMI falls within the range of 18.5 to 24.9 are considered to have a healthy weight, while those with a BMI score between 25 and 29.9 are considered overweight. Obese women are those with a BMI of 30 and above.

Most doctors who work with surrogates decline women with a BMI of 30 or higher as obesity reduces fertility and increases the risk of pregnancy complications. For these reasons, many agencies set their BMI requirements slightly below this number, although some doctors and agencies may have stricter limits.

Hence, a healthy BMI is a must-have for every woman who wants to become a surrogate.

1. Elevated BMI Inhibits a Woman From Becoming a Surrogate

BMI is a reliable indicator of the possible health risks that may prevent a woman from moving forward in the surrogacy process. Because of its very delicate nature, surrogacy needs to be carried out with as little risks as possible.

Women with a healthy BMI are more likely to have a healthy pregnancy and natural birth without complications. Not only does it take women with a high BMI a longer time to conceive, but they also have a higher chance of developing various health complications during pregnancy.

Women with higher BMI are at greater risk of gestational diabetes and are more likely to have hypertension (high blood pressure), amongst other complications. Having a BMI of 35 or above also increases a woman’s risk of preeclampsia, stillbirth, high birth weight, unsuccessful labor, as well as birth defects.

Given all of these reasons, it is understandable how otherwise qualified candidate will be turned down for not meeting required BMI levels.

2. Lost Revenue Due to Candidate Rejection Based on BMI Criteria

The average cost of surrogacy in the U.S. ranges between $90,000 and $200,000 (varies on location). The agency fees can vary widely depending on the kinds of services they provide. While some agencies include the costs of medical screening and legal services in their package, others charge for them separately, with the amount ranging between $20,000 and $50,000.

About 50 percent of the total surrogacy budget goes to the surrogate mother as compensation for her time and effort during the process. The legal fees and agency fees may take another 30%, approximately. The remainder of the budget covers medical procedures and other expenses.

Agencies are the first to be paid during a surrogacy journey (agency fees). These payments are made only once and are usually non-refundable. They cover all the activities the agency would need to do from the moment a parent submits application until they go home with the new bundle of joy.

In the United States, intended parents will pay nearly all the budget in advance (either to the agency, fertility clinic or into an escrow account) before starting the surrogacy journey.

When a candidate is rejected because of their BMI being outside the healthy range, agencies not only lose this potential revenue but also incur many wasted costs while recruiting the aspiring surrogates.

3. Surrogate Shortages

The number of women looking to become surrogates has reduced significantly in recent years. The situation has progressed to the point that many new intended parents have to wait 10 to 12 months to be matched with a gestational carrier even with the reputed agencies.

Before the pandemic, intended parents would commonly be matched with a surrogate within three to four months. Nowadays, it could take eight months or even longer before agencies can find a suitable surrogate for hopeful parents. Typically there is usually an increase in surrogacy applications in the spring, but last spring, there was no such increase.

As the world reopens after the pandemic, the surge in the number of available surrogates experienced in the previous years disappeared. When the vaccines were rolled out, many surrogates started withdrawing their availability for the summer, spring, and even fall. Some of the reasons for this included going on vacations with their family and visiting friends and relatives they have not seen.

This poses a challenge because many surrogacy contracts often include a clause restricting surrogates from traveling for up to a year except for medical reasons. In addition, coronavirus vaccines are oftentimes mandatory, which can deter candidates.

Nowadays, there seems to be a fewer number of women who qualify to become surrogates. The New York Times reported that ten prominent surrogacy agencies in the United States saw a 60% reduction in prospective surrogates. The most likely reason is that gestational carriers face more possible health risks and legal restrictions due to the pandemic. For instance, being pregnant increases a woman’s risk of becoming critically ill or even demising from COVID-19.

Pregnancy is not always easy. There are some risks involved. And perhaps, the pandemic has changed the priorities of surrogate mothers a bit, making pregnancy too big a risk for them to take on.

Another possible reason for the reduction in the number of potential surrogates is that these women also have their own lives to live. Many of them may be burned out (and who isn’t?) as they strive to manage their families, daily jobs, and household obligations – the same factors that contributed to the sharp decline in the national birth rate during the coronavirus pandemic.

Given this situation, declining an otherwise qualified surrogate just because of the BMI restriction would lead to an even smaller number of healthy surrogates ready for the journey. As a result, many agencies are asking hopeful parents to be ready to wait 6 to 12 months or even longer before they can be matched with a surrogate.


Considering the current surrogate shortage, having to turn down potential candidates due to an elevated BMI is proving quite costly for agencies. However, with a structured and supportive weight loss program, these potential candidates could quickly meet acceptable BMI requirements and increase an agency’s candidate pool and thus, revenue.

BioIntelligent Wellness works with surrogates and surrogacy agencies across the country to do just this. Our dedicated Surrogate BMI Management program guides surrogates in losing weight and meeting the BMI requirements for program acceptance, matching, medical screening, and embryo transfers.

If you are an agency or a practitioner that is looking for a reliable way to help your surrogates become healthier, check out our Surrogate BMI Management program and set up a complimentary appointment. We are always open for collaboration.

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