Can You Be a Surrogate If You Have Endometriosis?
Endometriosis is usually talked about as a fertility problem, and a lot of women who have it assume surrogacy is off the table. In gestational surrogacy, the parts of fertility it tends to affect aren't the parts you're being asked to use. Here's what clinics actually look at.
Often, yes: endometriosis by itself doesn't automatically rule you out, because in gestational surrogacy the embryo comes from the intended parents or a donor, so your eggs and fallopian tubes aren't part of the pregnancy. What decides it is how the condition affects you now, any surgery you've had, the medications you take, the health of your uterus, and whether you've already carried at least one term, uncomplicated pregnancy.
Endometriosis is common. The World Health Organization estimates that it affects about 10 percent of women of reproductive age worldwide, roughly 190 million people. It happens when tissue similar to the lining of the uterus grows outside it, most often in the pelvis, and it can cause painful periods, chronic pelvic pain and heavy bleeding. Many women are diagnosed while trying to get pregnant, and the WHO notes that as many as 25 to 50 percent of women with infertility have endometriosis.
So it makes sense that you'd assume it disqualifies you. In most cases, it's more nuanced than that.
Why the usual fertility worry matters less
Endometriosis often makes it harder to conceive because of what it does around the ovaries and fallopian tubes: scarring, inflammation, cysts and blocked tubes can all get in the way of an egg meeting sperm. A gestational surrogate doesn't need to conceive. The embryo is created by IVF from the intended parents' or a donor's eggs and sperm, and the clinic transfers it directly into your uterus. Your egg quality and your tubes aren't part of that.
What does matter is the place the embryo implants and grows, and how your body has handled pregnancy before. That's where the clinic's attention goes.
What clinics look at instead
- Your uterus. ASRM, the American Society for Reproductive Medicine, highly recommends that every carrier candidate have a uterine cavity evaluation, often by saline sonogram. For you, the clinic will also be looking for anything endometriosis-related that affects the uterus itself.
- Adenomyosis. This is a related condition where similar tissue grows into the muscular wall of the uterus. Because it affects the uterus directly, clinics usually look at it more closely, and it's a case-by-case medical decision.
- Surgery. Many women with endometriosis have had laparoscopy to diagnose or remove it. The clinic will want the operative report, especially if any surgery involved the uterus. A hysterectomy, of course, means you can't carry a pregnancy.
- Medications. Endometriosis is often managed with hormonal treatments such as birth control, progestins or other hormone-suppressing medications, plus pain relief. Clinics review everything you take, and ongoing use of strong prescription pain medication gets a closer look. Hormonal treatments typically have to be paused or adjusted before a transfer, under your doctor's direction. Never stop or change a medication on your own.
- Your past pregnancies. ASRM says that, ideally, a carrier should have had at least one term, uncomplicated pregnancy. If you've carried a healthy pregnancy with endometriosis already, that's strong evidence for the clinic.
- How you're doing now. Pain that's well controlled is a different picture from symptoms that disrupt your daily life, since a surrogacy journey takes time, travel and appointments.
Does endometriosis affect the pregnancy itself?
Research suggests it can. A systematic review pooling 28 studies found that women with endometriosis had higher rates of placenta previa (where the placenta covers the cervix), miscarriage, high blood pressure in pregnancy, preeclampsia and cesarean delivery. Many women with endometriosis still have healthy pregnancies, but this is part of why clinics look closely at your past pregnancies rather than at the diagnosis alone, and why your prior delivery records matter so much.
When and how you were diagnosed, any operative or pathology reports from surgery, recent pelvic imaging if you have it, a list of every medication you take for endometriosis or pain, and the records from your prior pregnancies and deliveries. Having those together makes the clinic's review faster and gives you a clearer answer.
One honest note about your own future
If endometriosis made it hard to have the children you have, and you might want more, think about that before you apply. Any pregnancy carries risks, including complications that could affect your own future fertility, and endometriosis can make your own future pregnancies harder to achieve. ASRM's guidance asks that carriers be counseled about the potential loss of their own fertility and about whether they want more children of their own. That isn't meant to talk you out of anything. It's meant to make sure that if you say yes, you say it knowing what you might be trading.
What we'll ask you
On a screening call, we'll ask when you were diagnosed, whether you've had surgery, what you take for it now, how your symptoms are day to day and how your pregnancies went. There are no wrong answers. If your history points toward programs that are comfortable reviewing endometriosis, we'll connect you there rather than leave you guessing, and the final medical decision always belongs to the clinic's doctor after reviewing your records.
The bottom line
Endometriosis is one part of your health history, not a verdict. If your uterus looks healthy, your symptoms are managed, and you've carried a term, uncomplicated pregnancy before, there's a real chance you can carry for someone else. A clinic's review of your records is what turns that chance into an answer.
Common questions
Does endometriosis affect embryo transfer for a surrogate?
It may not, since your own eggs and fallopian tubes aren't used when the embryo comes from the intended parents or a donor. The clinic still checks your uterus, medications and past pregnancies, because those affect implantation and the pregnancy.
Can you be a surrogate if you've had endometriosis surgery?
Often, yes. The clinic will want your operative report and will look more closely at any surgery that involved the uterus, and a hysterectomy means you can't carry a pregnancy.
Can you be a surrogate with adenomyosis?
Adenomyosis affects the muscular wall of the uterus itself, so clinics usually review it more closely, using imaging and your pregnancy history. It's a case-by-case medical decision rather than a blanket yes or no.
Do you have to stop endometriosis medication to be a surrogate?
Hormonal treatments for endometriosis typically have to be paused or adjusted before a transfer, but that's a decision for your doctors. Never stop or change a medication on your own.
See how the rest of it looks.
Our questionnaire takes about 10 minutes and covers your health and pregnancy history, with a plain explanation of where you stand.
See if you qualify →