Understanding the 20-Week Anatomy Scan in Surrogacy

The 20-week anatomy scan is a detailed ultrasound that provides a closer look at the baby’s development. Because your gestational surrogate is carrying the pregnancy, this appointment involves more coordination than a traditional pregnancy.

In this guide, we’ll explain what the 20-week anatomy scan checks for, how accurate it is and what happens if additional testing is recommended. We’ll also outline how American Surrogacy helps facilitate communication and next steps.

If you have questions about your surrogacy journey, fill out our form or call 1-800-875-BABY to speak with a surrogacy specialist.

What Is the 20-Week Anatomy Scan?

The 20-week anatomy scan — also called the mid-pregnancy or level 2 ultrasound — is a detailed checkup of the baby’s development. It usually takes place between 18 and 22 weeks of pregnancy.

During this ultrasound, the doctor carefully examines the baby’s growth and checks the placenta and amniotic fluid levels. This scan provides a much more complete picture than earlier ultrasounds.

American Surrogacy handles the logistics of the appointment so you can focus on the results. Our team makes sure you’re looped into the conversation and that the communication between you and your surrogate stays open and clear.

What Does the 20-Week Anatomy Scan Check For?

During the appointment, the sonographer uses high-resolution imaging to perform a head-to-toe assessment.

Here’s what the 20-week anatomy scan looks for:

Brain development
Facial structure
Heart chambers and rhythm
Spine alignment
Abdominal organs
Limb measurements
Placenta placement
Amniotic fluid levels
Cervical length

How Accurate Is the Anatomy Scan?

While anatomy scans can detect birth defects or structural abnormalities, they are not perfect. Accuracy depends on the baby’s position, the equipment’s quality, the technician’s experience, the surrogate’s body type and the specific condition.

Sometimes, a scan may raise a concern that turns out to be minor or resolves on its own. In other cases, a scan may appear normal, but a condition is discovered later in pregnancy or after birth. If anything unusual is detected, your doctor may recommend additional testing.

Is the Anatomy Scan Different in a Surrogacy Pregnancy?

Medically, the anatomy scan is the same as it would be in any other pregnancy. The difference in surrogacy is the coordination involved.

Because your surrogate is carrying the baby, plans for attending appointments and communicating results will be outlined in the surrogacy contract. What you can expect at the anatomy scan depends on what you agreed to during the legal phase. You might attend the appointment in person, join virtually or receive updates afterward.

Can Intended Parents Attend the Anatomy Ultrasound?

In many cases, yes. However, attendance depends on the provider’s policies and your surrogate’s comfort level.

For many intended parents, this is the appointment they’ve been waiting for. The anatomy scan offers one of the most detailed looks at your baby’s development. You may feel excited to see your baby and nervous about the results.

Many intended parents choose to travel for this appointment because it is an important milestone. If you can’t be there in person because of distance or clinic rules, we’ll work with the medical team to find other ways for you to participate.

This might include:

Joining via FaceTime or Zoom during the scan
Receiving a recording or digital images after the appointment
Scheduling a call with the medical team to review the results

When Do You Find Out the Baby’s Sex?

Some intended parents already know their baby’s sex. If you used preimplantation genetic testing (PGT-A) during in vitro fertilization, you can learn which embryos have XX or XY chromosomes before transfer.

If you did not use PGT-A, there are two common ways to learn the baby’s sex during pregnancy:

Non-Invasive Prenatal Test: This blood test can be performed as early as 10 weeks of pregnancy. It analyzes fetal DNA and can determine the baby’s sex.
20-Week Anatomy Scan: During the scan, the provider may be able to visually identify the baby’s sex, depending on the baby’s position.

If you prefer to keep the baby’s sex a surprise, let the sonographer know at the start of the appointment. They can complete the scan without revealing that information.

What Does a “Normal” Anatomy Scan Mean?

A “normal” anatomy scan means that the baby’s physical development appears on track for this stage of pregnancy. During the ultrasound, the provider evaluates the baby’s organs, body structure and measurements to confirm they align with expected ranges for the gestational age.

For many intended parents, this is reassuring news. It’s also a turning point when families begin to feel more confident planning ahead for their baby’s arrival.

After a normal scan, your gestational surrogate will continue with routine prenatal appointments and monitoring. American Surrogacy will make sure you receive updated information about the baby’s growth and overall health.

What Happens if Something Is Abnormal?

Hearing that something may be abnormal during the anatomy scan can feel overwhelming or frightening. If the sonographer identifies a “soft marker” or a potential structural concern, the next step is usually additional evaluation.

This may include a referral to a maternal-fetal medicine (MFM) specialist. MFM doctors specialize in high-risk pregnancies and advanced prenatal imaging.

They can perform more detailed scans, such as targeted ultrasounds or fetal echocardiograms, to better understand the finding and determine whether it requires further monitoring or treatment.

From there, you can review the findings and discuss next steps with your surrogate, the medical team and your surrogacy specialist. You’ll have space to talk through what the results mean for your family and decide how you want to move forward.

American Surrogacy will support you throughout the process. We can help coordinate appointments, provide guidance as you consider your options and connect you with counseling if needed. You won’t have to take the next step alone.

What Happens After the 20-Week Anatomy Scan in a Surrogacy Journey?

The 20-week scan marks an important transition from monitoring development to preparing for delivery. Around 24 weeks, the baby reaches what is often called the “viability threshold,” meaning there is a chance of survival if born prematurely.

During this stage, you will discuss:

Birth Planning: How you and the surrogate want the delivery experience to be handled
Hospital Coordination: Visiting the hospital and ensuring staff understand the surrogacy arrangement
Legal Steps: Completing a pre-birth order so your names are placed on the birth certificate when applicable
Insurance: Confirming coverage for the remainder of the pregnancy and delivery