How Does Surrogacy Work? The 7-Step Journey

Whether you’re looking to become a surrogate and carry a baby for someone else, or you are an intended parent looking for a surrogate yourself, this guide will walk you through the most important steps to take when considering surrogacy. 

For many prospective parents, surrogacy is the only option to have and raise a child of their own. For prospective surrogates and parents who are considering the gestational surrogacy process, having the right information is crucial in deciding when to consider surrogacy. In this blog, we will explain the process of gestational surrogacy for surrogates and prospective parents.

How Does Surrogacy Work?

What Does a Surrogate Do?

A surrogate is a woman who carries a baby for someone else. There are various reasons that people are unable to carry a child of their own. Surrogates offer to carry a child for someone else for different reasons; they usually enjoy pregnancy and delivery and are finished growing their own families.

They are generally very altruistic in their intentions, and, most of all, they want to help other people experience the joys of parenthood. Surrogates tend to have loved ones who have struggled with infertility, and they simply want to help. Also, the financial compensation that surrogates receive allows them to help their own families.

What does a surrogate do during the full surrogacy journey?

From start to finish, a surrogate:

• has an informative phone call with a surrogacy agency to learn about the basic requirements, surrogate process, and how being a surrogate works
• completes application materials, authorizes release of medical records, and obtains doctor’s clearance form
• evaluates health insurance to determine their suitability of coverage
• completes a psychological evaluation
• matches with intended parents
• completes contracts
• completes medical screening at the fertility clinic and learns how the medical process for surrogacy works
• begins IVF surrogacy medications to prepare for the surrogate embryo transfer.
• completes the embryo transfer procedure
• continues prenatal care with surrogate’s chosen OB/GYN or Midwife
• gives birth at surrogate’s chosen hospital or birthing center
• completes the legal steps to establish the parents’ parentage over the child, which will either occur before or shortly after the birth

How Does a Surrogate Get Pregnant?

The process of becoming pregnant involves a series of monitoring appointments, medications, and a non-invasive procedure where the embryo is transferred from a small catheter into a surrogate’s uterus.

IVF Surrogacy: In Vitro Fertilization And Surrogacy

IVF involves creating embryos at the fertility clinic and transferring them into a surrogate’s uterus.   

Embryos are created by fertilizing a prospective parent’s egg with a prospective parent’s sperm. The embryos grow for 2-6 days in the lab and are typically frozen and then thawed for future transfer when the time comes.  

Surrogates usually begin preparing for the embryo transfer process by taking medications to thicken their uterine lining and prepare their body for embryo transfer.  The embryo transferred into the gestational surrogate’s uterus through a small catheter that passes through the opening in the cervix. This is one of the most anticipated milestones during the surrogacy journey. 

After the embryo transfer, the surrogate and intended parents endure what is referred to as the dreaded “two-week wait,” during which they have 10-12 days to wait for pregnancy testing and, hopefully, a positive result.

Explore more about what surrogacy is and how the types of vary for both surrogates and intended parents. 

The 7 Step Surrogacy Process

At IARC, we’ve outlined a 7-step process for the surrogacy journey. This starts with initial research to discern if surrogacy is the right choice for both surrogates and parents and ends with the intended parents receiving their child.

1. Research and decide if surrogacy is right for you
2. Complete the initial screening process
3. Prepare to find a match and discuss legal requirements
4. Complete medical screening at a fertility clinic
5. Complete the fertilization and embryo transfer process
6. Have a successful pregnancy
7. Delivery and completion of the post-birth procedure

1. Research and Decide if Surrogacy is Right For You

It is important for every surrogate to carefully consider whether surrogacy is the right journey. Read the pros and cons of surrogacy. Some key factors to consider:

• Having a solid support system is important, although surrogates do not need to be married or in a relationship

• There is a higher level of commitment; there are more appointments involved in a surrogate pregnancy than for a “typical” pregnancy, which may require absences from work or school.

• Surrogates should be willing to involve their intended parents in the prenatal care decisions that involve their unborn child. This means that intended parents might request to make decisions for their unborn child that the surrogate might not have chosen for her own unborn child.

• Surrogates are encouraged to be content with the size of their own family before becoming a surrogate. Every pregnancy and delivery carries risks of experiencing complications that could prevent a surrogate from carrying another pregnancy.

• Surrogates should be financially independent and able to commit to the process without relying on compensation for daily living expenses.

• This process can sometimes take a couple of years from start to finish. Some future plans might be impacted by the timeline such as a move out of state, going on a big vacation, going back to school, etc.

Prospective Parents: As a prospective parent, you might be wondering, “how does having a baby via surrogate work?” You will need to choose a fertility clinic to have your embryos created, and this can happen before or after you begin working with the agency. Prospective parents will need to consider the expectations they have for the surrogacy journey.

• What kind of relationship do you expect to have with the surrogate during the journey and after your child is born?
• What kind of choices do you expect to make during the pregnancy regarding the medical care the surrogate and your unborn baby receives?
• What would you decide to do in the unfortunate event that the pregnancy resulted in a significantly abnormal fetus?
• What kind of lifestyle might you want a surrogate to have during the pregnancy?

It’s important that Prospective Parents and Surrogates who match together share the same expectations for the surrogacy journey, and your agency should help to facilitate these conversations.

Prospective Surrogates: As a prospective surrogate, you may be wondering, “how does the process of surrogacy work?” When you are considering becoming a surrogate, you will find yourself needing to consider your support system and how this process would impact your family.

For prospective surrogates who are in a committed relationship, what will your partner’s expectations be during the surrogacy process, and will they feel comfortable supporting your decision to pursue becoming a surrogate?

You will need to consider what kind of expectations you will have during the pregnancy and after the baby is born.

• Will you expect to have a relationship with the intended parents during the pregnancy and with the family after the baby is born?
• Are you able to make time in your schedule to include the intended parents in the important medical appointments and various milestones during the pregnancy?
• Are you content with the size of your own family?
• What expectations do you have for the choices you would make during the pregnancy?
• Are you willing to consider the intended parents’ choices during the pregnancy when it involves their unborn child?

Use our guide to learn everything you need to know about how to become a surrogate.

When to Consider Surrogacy

As a prospective parent, you may have considered various options to have a child of your own, and surrogacy is one of them (possibly the only one). Most prospective parents do not have the capability of carrying a pregnancy of their own, or if they do, it will put them at a much higher and unreasonable risk for experiencing complications to their own health or the health of their unborn child.

Maybe you are an intended father who is single and you have always wanted to be a father. Maybe you are a same-sex male couple who want to have children together, and you are ready to embark on the journey by finding a surrogate to carry your child(ren). Maybe you are already a parent, and you experienced complications that lead to not being able to have any more children without the help of a surrogate. 

As a prospective surrogate, you may have really enjoyed pregnancy and want to continue to enjoy the experience, although you do not wish to have any more children of your own. You may have friends or family members who have experienced infertility, and it has impacted your decision to look into helping others.

Surrogates’ medical records are reviewed to ensure they would not be putting themselves or an unborn child at unreasonable risk of complications during a surrogate pregnancy. 

Surrogates benefit from the much-deserved compensation they receive for the service they provide. It’s an opportunity to put money towards a vacation, house projects, college tuition for themselves or their children, etc. Although surrogates receive compensation for their time and effort throughout their surrogacy journey, they must already be financially independent to fit the criteria to become a surrogate.   

2. Choose an Agency and Complete the Initial Screening Process

A full-service agency will have a very hands-on approach to handling all aspects of your surrogate program from start to finish. During the screening process, the agency will rely on the medical and psychological professionals’ expertise to determine a surrogate candidate’s fitness for the journey.

Once a surrogate is a qualified candidate, she will begin the matching process. 

Matching is a two-way street as surrogates, and intended parents will enter the matching process based on their own criteria and expectations. Agencies want both parties to be compatible to ensure a successful journey. To do this, the agency looks into details of the surrogate’s and intended parents’ lives to see that expectations are aligned.

Prospective Parents: Prospective parents will want to know that an agency can advocate for them and communicate effectively with their fertility clinic and their surrogate. An experienced agency will take the time to consider prospective parents’ expectations and what kind of surrogate will help them succeed in building their family.

Prospective Surrogates: Surrogates should be able to learn about an agency and its process before choosing to work with them. It’s important for the surrogate to know what kind of expectations she can have and what expectations the agency and intended parents will have of her.

Matching is an important step in the process for a successful journey. An experienced agency will know what to consider when matching prospective parents with surrogates and how to help them have the experience they’ve been looking forward to.

The Difference Between a Surrogacy Agency and Surrogacy Attorney

A surrogacy agency works with surrogates and intended parents to prepare them for the surrogacy journey and continue this work to the end. An agency will:

• Screen surrogate candidates before they move on to matching with intended parents
• Help surrogates and intended parents match with each other based on each other’s expectations of the process
• Be hands-on throughout the surrogacy journey after matching
• Assist with completion of the contract phase with the parties’ respective attorneys
• Facilitate payment for all surrogate-related expenses and compensation
• Arrange travel accommodations for the surrogate’s medical screening and embryo transfer procedure
• Arrange surrogate’s monitoring appointments
• Support the surrogate and intended parents throughout the pregnancy, delivery, and legal process

A surrogacy attorney’s role is more limited. The attorneys draft and review the contract between the parties, and the surrogate and intended parent should each have a separate attorney for this step to ensure each of their best interests are considered.  The attorney will then become involved again to establish the intended parents’ parentage of the child prior to or immediately after the birth.

3. Prepare to Find a Match and Discuss Legal Requirements

The steps to a successful surrogacy journey include some critical decisions for both the surrogate and intended parent(s).

For Surrogates, those decisions include, but are not limited to:

• What kind of surrogate, traditional or gestational?
• Compensation amount

• Agency or attorney: an agency to help guide her entire surrogacy journey (including connecting with legal representation), or an attorney for legal representation only?
• Transfer one embryo or two embryos?
• The kind of relationship between surrogate and prospective parents
• The decisions prospective parents can expect to make for their unborn child during the pregnancy

Not all states or countries are uniform in their laws regarding surrogacy. Some U.S. states specifically permit surrogacy through laws that determine how and when the prospective parents will be granted permanent custody of their child. A few states prohibit surrogacy, and many states have no surrogacy laws, in which case parentage is established using the state’s existing parentage laws. Depending on the state law, surrogates’ and intended parents’ ability to proceed together as a match will sometimes depend on the marital status or sexual orientation of the prospective parents.

For Prospective Parents:

• What kind of surrogacy; traditional or gestational?
• Will they need an egg or sperm donor?
• What fertility clinic to use
• Will they transfer 1 or 2 embryos?

• What would they choose to do in the event physiological abnormalities are detected during pregnancy?

• What kind of relationship do they expect to have with their surrogate during and after the journey?

Prospective Parents: As Prospective parents, you will have important decisions to make when deciding on a fertility clinic, surrogate, and your goal for the outcome of the surrogate journey. An agency can provide guidance and support.

Prospective Surrogates: As a surrogate, considering the decisions you have to make can seem daunting. Doing the research and understanding your options is just as crucial as every other part of the process and should be made much easier when working with an agency.

4. Complete Medical Screening at a Fertility Clinic

The medical screening typically involves a blood draw to complete lab testing and a uterine cavity assessment that involves visualizing the uterus (via ultrasound or scope) to ensure that the uterus is optimal for a successful embryo transfer.

During the medical screening appointment, the Reproductive Endocrinologist will explain the embryo transfer procedure and the required medications. After the medical screening is completed, the fertility clinic will set a date for the embryo transfer.

These steps are ultimately determined by the intended parent’s fertility clinic.

Prospective Parents: Prospective parents will complete medical screening of their own to ensure that they do not carry any infectious diseases and to begin the process of preparing for the egg retrieval and/or sperm sample donation. Sometimes, prospective parents carry a trait or antibody that requires them to match with a surrogate who does or does not have that same trait or antibody. 

These recommendations are ultimately determined by the intended parent’s fertility clinic.

Prospective Surrogates: The medical screening appointment is usually a one-day trip for the surrogate at the Intended Parents clinic. If a surrogate has an IUD for contraception or another implanted contraceptive device, this would need to be removed prior to the medical screening. Surrogates might need to consider changing to another approved birth control measure. 

5. Complete the Fertilization and Embryo Transfer Process

The medications a surrogate will take will depend on the fertility clinic’s protocol. Generally, surrogates who have a medicated cycle can expect to take estrogen and progesterone as part of the protocol to promote and support the pregnancy.

When surrogates begin taking medications, they will also begin appointments to monitor their body’s response. The medication will depend on the fertility clinic’s medication protocol and can involve intramuscular injections, oral medications, or vaginal suppositories.

During the embryo transfer procedure, the Reproductive Endocrinologist transfers the embryo through a very thin catheter that goes through the opening of the cervix.

Prospective Parents: Prospective parents are usually eagerly awaiting the embryo transfer and results at this point. Depending on the relationship you have with your surrogate and your ability to travel, you might attend the transfer in person or witness the transfer virtually if possible.

You also need to have already had the conversation with your surrogate about whether or not you want to know any results from home pregnancy tests that she might take before the official pregnancy test that your fertility clinic will order.

Prospective Surrogates: When preparing for embryo transfer, surrogates want their bodies to cooperate, so they often have positive thoughts about the ultimate goal, which makes this step one of the most real and exciting experiences. Waiting for the official pregnancy test results can feel like an eternity, even though it’s only about 12-14 days.

6. Have a Successful Pregnancy

Once an ultrasound is performed to confirm a viable pregnancy, the surrogate will begin seeing her OB/Midwife who will then take over the prenatal care and delivery.  

Aside from the elective and non-invasive prenatal screening the prospective parents may request, prenatal care should be much like any other pregnancy. Beginning shortly after heartbeat confirmation, the compensation schedule for the surrogate’s gestational fee will begin.

The base compensation (or gestational carrier fee) that a surrogate chooses for herself will be disbursed to her throughout the surrogacy and will be pro-rated in the event of a late-term miscarriage or stillbirth. Reimbursement for actual expenses, which typically include lost wages, medical expenses, maternity clothing allowance, etc., will be reimbursed as incurred throughout pregnancy as well.

Prospective Parents: As Prospective Parents, you can typically rely on the agency to share the details of the medical appointments during the pregnancy so intended parents can be aware of everything and know what choices are available (i.e., first and second-trimester screening, etc.). 

Prospective Surrogates: As a surrogate, you may rely on your agency to share the medical details of each prenatal appointment with your prospective parents. You’ll see your OB/Midwife for your prenatal care and the delivery and include your prospective parents in the pregnancy and delivery plans so everyone can work as a team.

7. Delivery and Completion of the Post-Birth Procedure

Surrogates deliver the baby at their own hospital. The decision to have prospective parents in the delivery room will have already been made by the surrogate and prospective parents. When the baby is born, the prospective parents will typically have their own room with the baby, while the surrogate has her room to herself to rest and recover.

Surrogates and prospective parents will have already discussed whether or not the surrogate will pump breast milk for the baby. Prior to or shortly after the birth, a legal process will occur to formalize the parents’ parentage over the child. Surrogates can expect to receive the remainder of their gestational carrier fee shortly after birth.

Surrogates who are employed may need to take some time off of work to recover. Prospective parents are responsible for reimbursing lost wages according to the original contract, so a surrogate can expect to continue receiving her lost-wage reimbursement up to a point agreed upon in the contract.

Prospective Parents: Prospective parents typically arrive and stay in an area close to their surrogate within 1-2 weeks of delivery and travel home with their baby soon after the birth.

Prospective Surrogates: Surrogates will already have an idea of what to expect during labor and delivery because they’ve experienced it before. As with anything else, unexpected things can happen, and you will have been asked during the matching process who you would prefer to have as your support person in the room during labor and delivery.

Get Started With the IARC Surrogacy Process

Surrogacy is an option for prospective parents to have a child of their own and for prospective surrogates to help another family achieve that dream. There is a high demand for surrogates. If you are interested in learning about the process and to see if you qualify, complete our brief questionnaire. If you meet the basic surrogate requirements, we will reach out to and connect you with a Surrogate Coordinator to begin the surrogacy process.