How Does Surrogacy Work? Eight Steps to the Surrogacy Journey

From the beginning to the end, here are the eight steps you need to follow to have a successful surrogacy journey


Surrogacy is, with no doubt, one of the most strenuous and complex fertility treatment processes, but it can also be one of the most exciting and fulfilling for all parties involved.

Your approach, expectations and personal circumstances will make this journey unique, however, a great first step is seeking advice and guidance from one or more surrogacy professionals.

While all surrogacy journeys are unique in their own way, they will all follow the 8 steps listed below.

steps to the surrogacy

Step 1: Decide If Surrogacy Right for You

The first thing and most important thing to do is to determine if surrogacy is the right option for you. How do you decide?

Start with learning the basics about this reproductive technique. Along with reading up on the medical and legal phases of the surrogacy process, you should consider what it will demand of you from an emotional, legal, medical, and economic perspective.

In addition, women wanting to become a Surrogate mother need to keep in mind that all IVF clinics have certain requirements that need to be met in order for them to qualify. These requirements may vary depending on the fertility clinic, the most common ones are:

  • being of legal age
  • being in good health
  • having had at least one full term and healthy pregnancy
  • being a non-smoker
  • residing in a surrogacy-friendly location

Step 2: Create Your Surrogacy Plan

Once you have decided to start your journey, you should think about what your expectations are, list your preferences, and secure the necessary surrogacy experts. The goal is to draft a plan of what you want your journey to look like.

The first thing to do when creating the plan is to decide whether you want to proceed with a traditional surrogacy (also called straight, partial or IVF surrogacy) or a gestational surrogacy (also called host or full surrogacy). The main difference between these two forms of surrogacy is whether the Surrogate’s eggs are used.

In gestational surrogacy, the gestational Surrogate (also known as gestational carrier) will become pregnant after receiving an embryo created through IVF. The Surrogate’s eggs are not used in the IVF process, so the baby is not genetically tied to her. In other words, the gestational carrier’s role is limited to gestation and childbirth.

The next decision concerns the surrogacy professionals you want to work with. Basically, do you want an indie process or do you want to work with a surrogacy agency? The support that an agency can offer is very comforting for prospective parents and Surrogates, especially if it is their first journey. As with the first step, education is important. Research the costs and services that the agency provides and contact references.

Whether you choose to use an agency to handle the complexities or go the independent route, a surrogacy attorney is a must for all the legalities and paperwork inherent to the process.

It’s crucial not to rush through this second step. You have to have a clear definition of your objectives and preferences before moving to the next phase.

Step 3: Find Your Match

Finding the right match can be one of the most challenging steps of the journey but also be very exciting. Don’t be surprised if a lot of conflicting emotions emerge during the search. Remember to stay calm and to be patient. (Certainly not this easiest thing to do in this situation but it is, nevertheless, necessary.)

Finding Surrogate or intended parents can take weeks and months or it could take a matter of days. If you are choosing to go the independent route to surrogacy, then your options of finding a match are the online communities: Facebook, classifieds, or recommendations from relatives and friends.

On the other, if you choose to work with an experienced surrogacy agency, you will probably match faster because you will be able to take full advantage of the agency’s pre-established networks.

Regardless of the path you choose, remember that you must already know what you are looking for in a Surrogate mother or prospective parents – religion, education, location, or marital status, amount of contact, etc. – before you start your search.

Having access to all this information will help you choose the right person.

how much surrogate get paid

Step 4: Go Through the Screening Process

Once you choose your match, both parties must undergo a psychological evaluation (performed by a licensed therapist) and medical screening to verify that both, the prospective parents, and the Surrogate mother, are in a healthy place mentally and physically.

There will also be a medical screening that will include bloodwork and a physical exam. This will be performed by the medical staff at the IVF clinic.

Typically, the IVF clinic will be chosen by the prospective parents. If you’re working with a surrogacy agency, they can recommend some reputable IVF clinics as well as therapists who specialize in third party reproduction. However, it’s perfectly acceptable for you to choose your own fertility clinic and/or therapist. Before you choose your medical specialists you must do your own research. The goal here is to learn about their success rates, procedures, and fees. You may also want to look for referrals.

These exams, medical and psychological, are mandatory. They are there to reduce the possibility of complications during the journey and help increase the odds of having a healthy full-term pregnancy.

Step 5: Create and Sign a Surrogacy Contract

From a legal standpoint, surrogacy regulations can be complex and confusing, especially because laws vary from country to country and even from state to state. For example:

  • In the US, there are no federal laws that govern the legal process of surrogacy. Each state has its own regulations, which seem to be geared toward commercial surrogacy.
  • Similarly, all surrogacy arrangements in Australia are regulated by the states.
  • Canada has a federal law that only allows for altruistic surrogacy. However, each province and territory has its own laws regarding the birth registration process.
  • In the UK, surrogacy must be altruistic, but surrogacy agreements are not enforceable by law.
  • Finally, in Ukraine, surrogacy is enforceable under federal legislation, but is limited to heterosexual couples.

As you can see, the legal aspects of the process can be quite confusing. Because these laws vary from country to country (and even region to region within the same country) it is important to have the guidance of an experienced lawyer who is acquainted with surrogacy laws specific to the region in which the process is taking place. This guidance will help you avoid potential missteps.

A surrogacy agreement is meant to guarantee that both parties—the prospective parents and the Surrogate—are informed of their rights and obligations. Your lawyer will oversee the process, and answer any questions you might have. This step also defines compensation as well as actions to be taken in case of emergencies or unexpected events.

During this process, all parties should have individual representation to ensure that their legal rights and interests are protected.

For prospective parents pursuing a surrogacy process abroad, professionals recommend seeking legal advice in, both, their home country and abroad, to ensure that they meet all the legal requirements necessary to register the birth of the child.

Step 6: Undergo the Surrogacy Medical Process

Once the medical and psychological screenings are completed and all the legal paperwork is signed, the surrogacy medical protocol will proceed. Most fertility clinics require a legal agreement to be in place before the medical proceedings continue. Below you will find a break down of the five stages of the gestational surrogacy medical process.

  1. Create the Embryos. IVF is probably the most common fertility procedure used in gestational surrogacy to create the embryos. Sometimes an egg donor or sperm donor is needed to create the embryos.
  2. Prepare for the Embryo Transfer. Depending on the Surrogate and the IVF physician, the Surrogate will take medicine to prepare her body. This usually occurs three or four weeks prior to the transfer.
  3. Transfer the Embryo. When the time is right, the embryos are transferred to the Surrogate’s uterus. Depending on the country in which you are pursuing your process, there are legal limitations regarding the number of embryos you can transfer. For example, in the UK, no more than embryos two should be transferred. However, in the United States, the number depends on the age and quality of the embryos. You can find more info about the maximum number of embryos that can be transferred (by country) here.
  4. Confirm the Pregnancy. Ten days after the transfer, the IVF doctor will test for pregnancy hormone levels. Once pregnancy is confirmed, an ultrasound is performed six weeks later to confirm a heartbeat.
  5. Provide Prenatal Care. Like any other pregnancy, the Surrogate will receive hormones throughout her first trimester as well as prenatal care throughout the pregnancy, right up to delivery. If agreed by both parties, prospective parents may be a part of the whole process whether it’s taking part in the doctor/ultrasound appointments or supporting the Surrogate.

If you are considering traditional surrogacy, the process of getting pregnant will be different. It typically implies the artificial insemination of a traditional Surrogate with the intended father’s sperm (or donor sperm) via intrauterine insemination (IUI),

pros and cons of IVF and IUI

Step 7: Prepare for Delivery

As long as there are no complications, the delivery will take place at the agreed-upon hospital or birthing center. Most times, the prospective parents will be part of the delivery.

The Surrogate and prospective parents will discuss and agree upon the details of the birth plan during the legal agreement phase so that everyone is on the same page when the time for delivery arrives.

Step 8: Post-Birth

After the birth, a surrogacy lawyer will assist with the legal paperwork (DNA requirements, Declaration of Parentage, Birth Order, etc.). Once the intended parents have completed said paperwork, they will return home.

A common question is: What happens after surrogacy birth?

While there is no established set of rules surrounding communication between the Surrogate and IPs after the birth, this is typically discussed during the matching phase.

In some cases, Surrogates choose not to keep the line of communication open after the birth of the child, while in others, they will continue the relationship, sharing updates and photos of their families. Some Surrogates might even repeat the process again to provide a sibling for the child they previously gave birth to.

Final Thoughts

Whether you are a prospective gestational carrier, traditional Surrogate, or hopeful parents, keep in mind that, in the best case, the journey will take at least a year. Therefore, it is vital that you learn how surrogacy works and be as prepared as you can be.

Don’t forget that there are a great number of professionals who specialize in surrogacy. If you have any questions or require more information, be sure to contact them. They will take you through the entire process and assist you in making the best decisions.

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