7-Step Guide to Surrogacy Process

Surrogacy is a unique and overwhelming experience that pushes away all ongoing fertility struggles and changes the lives of all parties involved forever. At the end of the journey, the intended parents will come back home holding their beautiful Miracle and will announce having a new addition. The surrogate mother will return back to her home feeling inspired and satisfied for making someone’s dream come true and giving the Great Gift of Life.

There are many reasons why parents–to–be opt for surrogacy, including fertility issues, a history of failed IVF cycles, pregnancy losses, or being in a same–sex relationship. But whatever their reasons and circumstances are — surrogacy is an amazing experience of growing families — unlike any other. It involves the intended parent or parents, a surrogate mother, a surrogacy agency or lawyer, and a fertility clinic — and all parties are united for creating the new life. And although the surrogacy process may sound complicated and you don’t have an idea where to start, here are seven steps every surrogacy journey “follows”. Let’s get a closer look at each step.

Step 1: Deciding If Surrogacy Is Right for You.

The first step the prospective intended parents and prospective surrogate mothers take in any surrogacy process is to consider if surrogacy is right for them. Becoming a parent or a surrogate mother through surrogacy can be a long, overwhelming, emotional, and legally complicated journey. That is why, just like taking any serious decision, the singles and couples opting for surrogacy should explore current surrogacy laws, and nuances of the process, understand the pros and cons, learn all about the possible risks, talk to lawyers experienced in the surrogacy field and surrogacy professionals to understand if surrogacy is right for them.

For Prospective Intended Mothers and Fathers: There are many reasons to consider expanding your family through surrogacy, whether you are a couple who has struggled with infertility and having a history of many failed rounds of IVF, surgeries, miscarriages, ectopic pregnancies, or fetal death, a member of the LGBTQIA+ community or are looking to expand your family as a single parent.

Before you begin the surrogacy process, it is essential to consider the benefits and risks of surrogacy and ensure that you are ready to fully commit to the process. Intended parents opting for surrogacy should ensure that they have the resources to commit to surrogacy.

If you are struggling with the decision to have a baby through surrogacy or need additional information before taking the first step, consider talking to a lawyer or surrogacy specialist before proceeding with the surrogacy process.

For Prospective Surrogates: Becoming a surrogate mother is a powerful and life–changing decision that can be inspiring and fulfilling, but it is not without its challenges. Surrogacy requires your commitment to another person or couple for a year or more as you undergo comprehensive medical and psychological screenings and procedures, endure all of the challenges related to pregnancy and labor, and carry a baby that isn’t your own and you have to transfer this small Miracle to the intended parents. In some cases, surrogacy may also involve traveling abroad for fertility assessment, embryo transfer and delivery, or relocating to another city for a while when undergoing screening and medical procedures and two weeks before the estimated due date.

If this describes you, you are thrilled by the thought of creating the little Miracle and bringing this bundle of joy to this world, you enjoy being pregnant and would like to experience pregnancy again, you are a compassionate and cordial person, and you are ready to undergo embryo transfer and share your pregnancy journey with aspiring single or the couple, then, being a surrogate mother is your perfect role.

While growing a baby for another person or couple, you will enjoy a variety of services throughout the process, including top–notch healthcare services and counseling, base compensation (in case of commercial surrogacy), monthly allowances, and can create meaningful relationships between you and your intended parents.

If you are unsure about surrogacy or need more information before deciding, consider consulting with a surrogacy agency representative or lawyer to learn more if being a surrogate mother is right for you and whether you are ready to start the process.

Step 2: Preparing for the Surrogacy Journey

As soon as prospective intended parents or prospective surrogate mother has decided to commit to surrogacy, they should outline their goals and needs, what type of surrogacy they prefer, and what type of surrogacy professional they would like to work with.

Traditional vs. Gestational Surrogacy

First, there are two types of surrogacy to consider:

Traditional surrogacy — is less common and more legally complicated compared to gestational surrogacy, where the surrogate mother has a genetic connection to the baby she carries as the surrogate mother’s egg is fertilized using the intended father’s or donor’s sperm using intrauterine insemination or IVF (in vitro fertilization).

Gestational surrogacy — is more common and less legally complicated than traditional surrogacy, where the surrogate mother doesn’t have a genetic link to the baby she carries. The embryo is created using an intended mother’s or the donor’s egg and sperm from the intended father or a donor using in vitro fertilization (IVF). Once the egg is fertilized in the IVF lab and the embryo reaches Day 3 or Day 5, it is transferred to the surrogate mother.

Altruistic vs. Compensated Surrogacy

Secondly, there are two surrogacy arrangements: commercial surrogacy, with base compensation paid to the surrogate mother for providing surrogacy services, and altruistic surrogacy, with only reimbursement for medical costs and other pregnancy–related expenses without compensating the surrogate mother’s baby–carrying services.

Altruistic surrogacy refers to any arrangement where a surrogate mother volunteers to carry a pregnancy for the intended parents without receiving any monetary compensation for her services in return beyond reimbursement of medical expenses.

The alternative to altruistic surrogacy is commercial surrogacy, in which a surrogate mother is compensated for her services beyond reimbursement of medical expenses.

Agency vs. Independent Surrogacy

Thirdly, two types of surrogacy professionals can complete your surrogacy process:

Surrogacy Agency — may provide any or all surrogacy services (full–service surrogacy agency), including matching with intended parents, screening, multilingual support, case management, pregnancy care, counseling, legal and more. Working with a surrogacy agency makes the surrogacy process simpler and more secure, as surrogacy professionals provide almost every service needed to complete a surrogacy.

Surrogacy Lawyer — required in any surrogacy process to complete the legal work (consulting on parental and surrogacy rights and responsibilities, drafting and reviewing the surrogacy agreement, notarizing the surrogacy contract, and confirming legal parentage in a court of law for cases when it is necessary), but doesn’t provide the other services. Starting an independent surrogacy (surrogacy arrangement where the intended parents hire a surrogate mother) and working with a surrogacy lawyer involves self–management of the surrogacy process and coordination of services between their lawyer and fertility clinic by the intended parents and the surrogate mother.

Intended parents and surrogate mothers should consider these and many other factors when planning and preparing for surrogacy.

Surrogacy Tips for Prospective Intended Parents:

While preparing for the surrogacy process, you should craft the blueprint of your surrogacy journey, including:

The type of surrogacy (gestational or traditional)
Surrogacy budget (+ finances for covering extras and add–ons like Multiples fee, C–Section, neonatal care, NICU, etc.)
Surrogacy destinations (countries where commercial surrogacy is legal or countries where altruistic surrogacy is legal)
Are these destinations open for international gestational or/and traditional surrogacy?
If starting the surrogacy process abroad, how many days can you spend during your first and follow–up visits?
Will you work with a surrogacy agency or hire a surrogate mother independently?
Do you need legal assistance?
Does your insurance cover counseling, fertility assessment, lab tests, medication, egg retrieval, fertilization, or other IVF and surrogacy–related expenses?
Do you know a surrogate mother, or will you need matching services?
Do you need the donor’s eggs or sperm? If you need egg or sperm donation, consult on the procedure (as there are different egg donation options), donor criteria, and legal implications.
Do you need preimplantation genetic testing or/and gender selection? For sex selection for family balancing, make sure it is legal in the country where you plan to complete the surrogacy process.
Is it possible to import and export sperm, eggs, and embryos for starting the surrogacy process and after surrogacy?

If you are embarking on an independent surrogacy journey (without agency), you may add more questions to your blueprint:

Do you have the list of fertility clinics that provide IVF services and transfer the embryos to surrogate mothers?
Do you know the details of the procedure, number of visits, location of the clinic for procedure and follow–up visits, costs associated with the procedure, and insurance coverage?
Have you scheduled online consultations with clinics’ case managers to learn more about the surrogacy process, documents you should provide before starting the process, fees, and payment options?
Is it possible to import and export sperm, eggs, and embryos for starting the surrogacy process and after surrogacy?
Will you need the donor’s consent to transport the embryos (if you have created embryos using the donor’s eggs or sperm)?
If you have frozen embryos or oocytes (sperm, ovarian or testicular tissue) and would like to use them, you should explore the shipment process and the documents you need to prepare.

Hiring and working with a surrogate mother on your own is not the same as working with a surrogacy agency. You will have to coordinate every step on your own and manage the whole process from beginning to end. There will be hopes, dreams, and emotions all wrapped up in the delicate balance of the surrogacy arrangement. Having a surrogacy lawyer involved from the moment you decide to use surrogacy services or be a surrogate mother is a great way to ensure your surrogacy is completed legally and protect your rights and interests during the surrogacy process. Your surrogacy lawyer will be your legal representative who will protect you against legal issues relating to compensation, parental rights, or dereliction of duties.

Working with surrogacy is more costly than hiring a surrogate mother and managing the surrogacy process independently, as you will be charged an agency fee. But this enables you to have a smoother and less stressful experience as the surrogacy professionals will navigate you through the journey and manage every step of the process, including filing paperwork, matching with potential surrogate mothers, finding fertility clinic, providing counseling services, coordinating with a fertility clinic and lawyers, helping you handle health insurance, managing finances and more. From the first call until your departure, your case manager will work closely with you to ensure each step of surrogacy journey is completed successfully before moving further.

Once you have decided the type of surrogacy you would like to pursue and have selected either a surrogacy agency or surrogacy lawyer, you will begin to discuss your options, complete the screening process to meet your agency’s legal and medical requirements for intended parents, match with your surrogate mother, have a contract negotiations and sign the surrogacy contract.

Surrogacy Tips for Prospective Surrogates:

Once you have considered all pros and cons and have decided that being a surrogate mother is an ideal role for you, you will need to consider several factors and make decisions based on your situation.

Do you already know the intended parents, or will you need to work with an agency to facilitate the matching process?
What type of surrogacy are you interested in — gestational or traditional?
Which surrogacy journey that’s right for you — commercial or altruistic?
Would you like to work with an agency throughout the surrogacy process, or do you intend to undertake surrogacy independently?
Do you consider carrying multiples?

While blueprinting your surrogacy roadmap, consider each essential detail, including outlining your goals and preferences throughout the surrogacy process.

Suppose you choose to work without a surrogacy agency. In that case, you will need to hire a surrogacy lawyer, undergo a fertility assessment at an IVF clinic, finalize the surrogacy plan and surrogacy agreement with the intended parents, add the new details to your surrogacy plan when needed, manage everything on your own, and coordinate your steps with intended parents, surrogacy attorney, fertility clinic and maternity hospital.

If you choose to work with an agency, you will work closely with a surrogacy professional to guide you through from matching with the intended parents to your comfort level with. Your case manager will work closely with you to ensure you have met all screening requirements and are ready to move on to the next step of the process.

Step 3: Finding a Perfect Match

Once the surrogacy agency identifies an intended parent(s) and a surrogate mother who share similar surrogacy blueprints, the agency will provide them with a profile of the other party (the surrogate mother will get a profile of the intended parent(s) and vice versa) to see if there is interest in a match.

If both parties express mutual interest in a proceeding, they can explore their compatibility further by engaging in phone conversations, exchanging emails, or meeting face–to–face. Once they feel comfortable, they can finalize the match by drafting the initial legal contract.

For Prospective Surrogates: As the surrogate mother, you will decide what kind of intended parents you would like to work with and the type of relationship you would like to have with them.

For Prospective Intended Parents: As the intended parent(s), you will choose the surrogate mom you would like to be matched, and if after the matching, you feel you are comfortable working with the surrogate mother and the surrogate mother is inspired to work with you, you may start the process of drafting legal contracts.

Step 4: Drafting a Legal Contract

Once the intended parents and surrogate mother decide to move to the next step together, they must draft a legal contract. Both parties will have their surrogacy lawyer who will explain the local surrogacy laws and regulations, ensure that surrogacy is completed legally, prepare the surrogacy contract from draft to the final version, and protect the rights and interests during the surrogacy process.

Each party will meet with their lawyer on one–to–one to discuss the legal aspects, risks, nuances, and terms and conditions. As soon as the intended parents and the surrogate mother agree to the terms of the contract and each layer reviews and approves it, surrogacy contracts will be signed, and both parties will start to prepare for the embryo transfer.

For Prospective Intended Parents: Your surrogacy lawyer will meet with you to discuss the current surrogacy law, your legal rights, possible risks, and the compensation you and your surrogate mother agreed to. Once the contracts are signed, you will move to the next step — fertilization and embryo transfer.

Once the first trimester has passed, your lawyer will work with you to establish you as the legal parents of your child. It will enable you to make medical decisions for the baby your surrogate mother is carrying and include your names on the birth certificate. The process, commonly referred to as a pre–birth order, is a vital step towards legally claiming the child as your own.

For Prospective Surrogate Mothers: Your lawyer will arrange the meeting to cover all the legal aspects of surrogacy, including base and additional compensation and potential risks. He will also review the contract the intended parents’ lawyer prepared to ensure it aligns with your preferences. After the contracts are signed, you will receive a monthly allowance to assist with the agreed–upon expenses.

Step 5: Starting Fertilization and Embryo Transfer Process

Once surrogacy contracts have been signed, the intended parents and their surrogate mother will start to prepare for fertilization and embryo transfer. In almost all cases, this process will be handled by a fertility clinic.

For Prospective Intended Parents: The medical procedures involved in surrogacy will depend on your case, your preferences, and whether or not you are using an egg donor. If your oocytes are used in IVF surrogacy, you will start injecting and taking medications to stimulate egg production and prevent spontaneous egg release (spontaneous ovulation). When the time is right, you will undergo a mini–invasive procedure known as egg retrieval.

Once the intended mother’s or donor’s oocytes have been harvested, they will be fertilized using the intended father’s or donor’s sperm. Then, the embryos will be incubated and assessed for development (and undergo preimplantation genetic testing if necessary) before being transferred to the surrogate mother.

After the embryo transfer, the surrogate mother will visit the fertility clinic until the pregnancy is confirmed. As soon as a healthy heartbeat is detected, the surrogate mother will begin receiving payments.

For Prospective Surrogate Mothers: When the lining of the uterus is optimal for implantation, you will undergo an embryo transfer procedure. After the transfer, you will be prescribed fertility medications to boost the chances of successful embryo implantation.

After a few weeks (you will discuss the timeline of your first post–transfer appointment after embryo transfer), you will revisit the fertility clinic to take a pregnancy test to confirm the success of the embryo transfer. You will then be required to make regular visits to the fertility clinic for ultrasounds and blood tests to monitor the progress of your pregnancy.

Once an embryonic heartbeat is detected via ultrasound, typically around six weeks following a successful embryo transfer, you will begin receiving payments. From there, your pregnancy will be similar to any other pregnancy, except for additional appointments to ensure the baby’s health, and sharing your experience with the intended parents.

Prefertilization Events

The intended mother or egg donor will be given medication (most likely Gonadotropins), which stimulates her ovaries to produce and ripen the oocytes, and fertility drugs to prevent spontaneous ovulation (egg release). This stage, known as “controlled ovarian stimulation,” involves extensive monitoring and testing. As soon as the ultrasound scan confirms upcoming ovulation, the intended mother or egg donor will be given a single or double shot, triggering her ovaries to release oocytes and undergo an egg retrieval procedure.

Fertilization

Then, the oocytes will be evaluated and fertilized using the husband’s or donor’s sperm in the IVF laboratory to create an embryo, which will be sooner transferred to the surrogate mother.

Embryo Transfer

The surrogate mother will undergo endometrial preparation (stimulation injections) to allow implantation before the embryo transfer and will take medication after the embryo transfer to boost the chances of successful embryo implantation resulting in the pregnancy. The transfer will be performed as soon as the surrogate mother’s endometrium becomes “receptive.”

Post–embryo transfer

The surrogate mother will set an appointment schedule with her fertility specialist and continue to visit the fertility clinic after the embryo transfer for regular blood tests and ultrasounds to track the progress of the pregnancy.

Step 6: Confirming Pregnancy and Waiting for a Little Miracle

There will be a series of early pregnancy tests, including a Urine hCG Level Test to measure the levels of hCG (pregnancy hormone) and pregnancy blood test, and up to five ultrasound scans depending on the case (week 4 in pregnancy — possible endometrial thickening may be visible; week 5 in pregnancy — the ultrasound scan may detect a gestational sac; week 6 in pregnancy — yolk sac can be found; 5.5 to 6.5 weeks the ultrasound scan may detect fetal pole and possible fetal heartbeat; and 6.5 to 7 weeks fetal heartbeat can be heard).

Once a pregnancy is confirmed and fetal heartbeat is heard, the surrogate mother will be referred to an OB/GYN for setting up a prenatal appointment schedule and begin receiving payments for base compensation (base compensation is usually paid in installments) plus monthly allowance. She will also begin receiving prenatal care regularly, visiting her OB/GYN, and undergoing testing, which will continue throughout the pregnancy.

Step 7: Welcoming the Newborn or Even Twins

The surrogacy process may take longer than expected, sometimes up to 18 months. But the birth of the surrogacy baby is worth starting this overwhelming journey and long waiting. This event will change the life of both the surrogate mother and the intended parents forever. And mostly, all intended parents are coming to support their surrogate mother during this experience.

After the baby is born, the surrogate mother will transfer the baby to the intended parents. It is a special moment, and many intended parents take the first photos or video of their surrogate mother holding their baby and transferring the newborn to them. Then, in a couple of days, the surrogate mother and the newborn baby will be discharged from the hospital, and all will return home. The intended parents will come home with their newborn, and the surrogate mother will be back home feeling inspired and satisfied as she gave the greatest gift to someone who couldn’t do it on their own — the Gift of Life.

The bond between the surrogate mother and the family she helped, including the unique bond between the surrogate mother and the baby, may last for a long time or even forever. Both the surrogate mother and the intended parents may wish to maintain a relationship throughout life.

Wrapping Things Up

The silence around surrogacy has been broken, and more and more aspiring singles and couples are becoming mothers and fathers for the first, second, or third time. Although intended parents may not have nine months to bond with their baby before birth, bonding will happen naturally and will be deep, cordial, and intense. They will be excited to start the new chapter of their life with their newborn, and their hearts will explode with love for their small Bundle. But first, they will share the exciting announcement that they have become a mother or/and a father.