When you compare surrogacy agencies as a surrogate, the size of the agency and its advertised pay matter less than five other things. These are how carefully it screens, how clearly it itemizes your compensation, who holds the money, whether it insists you have your own attorney, and what support you get when something goes wrong. These shape the year or more you would spend in the process, and you can check every one of them before you sign anything.
You may be reading this before you have told a partner or family. Many women start that way. Understanding how agencies are structured first gives you something concrete to talk about later, if you decide to.
Surrogate Compass is an independent educational and matching platform for women considering gestational surrogacy in the United States. We are not an agency. Agencies screen, match, contract and pay. We help you understand your options and connect you with agencies. Surrogate Compass may be compensated by partner agencies. For that reason this page compares models and criteria and does not rank named agencies. A ranking shaped by who pays us would not help you, and the criteria below work on any agency you look at, including the ones we work with.
What a Surrogacy Agency Actually Does, and What It Doesn't
An agency matches surrogates with intended parents, runs or coordinates screening, manages the case from match to delivery, and offers support along the way. It does not provide medical care, and it does not give you legal representation.
Three separate parties do three separate jobs:
- The agency handles matching, coordination, scheduling and support.
- The fertility clinic handles everything medical: your medical evaluation, the medication protocol, embryo transfer and early pregnancy monitoring.
- A licensed reproductive attorney handles the legal contract and the steps that establish the intended parents' parentage, such as a pre-birth order where the state allows one.
Agencies also differ in scope. A full-service agency matches, manages your case and provides support throughout. A matching-only agency introduces you to intended parents and then steps back. Some agencies offer coordination only, for people who have already found each other. When you compare agencies, first find out which model you are looking at.
No single federal body licenses or regulates surrogacy agencies in the US, and state oversight varies a great deal. Two agencies can therefore operate to very different standards. Any task the agency does not cover becomes yours to manage. If nobody owns the job of chasing a late reimbursement, you end up chasing it.
Quick Comparison: Full-Service Agency vs. Matching-Only Agency vs. Independent Arrangement
All three models have real tradeoffs, and none is right for everyone. The table describes how each one commonly works. Individual agencies vary, so treat each row as a question to put to a specific programme.
| What you are comparing | Full-service agency | Matching-only agency | Independent arrangement |
|---|---|---|---|
| Screening depth | Usually the deepest: the agency pre-screens and refers you to the clinic | Varies; often lighter pre-screening | Whatever you and the intended parents arrange; the clinic still does medical screening |
| Case management | A dedicated case manager from match to delivery | Limited after the match | None; you and the intended parents coordinate everything |
| Legal coordination | Refers attorneys and schedules legal steps | May refer, then steps back | You and the intended parents find attorneys yourselves |
| Psychological support | Often offered beyond the initial evaluation; ask how long | Often limited to the initial evaluation | Arranged privately, if at all |
| Compensation transparency | Published ranges and itemized schedules are common; check the detail | Varies widely | Negotiated directly, through attorneys |
| If a match falls through | Re-matching is usually part of the service; ask about timelines | Depends on the agency's policy | You start again on your own |
| Contact after delivery | Some offer postpartum check-ins | Usually ends at the match or the birth | Depends on your relationship with the intended parents |
Full-service agencies carry the most work for you, and they usually charge the highest agency fee. That fee is commonly paid by the intended parents, so a higher fee does not by default come out of your pay. Confirm this in writing. The tradeoff is that you depend on the agency's quality. A good case manager makes a hard year easier, and a poor one adds friction.
Matching-only agencies can suit you if you are organized, have been through pregnancy before, and want fewer intermediaries. You take on more of the scheduling, follow-up and problem-solving yourself.
Independent arrangements have no agency between you and the intended parents. Some surrogates prefer this, often when the intended parents are people they already know. Independent does not mean unrepresented. In practice, each side still has its own reproductive attorney for the contract and the parentage steps. All the coordination and support work falls to you and the intended parents.
Our surrogate programs guide covers these paths in more depth.
Screening: What Agencies Check and Why the Depth Varies
Careful screening protects you as well as the intended parents. It is one of the clearest differences between agencies.
The American Society for Reproductive Medicine (ASRM) publishes professional guidance on the medical and psychological evaluation of gestational carriers. ASRM guidance is a set of professional recommendations, not federal law, and agencies are not required to follow it. Reputable agencies and clinics commonly use it as a reference point when they set their criteria.
Medical screening is done by the fertility clinic, not the agency. The agency sets the eligibility criteria that decide who gets referred to the clinic. Those criteria cover things like age, BMI, previous pregnancies and deliveries, and health history, and they differ between programmes. A history that one agency turns down, another may refer for medical review. The final medical decision belongs to a physician reviewing your records. Our page on pregnancy complications and surrogacy explains what clinics weigh in your history.
Psychological screening is a strong marker of rigour. Look for an evaluation by an independent licensed mental health professional, not by the agency's own staff. An independent evaluator has no stake in getting you matched quickly.
Background checks usually include some combination of the following:
- A criminal background check, often on you and on any adult in your household.
- A financial review, which looks at stability. It is not a judgement about your income level.
- A home study or home visit, which looks at your living situation and support at home.
None of these assesses whether the intended parents are a good fit for you. That depends on the agency's matching process and on your own conversations with them.
Ask what happens if screening turns up a concern. A careful agency tells you clearly and promptly, and tells you whether another route, such as a different clinic, might still be open. A careless one simply stops replying.
Screening should also run the other way. Ask what the agency checks on the intended parents' side, how it confirms they can fund the arrangement, and whether they go through psychological consultation too.