You may be early in this. You might be researching on your own before telling a partner or family, and trying to work out whether carrying a baby for someone else fits your life. Becoming a gestational surrogate usually moves through eight stages: checking eligibility, choosing a path, applying, medical and psychological screening, matching, legal contracts, the medical process through delivery, and compensation running alongside it all. As a rough estimate, the whole process takes 18 to 24 months from first inquiry to postpartum recovery, and it often takes longer.
This guide walks through each stage in order. It covers what you do, what other people do, and what you are waiting for. It also covers how long each stage tends to take and what can slow it down. The timelines are estimates. Every journey is different, and agencies, clinics and physicians make the real decisions at each step.
Surrogate Compass is an independent platform for women considering surrogacy in the US. We are not an agency. We help you understand whether you are likely to qualify, what you may earn, how the process works and which programmes might suit you. Then we connect you with agencies. Agencies screen, match, contract and pay. California gets the most detail here because it is the state we cover most deeply.
Before You Start: What Surrogacy Actually Requires
This guide covers gestational surrogacy. An embryo created from the intended parents' or donors' egg and sperm is transferred to your uterus. You have no genetic connection to the child. In traditional surrogacy, the surrogate's own egg is used. It is far less common today because it raises harder legal and emotional questions, and most agencies and clinics work only with gestational arrangements.
The commitment is substantial, and it is physical first:
- Medication. Weeks of hormone medication before transfer, often including daily injections, and often continuing into the first trimester.
- Monitoring. Repeated bloodwork and ultrasounds, sometimes at a clinic some distance from home.
- Pregnancy and birth. A full-term pregnancy, with its usual risks, followed by delivery, whether vaginal or by C-section.
- Recovery. Weeks of postpartum recovery, with no baby to bring home.
It is also relational. Your relationship with the intended parents can last more than a year. Your partner, your children and your work schedule all feel the effects. Some surrogates describe the experience as deeply meaningful. Others find parts of it harder than they expected. Both are normal.
Before you apply anywhere, three practical things help:
- Your records. Know where your prior pregnancy and delivery records are.
- Your OB. Have your current OB's contact details ready.
- Your insurance. Have your health insurance policy documents to hand, because screening will ask about each of these.
Step 1: Review the Basic Eligibility Requirements
The first step is a self-check against the criteria most programmes use. These are common ranges, not national rules. Agencies, clinics and physicians set their own standards, and a medical team makes the final call.
Many of these criteria trace back to guidance from the American Society for Reproductive Medicine (ASRM). ASRM is the professional body whose practice guidance clinics draw on when they set gestational carrier criteria. That guidance is a clinical standard, not law. It explains why the criteria exist: they are there for medical safety, not arbitrary preference.
- Age. Commonly about 21 to 40. Some programmes set a different range. The limits reflect medical risk, maturity and insurance considerations.
- A prior pregnancy and a child you are raising. Almost every programme requires this. A previous uncomplicated pregnancy carried to term shows how your body has handled pregnancy. It also means you know from experience what you are agreeing to.
- BMI. Commonly about 19 to 32. Some programmes cap lower and a few go higher. This is a medical screening threshold linked to pregnancy and procedure risk, not a judgment about you. The surrogate BMI requirements guide explains the variation.
- Smoking and substances. Most programmes look for a non-smoker in a smoke-free and drug-free household.
- Mental health medication. Recent use of certain psychiatric medications is reviewed individually. It is not automatically disqualifying.
- Financial stability. Many programmes do not accept candidates who receive certain means-tested public assistance. One reason is to avoid financial pressure shaping the decision. Another is that compensation could affect your benefits.
- Residency. You usually need to live in the US. Some agencies work only with residents of particular states.
Meeting these criteria is preliminary self-screening, not qualification. Agency, medical and legal screening decide that. If you want to see what each common question is testing, the surrogate eligibility quiz walks through them.
Step 2: Choose How to Proceed, Agency or Independent
There are two main paths. You can work with an agency, or you can arrange surrogacy independently.
The agency path. An agency typically:
- introduces you to intended parents and supports the matching process
- coordinates screening appointments
- arranges or refers the psychological evaluation
- helps coordinate the legal process
- often manages the escrow arrangement through which you are paid
- gives you a case manager as your point of contact
An agency does not perform your medical screening. It does not clear you psychologically and it is not your lawyer. Those roles belong to the fertility clinic, a mental health professional and your own attorney.
The independent path. In an independent arrangement, you and the intended parents find each other directly, often through personal networks or online communities. In an identified arrangement, you already know them. Each side then hires its own professionals. You keep more control. You also do more of the coordination yourself, including chasing paperwork and payments.
On either path, you have your own surrogacy attorney, separate from the intended parents' attorney.
Surrogate Compass sits before this choice. We help you compare options and connect you with agencies. We do not screen, approve, match or pay you. If you are weighing agencies, it helps to know what to compare in an agency. If you live in California, the California surrogate programs guide compares agency, independent and identified arrangements there.
Step 3: Submit an Application and Initial Screening
An application is mostly questions about your life. Expect sections on:
- your background and your household
- each prior pregnancy and delivery, including complications
- your lifestyle and health habits
- why you are considering surrogacy
At this stage the agency reviews two things. Is the application complete? Do your answers fit its stated criteria? It may also run background checks on you and adults in your household. Some agencies hold a phone or video interview here.
What the agency does not decide at this stage:
- whether you are medically suitable
- whether you are psychologically cleared
- whether there are legal obstacles
Initial review is often a matter of days to a few weeks, depending on the agency. A "yes" here means you may continue to the next round of screening. It does not mean you are qualified, matched or accepted.
Gathering your OB records and delivery summaries before you apply saves time. The clinic will need them, and requesting old records can take weeks.
Step 4: Complete Medical and Psychological Screening
This is where qualification is actually decided, and the agency does not make that decision.
Medical screening is usually done by the reproductive endocrinologist (RE) at the intended parents' fertility clinic. It commonly includes:
- an evaluation of your uterus, often by ultrasound or a procedure such as a saline sonogram or hysteroscopy
- bloodwork and hormone testing
- infectious disease testing, for you and often for your partner
- a review of your prior obstetric records
Psychological screening is an evaluation by a licensed mental health professional with surrogacy experience. It often includes an interview and a written assessment. It looks at:
- your motivation
- how well you understand the arrangement
- whether you are prepared to hand over the baby at birth
- how strong your support system is
If you have a partner, they usually take part.
The clinic and the mental health professional each give or withhold clearance. The agency does not override their findings. Neither does Surrogate Compass. Once appointments are scheduled, this stage often takes about four to eight weeks, but delays in getting records or appointments can stretch it. The surrogate screening process guide goes through each step in more detail.