The Surrogacy Process for Surrogates: A Step-by-Step Guide

The surrogacy process runs in seven stages: application, medical and psychological screening, matching, legal contracts, medical preparation and embryo transfer, pregnancy, and delivery and recovery. From first application to delivery, it commonly takes an estimated 12 to 18 months, and some journeys take longer. If you are reading this before telling anyone, you are probably trying to work out whether that year fits your body, your family and your work. This guide lays out what happens at each stage, who does what, and where the waiting happens.

It covers gestational surrogacy, where the embryo is created from the intended parents' or donors' eggs and sperm and you have no genetic link to the baby. Traditional surrogacy, which uses the surrogate's own egg, is legally complex, varies widely by state and is rarely practised. It is not covered here.

Before You Start: What Surrogacy Actually Requires

Most reputable programmes start from similar benchmarks, drawn partly from guidance published by the American Society for Reproductive Medicine (ASRM). These are common ranges, not universal rules:

• At least one prior pregnancy carried to term, usually with you raising the child.
• Age, commonly somewhere around 21 to 40, though programmes and clinics set their own limits.
• Non-smoker, and no use of nicotine or recreational drugs.
• A healthy BMI, with the cut-off varying by programme and clinic.
• No medical history that a physician considers a significant risk in a new pregnancy.

Every agency and clinic sets its own criteria, and a medical team reviewing your records makes the decision. A woman who falls outside one programme's range may fall inside another's. The surrogate eligibility quiz explains what each common question is for.

The practical demands matter as much as the medical ones. Expect many appointments at a fertility clinic, sometimes in another city, plus legal meetings, calls with your coordinator and regular contact with the intended parents. Emotional readiness is assessed too. Carrying a child you will not parent is a different experience from your own pregnancies, and programmes require a psychological evaluation for that reason.

Passing a preliminary eligibility check is not acceptance. Agency, medical and legal screening decide whether you go forward.

Step 1: Application and Preliminary Screening

The first contact is paperwork. You fill out an application with an agency, usually online, covering:

• Personal details and household situation
• Obstetric history: each pregnancy, how you delivered, any complications
• Lifestyle questions: smoking, medications, work, travel, support at home
• Often a background check, sometimes for your partner too

The agency reviews this against its own criteria and usually asks for your prior delivery records. At this stage it is asking a narrow question: does anything on paper rule you out before a clinic looks? A pass at this stage means the agency is willing to take your file further. It is not a guarantee of medical clearance, a match or acceptance.

Estimated time: days to a few weeks, often depending on how quickly your hospital releases records.

Some surrogates proceed independently, matching directly with intended parents without an agency. Medical screening, separate attorneys and payment arrangements are still required, and you take on the coordination yourself. The guide to choosing a surrogacy agency covers what an agency's role should include.

Step 2: Medical and Psychological Evaluation

The intended parents' fertility clinic conducts the medical evaluation, not your own OB. In many programmes this happens after matching, because the clinic is the one the intended parents have chosen. ASRM guidance is the professional standard clinics draw on for these evaluations.

The medical side commonly includes:

• A physical exam and review of your obstetric records
• A uterine assessment, often a saline sonohysterogram or a hysteroscopy, to check the shape and lining of your uterus
• Blood work, including infectious disease testing, and often testing for your partner
• Drug and nicotine screening

The psychological side usually combines a standardised written assessment with an interview by a licensed mental health professional. It covers why you want to do this, who supports you at home, how you expect to feel after delivery, and whether you understand the role. A partner is often asked to join part of it.

If screening finds a condition the clinic considers a risk, the clinic will usually explain what it found. Sometimes that ends the process. Sometimes a condition can be treated and reassessed, and another clinic may weigh it differently. Either way, the finding is useful health information about your own body.

Estimated time: about 4 to 8 weeks for medical and psychological evaluations combined. The surrogate screening process guide goes through each test in more detail.

Step 3: Matching With Intended Parents

Matching is where your preferences carry real weight. The agency presents profiles of intended parents whose situation and wishes line up with yours, and passes your profile to them.

You typically share your background, your family, why you are considering surrogacy, and your preferences: how often you want contact during the pregnancy, how many embryos you are willing to have transferred, and your views on termination and selective reduction. Intended parents share their background, why they are pursuing surrogacy, and what they hope the relationship will look like.

If both sides are interested, the agency sets up a match meeting, often a video call with a coordinator present. It is a conversation, not an interview you pass or fail. Either side can decline afterwards, and you can say no to a match without giving a reason.

Estimated time: weeks to several months. Narrow preferences, a particular clinic location or a slow period at the agency all lengthen it.

Step 4: Legal Contracts and the Surrogacy Agreement

Once a match is agreed, attorneys draft the surrogacy agreement. You and the intended parents each have separate attorneys. Independent representation for the surrogate is standard practice, and the intended parents commonly cover its cost. Confirm both points with your agency before you match.

The agreement typically covers:

• Base compensation, allowances and reimbursements, and when each is paid
• Medical decision-making, including how many embryos may be transferred
• Selective reduction and termination
• Communication and contact during and after the pregnancy
• Health insurance, life insurance and who pays for each
• Delivery room access and the parentage process

No embryo transfer happens until the agreement is fully signed by everyone. Your attorney's job is to explain what each clause means for you. Surrogate Compass is not a law firm, and nothing here is legal advice. Ask your attorney anything you are unsure of before you sign.

Parentage is also arranged at this stage. In California, the Family Code supports gestational surrogacy agreements, and courts routinely issue pre-birth orders that establish the intended parents as the legal parents before delivery. Other states differ considerably, and some are restrictive. Your attorney explains what applies where you live and where you will deliver. California surrogates can read what California surrogates should know when comparing agencies.

Estimated time: about 4 to 8 weeks for negotiation and signing.

Step 5: Medical Preparation and the Embryo Transfer

This is the most physically demanding stretch before pregnancy, and it deserves an honest description.

The fertility clinic prescribes medications to synchronise your cycle and prepare your uterine lining. Protocols vary, but commonly include:

• Medication to suppress your natural cycle, in some protocols
• Estrogen, as pills, patches or injections, to build the lining
• Progesterone, often as daily intramuscular injections, sometimes as vaginal suppositories, starting a few days before transfer

During this time you attend monitoring appointments for blood draws and transvaginal ultrasounds to check your hormone levels and lining. These can be frequent, and the clinic may adjust doses based on results.

The transfer itself is brief and non-surgical. A thin catheter passes through the cervix and places the embryo in the uterus under ultrasound guidance. Many women compare the sensation to a pap smear. The appointment typically takes 15 to 30 minutes, and many clinics ask for light activity for a day or two afterwards.

You then continue progesterone and wait about 10 to 14 days for a pregnancy blood test. If the test is positive, medications usually continue into the first trimester.

A first transfer does not always result in pregnancy. That is common in IVF and is not a judgement on your body. The clinic and intended parents then discuss a further transfer under the terms of your agreement.

Estimated time: a medication protocol of about 3 to 6 weeks before transfer, plus the wait for the test.

Step 6: Pregnancy, Prenatal Care, and Communication

After a confirmed pregnancy, the fertility clinic monitors you for the first several weeks. Around 8 to 10 weeks, once the pregnancy is confirmed as viable, you usually move to your own OB or midwife, subject to any approvals in your agreement.

From here, the experience looks more like your earlier pregnancies, with added structure:

• Appointments: intended parents often attend key ones, such as the anatomy scan. The agreement sets those expectations.
• Communication: frequency and format, whether calls, texts or photo updates, are agreed in the contract. You are not expected to be available around the clock.
• Payments: base compensation is commonly paid in monthly instalments once pregnancy is confirmed, usually through an escrow account. Check your own schedule in your contract.
• Your body: the agreement sets out expectations, but you remain the patient. Ask your attorney how the agreement handles medical decisions, including the selective reduction and termination clauses you agreed to.

Estimated time: about nine months from confirmed pregnancy to delivery. The risks of being a surrogate are covered plainly in a separate guide.

Step 7: Delivery, the Pre-Birth Order, and What Comes After

You deliver at a hospital, usually one agreed in advance. The intended parents are typically there, and the agreement specifies who is in the delivery room.

Where a pre-birth order has been granted, as is routine in California, it directs that the intended parents are named on the birth certificate. You do not appear as a legal parent. In states without pre-birth orders, parentage may be established after birth through a different court process, which your attorney explains.

The baby goes home with the intended parents. Your obligations under the agreement are then largely complete, apart from any postpartum terms.

Recovery still takes weeks, longer after a C-section. Ask your agency how your postpartum medical costs are covered and for how long. Many surrogates use counselling after delivery. Feeling a mix of relief, pride, tiredness and loss is common and does not mean regret. Ask whether your programme offers postpartum counselling and who pays for it.

Final payments, such as remaining instalments and outstanding reimbursements, are generally made after delivery according to your contract. Contact with the intended parents afterwards varies widely: some families stay close for years, others exchange occasional updates, and some step back.

Compensation: What Surrogates Are Paid and How It Works

There is no single figure. Pay is built from several parts, each written into your contract:

• Base compensation: the largest part, commonly paid in monthly instalments after pregnancy is confirmed.
• Allowances: monthly expenses, maternity clothing and travel, itemised in the contract.
• Reimbursements: medical co-pays, lost wages for appointments or bed rest, and childcare during appointments, usually with documentation.
• Transfer fee: a one-time payment for each embryo transfer.
• Procedure fees: additional payments for a C-section, amniocentesis, D&C or similar procedures, if they happen.

Insurance is a contract term, not a given. Ask who provides health cover during the pregnancy, whether a life insurance policy is arranged for you, who pays for it and how long it runs.

What moves the numbers: whether you have been a surrogate before, where you live, and the agency. An agency's advertised top rate usually reflects experienced surrogates, not a first journey. The surrogate compensation guide explains each component and when it is typically paid.

Tax treatment is not settled in a way that fits everyone. General IRS rules on what counts as income are the starting point (IRS), and tax professionals do not all apply them to surrogacy the same way. A tax professional familiar with surrogacy can advise on your situation.

Specific amounts are set in each contract. A consultation with an agency is the most reliable way to learn what your situation could pay.

How Long the Whole Process Takes

These are estimates. Every journey differs.

The biggest sources of delay are matching, slow release of medical records, clinic scheduling, and transfers that need to be repeated.

What Can Pause or End the Process

These are the common reasons a journey stops or slows:

• A clinic finding during screening that rules you out or requires treatment first
• No match that suits both sides, or a match that ends before contracts
• Contract negotiation stalling over specific clauses
• A transfer that does not result in pregnancy, or an early loss
• The intended parents running out of embryos or changing plans
• A change in your own health, family or work circumstances

You can withdraw before signing the agreement. After signing, the contract sets out what happens if anyone steps back, which is one more question for your attorney.

What You Can Do to Prepare

• Requesting delivery records from each prior pregnancy early in the process is one way to avoid a common source of delay.
• Programmes typically assess whether a surrogate's partner or main support person understands the appointment schedule, medication demands and time commitment involved.
• Work out who could cover childcare and work on clinic days.
• Write down your views on contact, number of embryos transferred, termination and selective reduction before matching begins.
• Compare agencies on itemised pay, escrow, attorney coverage and coordinator caseload.

Your Next Step

If you are still weighing this, a free eligibility review from Surrogate Compass is a low-pressure place to start. It takes a few minutes and there is no obligation. The Surrogate Compass team reviews your answers and tells you whether your situation looks likely to meet common programme criteria. The review indicates whether the answers provided appear to align with common programme criteria, which agency types may be relevant, and how compensation is generally structured for first-time surrogates. It is not approval: agencies and clinics make that decision. Contact Surrogate Compass to request your review whenever you are ready, and come back to it later if you are not.