The Surrogacy Process: All you need to know from definitions to a step-by-step guide

Eran Amir

CEO and Founder of GoStork

What is surrogacy?


Surrogacy is an arrangement, often supported by a legal agreement, whereby a woman (Gestational Carrier) agrees to become pregnant and give birth to a child for another person (Intended Parent) who is or will become the parent of the child.

Surrogacy includes 5 main parties:

  • Intended Parents (IP) – Intended parents can include all kinds of couples and single people. For example, intended parents can be:

– Single men who want a child

– Single women who cannot carry a child to term themselves

– Same-sex couples

– Heterosexual couples struggling with infertility and the inability to carry a child 

  • Egg Donor – Egg donor is a woman that donates her eggs to enable another woman to conceive as part of an assisted reproduction treatment (ART)
  • Carrier (Surrogate) – Gestational Carrier implies a woman who becomes pregnant and gives birth to a child with the intention of giving away this child to another person or couple, commonly referred to as the “intended parents”. 
  • Surrogacy Agency – They provide part or all the surrogacy services, including the surrogate matching process, support counseling, case management.
  • IVF Clinic – In vitro fertilization (IVF) is a process of fertilization where an egg is combined with sperm outside the body, in vitro (“in glass”).

Types of Surrogacy

Surrogacy is of two types: traditional and gestational.

  1. Traditional Surrogacy (genetic/partial) is the result of artificial insemination of the surrogate mother with the intended father’s sperm, making her a genetic parent along with the intended father.
  2. Gestational Surrogacy (host/full surrogacy) is defined as an arrangement in which an embryo from the intended parents or from a donated sperm is transferred to the surrogate uterus. In gestational surrogacy, the woman who carries the child has no genetic connection to the child.

Surrogacy may be Commercial or Altruistic, depending upon whether the surrogate receives financial reward for her pregnancy:

  1. Commercial Surrogacy – It is considered commercial if surrogate receives money for the surrogacy arrangement.
  2. Altruistic Surrogacy – It is considered altruistic if surrogate receives no compensation beyond reimbursement of her medical and other pregnancy related expenses along with the insurance coverage for her.

The Surrogacy Process

Step 1: Selecting Surrogacy Professionals

Once you have made up your mind and want to continue with the surrogacy journey, you must determine your goals, expectations, and the professionals you are willing to work with. Basically, the first step is to look for an IVF Clinic, a surrogacy agency and sometimes an attorney if the agency doesn’t have one for you:

  • IVF Clinic: This is the clinic where the In vitro fertilization (IVF) will be performed (an egg is combined with sperm outside the body).
  • Surrogacy Agency: They provide part or all the surrogacy services, including the surrogate matching process, support counseling, case management…
  • Surrogacy Attorney: Surrogacy is a fertility treatment in which a great deal of legalities are involved. The work of an attorney is required to complete the legal work (contracts, birth order, legal parentage, etc.).

At this stage, you will also decide about basic aspects, including whether you need donor sperm and/or eggs, whether you know the surrogate or need matching services.

Read more about “How to Choose IVF Clinic?” here

Read more about “How to Choose a Surrogacy Agency?” here

Step 2: Selecting an Egg Donor

Intended Parents can either bring their own egg donor or select one from a clinic’s or agency’s database. In either case, the candidate must pass a thorough medical screening. Their medical records should be reviewed by a reproductive endocrinologist before being accepted into the donor program. 

Read more about “How to Choose an Egg Donor?” here

Step 3: Selecting a Gestational Carrier

Similar to the previous step, Intended Parents can either choose a family member or a friend as their surrogate or go through an agency. The surrogate candidate will undergo medical, mental health, financial and criminal background screening. A profile is created for both Intended Parents and gestational carriers by the agency. When the time comes to make a match, they will try to match you with a surrogate whose surrogacy plans are similar to yours. 

Read more about “How to Choose a Gestational Carrier?” here

Step 4: Signing Contracts

All parties involved in this step of the process will have their own attorney representing their own interests. Before beginning the embryo transfer process, it is required that each party agrees to the terms of the contract and signs it.

Attorneys must have a license in the US state where the surrogate and the egg donor live.

To this end, each party will review the terms of the contract carefully beforehand:

  • Surrogate: Compensation, possible risks, rights and obligations, what to do in case of unexpected events, abortion rights, etc. Prospective gestational carriers should keep a close eye on these terms.
  • Intended parents: Making your legal rights clear, including how to manage potential risks and establishing the compensation that you will pay to your surrogate is crucial.

Only if both parties agree to the terms and conditions described on the contract and sign it, you will be able to start the medical process, a phase in which you will work closely with the fertility clinic you agreed upon at the beginning.

Step 5: Undergoing The Medical Process

At this stage, two steps are crucial—fertilization and embryo transfer. 

  1. Fertilization The eggs and sperm of the intended parents are used to create the embryo,
  2. Embryo Transfer – The embryo or embryos are transferred to the uterus of the surrogate.

Before the fertilization, the intended mother or the egg donor in case she cannot use her own eggs has to take medications in order to stimulate the ovaries for the production of multiple eggs. Once mature, they will be collected through follicle puncture (Eggs Retrieval).

Before the Embryo Transfer, the gestational carrier has to take medications in order to prepare the endometrium for it to be receptive at the moment of the embryo transfer.

The carrier will take a pregnancy test about 15 days before the transfer. Normally, surrogates start receiving their compensation in installments, monthly allowance, and prenatal care once the fetal heartbeat has been confirmed by ultrasound.

During the pregnancy, gestational carriers have to visit the clinic on a regular basis for blood tests and ultrasounds in order to check if everything is progressing as expected. If you agree so with the IPs, you can share your pregnancy journey with them.

Step 6: Pregnancy, Birth & Parental Rights

When the desired pregnancy is achieved, it is your program coordinator’s job to support both you and your gestational carrier and to prepare you for the birth of your child. Normally, intended parents wish to join the surrogate at the hospital experience it first hand.

Once the baby is born, it is crucial that you pay attention to all the necessary documents that you must complete and file to ensure that parental rights are properly established. It is your attorney’s responsibility to secure proper court orders, passports, legal documentation…

Intended parents living outside the United States have to ensure that every legal document required in their home country is properly filed. Checking what are the requirements in your departure country to register the birth of a child born abroad is a key step to a successful surrogacy journey.

When everything has finished, it is common among gestational carriers and intended parents to remain connected over the years and maintain a close relationship during the child’s life.