Becoming a surrogate starts with meeting a set of medical and personal eligibility requirements, then working with a surrogacy agency or fertility clinic through a process that typically takes 18 to 24 months from application to delivery. The journey involves medical screening, legal contracts, hormone treatments, and pregnancy, with first-time surrogates in the U.S. earning between $50,000 and $80,000 in base compensation.
Basic Eligibility Requirements
The American Society for Reproductive Medicine (ASRM) sets the guidelines most agencies and clinics follow. To qualify, you need to be between 21 and 45 years old, though most agencies prefer candidates under 40. You should have carried at least one pregnancy to term without major complications. This requirement exists because it demonstrates your body can sustain a healthy pregnancy and gives doctors a track record to evaluate.
There are upper limits too. You should not have had more than five total deliveries or more than three cesarean sections. Most agencies also set a BMI cap, typically under 33 or 35, though the exact number varies by clinic. Beyond the physical criteria, you’ll need to be a non-smoker, free of certain chronic conditions, and not receiving government assistance (a requirement many agencies impose because it can create legal complications). You also cannot currently have an IUD in place.
The Application and Screening Process
The first step is applying through a surrogacy agency. You’ll fill out a detailed application covering your medical history, pregnancy history, lifestyle, and motivation for becoming a surrogate. If the agency accepts your initial application, the screening process takes one to three months and has several layers.
Medical screening includes bloodwork, an infectious disease panel, a uterine evaluation, and a review of your obstetric records. The fertility clinic will assess whether your uterus can safely carry an embryo created through IVF.
Psychological screening is a separate requirement. ASRM guidelines recommend that all surrogate candidates undergo a psychosocial consultation and, where appropriate, psychological testing. This typically involves a clinical interview and a standardized personality inventory. The goal isn’t to catch you off guard. It’s to confirm you understand the emotional complexity of carrying a pregnancy for someone else, that you have a stable support system, and that you’re making this decision freely. Your partner or spouse, if you have one, may also need to participate in part of the evaluation.
Getting Matched With Intended Parents
Once you’re medically and psychologically cleared, the agency works to match you with intended parents. This stage can take anywhere from two to ten months depending on the agency and how specific the preferences are on both sides. Some agencies facilitate a video call or in-person meeting so both parties can decide if the relationship feels right. You’re not obligated to accept a match that doesn’t feel comfortable.
Matching considers factors like your location, the intended parents’ preferences, whether you’re open to carrying multiples, and your stance on topics like selective reduction or termination for medical reasons. These conversations happen early so there are no surprises later.
Legal Contracts
Before any medical procedures begin, both you and the intended parents sign a legally binding surrogacy agreement. This process takes one to two months and requires that each side has independent legal representation. In several states, including New York and Illinois, both attorneys must be licensed in that state.
The contract covers compensation, medical decision-making, what happens if complications arise, insurance arrangements, and how parental rights will be established after birth. Surrogacy laws vary dramatically by state. Some states like Connecticut, Illinois, and Texas have specific statutes that spell out requirements for valid surrogacy agreements and allow pre-birth parentage orders, meaning the intended parents’ names go directly on the birth certificate. Other states have more restrictive or ambiguous laws. Your agency and attorney will guide you through what applies in your state, but where you live matters significantly.
The Medical Process
As a gestational surrogate, you carry an embryo created through IVF using the intended parents’ or donors’ eggs and sperm. You have no genetic connection to the baby. The medical preparation involves hormone medications to prepare your uterine lining for embryo transfer. You’ll typically start with birth control pills in the month before the cycle to synchronize timing, then transition to hormones that thicken your uterine lining.
The medications are usually self-administered injections, and the medication phase lasts roughly two to four weeks before the embryo transfer. The transfer itself is a short outpatient procedure, often compared to a Pap smear in terms of discomfort. About two weeks later, a blood test confirms whether the pregnancy has taken hold. If the first transfer doesn’t succeed, you may go through a second cycle after a rest period.
Once pregnant, your prenatal care looks similar to any other pregnancy, with regular OB appointments, ultrasounds, and standard monitoring. The intended parents are typically kept informed and may attend key appointments.
Compensation and Benefits
First-time surrogates in the U.S. earn a base compensation of $50,000 to $70,000 in 2025, paid in monthly installments that begin after a fetal heartbeat is confirmed. Experienced surrogates who have completed a previous surrogacy journey earn $75,000 to $90,000 or more.
On top of base pay, surrogates receive additional stipends and bonuses:
- Monthly allowance for transportation, meals, childcare, and incidental expenses
- Maternity clothing and wellness benefits covering nutrition and pregnancy-related needs
- Lost wages reimbursement for you or your partner, up to $10,000 combined
- Multiples bonus of $10,000 or more if you carry twins or triplets
- C-section compensation of $5,000 for a first cesarean, $3,000 for a repeat
- Housekeeping support up to $200 per week during pregnancy
- IVF medication stipend as a one-time payment when you begin the hormone protocol
All medical expenses related to the surrogacy pregnancy are covered by the intended parents, not by you. How that coverage works depends on your existing health insurance. Some personal insurance policies exclude surrogacy, in which case the intended parents purchase a surrogacy-specific policy for you. Your contract will specify exactly how medical costs are handled. If you’re a TRICARE beneficiary, TRICARE will pay as secondary coverage after the intended parents’ contractual obligations are exhausted.
Risks to Be Aware Of
Surrogate pregnancies carry the same risks as any pregnancy, but research published in The BMJ found that surrogates face a somewhat higher rate of certain complications compared to women who conceive naturally. These include a greater likelihood of severe preeclampsia (dangerously high blood pressure), postpartum hemorrhage, and preterm delivery. Part of this elevated risk comes from the IVF process itself, and part reflects that surrogates are more likely to carry multiples, which raises the chance of complications regardless of how conception occurred.
These risks don’t mean surrogacy is unsafe, but they’re worth understanding before you commit. Your medical screening exists in part to identify whether you’re at higher or lower risk for these outcomes based on your personal health history.
After Delivery
Once the baby is born, the intended parents take custody, and depending on your state’s laws, a pre-birth or post-birth court order formally establishes their legal parentage. Your postpartum recovery is your own, and your contract typically includes a recovery period with continued support from the intended parents.
Some surrogates choose to pump breast milk for the baby after delivery. This is an optional arrangement worked out between you and the intended parents. If you’re interested, many surrogates donate through nonprofit milk banks, which require a brief health screening and blood test. Milk banks typically ask for a minimum donation of around 150 ounces and provide shipping supplies if you don’t live near a collection depot. Pumping is never required, and nonprofit milk banks do not compensate donors, though some intended parents offer separate compensation for pumping through private arrangements.
How Long the Entire Process Takes
From your first application to delivery day, expect the full journey to span 18 to 24 months. The breakdown looks roughly like this: one to three months for screening, two to ten months for matching, one to two months for legal contracts, about two months for the medical cycle and embryo transfer, and then nine months of pregnancy. Some journeys move faster, and some stretch longer, particularly if the first embryo transfer doesn’t result in pregnancy. Most surrogates describe the process as deeply rewarding but also emotionally and physically demanding, so having a strong support system at home makes a meaningful difference.