Surrogacy is a multi-step process that typically takes 15 to 24 months from start to birth and costs between $120,000 and $180,000 in the United States. It involves matching with a surrogate, completing legal agreements, preparing both parties medically, transferring an embryo, and carrying the pregnancy to term. The specific steps depend on whether you pursue gestational or traditional surrogacy, though gestational surrogacy accounts for the vast majority of arrangements today.
Gestational vs. Traditional Surrogacy
The two types of surrogacy differ in one fundamental way: who provides the egg. In gestational surrogacy, the surrogate has no genetic connection to the baby. An embryo is created through IVF using eggs and sperm from the intended parents, donors, or a combination, then transferred into the surrogate’s uterus. In traditional surrogacy, the surrogate uses her own egg, making her the biological mother of the child. Fertilization in traditional surrogacy typically happens through intrauterine insemination rather than IVF.
Gestational surrogacy is far more common because it creates a clearer legal and emotional separation between the surrogate and the child. Most surrogacy agencies and fertility clinics work exclusively with gestational carriers. The rest of this article focuses on gestational surrogacy, since that’s the process most people will go through.
Finding and Matching With a Surrogate
Most intended parents work with a surrogacy agency, which maintains a pool of pre-screened candidates and facilitates introductions. The agency considers preferences on both sides: location, communication style, views on pregnancy decisions, and whether the surrogate and intended parents want an ongoing relationship. Matching alone takes six months to over a year, making it the longest pre-pregnancy phase of the process.
Some intended parents skip agencies and work with someone they already know, such as a friend or family member. This route is less expensive but still requires the same medical and legal steps. Independent arrangements carry more coordination burden since there’s no agency managing timelines and paperwork.
Screening the Surrogate
Once a potential match is identified, the surrogate goes through extensive medical and psychological evaluation before anything moves forward. The American Society for Reproductive Medicine recommends a medical history review, physical examination, lab work, and an evaluation of the uterine cavity to confirm the surrogate can safely carry a pregnancy.
Candidates are ruled out for specific red flags: evidence of sexually transmitted infections, nonmedical drug use, or signs of transmissible disease. On the psychological side, evaluators look for the ability to emotionally separate from the child at birth, an altruistic motivation for becoming a surrogate, and sufficient cognitive functioning to give informed consent. A history of major depression, postpartum mood disorders, current use of psychoactive medications, or any evidence of financial or emotional coercion will disqualify a candidate.
The surrogate also needs a stable home environment with a support system to help manage the physical and emotional demands of carrying a pregnancy for someone else. Medical screening typically costs $1,000 to $2,500, and the psychological evaluation runs $600 to $1,200.
Legal Contracts
Before any medical procedures begin, both parties sign a legal agreement that spells out parental rights, financial obligations, decision-making authority during pregnancy, and what happens in various scenarios (multiples, complications, pregnancy termination). Each side has their own attorney. This contract is what protects both the intended parents’ parental rights and the surrogate’s rights and compensation. In many states, this agreement is also the basis for obtaining a pre-birth order, which puts the intended parents’ names on the birth certificate from day one.
Creating the Embryo
If the intended parents don’t already have frozen embryos, the next step is an IVF cycle. The egg provider (either the intended mother or an egg donor) takes hormone medications to stimulate the ovaries to produce multiple eggs in a single cycle. Those eggs are retrieved in a short outpatient procedure and fertilized with sperm in the lab. The resulting embryos develop for five to six days before being frozen or selected for transfer. An IVF cycle including embryo creation typically costs $16,000 to $28,000.
Preparing the Surrogate’s Body
While the embryo is being created or thawed, the surrogate begins a medication protocol to prepare her uterus for implantation. This involves three main components. Estrogen supplements, taken orally two to three times per week starting at the beginning of her cycle, build up the uterine lining to the right thickness. Progesterone, usually administered as a vaginal insert or cream, makes the uterus receptive to the embryo by triggering it to produce the nutrients an embryo needs in its earliest days. Some surrogates also take an injectable medication that prevents their natural menstrual cycle from interfering with the carefully timed preparation. This injection is typically self-administered.
The fertility clinic monitors the surrogate’s uterine lining through ultrasounds and blood work to confirm she’s ready for the transfer.
The Embryo Transfer
The transfer itself is one of the simplest parts of the entire process. It takes about 10 to 15 minutes and doesn’t require anesthesia. A doctor uses ultrasound guidance to thread a thin, soft catheter through the cervix and place the embryo in the upper or middle portion of the uterine cavity. Research shows that ultrasound-guided transfers improve both pregnancy and live birth rates compared to blind transfers.
Beforehand, the doctor removes cervical mucus to give the catheter a clear path, which also improves outcomes. After the embryo is deposited, the catheter is withdrawn immediately. Despite what many people assume, bed rest after the transfer is not recommended. Studies show it doesn’t improve success rates, and the surrogate can resume normal activity right away.
A frozen embryo transfer costs $3,000 to $5,000 on top of the original IVF cycle. About 10 to 14 days after the transfer, a blood test confirms whether the pregnancy has taken.
Pregnancy and Ongoing Care
If the test is positive, the surrogate continues taking estrogen and progesterone for about eight weeks to support the pregnancy until the placenta takes over hormone production. After that point, she transitions to standard prenatal care with an OB-GYN, following the same schedule of checkups, ultrasounds, and lab work as any other pregnancy.
Throughout the pregnancy, intended parents and surrogates typically stay in close contact. Many attend ultrasound appointments together. The surrogate receives a monthly allowance (usually $250 to $350) plus coverage for maternity clothing and other pregnancy-related expenses. If complications arise that require bed rest or time off work, separate disability insurance can cover lost wages, childcare, and household help.
Insurance and Medical Costs
Health insurance for the surrogate is one of the more complex financial pieces. Some surrogates have existing insurance plans that cover surrogacy-related care, but many don’t, and some plans explicitly exclude it. If coverage isn’t available through the surrogate’s own policy, intended parents purchase a dedicated surrogacy maternity insurance plan, which typically costs $15,000 to $30,000.
These plans cover routine prenatal visits, hospital delivery charges, and complications like preterm labor, gestational diabetes, or hypertension. Without insurance, intended parents bear the full financial risk, which can reach hundreds of thousands of dollars if serious complications occur during pregnancy or delivery. Many families also add backup maternity insurance in case the surrogate’s existing plan changes mid-pregnancy.
Full Cost Breakdown
The total cost of surrogacy in the United States for 2025 ranges from $120,000 to $180,000. Here’s where that money goes:
- Surrogate base compensation: $45,000 to $65,000. First-time surrogates fall on the lower end ($45,000 to $55,000), while experienced surrogates earn $60,000 to $65,000.
- Agency fees: $26,000 to $38,000
- IVF and embryo creation: $16,000 to $28,000
- Surrogate insurance: $15,000 to $30,000
- Surrogate benefits and allowances: $6,000 to $12,000
- Frozen embryo transfer: $3,000 to $5,000
- Medical and psychological screening: $1,600 to $3,700
These figures don’t include legal fees, which vary by state, or the cost of egg or sperm donation if needed. Multiple transfer attempts also add to the total. Some intended parents spend less by working independently without an agency or by using a known surrogate, though legal and medical costs remain.
How Long the Whole Process Takes
From the moment you begin working with an agency to the day the baby is born, expect roughly 15 to 24 months. The matching phase alone accounts for six months to over a year. Legal contracts, medical screening, and surrogate preparation add another two to three months. Then there’s the pregnancy itself, which is a standard 9 months (closer to 10 calendar months). If the first embryo transfer doesn’t result in pregnancy, add another one to two months per additional attempt.