Getting a surrogate in the United States is a multi-step process that typically takes 15 to 21 months from your first consultation to birth, with total costs averaging $150,000 to $200,000. The process involves choosing a type of surrogacy, finding and screening a surrogate, completing legal agreements, and coordinating the medical side through a fertility clinic. Here’s how each stage works.
Gestational vs. Traditional Surrogacy
The first decision you’ll make is which type of surrogacy to pursue. In gestational surrogacy, the surrogate carries an embryo created from the intended parents’ egg and sperm (or donor eggs and sperm), meaning she has no genetic connection to the child. This is the more common form of surrogacy today and the one most agencies, clinics, and attorneys work with.
In traditional surrogacy, the surrogate’s own egg is used, making her the biological mother. This creates significant legal complications around parental rights, so very few agencies facilitate it, and some states restrict or prohibit it altogether. For most intended parents, gestational surrogacy is the clearer, more legally straightforward path.
Agency vs. Independent Surrogacy
You can find a surrogate through an agency or on your own. Each route has real trade-offs.
A surrogacy agency handles matching, coordinates medical and psychological screening, manages the surrogate’s compensation through an escrow account, and connects you with reproductive attorneys. Agency fees typically run $30,000 to $50,000 on top of all other costs, but the structure they provide is substantial, especially for first-time intended parents navigating an unfamiliar process.
Independent surrogacy skips the agency fee entirely. Some intended parents already know someone willing to carry for them, which makes independent surrogacy a natural fit. But if you don’t already have a surrogate in mind, finding and vetting one on your own is difficult. You’ll need to independently arrange legal counsel, escrow services, psychological evaluations, and medical coordination. The savings are real, but the logistical burden shifts entirely to you.
Finding and Matching With a Surrogate
If you’re working with an agency, matching is their core service. You’ll fill out detailed profiles covering your preferences, values, and expectations for the pregnancy (things like communication frequency, dietary preferences, and whether you want to attend appointments). The agency then presents potential surrogates who align with your profile.
Expect this stage to take six months to over a year. Demand for surrogates consistently outpaces supply, and a good match matters more than a fast one. You’re looking for someone whose expectations, communication style, and comfort level with the arrangement align with yours. Most agencies arrange an initial meeting, either in person or by video, so both parties can decide whether the relationship feels right before moving forward.
Screening and Medical Requirements
Before any legal contracts are signed, your surrogate will go through medical and psychological screening. The American Society for Reproductive Medicine recommends a psychosocial evaluation by a qualified mental health professional for all potential surrogates and their partners. This evaluation covers emotional readiness, motivation, support systems, and an understanding of what relinquishing the baby involves.
On the medical side, the fertility clinic will run infectious disease testing, a review of the surrogate’s obstetric history, and a uterine evaluation. Women who test positive for certain active infections are excluded until signs of infection clear. The surrogate’s overall health, age, and prior pregnancy outcomes all factor into whether the clinic will approve her.
This screening typically happens after you’ve matched but before legal agreements are finalized. If a surrogate doesn’t pass screening, the matching process starts over, which is one reason the timeline can stretch.
Legal Agreements and Parental Rights
Both you and the surrogate will retain separate reproductive law attorneys to draft and negotiate a surrogacy contract. This agreement covers compensation, medical decisions during pregnancy, expectations around lifestyle during the pregnancy, what happens if there are complications, and how parental rights will be established. Attorney fees for both sides together generally add $8,000 to $16,000 to the total cost.
How you secure your legal parentage depends heavily on which state the baby is born in. Some states allow pre-birth orders, which are court orders issued before the child is born that name you as the legal parents and place your names directly on the birth certificate. If a pre-birth order isn’t available in the state of birth, you may be able to obtain one from a different state (such as your home state or the state where the embryo transfer occurred) and have it recognized across state lines.
Other states require a post-birth parentage order, which works similarly but is filed after delivery. Genetic testing may be required, and if one intended parent isn’t genetically related to the child, a stepparent adoption is sometimes necessary. In cases where neither intended parent has a genetic connection to the child (for example, when using both donor eggs and donor sperm), some states require a full adoption. A handful of states have simpler administrative processes where you file affidavits directly with the vital records office. Your attorney will map out the specific legal path based on where everyone lives and where the birth will occur.
The IVF and Embryo Transfer Process
Once the contract is signed, the medical process begins at a fertility clinic. If you’re using your own eggs, you’ll go through an egg retrieval cycle involving hormone injections over roughly 10 to 14 days, followed by a minor procedure to collect the eggs. The eggs are fertilized in the lab to create embryos, which can be tested for genetic abnormalities before transfer.
The surrogate takes hormones to prepare her uterine lining, and then one embryo is transferred. Live birth rates for gestational surrogacy using donor eggs from women under 35 are around 55%, which is higher than standard IVF because surrogates are specifically selected for their history of healthy pregnancies. If the first transfer doesn’t result in pregnancy, subsequent transfers can be attempted with remaining embryos.
After a confirmed pregnancy, the surrogate transitions to regular prenatal care with an OB-GYN. Most intended parents attend key appointments and the birth itself, though the specifics are whatever you and the surrogate agreed to in your contract.
What It Actually Costs
The $150,000 to $200,000 average covers several major categories. Surrogate compensation is the largest single expense. First-time surrogates typically receive $50,000 to $70,000 in base pay, with variation by state: Florida starts around $50,000 to $60,000, Massachusetts around $60,000, and Illinois around $70,000. Experienced surrogates who have completed previous journeys command higher fees.
Beyond base compensation, you’ll cover the surrogate’s pregnancy-related expenses: maternity clothing, travel to appointments, lost wages, and health insurance premiums or a surrogacy-specific insurance policy if her existing plan doesn’t cover surrogate pregnancies. Agency fees add $30,000 to $50,000, legal fees add $8,000 to $16,000, and IVF costs (including medications, lab work, and embryo transfer) typically run $15,000 to $30,000 per cycle.
Some intended parents reduce costs by working independently, using known surrogates, or pursuing surrogacy in states with lower compensation baselines. Financing plans and surrogacy-specific loans exist, though interest rates vary widely. It’s worth mapping out the full cost breakdown with your agency or attorney early, since unexpected expenses (a failed transfer requiring a second cycle, complications requiring bed rest pay) can push the total higher.
Choosing the Right State
Surrogacy law in the United States is regulated at the state level, and the differences are significant. Some states, like California, Illinois, and Connecticut, have well-established surrogacy-friendly statutes with straightforward pre-birth order processes. Others have restrictive or ambiguous laws that make the process harder or riskier.
Your surrogate doesn’t have to live in the same state you do. Many intended parents work with surrogates in surrogacy-friendly states specifically to take advantage of clearer legal protections. Your reproductive attorney will help you evaluate the legal landscape based on your situation, including your state of residence, the surrogate’s location, and where the embryo transfer and birth will take place.