A surrogate is a person who carries and delivers a baby for someone else. The intended parents, the people who will raise the child, may turn to surrogacy because of infertility, medical conditions that make pregnancy dangerous, or because they are unable to carry a pregnancy themselves. The surrogate goes through pregnancy and childbirth, then the baby goes home with the intended parents.
Two Types of Surrogacy
There are two distinct forms, and they differ in one critical 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 or donors, then transferred into the surrogate’s uterus. This is by far the more common arrangement today.
In traditional surrogacy, the surrogate’s own egg is used, typically fertilized through artificial insemination with sperm from the intended father or a donor. That makes the surrogate the biological mother of the child. Because of the legal and emotional complications this creates, traditional surrogacy is rarely used and many agencies won’t facilitate it.
Who Can Become a Surrogate
Not everyone qualifies. Clinical guidelines from the New York State Department of Health, which reflect standards used across much of the U.S., require that a potential surrogate be between 21 and 45 years old. She must have already carried at least one pregnancy to term without complications, and she cannot have had more than five total deliveries or more than three cesarean sections.
Beyond physical health, candidates go through psychological evaluation and counseling. Evaluators assess coping skills, personality style, psychiatric history, and social support systems. Conditions like major depression, bipolar disorder, psychosis, significant anxiety disorders, or unresolved addiction are disqualifying. So is an HIV diagnosis or active hepatitis. The surrogate also needs a stable home environment with adequate support to manage the physical and emotional demands of carrying a pregnancy for someone else.
What the Medical Process Looks Like
For gestational surrogacy, the process starts with fertility medication that prepares the surrogate’s uterus to receive an embryo. Meanwhile, embryos are created through IVF, either using the intended parents’ eggs and sperm or donor material. Once an embryo is ready, it’s transferred into the surrogate’s uterus.
If the pregnancy test comes back positive, the surrogate continues taking hormones (estrogen and progesterone) for about eight weeks to support the early pregnancy. Around 8 to 10 weeks, care transitions to the surrogate’s local obstetrician, and from that point the pregnancy looks much like any other, with regular prenatal visits through delivery.
A CDC analysis found that gestational carrier cycles using the intended mother’s eggs had a 17% higher live birth rate compared to standard IVF cycles where the person providing the egg also carries the pregnancy. Surrogates are specifically screened for their ability to carry a healthy pregnancy, which likely contributes to these outcomes.
How Long the Entire Process Takes
Surrogacy is not quick. Matching alone, finding a surrogate who is medically and personally compatible, takes six months to over a year. After matching, both sides go through legal negotiations, medical screening, and psychological evaluations before any embryo transfer happens. Then there’s the pregnancy itself. From start to finish, most intended parents should expect the journey to take 15 to 24 months, and sometimes longer if the first embryo transfer doesn’t result in pregnancy.
The Legal Side
Surrogacy law in the United States is determined state by state, and the rules vary dramatically. Some states, like California and Illinois, have comprehensive laws that strongly favor intended parents. Others, like certain states in the South, have restrictive provisions or no surrogacy-specific law at all.
A few common legal requirements show up across most surrogacy-friendly states. Both the surrogate and the intended parents need independent legal representation, meaning each side has their own attorney. Many states also require mental health clearance for both parties. Some states, like Texas, require proof that the intended mother cannot safely carry a pregnancy herself. In Oklahoma, the surrogacy agreement must be validated by a court before any embryo transfer takes place.
New York, which legalized gestational surrogacy in 2021, created a Surrogate’s Bill of Rights addressing independent legal counsel, life insurance, and the surrogate’s right to make her own medical decisions. Several financial obligations of intended parents extend until one year after the pregnancy ends. These protections reflect a broader trend toward formalizing the surrogate’s rights, not just the intended parents’ interests.
What Surrogates Are Paid
In the U.S., surrogates typically earn between $60,000 and $125,000 depending on experience and location. First-time surrogates generally receive $60,000 to $75,000, while experienced surrogates (those who have successfully completed a prior surrogacy) earn $85,000 to $125,000 or more. Base compensation is usually paid in equal monthly installments throughout the pregnancy.
On top of base pay, surrogates receive milestone bonuses at contract signing, when medications start, and at embryo transfer, adding roughly $3,500 to $5,500. Additional bonuses may apply for specific circumstances: $5,000 to $10,000 for carrying twins, $3,000 to $5,000 for a cesarean delivery, and $250 to $300 per week if the surrogate provides breast milk after birth.
This is the compensation to the surrogate alone. Intended parents also cover all medical expenses, legal fees, agency fees, and IVF costs, which together make surrogacy one of the most expensive paths to parenthood.
Psychological Screening and Support
Both surrogates and intended parents go through psychological evaluation before the process begins. For surrogates, evaluators use standardized tools that measure emotional functioning, coping patterns, and screen for depression and anxiety. For intended parents, relationship stability may also be assessed. The goal is to confirm that everyone involved is emotionally prepared and has realistic expectations about the journey ahead.
These evaluations aren’t just a gate to pass through. They help identify potential friction points early, like differing expectations about how much contact the surrogate and intended parents will have during the pregnancy, or how involved the intended parents want to be at medical appointments. Strong support systems matter: evaluators look at whether the surrogate has family or friends who understand and support her decision, since carrying a baby you won’t take home requires a level of emotional resilience that’s hard to sustain in isolation.
Where Surrogacy Is Legal Worldwide
Globally, surrogacy laws fall into three categories: countries that allow commercial surrogacy (where the surrogate is paid), countries that allow only altruistic surrogacy (where the surrogate receives no compensation beyond expenses), and countries where surrogacy is banned entirely.
The U.S. remains the most popular destination for commercial surrogacy, particularly in states like California and Illinois, which offer strong legal protections for all types of intended parents, including same-sex couples and single individuals. Georgia (the country) also permits commercial surrogacy with laws that recognize intended parents as legal parents from birth.
Canada and the United Kingdom allow only altruistic surrogacy. In the UK, the surrogate retains legal parenthood until the intended parents obtain a court order after birth, which adds a layer of legal complexity. Canada’s system is more streamlined, but the altruistic model means longer wait times since fewer people volunteer without compensation. Iran permits both commercial and altruistic surrogacy, but restricts it to legally married heterosexual couples.