How Does Surrogacy Work? The Complete Step-by-Step Guide
For many intended parents, surrogacy is how a long-awaited family becomes possible. In gestational surrogacy, an embryo created through in vitro fertilization (IVF) is transferred to a gestational carrier, who carries the pregnancy but has no genetic connection to the baby. In practice, medical care, legal preparation, and coordination between everyone involved often happen alongside one another.
This guide explains each stage from an intended parent’s point of view: what happens, who handles it, what needs to be ready before the next step, and what can slow things down. It also covers timelines and costs, including how the process works at Physician’s Surrogacy, the nation’s only OB-managed surrogacy program.
Key Takeaways
- Gestational surrogacy is the standard form in the U.S. The surrogate carries the pregnancy but is not genetically related to the baby.
- Embryo readiness has a large effect on timing. You can begin planning and matching while embryos are created, but they must be ready before a transfer.
- Screening, a signed legal agreement, insurance review, and funded escrow all need to be in place before an embryo transfer.
- Legal parentage comes from state-specific legal steps, not from genetics or a contract alone.
- Physician’s Surrogacy’s core programs have an estimated timeline of 18 to 22 months from matching to baby, with prices from $145,000 to $260,000 that are fixed once your plan is set.
What Is Gestational Surrogacy?
Surrogacy is an arrangement in which a woman carries a pregnancy for another person or couple. There are two types, and in practice only one is widely used today.
Gestational Surrogacy
The embryo is created through IVF and transferred to the carrier’s uterus. The eggs and sperm can come from the intended parents, from donors, or from a combination of both. The carrier has no genetic connection to the baby. This is the form used in almost all U.S. surrogacy arrangements and the only form Physician’s Surrogacy offers.
Traditional Surrogacy
The carrier’s own egg is used, so she is genetically related to the baby. This adds legal complexity, is restricted in a number of states, and is offered by few programs, for reasons set out in our comparison of gestational and traditional surrogacy.
Who Uses Surrogacy?
People come to surrogacy for many reasons. Some have a medical condition that makes pregnancy unsafe or impossible, or have had a hysterectomy or cancer treatment. Some have experienced recurrent pregnancy loss or IVF cycles that did not lead to a pregnancy. Gay couples, single men, and single women also build their families this way, and LGBTQ+ surrogacy and surrogacy for single parents each bring their own legal and planning considerations.
The Surrogacy Process Step by Step
Most arrangements follow the stages below. Some happen at the same time, and the exact order depends on your program, your fertility clinic, and the state where your baby will be born.
Step 1: Consultation and Planning
You talk through your goals, embryo status, preferred timing, budget, and where your baby might be born. At Physician’s Surrogacy, this first conversation is a complimentary consultation with our team.
What to clarify here: your program options, embryo status, budget, and next steps.
Step 2: Embryo Creation or Embryo Review
If you already have frozen embryos, your fertility clinic reviews them, including any genetic testing results, and confirms how many are available. If you don’t, your clinic creates embryos through IVF, using eggs and sperm from the intended parents, from donors, or both.
Embryo creation can run alongside matching, but embryos must be ready before a transfer can be scheduled. Starting early can help prevent delays later.
Step 3: Surrogate Screening
Every potential surrogate goes through medical, psychological, and background screening. Professional guidance from the American Society for Reproductive Medicine on gestational carriers calls for a complete medical evaluation and a psychological evaluation for the surrogate and her partner, and psychosocial counseling for intended parents.
At Physician’s Surrogacy, candidates are evaluated under a screening protocol designed by our onsite OB/GYNs. Surrogates in our Medically Cleared Program complete their medical and psychological clearance before they are matched, through a partner IVF clinic. This route requires your embryo transfer procedure to take place at a partner IVF clinic.
If your embryos are currently stored elsewhere, you can ask us about arranging for them to be shipped to a partner IVF clinic. If you prefer to complete your embryo transfer at an outside clinic, our Medically Pre-Screened route applies instead, and that clinic performs its own review and medical screening of your surrogate.
Step 4: Matching
Matching pairs you with a surrogate whose expectations align with yours. That includes communication preferences, views on medical decisions such as how many embryos to transfer, and the relationship you each hope to have during and after the pregnancy. Both sides agree before a match is confirmed.
At Physician’s Surrogacy, the average match time is about one week. Your own timing will depend on your preferences and circumstances.
Step 5: Legal Agreement, Insurance, and Escrow
After matching, you and your surrogate each work with an independent attorney licensed in the relevant state. Together they draft and negotiate the surrogacy agreement, which covers compensation, expenses, medical decision-making, insurance, communication, and the legal steps to establish parentage.
At the same time, your surrogate’s health insurance is checked for surrogacy coverage, and funds are placed in escrow.
Ready before the next step: a signed agreement, confirmed insurance, and funded escrow.
Step 6: Transfer Preparation and Embryo Transfer
Your fertility clinic confirms that your surrogate is ready for transfer under its own requirements, then prepares her with medication. The embryo transfer is a brief outpatient procedure. ASRM strongly recommends transferring a single embryo in gestational carrier cycles to reduce the health risks of a multiple pregnancy.
Step 7: Pregnancy Confirmation and Prenatal Care
A blood pregnancy test follows the transfer, and early ultrasounds take place at the fertility clinic. Once the pregnancy is established, care moves to the surrogate’s obstetrician for routine prenatal visits.
Throughout the pregnancy, our onsite OB/GYNs review your surrogate’s prenatal records and share physician updates with you. If a complication arises, they consult directly with her obstetrician. Your surrogate keeps the right to make decisions about her own body and medical care. ASRM’s ethics guidance states that she retains ultimate decision-making authority over her own care.
If a transfer doesn’t lead to an ongoing pregnancy: this happens, and it is hard. Your clinic reviews the cycle with you. If embryos remain, another transfer can be planned based on your clinic’s advice, with both you and your surrogate agreeing, under the terms of your agreement. How additional transfers are covered depends on your program, so ask about this before you sign.
Step 8: Parentage, Delivery, and After Birth
Legal parentage is established through state-specific steps. In many surrogacy-friendly states, your attorney can request a pre-birth order during pregnancy so the hospital can list you as the parents. Other states require steps after birth. Parentage rules are among the biggest differences in surrogacy laws by state.
Before delivery, a hospital plan sets out who will be in the delivery room, how you will care for your baby after birth, and what paperwork the hospital needs. Your surrogate delivers at her local hospital, and support for her continues through her recovery.
Schedule a complimentary consultation with our team.
How Long Does Surrogacy Take?
Three things drive most of the timeline: whether your embryos are ready, how quickly you match, and whether the first transfer leads to an ongoing pregnancy. Once a transfer succeeds, a full-term pregnancy takes roughly nine more months.
Physician’s Surrogacy’s core programs have an estimated timeline of 18 to 22 months from matching to baby. Planning and embryo creation before matching sit outside that range. The Physician Plus add-on has an estimated timeline of 11 to 13 months from program commitment to delivery, our fastest. That estimate assumes your embryos are already available, or are created without delaying treatment.
The table shows the order of stages, what each one depends on, and what may happen at the same time. Exact sequencing depends on your program and clinic.
| Stage | What needs to be ready | What may overlap |
|---|---|---|
| Planning and program choice | Your consultation | Embryo planning |
| Embryo creation or review | A fertility clinic and either existing embryos for review or a plan for egg and sperm sources | Matching and legal work |
| Matching | A program choice and screened surrogate candidates | Embryo creation |
| Legal agreement, insurance, and escrow | A confirmed match | Embryo creation |
| Transfer preparation | A signed agreement, confirmed insurance, funded escrow, ready embryos, and your clinic’s go-ahead | Varies by clinic |
| Transfer and pregnancy confirmation | Completed transfer preparation | Parentage planning |
| Prenatal care | A confirmed ongoing pregnancy | Parentage steps and hospital planning |
| Delivery and after birth | A hospital plan | Post-birth legal steps, where required |
What Can Cause Delays
- Embryos that aren’t ready. Additional IVF cycles or genetic testing can add months. Start embryo planning early.
- Medical screening after matching. When full screening happens after a match, a surrogate can be declined at that stage. Our Medically Cleared Program moves medical and psychological screening before matching to reduce this risk, for transfers at a partner IVF clinic.
- Insurance gaps. If your surrogate’s policy doesn’t cover surrogacy, the gap needs to be resolved through an approved insurance plan before transfer.
- State legal requirements. Some states require more steps, or steps after birth. Knowing your delivery state early lets attorneys prepare in parallel.
- A transfer that doesn’t lead to pregnancy. Each additional transfer adds a new medical cycle.
- Pregnancy complications. These can change delivery timing and the care plan.
How Much Does Surrogacy Cost?
The total cost of surrogacy usually includes surrogate compensation and expenses, program coordination, legal fees for both sides, IVF and embryo transfer costs, and insurance. What is included varies widely between providers, so compare them line by line. Each category is broken down in our surrogacy cost guide.
At Physician’s Surrogacy, inclusions differ by program:
| Program | Price | Estimated timeline | What it adds |
|---|---|---|---|
| Surrogacy Flat Rate | $145,000 | Estimated 18–22 months, matching to baby | Core services included in every program |
| Surrogacy Livebirth Guarantee | $213,000 | Estimated 18–22 months, matching to baby | All gestational carrier IVF expenses, plus the livebirth guarantee |
| All Inclusive Bundle | $260,000 | Estimated 18–22 months, matching to baby | Donor eggs, gestational carrier IVF, and the livebirth guarantee |
| Physician Plus (add-on) | +$48,000 | Estimated 11–13 months, program commitment to delivery, subject to embryo readiness* | Priority matching, a dedicated advisor, and birth concierge; can be added to any program |
Every program includes in-house OB medical oversight, surrogate compensation, escrow management, legal contracts, IVF coordination, and antenatal testing.
Before quoting, we review your surrogate’s state and its laws, your IVF clinic, your embryo status, and any medical requirements specific to you. Once your plan is set, your price is fixed. Current details, including when payments are due, are on our program pricing and financing page.
How Surrogate Funds Are Protected
Ask any program how surrogate compensation is held. With escrow, funds sit in a separate account and are released on the schedule set in your agreement as milestones are reached. That protects both you and your surrogate. At Physician’s Surrogacy, all surrogate compensation is managed this way. A program that asks you to pay a surrogate directly deserves a closer look, as do the other surrogacy red flags for intended parents.
A Note for International Intended Parents
Surrogacy in the U.S. involves both U.S. law and the law of your home country, including how your child’s citizenship and travel documents are handled. Federal rules on citizenship for some U.S.-born children have recently been the subject of executive action and court challenges. Speak with an attorney experienced in both assisted reproduction and immigration before you match.
How Physician’s Surrogacy Supports Each Stage
Physician’s Surrogacy is the nation’s only OB-managed surrogacy program.
birth rate than the
U.S. average
*Based on Physician’s Surrogacy outcomes data (2022), compared with the U.S. preterm birth rate of about 1 in 10 births reported by the CDC for the same year.
In practice, our physician-led model shapes each stage:
- Screening. Our onsite OB/GYNs design the screening protocol and review candidates.
- Matching. Our average match time is about one week. Through the Medically Cleared Program, surrogates are medically cleared before matching, with transfer at a partner IVF clinic.
- Pregnancy. Our physicians review prenatal records, send you physician updates, and consult directly with your surrogate’s obstetrician if a complication arises.
- Costs. Program prices are fixed once your plan is set, with surrogate funds managed through escrow.
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Frequently Asked Questions: How Does Surrogacy Work?
Julianna Nikolic
Chief Strategy Officer Julianna Nikolic leads strategic initiatives, focusing on growth, innovation, and patient-centered solutions in the reproductive sciences sector. With 26+ years of management experience and a strong entrepreneurial background, she brings deep expertise to advancing reproductive healthcare.
