Surrogacy for a Friend or Family: 9 Questions to Ask First

Carrying a baby for a friend or family member is one of the most generous gifts you can give. If you’re considering this incredible act of love, you’re probably filled with a mix of excitement and questions.

But the path to surrogacy can feel complicated and overwhelming. You might be worried about unexpected costs like legal fees or special insurance, or feel lost navigating the different state laws. It’s a journey with significant financial, legal, and emotional considerations that need careful planning.

That’s why we’ve put together this guide. We’ll walk you through the most important questions to discuss with your loved ones before starting this journey. Our goal is to help you begin this incredible process with clarity and confidence.

Key Takeaways

• Becoming a surrogate for a loved one is a year-long journey requiring thorough medical, legal, and psychological screenings.
• Even in an “altruistic” arrangement, all expenses—from legal fees to lost wages—must be clearly defined and covered by the intended parents.
• A formal legal contract, drafted by separate lawyers for each party, is essential to protect everyone and prevent future misunderstandings.

Here at Physician’s Surrogacy, we believe that every surrogacy journey, especially one built on love, deserves the best support. Our OB-managed approach provides a layer of medical safety and guidance that can make all the difference.

1. What does this commitment really involve?

When you think about becoming a surrogate, you might focus on the pregnancy itself. But the reality is that surrogacy is a commitment that extends well beyond those nine months. In fact, the entire process typically takes more than a year from start to finish.

Before you even become pregnant, you’ll go through:

• Comprehensive medical screenings
• Psychological evaluations
• Legal consultations
• Multiple fertility clinic appointments

Many surrogates are surprised by the number of “hoops to go through before being approved to carry.” These steps aren’t just formalities—they’re important safeguards for everyone involved.

Once pregnancy begins, you’ll have:

• Regular OB appointments (often more frequent than a typical pregnancy)
• Additional ultrasounds
• Possible specialist visits
• Check-ins with the fertility clinic

The emotional commitment is significant too. The IVF process can be a roller coaster of hope and disappointment if transfers aren’t successful on the first try. You’ll be sharing this emotional journey with your friend or family member, which adds another layer of complexity to your relationship.

Remember: This isn’t just about having a baby—it’s about helping someone else have their baby, which requires a different mindset and expectations than your own pregnancies.

2. Am I medically and psychologically ready for this?

Before you can become a surrogate, you’ll need to meet certain medical and psychological criteria. These requirements aren’t meant to be obstacles—they’re in place to protect you, the baby, and the intended parents.

The Basic Requirements

Most surrogacy arrangements require that you:

• Age: Be between 21-42 years old
• Pregnancy History: Have given birth to at least one child with no major complications. Most agencies and clinics limit surrogates to no more than three previous C-sections or six total births
• Health: Be in good general health with a BMI typically below 32, be a non-smoker, and have no active drug use
• Lifestyle: Have a stable home environment and a strong support system

These requirements may seem strict, but they’re based on medical data about what makes for the safest possible surrogate pregnancy.

The Full Medical Screening Process

The medical screening process is comprehensive and includes:

• Medical Records Review: Your past pregnancy and health records will be carefully reviewed by medical professionals
• In-Clinic Screening:
  • Physical exam (height, weight, BMI, vitals)
  • Pelvic ultrasound to check your uterus and ovaries
  • Blood and urine tests for infectious diseases, drug use, hormone levels, and immunity
  • Sometimes additional tests like a hysterosalpingogram or saline ultrasound to check your uterine cavity
• Partner Screening: Your partner (if you have one) will also likely need to be screened for drug use and infectious diseases

The Psychological Evaluation

The psychological component involves:

• A consultation with a Licensed Mental Health Professional
• Often a personality assessment
• Discussions about how you’ll handle the emotional aspects of carrying someone else’s child

This evaluation isn’t about judging you—it’s about making sure you’re emotionally prepared for this journey and helping you anticipate potential challenges.

Getting through all this screening can feel like a long wait. That’s why we developed our Medically Cleared Fast Track Program. We help surrogates complete all their medical and psychological screenings upfront, so when you and your loved ones are ready, there are no delays or surprises.

3. How will we handle the money and expenses?

Let’s talk about something that can be awkward but is absolutely necessary—money. It can feel uncomfortable to discuss finances with friends or family, but it’s one of the most important conversations you’ll need to have.

Altruistic vs. Commercial Surrogacy

When you’re becoming a surrogate for someone you care about, you might hear the term “altruistic surrogacy.” This typically means you’re not receiving a large fee for carrying the pregnancy.

But here’s a critical point that many people misunderstand: Altruistic does not mean free.

As one surrogate shared, even in an altruistic arrangement, the intended parents still paid for “psych appointments and evaluations, lawyers and contract time, notary… ART risk insurance… and life insurance.”

The total costs for medical expenses, even in an altruistic arrangement, can range from $15,000 to over $100,000. That’s why clear communication about finances is essential from the beginning.

Expenses to Discuss

Here’s a list of expenses that should be covered, even in an altruistic arrangement:

• Medical Expenses: All co-pays, deductibles, medications, and medical procedures not covered by insurance
• Legal Fees: Costs for two separate lawyers (one for you, one for the intended parents) to draft and review the surrogacy contract
• Insurance: The cost of a new health insurance policy if yours isn’t surrogacy-friendly, plus life insurance and disability policies
• Lost Wages: Compensation for time taken off work for appointments and recovery after birth
• Pregnancy-Related Costs: Maternity clothes, travel to and from appointments, childcare for your own children during appointments, etc.

It’s important to create a detailed budget that accounts for all these expenses. Being thorough now helps prevent uncomfortable situations later.

While you’re helping a loved one, you should be fully supported, not financially burdened. At Physician’s Surrogacy, our compensation packages (starting from $48,000) are transparent and designed to cover all these needs, providing a helpful framework for your own discussions.

4. What do we need to know about the legal side of things?

When it comes to surrogacy for a friend or family member, you might think you can skip the legal formalities. After all, you trust each other, right? The truth is, a formal legal contract is non-negotiable, no matter how close you are. This protects everyone involved.

State Laws Matter

One crucial point that came up in our research is the importance of working with an attorney who understands your specific state’s laws. As one person wisely shared, “if you have a good attorney who knows everything involved (from your state bc of adoption and surrogacy laws differ state to state) you should be good.”

Surrogacy laws vary dramatically across the United States. Some states are very surrogacy-friendly, while others have restrictions or even prohibitions on certain types of arrangements.

Two Lawyers are a Must

Even though you’re helping someone you care about, you and the intended parents need separate legal representation. This isn’t about not trusting each other—it’s about making sure both parties fully understand their rights and responsibilities, and that the agreement is fair to everyone.

What the Contract Should Cover

Your surrogacy contract should address:

• Parental rights and who will be on the birth certificate
• A detailed breakdown of all financial responsibilities
• Decisions about medical care during the pregnancy (including sensitive topics like selective reduction or termination)
• Expectations for communication and involvement during pregnancy
• Plans for the birth and immediately afterward
• Future contact and relationship expectations

Taking the time to address these issues legally now can prevent misunderstandings and protect your relationship in the long run.

5. How will this affect our relationship?

Becoming a surrogate for a friend or family member will inevitably change your relationship. This journey can bring you closer together through a shared, life-changing experience—but it can also add new pressures to your existing relationship.

Key Questions to Discuss Beforehand

Before you begin, have open, honest conversations about:

• Pregnancy Involvement: How many appointments do the intended parents want to attend? How often will you communicate about the pregnancy (texts, calls, updates)?
• Boundaries: What level of input will they have about your activities, diet, and lifestyle during pregnancy? How will decisions be made if there are differing opinions?
• Parenting Philosophies: Talk openly about their views on healthcare, lifestyle, and other choices. Remember, you are helping them build their family.
• The “What Ifs”: What happens if the embryo transfer doesn’t work the first time? What if the doctor recommends bed rest? What if there are complications?
• After the Birth: What will your relationship look like? Will you be “Auntie”? How will you talk about the surrogacy journey with the child as they grow up?

The goal of these conversations isn’t to agree on everything, but to understand each other’s perspectives and make sure everyone feels respected.

Sometimes, people assume they’re on the same page because they’re close, only to discover differences when they’re already in the midst of the journey.

6. What kind of support system will I have?

The saying “it takes a village” definitely applies to surrogacy. While the intended parents will be your primary support, you’ll need a broader network to help you through this journey.

Your Personal Network

Start by having honest conversations with:

• Your Partner: They’ll need to understand the physical and emotional demands of the process, as well as how it might affect your relationship or family dynamics.
• Your Children: If you have kids, they’ll need age-appropriate explanations about why you’re pregnant but the baby won’t be coming home with you.
• Close Friends and Family: Identify people who can provide practical support (like childcare during appointments) and emotional support (a listening ear when things get tough).

Being clear about what you’ll need—whether it’s help with household chores during bed rest or someone to watch your kids during appointments—makes it easier for people to support you effectively.

Professional Support

Beyond your personal network, professional support is invaluable:

• Mental Health Professional: A therapist or counselor who specializes in third-party reproduction can help you navigate the complex emotions that can arise.
• Surrogate Support Groups: Connecting with others who have been surrogates (either online or in person) gives you access to people who truly understand what you’re experiencing.
• Dedicated Coordinator: Having a point person who can answer questions and coordinate between medical providers helps reduce stress.

This is where an agency can be a huge help, even in a private journey. Here at Physician’s Surrogacy, our surrogates have 24/7 access to their coordinator and a full team providing emotional and psychological support. Having an experienced, neutral third party to lean on can be a relief for both you and your loved ones.

7. What happens during the medical process and pregnancy?

Understanding the medical journey ahead helps you prepare mentally and physically for each step.

The Medical Process

Here’s a simplified overview of what to expect:

• Pre-Cycle Testing: Before starting medications, you’ll undergo baseline testing to check your hormone levels and uterine lining.
• Medications: You’ll take medications (often including injections) to prepare your body for pregnancy. These may include estrogen to build your uterine lining and progesterone to prepare it for implantation.
• Embryo Transfer: This is a relatively simple procedure at the fertility clinic where the embryo is transferred to your uterus using a thin catheter. It’s similar to a pap smear and usually doesn’t require anesthesia.
• Pregnancy Monitoring: The first few weeks will be closely monitored by the fertility clinic with blood tests and ultrasounds to confirm pregnancy and check for proper development.
• Transition to OB Care: Around 8-12 weeks, you’ll “graduate” from the fertility clinic to regular OB care for the remainder of the pregnancy.

Medical Oversight Makes a Difference

One of the biggest worries for everyone is the health of the surrogate and the baby. That’s why our process is OB-managed from start to finish. You’re not just handed off to a random doctor; our in-house medical team monitors your health and communicates directly with your IVF and OB clinics.

This level of oversight is why our surrogates have a preterm delivery rate that is less than 50% of the national average, offering incredible peace of mind for everyone.

For added reassurance, we also offer advanced testing options like NIPT (Non-Invasive Prenatal Testing) and Fetal Echocardiograms that can provide detailed information about the baby’s health during pregnancy.

8. What happens after the baby is born?

The birth is a momentous occasion, but it’s not the end of the surrogacy journey. Planning for the post-birth period is just as important as planning for the pregnancy itself.

The Emotional Transition

The days and weeks after birth can be emotionally complex. Even when you’re 100% committed to the surrogacy arrangement and have no desire to parent this child, your body doesn’t know that. Hormone fluctuations can trigger unexpected emotions.

It’s completely normal to feel a range of emotions: joy at completing your mission, grief for the end of this special time, sadness from hormonal changes, or relief that the pregnancy is over. Having support to process these feelings is important.

The Hospital Plan

To make the birth go smoothly, discuss these logistics beforehand:

• Who will be in the delivery room? (The intended parents? Your partner? Other support people?)
• Will the baby room-in with the intended parents?
• How will you handle hospital staff and paperwork? (Having copies of your legal agreement and birth plan for hospital staff is helpful)
• How much interaction do you want with the baby after birth?
• Will you be pumping breastmilk? If so, for how long?

Many hospitals are now familiar with surrogacy arrangements, but it’s still helpful to meet with the hospital’s social worker or patient advocate before delivery to make sure everyone understands the plan.

Postpartum Support

Remember that you’ll need time to recover physically and emotionally after birth:

• Plan for help at home during your physical recovery
• Consider scheduling check-ins with your therapist or support group
• Discuss what kind of contact you’ll have with the intended parents and baby in the immediate postpartum period

While the intended parents will be focused on their new baby, it’s important that they also acknowledge your recovery needs and the tremendous gift you’ve given them.

9. Is this really the right thing for me and my loved ones?

This final question is perhaps the most important one. Surrogacy is a profound commitment that will affect not just you, but your entire family.

Honest Self-Assessment

Ask yourself:

• Am I doing this because I truly want to, or because I feel pressured?
• Can my family handle the demands of this process?
• Am I prepared for the possibility of complications or difficult decisions?
• Have I thought through how this might affect my children and my relationship with them?

Family Considerations

Your children and partner will be on this journey with you. They’ll experience:

• Your time being dedicated to appointments and procedures
• Possible restrictions on family activities during the pregnancy
• Emotional ups and downs that may affect the household dynamic
• Questions from friends, family, and community members

Make sure you’ve discussed how this will impact them and that they’re supportive of your decision.

The Right Reasons

The best reason to become a surrogate is because you genuinely want to help create a family, understand what’s involved, and feel confident in your ability to complete the journey successfully.

If you’re feeling any doubts or pressures, it’s worth taking more time to consider or speaking with a counselor who specializes in surrogacy before making your decision.

Start Your Journey with Confidence

A successful surrogacy journey is built on love, trust, and clarity. To protect your relationship and set clear expectations, remember to create a formal legal contract and have honest conversations about money—”altruistic” doesn’t mean free, and all costs must be covered.

Your next step is simple: Choose one question from this guide to discuss openly with your loved one this week.

FAQs

What’s the difference between altruistic and commercial surrogacy?

The main difference between altruistic and commercial surrogacy is compensation. In an altruistic arrangement, you do not receive a large fee, but all expenses like medical bills, legal fees, and lost wages must still be fully covered by the intended parents.

How long does the entire surrogacy process take?

The entire surrogacy process typically takes over a year from start to finish. This includes initial screenings, legal contracts, the IVF cycle, the nine-month pregnancy, and postpartum recovery, making it a significant time commitment.

Do I really need a lawyer if it’s for a family member?

Yes, you absolutely need a lawyer even if the surrogacy is for a family member. A formal legal contract is essential to protect both you and the intended parents, clarify parental rights, and outline all financial responsibilities to prevent future misunderstandings.

What are the main medical requirements to be a surrogate?

The main medical requirements to be a surrogate include being 21-42 years old, having had at least one healthy pregnancy without complications, and being in good overall health with a stable lifestyle. These criteria ensure the safest possible journey for everyone.

Who pays for all the medical and legal expenses?

The intended parents pay for all medical and legal expenses in any surrogacy arrangement. This includes insurance co-pays, legal fees for both parties, lost wages for appointments, and other pregnancy-related costs. The surrogate should have no out-of-pocket expenses.

What happens if an embryo transfer doesn’t work?

If an embryo transfer doesn’t work, you and the intended parents will discuss next steps with the medical team. Your legal agreement should outline how many transfer attempts will be made and address the emotional and financial aspects of this possibility.

Can I be a surrogate if I’ve had a C-section?

Yes, you can often be a surrogate if you’ve had a C-section. However, most clinics and agencies prefer surrogates with no more than three previous C-sections to ensure the safety of the pregnancy. Your full medical history will be reviewed during screening.