Becoming a gestational surrogate involves meeting specific health and lifestyle requirements, passing medical and psychological screenings, matching with intended parents, and completing legal agreements before the embryo transfer process begins. The entire journey from application to delivery typically spans 12 to 18 months, with base compensation for first-time surrogates ranging from $55,000 to $70,000 depending on your state.
Basic Eligibility Requirements
Most surrogacy agencies and fertility clinics follow guidelines from the American Society for Reproductive Medicine (ASRM) when screening candidates. The ideal surrogate is a healthy woman between the ages of 21 and 42, though most agencies prefer candidates younger than 35. You need a history of at least one normal pregnancy carried to full term without major complications. This requirement exists because it demonstrates your body can sustain a healthy pregnancy and gives the fertility team confidence in a successful outcome.
Beyond reproductive history, agencies typically require a BMI within a healthy range (often under 33), no history of serious pregnancy complications like preeclampsia or preterm birth, and a stable living situation. You cannot smoke, use recreational drugs, or have certain chronic health conditions. Most agencies also require that you are not currently receiving government assistance, since surrogacy compensation could affect your eligibility for those programs.
The Application and Matching Process
Your first step is applying with a surrogacy agency or, less commonly, connecting independently with intended parents. Agency applications ask about your medical history, pregnancy history, lifestyle, motivations for surrogacy, and family support. If your application is accepted, you enter a matching phase where the agency pairs you with intended parents based on preferences like communication style, views on selective reduction, and geographic proximity.
Matching alone can take six months to over a year. During this time, you and the intended parents typically have phone calls or video meetings to see if you are a good fit. Once both sides agree, the formal screening process begins.
Medical Screening
Medical screening is thorough and can take several weeks. It starts with a full physical examination, after which both you and your partner (if applicable) are tested for infectious diseases including HIV, Hepatitis B and C, syphilis, gonorrhea, chlamydia, and cytomegalovirus. You are also tested for blood type and Rh status, immunity to chickenpox and German measles, and screened for illicit drug use.
Your uterus gets evaluated through two types of ultrasound. A standard transvaginal ultrasound checks for abnormalities like fibroids or ovarian cysts. A second ultrasound called saline infusion sonography fills the uterine cavity with a saline solution, which opens the walls of the uterus so the doctor can examine the lining for fibroids, polyps, or scar tissue. Any of these findings could disqualify you or require treatment before moving forward.
Psychological Evaluation
ASRM guidelines recommend that all surrogate candidates undergo a psychosocial consultation and, where appropriate, psychological testing. The evaluation typically involves a clinical interview and a standardized personality questionnaire. A licensed mental health professional assesses your emotional readiness, your understanding of the surrogacy process, your ability to form and then release the attachment to the baby, and the strength of your support system at home.
This is not a pass/fail test of your mental health. The evaluator is looking for red flags like unresolved grief, financial desperation as a primary motivator, or a lack of family support. Your partner or spouse may also be interviewed, since surrogacy affects the entire household. Agencies typically cover the cost of this evaluation, and many offer ongoing counseling throughout the pregnancy as well.
Legal Contracts
Before any medical procedures begin, both you and the intended parents hire separate attorneys to draft and review a surrogacy contract. This legal agreement covers compensation, medical decisions, communication expectations, what happens in the event of complications, and the parental rights of the intended parents. Having independent legal counsel protects your interests, and the intended parents typically cover the cost of your attorney, often around $3,000.
Surrogacy laws vary significantly by state. Some states have clear, surrogate-friendly legal frameworks. Others have restrictions or lack established case law. Your attorney will ensure the contract is enforceable in your jurisdiction and that the intended parents’ names can be placed on the birth certificate, ideally through a pre-birth order.
Preparing Your Body for Embryo Transfer
Once medical clearance, psychological evaluation, and legal contracts are complete, you begin the medication protocol to prepare your uterus for an embryo transfer. This involves two key hormones. Estrogen is prescribed first to thicken your uterine lining and can be delivered through skin patches, injections, oral tablets, or vaginal inserts. You start estrogen after a baseline ultrasound confirms your body is ready.
Progesterone begins around day 15 of your cycle, pending ultrasound results confirming your lining has reached the right thickness. Progesterone supports the uterine lining and helps the embryo implant. It is given as an intramuscular injection (typically in the hip or upper buttock) or as a vaginal suppository. Many surrogates find the daily injections to be the most physically demanding part of the process. If the transfer is successful and pregnancy is confirmed, you continue progesterone for about 8 to 12 weeks before your body takes over hormone production naturally.
The embryo transfer itself is a brief, outpatient procedure. A doctor places the embryo into your uterus using a thin catheter, guided by ultrasound. It feels similar to a routine gynecological exam. You rest briefly afterward and then go home the same day. A pregnancy blood test follows about 10 to 14 days later.
What Happens During the Pregnancy
If the transfer results in a positive pregnancy test, you remain under the care of the fertility clinic for the first 8 to 10 weeks. After that, care transitions to your local OB-GYN, and the pregnancy proceeds much like any other. You attend regular prenatal appointments, and the intended parents are typically involved in major milestones like ultrasounds.
Communication during the pregnancy depends on what you and the intended parents agreed to in your contract. Some surrogates and intended parents develop close relationships with frequent updates. Others prefer a more business-like arrangement. There is no single right approach, but clear expectations set early prevent misunderstandings later.
Compensation Breakdown
Surrogate compensation varies by location and experience. As of 2025, first-time surrogates in most U.S. states earn a base of around $55,000, while those in California, where surrogacy demand is especially high, earn closer to $70,000. Repeat surrogates earn $65,000 to $85,000. These figures represent base pay only.
On top of base compensation, surrogates receive additional payments and covered expenses throughout the process:
- Monthly allowance: $350, starting at contract signing
- Medication start bonus: $500
- Embryo transfer bonus: $1,500
- Maternity clothing allowance: $1,500
- C-section compensation: $5,000
- Multiple births: $10,000 per additional baby
- Breast milk pumping: $350 per week
- Housekeeping allowance (third trimester): $300 per month
- Bedrest childcare and housekeeping: $400 per week if needed
Intended parents also cover your surrogacy-related health insurance (around $5,000 if your existing policy does not cover surrogacy), all medical expenses not covered by insurance, travel costs for clinic appointments, lost wages for you and typically up to 10 days of lost wages for your spouse, and a life insurance policy covering up to $700,000. When you add base pay, bonuses, and allowances together, total compensation for a first-time surrogate often exceeds $70,000 to $90,000.
How Long the Entire Process Takes
From your initial application to delivery, the surrogacy process generally takes 15 to 20 months. The application and matching phase is the least predictable, ranging from a few months to over a year. Once matched, medical screening, psychological evaluation, and legal contracts typically take two to three months combined. The medication protocol and embryo transfer add another four to six weeks. Then you carry the pregnancy for the standard 9 months.
Some surrogates need more than one embryo transfer to achieve pregnancy, which can add weeks or months to the timeline. Transfer success rates vary based on embryo quality, your age, and uterine health, but most fertility clinics report success rates of 60 to 75 percent per transfer with high-quality embryos.