Becoming a surrogate involves meeting a specific set of medical, psychological, and legal requirements before you’re matched with intended parents and begin the medical process. Most surrogacy agencies follow similar eligibility criteria, and the full journey from application to delivery typically takes 12 to 18 months. Here’s what the process actually looks like, step by step.
Basic Eligibility Requirements
The baseline criteria are consistent across most agencies and fertility clinics. You need to be between 21 and 43 years old, have carried at least one pregnancy to term and delivered a healthy child, and have a BMI between 18 and 35. Many clinics cap the BMI limit lower, at 32, so where you apply matters. A select few will consider applicants with a BMI up to 37 on a case-by-case basis.
The American Society for Reproductive Medicine, which sets the professional standards most clinics follow, states that carriers should be healthy, have a stable social environment, and have had at least one uncomplicated pregnancy resulting in a healthy child. You’ll also need to be a non-smoker (including vaping), not currently pregnant, and at least six months to a year past your most recent delivery.
What Disqualifies You
Some conditions are firm disqualifiers. HIV, hepatitis B or C, active substance use disorders, and active smoking or vaping will rule you out. So will a history of severe pregnancy complications like uterine rupture, eclampsia, or placental abruption that required an emergency hysterectomy. If you’re currently taking antipsychotic medication for conditions like schizophrenia, that’s also a hard disqualifier.
Other factors are evaluated individually rather than being automatic deal-breakers:
- Prior C-sections: One or two rarely disqualify you. Three puts you at the guideline limit and requires closer review.
- History of preeclampsia: Doctors look at severity, when it started, and whether later pregnancies were uncomplicated.
- Gestational diabetes: If you managed it with diet alone, it’s typically fine. Insulin-managed cases get more scrutiny.
- Depression or anxiety: Being on antidepressants doesn’t automatically disqualify you. Clinicians evaluate the specific medication, your dosage stability, and compatibility with pregnancy.
- GLP-1 medications: If you’re taking drugs like Ozempic or Wegovy for weight management, eligibility depends on timing and being fully cleared off the medication before embryo transfer.
The Application and Screening Process
Once you apply through a surrogacy agency, expect a thorough screening that covers your medical records, psychological health, and personal circumstances. The medical screening includes a review of your obstetric history, bloodwork, and a physical exam at a fertility clinic. You’ll also undergo an infectious disease panel.
The psychological evaluation is more involved than most people expect. It includes standardized personality assessments and a clinical interview covering your social history, family background, coping strategies, and how you handle conflict and stress. The evaluator will ask about any history of mood disorders, anxiety, eating disorders, prior hospitalizations, and past or current mental health treatment. If you have a therapist or psychiatrist, they may be contacted as part of the process.
Your spouse or partner, if you have one, also undergoes psychological evaluation. You’ll be asked to consider how the surrogacy will affect your own children and what you plan to tell them about the pregnancy. These conversations happen early because agencies want to confirm you have strong social support and realistic expectations before matching you with intended parents.
Legal Steps Before You Start
Surrogacy law varies dramatically by state. States like California, Colorado, Connecticut, Illinois, New York, and about 15 others have clear legal frameworks that permit gestational surrogacy and allow pre-birth parentage orders regardless of marital status or genetic connection. These are considered surrogacy-friendly states where the legal path is straightforward.
A few states create significant complications. In Arizona and Indiana, surrogacy contracts are either prohibited or unenforceable. Nebraska also declares surrogacy contracts void, and pre-birth parentage orders aren’t available there. Louisiana only permits surrogacy for married heterosexual couples who are both genetically related to the child. If you live in one of these states, the process is either impossible or requires careful legal navigation.
Regardless of your state, you’ll need your own independent attorney, separate from the intended parents’ lawyer. The contract covers compensation, medical decisions, expectations around prenatal care, and what happens in various scenarios. One important principle: you remain the sole source of consent for all medical decisions from embryo transfer through delivery and aftercare. No contract can override that.
The Medical Process
Gestational surrogacy uses IVF, meaning the embryo is created from the intended parents’ or donors’ eggs and sperm and then transferred to your uterus. You won’t be genetically related to the baby.
About a month before the transfer cycle, you’ll start on a medication schedule that typically begins with birth control pills to sync your cycle. You’ll then take hormones to prepare your uterine lining for implantation. The intended mother or egg donor goes through a separate stimulation process on her own timeline.
The embryo transfer itself is a short procedure. After three to five days of embryo development in the lab, a single embryo is transferred to your uterus. Single embryo transfer is the preferred approach for surrogacy cycles, which reduces the risk of twins. About 10 days after the transfer, you’ll take a pregnancy test to confirm whether implantation was successful. If it works, you continue hormone support for several weeks before transitioning to standard prenatal care.
Compensation and Financial Details
First-time surrogates in 2025 can expect base pay ranging from $55,000 to $75,000 or more. Experienced surrogates who have completed a previous journey typically earn higher. On top of base pay, most contracts include a monthly allowance for incidentals, reimbursement for maternity clothing, and coverage for all medical expenses, legal fees, and travel costs. Compensation is structured to pay you for the time, physical burden, and risk involved, not contingent on delivering a healthy baby.
Insurance is one of the trickier financial pieces. Standard health insurance rarely covers surrogacy outright. Even if your plan covers prenatal care and delivery, many policies contain surrogacy exclusions or “intent to parent” language that restricts maternity coverage when the insured isn’t planning to raise the child. This exclusion isn’t always clearly labeled in policy documents, so your insurance will be reviewed carefully during screening. If your existing plan doesn’t work, the intended parents typically purchase a specialized surrogacy insurance policy, which runs $10,000 to $25,000 or more. Costs for pregnancy complications, postpartum care, and anything beyond routine coverage depend on the specific plan language and are negotiated as part of the contract.
What the Timeline Looks Like
From your first application to embryo transfer, expect roughly three to six months of screening, matching, and legal work. The matching process alone can take weeks to months depending on the agency and how quickly you connect with intended parents. After a successful transfer, you carry a standard pregnancy of about 40 weeks. All told, most surrogates spend about a year to a year and a half from application to delivery.
Throughout the pregnancy, you’ll attend regular prenatal appointments and stay in communication with the intended parents to whatever degree you’ve both agreed on. Some surrogates and intended parents develop close relationships; others keep communication more structured. That dynamic is something you’ll discuss during matching and outline in your contract, so there are clear expectations on both sides from the start.