A gestational surrogate (also called a gestational carrier) is a woman who carries and delivers a baby for another person or couple but has no genetic connection to the child. The embryo is created through in vitro fertilization (IVF) using eggs and sperm from the intended parents, donors, or a combination of both, then transferred into the surrogate’s uterus. This distinction matters because it separates gestational surrogacy from traditional surrogacy, where the surrogate provides her own egg and is biologically related to the baby.
Gestational vs. Traditional Surrogacy
The key difference comes down to genetics. In traditional surrogacy, the surrogate is artificially inseminated with the intended father’s sperm, making her one of the child’s biological parents. In gestational surrogacy, the embryo is created entirely outside the surrogate’s body and then placed into her uterus. She provides the environment for the pregnancy but contributes no DNA to the child.
This genetic separation has significant legal and emotional implications. Because a gestational surrogate has no biological tie to the baby, establishing legal parentage for the intended parents is typically more straightforward. It’s also the reason gestational surrogacy has become far more common than the traditional arrangement. Most surrogacy agencies and fertility clinics in the United States now work exclusively with gestational carriers.
How the IVF Process Works
Gestational surrogacy requires IVF, which involves several coordinated steps between the egg source and the carrier. If the intended mother is using her own eggs, she takes fertility medication to stimulate her ovaries to produce multiple eggs at once. Those eggs are then retrieved and fertilized with sperm in a lab. In some cases, donor eggs, donor sperm, or both are used instead.
Once an embryo forms, the gestational carrier takes fertility medication to prepare her uterine lining for implantation. The embryo is then transferred into her uterus, and if it implants successfully, the pregnancy proceeds like any other. From that point forward, the surrogate receives standard prenatal care through delivery.
Who Uses Gestational Surrogacy
People turn to gestational surrogacy for a range of reasons, almost all rooted in the inability to safely carry a pregnancy. Women born without a uterus, those who have had a hysterectomy, or those with a uterine condition that makes pregnancy dangerous are common candidates. Women with serious health conditions where pregnancy would pose a life-threatening risk, such as severe heart disease, also pursue surrogacy.
Same-sex male couples and single men use gestational surrogacy combined with an egg donor to have biologically related children. Some intended parents have experienced repeated pregnancy losses or multiple failed IVF cycles and choose surrogacy after years of trying other options. In each of these situations, the intended parents may still contribute their own eggs or sperm, maintaining a genetic link to the child even though someone else carries the pregnancy.
Success Rates
Gestational surrogacy tends to have higher success rates than standard IVF cycles. A large U.S. study covering 2009 to 2013 found that when the intended mother’s own eggs were used (fresh transfer), the live birth rate per embryo transfer was 41.5% for gestational carrier cycles, compared to 36.5% for non-carrier cycles. When donor eggs were used, the numbers climbed higher: 60.5% for gestational carriers versus 55.2% for non-carrier transfers.
The higher rates likely reflect the screening process. Gestational carriers are selected in part because they have a proven track record of healthy pregnancies and deliveries, which makes successful implantation and full-term pregnancy more likely. Donor eggs also tend to come from younger women, which improves embryo quality.
What the Process Costs
Surrogacy in the United States is expensive. The average total cost in 2025 ranges from $100,000 to $140,000, covering agency fees, legal costs, medical expenses, and surrogate compensation. Depending on the specifics (donor eggs, multiple transfer attempts, insurance complications), that figure can reach $250,000 or more.
The surrogate’s base compensation typically falls between $35,000 and $60,000, though total compensation including benefits, maternity expenses, lost wages, and childcare can range from $65,000 to $95,000. Intended parents also cover all pregnancy-related medical costs and often purchase or supplement health insurance for the carrier. Legal fees for drafting contracts and establishing parental rights add several thousand more.
How Long the Process Takes
From initial planning to delivery, a typical surrogacy journey takes 18 to 24 months. The early phase involves finding and screening a surrogate, which alone can take several months depending on whether you work with an agency or pursue an independent match. Legal contracts need to be drafted and signed before any medical procedures begin.
The medical phase, from fertility medication through embryo transfer, usually spans a few months. If the first transfer doesn’t result in pregnancy, subsequent attempts add time. Once pregnancy is confirmed, the remaining timeline follows a standard nine-month pregnancy. Some intended parents begin the process even earlier by creating and freezing embryos before they start searching for a carrier.
Health Risks for the Carrier
A gestational surrogate faces the same health risks as any pregnant woman, plus a few considerations specific to IVF pregnancies. The fertility medications used to prepare her uterus can cause bloating, mood changes, and in rare cases a condition called ovarian hyperstimulation (though this risk is lower for carriers than for egg donors, since carriers don’t undergo egg retrieval).
When more than one embryo is transferred and both implant, the pregnancy becomes a multiple pregnancy, which carries elevated risks. Women carrying multiples are more than twice as likely to develop high blood pressure during pregnancy and more than twice as likely to develop anemia. Over 60% of twins and nearly all higher-order multiples are born premature. Multiple pregnancies also increase the chances of cesarean delivery, postpartum bleeding, and placental complications. For these reasons, single embryo transfer has become the standard recommendation in most surrogacy arrangements, reducing the likelihood of twins or triplets.
Even in singleton pregnancies, gestational carriers may face risks like gestational diabetes, preeclampsia, or the need for a C-section. Surrogates are screened carefully for factors that minimize these risks, including age, BMI, and a history of uncomplicated pregnancies, but no pregnancy is entirely without risk.