A surrogate pregnancy is an arrangement in which a woman carries and delivers a baby for another person or couple, known as the intended parents. The intended parents become the child’s legal parents after birth, while the surrogate has no parental role once the baby is born. Surrogacy is used by people who cannot carry a pregnancy themselves, including those with medical conditions affecting the uterus, same-sex male couples, and single men.
Gestational vs. Traditional Surrogacy
There are two types of surrogacy, and the distinction comes down to genetics. In gestational surrogacy, the surrogate carries an embryo created through IVF using the intended mother’s egg (or a donor egg) and the intended father’s sperm (or donor sperm). The surrogate has no genetic connection to the baby. In traditional surrogacy, the surrogate uses her own egg, making her the biological mother of the child.
Gestational surrogacy is far more common today. In a survey published in the Journal of Women’s Health, 91.9% of surrogates were gestational carriers, while only 8.1% were traditional surrogates. The shift toward gestational surrogacy is largely driven by legal and emotional considerations. Because the surrogate has no genetic tie to the child, parentage disputes are less likely, and courts in most states handle these cases more straightforwardly.
Who Can Be a Surrogate
Surrogacy agencies and fertility clinics have specific criteria a woman must meet before she can carry for someone else. The requirements typically include being at least 21 years old, having previously carried a pregnancy to term without major complications, and having a BMI between 19 and 32. Prior pregnancy experience is considered essential because it demonstrates the surrogate’s ability to carry successfully and gives her a realistic understanding of what pregnancy involves.
Beyond physical health, surrogates go through psychological screening with a mental health professional. This evaluation covers her mental health history, her understanding of the emotional risks of surrogacy, and whether she feels genuinely prepared to carry a child she will not raise. Criminal background checks are also standard for all adults involved in the arrangement, including the surrogate’s spouse or partner living in the home, and the intended parents.
How the Process Works
A surrogacy journey from start to finish typically takes 15 months to two years or longer. The matching phase alone, finding a surrogate who is a good fit for the intended parents, can take six months to over a year. After matching, both parties undergo legal consultations and finalize a surrogacy agreement before any medical procedures begin.
Once the contract is signed, the medical phase starts. In gestational surrogacy, the intended mother or egg donor goes through an egg retrieval cycle, and the resulting embryos are created in a lab through IVF. The surrogate takes medications to prepare her uterine lining, and then one embryo is transferred. If the transfer is successful, the surrogate carries the pregnancy like any other, attending regular prenatal appointments and delivering at a hospital.
Throughout the pregnancy, the surrogate and intended parents stay in contact, often attending ultrasounds together. The level of involvement varies based on what both parties agree to, but most surrogacy agreements spell out expectations for communication, medical decisions, and birth plans.
Success Rates for Embryo Transfers
Surrogacy through IVF has strong success rates, partly because surrogates are pre-screened for healthy reproductive histories. When using the intended mother’s own eggs (fresh, non-donor), the live birth rate per embryo transfer is about 41.5%. When using donor eggs, that rate jumps to 60.5%. The higher success with donor eggs makes sense: egg donors are typically young women selected for optimal fertility, which independently improves outcomes.
Gestational carrier cycles also outperform standard IVF cycles overall. Compared to non-surrogate IVF, surrogacy cycles show roughly 17% higher live birth rates when using the intended mother’s eggs. This likely reflects the careful screening surrogates undergo, ensuring they have uteruses well-suited for carrying a pregnancy.
What Surrogacy Costs
In the United States, a complete surrogacy journey typically costs between $100,000 and $150,000. That breaks down into three main categories.
- Agency fees ($30,000 to $45,000): This covers surrogate recruitment and screening, matching, case management, psychological evaluations, and coordination throughout the journey.
- Medical costs ($40,000 to $60,000): This includes IVF and embryo transfer, fertility medications for the surrogate, monitoring and bloodwork, prenatal care, hospital delivery, and health insurance for the surrogate if she doesn’t already have coverage.
- Legal fees ($5,000 to $10,000): This pays for drafting the surrogacy contract, independent legal representation for the surrogate, and filing the court orders that establish the intended parents’ legal parentage.
The surrogate also receives compensation, which is typically included within the agency’s overall cost structure. Additional expenses like maternity clothing, travel, and lost wages during bed rest can add to the total. International surrogacy in countries where it’s legal can cost significantly less, but introduces complex legal and ethical considerations.
How Legal Parentage Is Established
One of the most important parts of any surrogacy arrangement is the legal process that transfers parental rights to the intended parents. This is handled through either a pre-birth order or a post-birth order, depending on the state.
A pre-birth order is filed during the pregnancy and asks a court to declare the intended parents as the legal parents before the baby is even born. When granted, custody vests in the intended parents immediately at delivery, and their names go directly on the birth certificate. In states like California, which expressly permits surrogacy, this process is well-established and routine.
Not every state allows pre-birth orders, though. In New Jersey, for example, courts have ruled that a surrogate cannot relinquish her parental rights until at least 72 hours after birth. In these states, a post-birth order is filed after delivery. The practical difference matters: in states without pre-birth orders, the surrogate may technically be considered the legal mother at the moment of birth, which can affect who has authority to make medical decisions for the newborn in those first hours or days. Surrogacy contracts should address this gap explicitly.
Where Surrogacy Is Legal
Surrogacy laws vary dramatically from state to state in the U.S. and from country to country worldwide. Some states, like California, have clear statutes that expressly permit and regulate surrogacy. Others, like Alabama, have carved out specific exemptions allowing surrogate compensation without running afoul of adoption payment laws. Kansas permits even compensated traditional surrogacy, though it requires additional legal steps like confirmatory adoptions.
A handful of U.S. states still restrict or discourage surrogacy, and a few have laws that make compensated surrogacy unenforceable. Internationally, some countries allow only altruistic surrogacy, where the surrogate is reimbursed for expenses but receives no additional compensation. Others ban surrogacy entirely. Intended parents considering surrogacy should work with a reproductive attorney familiar with the laws in both the surrogate’s state and their own, since conflicts between jurisdictions can create serious complications for establishing parentage.