A surrogate is a person who carries and delivers a pregnancy for someone else. The intended parents, those who will raise the child, may turn to surrogacy because of infertility, medical conditions that make pregnancy dangerous, or because they are unable to carry a pregnancy themselves. Surrogacy has become increasingly common, and the process involves medical procedures, legal agreements, and significant financial planning.
Two Types of Surrogacy
The distinction between the two types comes down to genetics. A gestational surrogate (sometimes called a gestational carrier) becomes pregnant through an embryo transfer using eggs and sperm from other people. She has no genetic connection to the baby. This is by far the more common arrangement today.
A traditional surrogate, by contrast, uses her own egg. She is inseminated with sperm from the intended father or a donor, making her the biological mother of the child. Traditional surrogacy is still used in the United States, but it’s less common because the genetic link creates more complex legal and emotional dynamics.
Who Can Become a Surrogate
Not everyone who wants to be a surrogate qualifies. Agencies and fertility clinics screen candidates on both physical and psychological criteria. On the medical side, surrogates are generally expected to be under 40 and to have already had at least one healthy pregnancy and delivery. That prior experience gives doctors confidence in how a candidate’s body handles pregnancy and reduces the chance of complications.
Psychological screening is equally important. The American Society for Reproductive Medicine recommends that all gestational carrier candidates undergo a psychosocial consultation. This typically involves a clinical interview and a personality inventory, though some programs are moving toward more comprehensive, multi-method assessments. Evaluators look at the psychological well-being of the surrogate candidate, her partner if she has one, and even her existing children, since the surrogacy process affects the whole family.
How the Medical Process Works
In gestational surrogacy, the process begins with creating embryos. The egg provider takes hormones to stimulate her ovaries to produce several mature eggs in one cycle, which are then surgically retrieved and fertilized in a lab.
Meanwhile, the surrogate prepares her body separately. She may take birth control pills or medication that suppresses her natural ovulation cycle so doctors can precisely control timing. She then takes estrogen to build up and thicken her uterine lining, creating the best possible environment for an embryo to implant. Once everything is ready, the embryo is transferred to the surrogate’s uterus. The transfer procedure itself is the same as it would be for any IVF patient.
Success rates are encouraging. When using fresh donor eggs, gestational carrier cycles achieve a clinical pregnancy rate of about 70% and a live birth rate of roughly 60%. With non-donor eggs, clinical pregnancy rates sit around 52% and live births around 42%. These rates are actually higher than standard IVF cycles where the patient carries her own pregnancy, likely because surrogates are specifically selected for their reproductive health.
Compensation and Cost
Surrogacy arrangements fall into two categories: commercial and altruistic. In commercial surrogacy, the surrogate receives payment beyond her pregnancy-related expenses. In altruistic surrogacy, the surrogate can only be reimbursed for necessary costs like medical bills and maternity clothing, with no additional fee.
In the United States, where commercial surrogacy is legal in many states, first-time surrogates in 2026 typically earn between $60,000 and $75,000 in base compensation, paid in equal monthly installments. Experienced surrogates with prior successful journeys can earn $85,000 to $125,000 or more when bonuses and reimbursements are included. Base pay usually begins after a fetal heartbeat is confirmed.
On top of base pay, surrogates receive milestone bonuses at contract signing, medication start, and embryo transfer, adding $3,500 to $5,500 to total compensation. Additional bonuses cover specific situations: $5,000 to $10,000 for carrying twins, $3,000 to $5,000 for a cesarean delivery, and $250 to $300 per week if the surrogate chooses to provide breast milk after birth. Lost wages, monthly personal allowances, and coverage for everyday pregnancy costs are also standard.
The Legal Agreement
A surrogacy contract is the legal backbone of the entire arrangement. Both the surrogate and the intended parents must have separate attorneys, a requirement that protects each side from conflicts of interest. The contract spells out how parentage will be established, ensuring the intended parents become the legal parents and the surrogate is relieved of all parental rights and responsibilities.
Financial terms are laid out in detail: the nature and timing of every payment, who covers insurance deductibles and uncovered medical costs, and who provides health insurance for the child. The contract also addresses the medical plan, including whose eggs and sperm will be used, whether embryos are fresh or frozen, how many embryos will be transferred per attempt, and how many attempts the parties will make. Surrogates generally agree to reasonable restrictions on travel, nutrition, and activities during the pregnancy.
Dispute resolution is built in as well. The contract specifies which state’s laws govern the arrangement, defines what counts as a breach, and typically requires the parties to attempt mediation before going to court.
Where Surrogacy Is Legal
Surrogacy laws vary dramatically around the world. In the United States, legality depends on the state. California, Nevada, and Illinois are among the most permissive, allowing commercial gestational surrogacy with clear legal frameworks. Other states have more restrictive rules or no specific surrogacy legislation at all.
Several countries allow only altruistic surrogacy. Canada, the United Kingdom, Australia, and New Zealand all permit surrogacy but prohibit paying the surrogate beyond reimbursed expenses. India shifted to an altruistic-only model and restricts surrogacy to Indian heterosexual couples, banning foreign participation entirely. South Africa and Portugal also allow altruistic surrogacy under strict legal criteria.
Commercial surrogacy remains legal in a smaller number of countries. Ukraine and Georgia both permit it for heterosexual married couples. Colombia allows surrogacy but operates in a legal gray zone, relying on court precedents rather than specific legislation.
A number of countries ban surrogacy outright. France, Germany, Italy, and Spain prohibit all forms, and surrogacy contracts are considered void and unenforceable. China bans commercial surrogacy, though underground arrangements exist. Thailand, Nepal, and Cambodia banned commercial surrogacy for foreigners after concerns about exploitation.