Gestational Surrogacy

The surrogate (gestational carrier) has no genetic connection to the child. Embryos are created via IVF using the intended parents' eggs and sperm (or donor gametes) and transferred to the surrogate's uterus. Accounts for >99% of surrogacy arrangements in the US.

Legal Status: More legally straightforward in most jurisdictions. Pre-birth orders available in many states.

Advantages

• No genetic link between surrogate and child simplifies legal proceedings
• Intended parents can both be genetically related to the child
• Most widely accepted form legally and socially
• Established medical protocols with high success rates

Disadvantages

• Requires IVF (costly)
• Surrogate must undergo embryo transfer and hormonal preparation
• More medically complex than traditional surrogacy

Traditional Surrogacy

The surrogate uses her own eggs, making her the biological mother. Conception typically via IUI with intended father's or donor sperm. Rarely practiced today due to legal complexities—the surrogate must legally relinquish parental rights.

Legal Status: Legally complex and banned or unenforceable in many states. Courts have sometimes sided with surrogates seeking to keep the child.

Advantages

• No IVF required (lower medical cost)
• Simpler medical procedure (IUI)
• Viable option when intended mother cannot provide eggs and donor eggs are unaffordable

Disadvantages

• Genetic connection between surrogate and child creates legal risk
• Many agencies refuse to arrange traditional surrogacy
• Psychological complexity for all parties
• Banned in many jurisdictions

Initial Consultation & Decision

Duration: 1-3 months

Intended parents meet with a reproductive attorney and fertility clinic to assess surrogacy as an option. Psychological readiness evaluation, financial planning, and decision between agency and independent surrogacy.

• Consult reproductive endocrinologist
• Consult reproductive attorney
• Mental health assessment for intended parents
• Financial planning and budgeting
• Choose agency vs independent surrogacy

Surrogate Matching

Duration: 1-6 months

Agency presents profiles of screened surrogates, or intended parents find a surrogate independently. Matching considers values, communication preferences, views on selective reduction and termination, geographic proximity, and personal connection.

• Review surrogate profiles
• Initial meeting (video or in-person)
• Mutual agreement to proceed
• Background checks and screening begin
• Match confirmation

Surrogate Screening

Duration: 1-3 months

Comprehensive medical and psychological evaluation of the surrogate and her partner (if applicable). Medical screening includes uterine evaluation, infectious disease testing, and overall health assessment.

• Medical history and physical exam
• Uterine evaluation (HSG or saline sonogram)
• Infectious disease panel (HIV, Hepatitis B/C, syphilis, gonorrhea, chlamydia)
• Psychological evaluation (MMPI-2 or PAI)
• Background check (criminal, financial)
• Drug screening
• Obstetric history review (must have at least one prior uncomplicated pregnancy)

Legal Contracts

Duration: 1-2 months

Both parties retain separate reproductive attorneys. Contracts cover compensation, medical decisions, number of embryos transferred, selective reduction policies, communication during pregnancy, maternity leave, and post-birth arrangements. All parties must have independent legal representation.

• Draft gestational carrier agreement
• Independent legal review for surrogate
• Negotiate terms
• Execute contracts
• Establish escrow account for compensation
• Life insurance policy for surrogate (typically $500K-$750K)

Medical Cycle & Embryo Transfer

Duration: 2-3 months

IVF cycle for intended mother or egg donor to create embryos. Surrogate undergoes endometrial preparation with estrogen and progesterone. Synchronized cycles if using fresh transfer; more commonly, frozen embryo transfer (FET) is used.

• IVF stimulation and egg retrieval (if not using existing frozen embryos)
• Embryo creation and optional PGT-A testing
• Surrogate begins estrogen for endometrial buildup
• Progesterone supplementation begins 5 days before transfer
• Embryo transfer (usually single blastocyst)
• Beta-hCG test 9-12 days post-transfer

Pregnancy

Duration: 9 months

Standard obstetric care with additional coordination between surrogate, intended parents, and reproductive attorney. Regular check-ins per the agreement. Intended parents typically attend key appointments and ultrasounds.

• Transfer of care from RE to OB/MFM
• Regular prenatal visits
• Monthly updates and communication per agreement
• Hospital pre-registration and birth plan
• Pre-birth order filed (where available) 2-3 months before due date
• Travel arrangements if IP and surrogate are in different states

Birth & Post-Birth Legal

Duration: 1-3 months post-birth

Intended parents are present at birth (per agreement). Legal parentage is established via pre-birth order (in favorable states) or post-birth adoption/parentage order. Birth certificate is issued with intended parents' names.

• Hospital birth with planned delivery team
• Newborn care arrangements
• Post-birth legal parentage proceedings (if pre-birth order not available)
• New birth certificate issuance
• Insurance coordination for newborn
• Post-partum support for surrogate