Surrogacy means one person carries and delivers a baby for someone else, who then becomes the child's legal parent. What is gestational surrogacy and how does it work? Almost all surrogacy today is gestational: the surrogate has no genetic link to the baby, because an embryo made through IVF from the intended parents' or donors' eggs and sperm is transferred to her uterus.
The process runs in the following order: find a match, sign contracts, complete an embryo transfer, carry the pregnancy for about nine months, then finalize legal parentage at birth.
This guide walks through each part. Each stage has a dedicated guide, linked as we go, so you can start broad here and go deep where you need to.
How does surrogacy work? The short answer
Surrogacy works in seven steps. In most US cases this takes about 12 to 24 months and costs between $110,000 and $220,000. Each step is explained below.
- Decide between agency or independent surrogacy
- Find and match with a surrogate
- Complete legal contracts
- Complete medical and psychological screening
- Prepare embryos and complete the embryo transfer
- Continue prenatal care through pregnancy
- Complete birth planning and legal parentage
Gestational vs. traditional surrogacy
The first thing to understand is which kind of surrogacy you are interested in, because it changes everything that follows.
Gestational surrogacy uses an embryo made from the intended parents' or donors' eggs and sperm, so the surrogate shares no genetic tie with the baby. Traditional surrogacy uses the surrogate's own egg, making her the biological mother.
Nearly every arrangement today is gestational, because the absence of a genetic link keeps parentage clear and many clinics no longer take traditional cases. Why is gestational surrogacy more common today? Our guide to the types of surrogacy maps all the variations; gestational surrogacy and traditional surrogacy each have a full explainer.
Who uses surrogacy?
No single kind of family ends up here, and most arrive after a hard road. Common paths include infertility or a uterine condition that rules out pregnancy, repeated miscarriage or failed IVF, a health condition that makes pregnancy unsafe, being an LGBTQ+ couple (especially gay men who need a gestational carrier for a genetically related child), or choosing to become a parent on your own.
The seven steps
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1
Agency or independent surrogacy
The first decision is who runs the process. Most people work with an agency, which handles matching, coordinates screening, manages paperwork, and gives you someone to call, for a fee that is one of the biggest single line items in the budget. Others go independent, often because they already know a potential surrogate, which lowers cost but puts the coordination on them.
Don't skip thisIndependent does not mean skipping safeguards. Screening, separate lawyers, escrow, and insurance review still apply to a surrogate you found yourself. The savings come from cutting the agency's fee, not from cutting the parts that protect everyone. Platforms like FindSurrogate fill this gap, an independent matching platform, not an agency, with ID-verified profiles, while you bring in the lawyers, clinic, and escrow yourself.
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2
Matching with a surrogate
Matching means finding a surrogate whose expectations and availability line up with yours, after both sides pass screening. Timing swings more here than anywhere else. Some families match in weeks, others wait six months or more. The American Society for Reproductive Medicine recommends carriers be 21 to 45, and have had at least one uncomplicated full-term pregnancy.
Once there is a potential match, both sides talk through the things that matter: contact during pregnancy, who makes medical decisions, and what the relationship looks like after birth. Match on values and communication style, not just timeline and location. If you are matching on your own, our guides to how to find a surrogate and finding a surrogate without an agency can help you.
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3
Legal contracts
The surrogate and the intended parents each retain their own lawyer and negotiate a contract covering compensation, medical decision-making, and how parentage will be established. There is no federal surrogacy law in the US, so this depends heavily on your state.
Hard ruleNever sign a surrogacy contract without separate attorneys for each side. Not a shared lawyer, not an online template.
State law varies widely and keeps shifting. As of 2026, surrogacy agreements are enforceable with some limits in about 31 states, void by statute in at least one, and simply unaddressed in roughly 17 more, per Axios reporting citing Surrogacy360. Nebraska and Louisiana are most often flagged for barring paid contracts; New York legalized paid gestational surrogacy in 2021; Michigan did so in 2025; and California, Nevada, Illinois, New Jersey, Washington, and Colorado tend to have the clearest laws with routine pre-birth orders. Because the rules vary, many families arrange the birth in a state with clearer protection. Our guide to paid surrogacy laws by state and the Creative Family Connections law map track the details.
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4
Medical screening
Before a transfer, the surrogate completes a medical history review, a check of her uterus, and infectious-disease testing; the intended parents or their donors are screened at the clinic. ASRM guidance requires infectious-disease testing within 30 days of transfer for both sides, because older results may not reflect current health. The surrogate's screening also includes confirming her uterus is ready, and some clinics speak with her partner to confirm support at home. Additionally, it's recommended to pass a psychological evaluation too.
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5
IVF and embryo transfer
If the intended parents do not already have frozen embryos, this stage begins with an IVF cycle: eggs are retrieved from a parent or donor, fertilized, and grown in the lab for a few days. Once an embryo is ready and the surrogate's uterus is prepared, it is transferred in a short outpatient procedure, with a pregnancy test about two weeks later.
Not every transfer works the first time; a failed one adds roughly two months to try again. Plan for that possibility, because families who budgeted for a single attempt are hit hardest when a second is needed. Research in JAMA Network Open finds gestational-carrier pregnancies often have outcomes as good as or better than other IVF pregnancies, partly because carriers are carefully screened.
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6
Pregnancy
Once pregnancy is confirmed, the surrogate begins routine prenatal care, and both sides stay in contact on the terms set in the contract. This stretch runs about nine to ten months and is the longest part of the journey. With an agency, a case manager checks in with both sides throughout; it is often where the bond between surrogate and intended parents grows the most.
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7
Birth and legal parentage
In states with clear surrogacy laws, a court often issues a pre-birth order so the intended parents' names go straight on the birth certificate; elsewhere, the legal process happens after birth and takes longer.
Most families also agree a birth plan covering who is in the delivery room and how the baby is handed over. The surrogate's recovery matters after delivery, not just before. If she lives in another state plan for travel, since you may need to be in her city for the birth and several days after while paperwork clears.
How long does surrogacy take?
Most US journeys take about 12 to 24 months from the first step to bringing the baby home: matching (a few weeks to six-plus months), legal and screening (one to two months), the embryo transfer, and pregnancy (nine to ten months).
Families with frozen, tested embryos who stay flexible on matching can finish closer to 12 to 15 months; a failed transfer or a drawn-out search can push past 24.
How much does surrogacy cost?
Most US gestational surrogacy journeys cost between $110,000 and $220,000, and often $150,000 or more through a full-service agency, based on 2026 industry cost guides. Some journeys run $250,000 or more with donor eggs, multiple transfers, or a live-birth guarantee.
| Surrogate compensation | $65,000–$95,000 |
|---|---|
| IVF and medical care | Varies |
| Agency fees | $20,000–$45,000 |
| Legal fees | $4,000–$16,000 |
| Insurance and travel | $15,000–$30,000 |
| Typical total | $110,000–$220,000 |
The full breakdown is in how much does gestational surrogacy cost, and ways to lower it are in how to afford surrogacy.
Do not assume health insurance will cover a surrogate pregnancy. Most policies now carry a surrogacy exclusion, and if the surrogate's does, a separate policy can run $15,000 to $30,000. Read the actual policy before the transfer; this is the cost that blindsides people.
What to do next
The best next move is usually not choosing an agency or a state, but sitting down with a reproductive attorney and a fertility clinic experienced in gestational surrogacy, so the guidance is built around your situation. If you are exploring the surrogate side instead, start with how to become a surrogate.
Frequently asked questions
Is surrogacy legal everywhere in the US?
There's no federal law. Most states allow and enforce surrogacy agreements to some degree, a few restrict paid contracts, and some have no specific law. The intended parents and surrogate don't need to live in the same state as the birth.
How is legal parentage established?
Through a court order, either before birth or after, depending on the state.
Can a surrogate change her mind and keep the baby?
Because she has no genetic link to the child, the contract and parentage order are meant to secure the intended parents' rights before or just after birth.
How much does surrogacy cost in total?
Most US journeys fall roughly between $110,000 and $220,000, and complex cases can exceed $250,000.
How long does surrogacy take?
Roughly 12 to 24 months, covering matching, medical and legal preparation, and about nine to ten months of pregnancy.
What actually happens during the embryo transfer?
Once an embryo has been created through IVF, the surrogate's cycle is medically prepared to receive it, and the embryo is placed into her uterus in a short outpatient procedure. A pregnancy test follows about two weeks later. Transfer doesn't always succeed on the first attempt, which is part of why timelines vary.
Who's actually involved in a surrogacy journey besides the surrogate and intended parents?
A fertility clinic handles the medical side, each party has their own attorney, and most journeys also involve a case manager, whether through an agency or a platform handling the match. Insurance specialists and escrow managers often get involved too, once things move past matching.
Surrogacy law and reported cost ranges change often and vary by state and personal circumstances. This guide reflects publicly available information as of mid-2026 and is not legal or financial advice. Talk to a reproductive law attorney and a licensed fertility clinic for guidance specific to your situation.