Gestational Surrogacy: Meaning, Process & How It Works

Last reviewed: August 2026. Gestational surrogacy is an arrangement in which a person carries a pregnancy created through embryo transfer and does not provide the egg used to create the embryo. The gestational carrier is therefore not genetically related to the child.

How does gestational surrogacy work?

An embryo is created through IVF using eggs and sperm from intended parents, donors, or a combination of both. After appropriate screening and legal clearance, the embryo is transferred to the gestational carrier's uterus. If pregnancy occurs, she receives obstetric care during the pregnancy and delivery.

Gestational vs. traditional surrogacy

• Gestational surrogacy: the carrier does not provide the egg and has no genetic relationship to the child.
• Traditional surrogacy: the person carrying the pregnancy also provides the egg and is genetically related to the child.

Traditional surrogacy can create different legal and parentage issues because the carrier is also a genetic parent. Gestational surrogacy is the predominant model used by U.S. fertility clinics and professional surrogacy programs.

What happens before embryo transfer?

• Matching between intended parents and a prospective gestational carrier
• Review of prior pregnancy and medical records
• Fertility-clinic medical clearance
• Psychological evaluation or psychoeducation according to the program
• Independent legal representation for the parties
• Insurance review and financial or escrow planning
• Completion of legal agreements before treatment proceeds

Who makes medical decisions during the pregnancy?

The gestational carrier retains the right to make medical decisions about her own body, pregnancy, labor and delivery. Intended parents and the carrier can discuss preferences before the journey, but a contract does not replace informed medical consent.

How is legal parentage established?

There is no single nationwide U.S. parentage procedure. Depending on the state and circumstances, attorneys may use a pre-birth order, post-birth order, adoption or another legal process. A birth certificate is an important record but is not a substitute for understanding the legal parentage procedure that applies to the journey.

Is gestational surrogacy legal in every U.S. state?

No single federal surrogacy law governs every U.S. journey. State statutes and court procedures differ, and laws can change. Rather than relying on a static list of “friendly” or “unfriendly” states, intended parents and gestational carriers should obtain current advice from qualified reproductive-law attorneys familiar with the states involved.

How much does gestational surrogacy cost?

There is no universal total cost. A U.S. journey may include gestational-carrier compensation, IVF and embryo-related expenses, agency or coordination fees, independent legal fees, insurance, escrow, travel, screening and pregnancy-related reimbursements. Prices change over time and vary by provider and circumstances, so intended parents should request current written estimates and maintain a contingency budget.

Bottom line

Gestational surrogacy combines fertility treatment, pregnancy, legal planning and coordination among several professionals. The carrier is not genetically related to the child, but that fact alone does not eliminate the need for medical screening, independent legal advice or a jurisdiction-specific parentage process.

This article provides general educational information and is not medical or legal advice.