Surrogacy Process in the U.S.: Complete Step-by-Step Guide (2026)

Last reviewed: August 2026. A U.S. gestational-surrogacy journey combines fertility treatment, matching, medical and psychological screening, independent legal representation, insurance planning, escrow, embryo transfer, pregnancy, delivery and parentage. There is no single nationwide process, timeline or price because clinic protocols, state law and individual circumstances vary.

What is gestational surrogacy?

In gestational surrogacy, the person carrying the pregnancy does not provide the egg used to create the embryo and is therefore not genetically related to the child. The embryo is created through IVF using eggs and sperm from intended parents, donors, or a combination of both.

Who uses surrogacy?

Gestational surrogacy can be a family-building option for people who cannot safely carry a pregnancy, people without a uterus, single intended fathers, male couples and others whose medical or family circumstances make pregnancy through a gestational carrier appropriate. Eligibility for treatment and legal parentage should be evaluated for the specific people and jurisdictions involved.

Step 1: Decide on embryo and donor planning

Some intended parents already have embryos before beginning a surrogate search. Others create embryos while searching or after identifying a carrier. There is no universal requirement to have embryos first, but many programs prefer intended parents to have embryos available—or at least a clear IVF plan—before final medical clearance and transfer planning.

If egg or sperm donation is needed, donor screening, identity-release preferences, genetic carrier screening and legal consent may add additional steps. The fertility clinic should guide all clinical decisions, including whether PGT-A or other embryo testing is appropriate; PGT-A is not universally required for surrogacy.

Step 2: Find and mutually match with a gestational carrier

Intended parents may find a carrier through a surrogacy agency, a matching platform, a referral or an independent search. Expecting.Ai lets intended parents browse available surrogate profiles and compare surrogacy agencies in one place. A profile is only an introduction. Before moving forward, both sides should discuss communication, travel, appointment expectations, number of embryos to transfer, pregnancy-related decision making, termination or selective-reduction scenarios, delivery preferences and post-birth contact.

Matching should be mutual. A prospective carrier should be free to decline intended parents or a proposed arrangement without pressure, just as intended parents should be able to decide whether the match fits their needs.

Step 3: Agency prescreening and medical records

An agency or matching program may review age, pregnancy history, delivery records, current health, support system and other preliminary criteria. These criteria vary. Agency approval is not final medical clearance.

Step 4: Fertility-clinic medical clearance

The treating fertility clinic reviews prior obstetric and medical records and performs the examination and testing it requires before embryo transfer. BMI, age, prior C-sections, pregnancy complications, medications and other factors should be evaluated individually rather than treated as one universal online checklist.

Step 5: Psychological evaluation and preparation

A qualified mental-health professional experienced in third-party reproduction may assess informed consent, expectations, coping resources, support, communication and the emotional implications of the arrangement. Intended parents may also receive psychoeducation or counseling. Psychological screening should support informed participation rather than function as a simplistic pass/fail personality test.

Step 6: Insurance review

The carrier's actual health-insurance policy should be reviewed for maternity coverage, surrogacy exclusions, reimbursement provisions, network rules, deductibles and out-of-pocket exposure. Newborn coverage is a separate issue and should be planned in advance. Do not assume that pregnancy coverage automatically means a surrogate pregnancy is covered.

Step 7: Independent legal agreements

Intended parents and the gestational carrier should have independent reproductive-law counsel. The agreement commonly addresses compensation and expenses, insurance, escrow, travel, communication, confidentiality, pregnancy-related preferences and other responsibilities. The carrier retains the right to make medical decisions about her own body, pregnancy, labor and delivery; a contract cannot replace informed medical consent.

Step 8: Escrow and financial clearance

When compensation or reimbursable expenses are part of the journey, the agreement typically sets out how funds are held and paid. An independent escrow or financial administrator is commonly used. The required amount and timing vary by contract and state law.

Step 9: Embryo transfer

The fertility clinic determines the endometrial-preparation and monitoring protocol. Professional guidance strongly favors single-embryo transfer in gestational-carrier cycles because multiple pregnancy increases health risks. Even with one embryo, identical twins can occasionally occur.

If the first transfer does not lead to an ongoing pregnancy, the clinic reviews the cycle and decides whether additional evaluation, a protocol change or another transfer is appropriate. There is no universal fixed waiting period between attempts.

Step 10: Pregnancy and obstetric care

Early pregnancy may initially be monitored by the fertility clinic before care transitions to an obstetric provider according to the medical plan. Communication between intended parents and the carrier should follow the expectations they agreed on, while medical decisions remain with the pregnant patient and her clinical team.

Step 11: Parentage and birth planning

There is no federal U.S. surrogacy law and no single nationwide parentage procedure. State statutes and court practices differ. Depending on the jurisdiction and facts, attorneys may use a pre-birth order, post-birth order, adoption or another procedure. Intended parents should not assume that the birth certificate alone establishes every legal right or that every gestational carrier must “relinquish” parental rights after birth.

Step 12: Delivery and postpartum care

The hospital plan should account for the gestational carrier's medical needs and consent, intended-parent access and newborn care. After delivery, the carrier needs normal postpartum follow-up and should know warning signs that require urgent medical attention. Emotional support may also be valuable during the transition after the journey.

How long does surrogacy take?

There is no reliable universal timeline. A journey often takes well over a year and may take considerably longer depending on embryo creation, matching, medical clearance, legal work, insurance, unsuccessful transfers and pregnancy. Provider estimates should be treated as planning ranges, not guarantees.

How much does surrogacy cost in the U.S.?

There is no single national total. Costs can include gestational-carrier compensation, IVF and embryo creation, agency or coordination fees, legal work, insurance, escrow, screening, travel, lost wages, childcare and pregnancy-related reimbursements. Because fees change and journeys differ, intended parents should request current itemized estimates from each provider and keep a contingency reserve. For a detailed breakdown, see our guide to surrogacy costs and where families may be able to save.

Are all U.S. states the same?

No. Surrogacy statutes, enforceability of agreements, compensation rules and parentage procedures vary by state and can change. Static lists of “friendly” and “unfriendly” states quickly become outdated. Obtain current advice from reproductive-law counsel in every state relevant to the carrier, intended parents and expected birth.

Agency-assisted vs. independent surrogacy

A full-service agency can coordinate matching, records, professionals and support. An independent journey may reduce agency fees and give the parties more direct control, but it does not eliminate the need for fertility-clinic screening, psychological support, independent legal counsel, insurance analysis, escrow and careful coordination.

Questions intended parents should ask before starting

• Do we have embryos, or what is our embryo-creation plan?
• Which professionals make final medical, psychological and legal decisions?
• Which state laws and parentage procedures apply?
• Has the carrier's insurance been professionally reviewed?
• What is included in each provider's fee and what is not?
• What happens financially after a failed match or failed transfer?
• How are compensation and reimbursements funded and administered?
• How will medical decision-making and informed consent be respected?
• What support continues through delivery and postpartum recovery?

Bottom line

A well-run surrogacy journey is not just about finding an available carrier. It depends on appropriate medical screening, mutual matching, informed consent, independent legal representation, insurance and financial planning, and clear communication throughout the pregnancy and postpartum period.

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