Surrogacy Process Step by Step: Who Does What, and When

A surrogacy journey is usually described as if it were one decision. It is closer to nine decisions in a row, each with a different professional in front of you, and each one costing money or time whether or not the next stage succeeds.

The stages below are the usual shape of a program, not an order you have to follow: the sequence varies by destination, by clinic, and by whether you need donor eggs or sperm.

In the position statement published in 2025, the International Federation of Gynaecology and Obstetrics supports gestational surrogacy arrangements, where the woman carrying the child is not genetically related to it, and discourages arrangements in which a woman agrees in advance to surrender a child she is genetically related to. It also sets out what support each side must be given, and screening is where that standard gets tested.

The stages

1. Your own position, before anyone else’s

Medical, legal and financial questions all start with facts about you: whether you or a partner have eggs or sperm available, whether a clinic thinks a pregnancy is medically advisable for you or for a future child, your marital or relationship status, your citizenship, and the country the child will live in.

Settle these first, because they decide which destinations are open to you at all. The answer changes the whole plan, not a detail of it.

2. Choosing a destination, then choosing people

In practice most people look at providers and countries at the same time, because a program is only available where a clinic, a lawyer and a willing carrier can all operate. What matters is that the destination is chosen on legal grounds before the money starts moving. The legal considerations guide covers what to establish. The agency guide covers what to ask a provider.

3. Screening

Screening runs in two directions. Your own fertility assessment, and the carrier’s medical and psychological screening. FIGO’s position is that psychological screening and ongoing counselling should be mandatory, which is a useful standard to hold a program to: if a provider treats counselling as optional or as a formality, that tells you something about how the rest is run.

Ask who pays for screening, what happens if you are not accepted, and what happens if a candidate carrier is not accepted after you have paid a fee toward matching.

4. Matching

Matching is where an agency’s stated service and its actual service are most often different. Some programs introduce you to a specific candidate; others put you in a pool; others charge a fee that covers several attempts. The questions worth putting in writing are: how long matching typically takes, what you may say to a candidate, who decides when it is not working, and what happens to the fee if no match happens.

5. The agreement, and the money behind it

Before treatment, the arrangement is documented, and the document is expected to carry the money rather than point at it: the bar association for adoption and assisted reproduction attorneys puts the whole financial side of the arrangement inside the signed agreement instead of leaving it to be agreed afterwards. What that does to your exposure, including the funding date that catches people out, is worked through on the page about escrow accounts and payment stages.

The same holds for lawyers: academic review of US practice records that each side is expected to have its own counsel, and that in some states this is a requirement rather than a recommendation. Independent legal advice for the carrier is not a formality you are paying for on your behalf; it is the protection that makes the arrangement sound.

6. Medical treatment and transfer

Medication and monitoring, then the embryo transfer. Where a donor egg is involved, an earlier cycle of retrieval and laboratory work sits in front of this. This is the stage where the schedule stops being yours: appointment dates are set by clinic calendars and by the carrier’s cycle.

7. Pregnancy

Prenatal care runs through the carrier’s obstetric provider. Your involvement, what you are asked to pay for, and how decisions get made are contract questions that were supposed to be settled in stage 5. This is the stage where badly drafted agreements become expensive.

8. Birth and parentage

The parentage route determines what happens in the delivery room and after it. The legal considerations guide states the rule that surprises families most, and the UK article gives the clock attached to it. In the United Kingdom the woman who gives birth is the child’s legal mother until a court hands that status somewhere else, so the application follows the birth rather than preceding it, and the wait reported there runs from six months to a year. Other systems issue an order before the birth. Which one applies to you is a question for a lawyer in that jurisdiction, and it changes what you plan around.

9. Bringing the child home

Registration, a birth certificate, a passport or consular document, and whatever your home country requires to recognise the arrangement. Cross-border intended parents are not a rare edge case: of the 40,177 transfers to surrogates recorded in the US between 2014 and 2020, 32 percent belonged to intended parents living abroad.

Who is involved, and what each one is accountable for

The line that causes the most damage is the one between an agency and a lawyer. An agency that answers legal questions is not giving you legal advice, however experienced it is. A program that presents its own assurances about enforceability, parentage or immigration is describing its sales position.

What people are expected to prepare

Realistically, four things, and none of them is a deposit:

1. A decision about how much risk you will carry. How many transfer attempts, over how long, and what you will do if it does not work. This is the number that determines your budget more than any fee schedule does.
2. Availability. Transfers, appointments and birth dates are not scheduled around your leave. Cross-border journeys add immigration appointments to that list.
3. Documents in order. Identity, relationship, marital status, medical records, and anything a court or registry will ask for later. Getting these translated or apostilled after a birth is a different and slower process.
4. A question list you wrote, not one you were handed. A provider’s own FAQ answers the questions the provider is comfortable with.

What you still have to settle elsewhere

What happens to the money if a pregnancy is lost, a specific clinic’s transfer protocol, whether a court in your country will recognise an order, how long any of it takes: these are document and jurisdiction questions, and they have specific answers nobody can give in general.

US surveillance records assisted reproduction cycle data from more than 90 percent of clinics, including transfers to surrogates. It does not record surrogacy agreements, compensation, matching or program outcomes. So there is no official statistic for how many surrogacy journeys succeed, or how long they take, because nobody counts them.