Typical Steps and Decisions in the Surrogacy Process

We created this document in order to take a broad look at the crucial decisions and milestone prospective parents face in their pursuit of biological parenting. It outlines some of the typical steps and milestones parents go through, presented chronologically and as a decision-tree.

Initial research:


Check web, attend a workshop, speak to surrogacy veterans, and attend free consultations with agencies. While you do not have to make all of the following decisions upfront, you may want to keep these questions in the back of your mind:
  • Consider surrogacy versus other options like adoption, foster care, shared parenting.
  • Consider Traditional Surrogacy (TS) versus Gestational Surrogacy (GS).
  • These options vary considerably in process, cost, duration, legality and likely future relationships with the surrogate /egg donor.
  • In TS, a surrogate is carrying a baby conceived through artificial insemination using the sperm of one of the intended parents. In GS, a carrier is impregnated with embryos created through IVF (In Vitro Fertilization), using the couples' sperm and donated eggs.
  • If you decide on GS, consider various options for egg donation: unknown, known (donors who are open to meeting the children or providing additional medical history information should the need arise in the future), or even from a family member or a friend.
  • If you are a couple, think of paternity options: should one of you provide the sperm, or should you mix your samples before the insemination /fertilization? If you are doing IVF, you can fertilize half of the eggs with each sperm sample, so that the paternity of each embryo can be known, and you can choose to implant embryos from both dads.
  • Think ahead of your desired family makeup: are you likely to want to go through the process again in the future for a sibling? Would you like to maximize the possibility of having twins in the first round?
  • Consider options for establishing parentage: will you be seeking second parent adoption? Are you interested in a pre-birth order?
  • Understand the likely timeline for each scenario, and possible setbacks: the chances that you may need more than one cycle to achieve pregnancy, having to consider changing the egg or sperm donor, or even a carrier, and the possibility of a miscarriage. 
Once you researched and considered these and other issues, you may be ready to decide: what professional help will you require in your process? Will you try to keep outside help to the minimum (the Independent Track)? Will you employ a full service agency - or maybe just a lawyer? Will you first choose a clinic? 



The GS /Agency Track:


Most people who choose to pursue Gestational Surrogacy tend to use the help of semi or full service agency and /or an IVF clinic.  The following are typical steps in this process:
  • Choosing the agency signing a retainer /engagement agreement
  • Choosing a clinic: IVF clinics vary in many ways, and most agencies work with more than one clinic.  Consider costs (including medications, monitoring if done there or outside clinics, cost of frozen embryo transfers if first round does not take, cost of storing embryos for a sibling cycle), medical expertise / track record / reputation, location, familiarity and accommodation of with same-sex couples (do they allow both partners to provide sperm in the same cycle?), availability of egg donors, egg donation options (fresh, shared, frozen), do they offer risk sharing /multiple tries packages, number of embryos they are willing to transfer per cycle (most will not transfer more than two high grade embryos, some will only transfer one), etc.
  • Client paperwork and Medical tests to inform matching process
  • Matching with an Egg Donor (previously screened)
  • Matching with a screened Carrier, first introduction /meeting (some agencies pre-screen all carriers, other screen them only after prospective parents express interest in each carrier).
  • Sign legal agreements, arrange for life and health insurance, agree on fees and establish a trust account /escrow.
  • Medical preparations: medications and synchronization of cycles between the gestational carrier and egg donor.
  • IVF procedure: Egg retrieval, the provision of sperm, fertilization, and 3 or 5 days later: embryo transfer to the carrier. 
  • Establishing pregnancy and first trimester monitoring (typically still at the responsibility of the clinic)
  • Regular maternity care by an obstetrician, identifying a hospital in preparation for birth
  • Preparing the legal process for establishing or confirming parental rights
  • Discuss birth arrangements and expectations with carrier and hospital (including notification, presence during labor, rooming, breast feeding / pumping, relinquishment, hospital discharge, traveling home, etc.)
  • BIRTH!

The Independent /TS track:


Many people who choose to pursue Traditional Surrogacy (and some who choose GS) may opt to go about it independently.  The following are typical steps in this process:
  • Exploring various avenues for finding a surrogate: websites, advertisements, classifieds
  • Medical tests of sperm donor
  • Interviewing surrogates, conducting background checks, references, other screening if possible
  • Negotiate fees, reimbursement items and rates, financial contingencies, arbitration options and payment process.
  • Discuss pregnancy, birth, relinquishment, parental rights and future relationship.
  • Sign legal contracts (generic or custom made by a lawyer), arrange for life and health insurance
  • Artificial insemination procedure (with the help of a clinic or at home)
  • Establishing pregnancy and maternity care by an obstetrician, identifying a hospital in preparation for birth
  • Preparing the legal process for establishing or confirming parental rights
  • Discuss birth arrangements and expectations with surrogate and hospital (including notification, presence during labor, rooming, breast feeding, relinquishment, hospital discharge, traveling home, etc.)
  • BIRTH!