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How does gestational surrogacy work? Here’s what you can expect

If you’re just starting to look into the gestational surrogacy process, it can be a bit overwhelming. You might not know where to begin in terms of how to find a surrogate, how the entire process works, and what you can expect to encounter during the nine months that your surrogate is pregnant.

And of course, you’ll likely have lots of questions about what will happen during labor and delivery, in terms of how involved you’ll get to be. However, the whole gestational surrogacy process can be easy to follow with the right information. Here are the answers to all of your top FAQs.

pregnant lady's tummy

What is gestational surrogacy?

A gestational surrogate, also called a gestational carrier, carries someone else’s baby for them. The surrogate is someone with a uterus who has someone else’s fertilized egg implanted in them and then carries that embryo to term and births the baby and gives the baby to the intended parents. The surrogate is not biologically related to the baby.

Who uses gestational surrogacy?

If a couple or individual can’t carry and birth a baby on their own, a gestational surrogate can do it for them. Some people who would be in this situation could be:

  • Two partners of the same sex who are looking to become parents
  • A man and a woman in a relationship with each other where the woman cannot carry a baby for physical reasons (previous hysterectomy, recurrent pregnancy losses, fibroids, medical conditions that put them at high risk if pregnant)
  • Another situation such as a single parent by choice, a throuple, or another arrangement where there is not a person with a uterus who is able to and willing to carry a baby

Whose egg and sperm are used?

This will depend on who is having the baby, but it is not the gestational surrogate’s egg unless she is also the egg donor. If an intended mother is able to be the egg donor, then she can be, and if an intended father is able to be the sperm donor, then he can be. That depends on factors like fertility, testing and compatibility, and who the intended parents are, and who they want the genetics of their baby to come from.

If the intended parents cannot provide the egg and the sperm, one or both will have to be provided by donors. Egg donors and sperm donors can be anonymous or known to the parents.

The egg and sperm are put together outside the body and then put into the body after they are already an embryo. The surrogate will take hormones to help improve the odds of the embryo implanting in her uterus.

Pregnant married woman standing in a floral gown

How can I find a gestational surrogate?

You would first find an agency to work with and they would work to match you with a surrogate. You would have to sign legal paperwork with the surrogate to protect your rights and hers and to be make everything clear. Will you allow or provide any contact between her and the baby after birth? Will you pay her medical costs if the birth disables her? Will she travel to you for visits during the pregnancy or will you travel to her? There is a lot to work out and the agency drawing up the paperwork will have experience with all of it.

Agencies screen surrogates for age, history of healthy pregnancies, medical history, BMI, psychological evaluation, and other health factors. You will be able to see profiles with this information when choosing a surrogate.

How can I become a gestational surrogate?

It is somewhat easier to become a surrogate than an egg donor since you are not passing on your genetics to the baby and don’t need to be as young. Your first step will be to find an agency and to pass their testing to become one of their surrogates. They can then match you with intended parents.

The agency will likely want you to be between 21 and 45 years old, pass medical tests to show you don’t have any conditions including HIV, diabetes, hepatitis, etc., pass a psychological evaluation, pass a background check, weigh in at a healthy BMI, and other screenings. They will likely prefer that you’ve given birth before. You can read more about recommended guidelines for surrogates here.

You can be married, have kids, be single, not have kids… just about anyone healthy with a uterus can be a surrogate.

What should I consider what choosing a surrogacy agency?

Here are some questions to consider about a potential agency:

  • What screenings do they perform on both the surrogates and the intended parents? You want them to be thorough on both parties.
  • What services do they provide surrogates and intended parents? These might include legal, counseling, and more.
  • How long have they been around? How many matches have they successfully performed?
  • Do they have an in-house attorney? Do they coordinate legal paperwork? Are legal fees included in their costs?
  • What do they charge intended parents and how do they compensate surrogates?

Always do a search on the agency as well to see what reviews or stories pop up, too.

No matter where you end up on your surrogacy journey, find support along the way. Whether helping intended parents or becoming parents yourselves, surrogacy can be a beautiful way to bring a baby into the world.

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Sarah Prager
Sarah is a writer and mom who lives in Massachusetts. Her writing has appeared in The New York Times, The Atlantic, National…
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