Surrogacy 101: A Step-by-Step Guide for Intended Parents

Surrogacy, Mom holding Baby's feet

Starting a surrogacy journey is both profound and complex.

As intended parents, you may feel a blend of excitement, hope, uncertainty, and even overwhelm. But with clear guidance, trust in the process, and a caring support team, it becomes a path you can walk with confidence. At Over the Rainbow, our heart is to offer personalized support and clarity at every stage.

In this guide, we’ll walk you through each step of the surrogacy journey; what it looks like, what to expect, and how to stay empowered. Along the way, I’ll link to expert resources you can explore deeper. Let’s get started.

1. Understanding the Basics: What Is Surrogacy?

Before diving into process steps, it’s important to ground ourselves in definitions and types.

Types of Surrogacy

  • Gestational Surrogacy: This is the predominant form of surrogacy today. In this scenario, a surrogate (often called a gestational carrier) carries an embryo created via IVF using eggs and sperm from the intended parents or donors. The surrogate is not genetically related to the child. Cleveland Clinic

  • Traditional Surrogacy: Less commonly used due to greater legal complexity, here the surrogate uses her own egg, so she is genetically related to the child. 

Why Choose Surrogacy?
Intended parents may choose surrogacy for various reasons: medical conditions, repeated miscarriages, absence of a uterus, risk to maternal health, same-sex couples, or single individuals seeking biological connection. 

As you read on, know that every journey is unique and this guide is your compass, not a rigid map.

2. Step 1: Research & Preparation (Pre-Commitment)

This foundational phase is about educating yourself, aligning with your partner (if applicable), and clarifying your goals.

A. Clarify Your Why & Expectations

  • Talk openly about your goals, fears, values, and level of involvement with the surrogate.

  • Read stories/testimonials from intended parents to understand varied experiences.

  • Ask agencies or consultants for a “roadmap” of timelines, risks, and common emotional curves.

B. Understand Legal Terrain

Surrogacy laws vary state by state (and country by country). Some states have supportive statutes; others restrict or ban compensated surrogacy. Ensure you research the laws in your jurisdiction or consult an attorney experienced in fertility and assisted reproduction.

One resource: ASRM’s recommendations on using gestational carriers offer medical, psychological, and ethical guidance.

C. Budget & Financial Planning

Surrogacy is a major financial commitment. You’ll need to estimate costs for:

  • IVF / embryo creation

  • Surrogate screenings

  • Agency or coordination services

  • Legal contracts

  • Insurance & medical coverage

  • Travel, lodging, contingency funds

Several sources report total costs between $100,000 to $200,000+ depending on location, complexity, and components. Investopedia. At this point you might also explore grants, fertility benefits, or loan options. This planning ensures you begin the process from a place of confidence, not uncertainty. Over the Rainbow will help you through every single step of the financial planning process. You are never alone!

3. Step 2: Selecting an Agency, IVF Clinic, & Legal Team

Once you’re committed, you need a trustworthy support team. Your agency, fertility clinic, and legal counsel will form the backbone of your journey.

A. Choosing a Surrogacy Agency / Coordinator

A high-quality agency offers:

  • Full coordination and case management

  • Matching services and profiles

  • Emotional support and counseling

  • Oversight of medical, legal, and insurance logistics

  • Transparent fees and breakdowns

When evaluating agencies, ask questions like:

  • What is your success rate (or “live births per journey”)?

  • Do you support both intended parents and surrogates emotionally?

  • How do you do matching (values, preferences, communication style)?

  • What happens if an embryo transfer fails?

  • What post-birth services do you provide?

B. Fertility Clinic / IVF Partner

Your clinic must be experienced in working with gestational carriers. Key considerations:

  • Success rates and donor/egg bank relationships

  • Proximity or partnerships with monitoring clinics

  • Protocols for embryo transfer, freezing, and thawing

  • Experience with intended parent–carrier journeys

C. Legal Counsel

You’ll need experienced reproductive law attorneys (often on both sides) to draft and review your surrogate agreement, pre-birth parentage orders, insurance clauses, breach clauses, and more. Legal safety is nonnegotiable and Over the Rainbow will help you coordinate and execute all legal matters.

4. Step 3: Intended Parent & Surrogate Screening

At this stage, both you and potential surrogates go through assessments to ensure readiness—medically, psychologically, and emotionally.

A. Intended Parent Screening

Though you are not carrying the pregnancy, clinics and agencies typically review your medical history, fertility evaluations, previous IVF or embryo data, genetic testing, and overall health. Some agencies impose “intended parent requirements” regarding embryo quality or health disclosures. 

You may also undergo counseling to help anticipate emotional challenges, which we can help facilitate.

B. Surrogate Screening (by the agency / clinic)

The surrogate will go through strict screening in areas like:

  • Medical/obstetric history (prior full-term pregnancy, cesarean history, complications)

  • Physical health: BMI limits, overall wellness

  • Psychological evaluation (motivation, support system, expectations)

  • Background checks, lifestyle, insurance eligibility

  • Geographic and legal eligibility (residency in a surrogacy-friendly state)

This screening ensures safety, reduces risk, and protects all parties.

5. Step 4: Matching & Initial Meeting

Now comes one of the most important and personal phases—matching with your surrogate.

A. Reviewing Surrogate Profiles

Agencies will present you with curated profiles that align with your preferences (age, family size, values, location, communication style, prior experience). You’ll review medical history, personality, motivations, and preferences.

B. Getting to Know Each Other

Often, an introductory call or meeting is arranged (virtually or in person) so you can ask questions, feel their personality, and build rapport. Compatibility in expectations about communication, birth plan, boundaries, and relationship style matters deeply. 

C. Making the Match

If both sides are comfortable, you formally accept a match. At that point, more in-depth conversations begin: expectations, contract negotiations, logistics, and communication norms.

6. Step 5: Legal Contracting & Escrow / Funding

With a match in place, it’s time to formalize your journey.

A. Drafting the Surrogacy Agreement

Your attorneys will draft a gestational carrier agreement (GCA). Key elements typically include:

  • Rights and responsibilities of each party

  • Medical and psychological risk terms

  • Insurance expectations and coverage

  • Remuneration and reimbursement schedules (if applicable)

  • Clauses for complications, multiple embryos, miscarriage, selective reduction

  • Communication, dispute resolution, and confidentiality

B. Escrow / Funding

Agencies or attorneys often use an escrow fund to manage payments to the surrogate according to milestones and expense reimbursements. The funding may include base compensation, insurance, travel, maternity clothing, child care, etc. 

C. Legal Parentage & Pre-Birth Orders

Depending on your state or country, there may be a pre-birth parentage order, recognition of intended parent rights, or post-birth adoption requirements. These steps typically happen around the second trimester so that legal parentage is established by birth.

7. Step 6: Medical Protocol & Embryo Transfer

With legal clarity, the medical process begins.

A. Preparing the Surrogate’s Uterus

The surrogate may undergo hormone protocols to build the uterine lining (e.g., estrogen, progesterone). The timing is coordinated with your embryo plan.

B. Embryo Thaw / Transfer

One or more embryos (fresh or frozen) are transferred. After the transfer, hormone support continues, and early pregnancy monitoring begins (beta hCG tests, ultrasounds). Cleveland Clinic

C. Pregnancy Monitoring

Regular ultrasounds, medical checkups, and communication with the surrogate become a new rhythm. Your involvement should be guided by your match agreement—some IPs attend scans, some prefer distance.

8. Step 7: Pregnancy, Birth Planning & Monitoring

Now you step into the delicate balance of support, care, and communication.

A. Communication & Relationship

Maintain open lines of communication, from appointment updates to emotional check-ins. Respect the surrogate’s autonomy while preserving shared goals. 

B. Birth Plan & Hospital Coordination

Work with your surrogate, doctors, and hospital to define who will be in the delivery room, moments after birth, cord cutting, and immediate bonding. Some hospitals allow you to hold the baby right away; others have protocols.

C. Breast Milk / Colostrum Considerations

Some surrogates may choose (if willing and able) to express colostrum or breast milk for the newborn. However, this is not guaranteed, intended parents should discuss this early and not assume it will occur. Greenspoon Marder 

There are guides on shipping breast milk, handling logistics, and safety measures. 

9. Step 8: Birth, Transfer of Custody & Postpartum

This is the culmination—bringing your baby home and closing the surrogacy chapter.

A. Delivery & Immediate Aftermath

  • The baby is delivered under the agreed plan.

  • Intended parents commonly cut the umbilical cord, hold the baby, and begin bonding.

  • Medical staff will care for the newborn and assess health status.

  • The surrogate may or may not have a role depending on your agreement, but many families include a moment of gratitude or acknowledgment.

B. Legal Steps for Parentage

If not already done, finalize any post-birth orders or court recognition so that intended parents have legal custody and parental rights.

C. Postpartum Care & Closure

  • The surrogate will recover postpartum—check on her physical and emotional well-being.

  • Some agencies facilitate a “closure meeting” or discussion of what’s next in your relationship (communication boundaries, future contact).

  • Celebrate your family, but also allow space for reflection, processing, and gratitude.

FAQs (Frequently Asked Questions)

Below are some FAQs that often come up for intended parents. (These also help with SEO and capturing long-tail traffic.)

Q: How long does the surrogacy process take?
A: It varies. From initial research to birth, many journeys span 12 to 24 months, depending on matching time, legal complexity, and medical scheduling. 

Q: What is the difference between gestational and traditional surrogacy?
A: In gestational surrogacy, the surrogate is not genetically related to the child—the embryo comes from you or donors. In traditional surrogacy, the surrogate uses her own egg and is genetically related. 

Q: Can my surrogate breastfeed or provide milk?
A: Possibly—but it depends on her comfort, physiology, and your mutual agreement. Some surrogates express colostrum or milk, but it’s not guaranteed. Always discuss this early in the contract. 

Q: What if the embryo transfer fails?
A: Many contracts account for this possibility. You may have the option to rematch, reuse frozen embryos, or renegotiate terms depending on your agreement and agency policies.

Q: Are surrogacy agencies necessary?
A: While you can pursue independent surrogacy, agencies simplify coordination, screening, legal management, emotional support, and compliance. For many intended parents, the agency’s value is worth the cost. 


Ready to Start Your Journey?

Connect with Over the Rainbow for a free consultation call. We’re happy to walk through the process, answer all your questions, and partner in your journey to parenthood. 

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The Boutique Surrogacy Difference: Why Small Agencies Matter

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The Benefits of Being a Surrogate: Why Women Choose This Life-Changing Journey