The Surrogacy Process Step by Step

The 10 steps of the surrogacy process

1. Research and self-assessment — 1–4 weeks
2. Choose an agency — 2–4 weeks
3. Submit your application — 2–6 weeks
4. Medical screening — 1–2 months
5. Psychological screening — 2–4 weeks
6. Matching with intended parents — 1–6 months
7. Legal contracts — 2–6 weeks
8. Medical protocol and embryo transfer — 1–2 months
9. Pregnancy — about 9 months
10. Delivery and post-birth recovery — 4–8 weeks

The timeline, drawn to scale

Most first-time surrogates land at 15–18 months. The chart plots a typical journey on a 24-month axis. The highlighted band on step 6 is the matching variance: it can take a few weeks or most of a year, and it moves everything after it.

Each step, month by month

The months in each label are cumulative from the day you apply, assuming a typical journey. Yours will drift, mostly at step 6.

1. Month 0

   Step 1: Research and self-assessment 1–4 weeks

   Before you contact any agency, do the honest internal work. Can your body handle another pregnancy? Can your household handle an 18-month commitment with travel, injections, and appointments in it? Is your motivation clear enough that the hard weeks will still feel worth it?

   This step is free, and it's the one most people skip. Skipping it is how women realize six months in that surrogacy isn't right for them, after other people have started counting on them. Our nine honest questions to ask yourself is built for exactly this week. If you want the reference version of what agencies check, read the 12 surrogate requirements first.

   What agencies won't volunteer

   Recruiters are measured on applications, not on completed journeys. Nobody at an agency benefits from telling you to wait a year. You have to be the one who decides that.
2. Month 0–1

   Step 2: Choose an agency 2–4 weeks

   Research three to five agencies. Check whether they use independent escrow, whether your attorney is truly separate from theirs, how they handle a failed transfer, and what surrogates say about them on more than one platform. Our partner agency reviews cover the four that met our baseline, and the agency red flags guide lists what should make you walk away.

   You can also go independent (find intended parents yourself and hire your own attorney and escrow) or work with someone you already know. Both are real paths. Both put more of the coordination on you.

   What agencies won't volunteer

   Applying to two agencies at once is allowed, and it's the only way to compare how they actually treat you before you commit. Some agencies discourage it. That's information too.
3. Month 1–2

   Step 3: Submit your application 2–6 weeks

   The application is long. Expect questions about your full medical history, pregnancy and delivery records, current medications, lifestyle, criminal background, insurance, photos of you and your family, and why you want to do this. Be exact; agencies pull records and verify.

   Review usually takes 2–4 weeks. Agency approval means you fit their criteria on paper. It is not medical clearance.

   What agencies won't volunteer

   The delivery records request is the slow part. Hospitals can take weeks to send them. Request your own records the day you decide to apply and you'll skip a month of waiting.
4. Month 2–3

   Step 4: Medical screening 1–2 months

   Medical screening happens at the intended parents' fertility clinic, which may be in another state. Travel is reimbursed. You'll have bloodwork including an infectious-disease panel, a physical exam, a uterine evaluation (saline sonogram or hysteroscopy), pap smear, STI testing, a urine drug screen, and a review of your pregnancy history. If you have a partner, they're usually tested for infectious disease too. The medical screening guide walks through each test.

   The clinic, not the agency, makes the final medical decision. You can pass agency screening and still be declined by the clinic. Common reasons are a BMI that's higher than reported, fibroids or polyps, a positive drug screen, or a delivery record that reads differently from how you remembered it. Our page on what screening screens for lists each one and which of them flex.

   What agencies won't volunteer

   Some agencies match you before the clinic has cleared you. If the clinic then says no, you've already met a family who was counting on you. Ask your agency whether matching happens before or after clinic clearance, and ask for it in writing.
5. Month 3

   Step 5: Psychological screening 2–4 weeks

   ASRM recommends a psychological evaluation for every gestational-carrier cycle, and some states require one by statute. You'll complete a standardized personality inventory (typically the MMPI-2-RF or the PAI, a few hundred questions), sit for a clinical interview with a licensed mental-health professional, and your partner will usually be interviewed too. The psychological screening guide explains what they're actually looking for.

   Not everyone clears this stage. The usual reasons aren't mental illness. They're an unsupportive partner, a major life stressor in the last six months, or expectations about the intended-parent relationship that don't match reality. Those are all things you can work on and come back from; the disqualifications page explains which ones are permanent and which aren't.

   What agencies won't volunteer

   The evaluator is often contracted by the clinic or the agency, not fully independent. That's normal. It also means you should answer as yourself, not as the person you think they want. Mismatches surface later, when it costs more.
6. Month 3–6 (can run to 9+)

   Step 6: Matching with intended parents 1–6 months

   This is the biggest variable in the whole timeline. Once you clear screening, you enter the matching pool. Your flexibility on family type, location, communication style, and views on things like selective reduction affects how fast a match comes. Matching can happen in two weeks. It can take most of a year.

   The agency sends you one or more intended-parent profiles. If something fits, there's a video call. Both sides can say no afterward, and nobody should pressure you either way. A match you're not sure about is a match to pass on.

   ?

   Named surrogate pull-quote about the matching wait — hidden until written consent and a verifiable first name are on file.

   Slot: real first name, real photo or illustrated avatar, quote published with consent.

   What agencies won't volunteer

   Matching speed depends on how many intended parents the agency has in your state, and agencies rarely publish that number. Ask how many active intended-parent families they have who could match with someone in your state right now. A vague answer is an answer.
7. Month 6–7

   Step 7: Legal contracts 2–6 weeks

   Both sides hire attorneys. Yours is paid by the intended parents but works for you alone. The contract covers compensation (base and every contingent item), medical decision-making, how many transfers you've agreed to, what happens after a miscarriage, insurance, communication expectations, travel, bed rest, and post-birth contact. Read every word. Don't let anyone rush this.

   The contract also sets up the parentage path. In pre-birth-order states, your attorney will file during the pregnancy so the intended parents are the legal parents before delivery; our surrogacy laws by state page shows which states do that and which use a post-birth process.

   What agencies won't volunteer

   Escrow has to be funded before you start medications. That means the intended parents deposit your full base compensation and expense fund with an independent escrow company before step 8 begins. If anyone suggests starting meds "while the escrow paperwork finishes," stop. Your contract should say the money is in place first.
8. Month 7–8

   Step 8: Medical protocol and embryo transfer 1–2 months

   Your body is prepared with hormones: estrogen first, then progesterone, for roughly 2–4 weeks before transfer. Progesterone is usually an intramuscular injection, often daily. Monitoring appointments (bloodwork and ultrasound) confirm your lining is ready. The transfer itself is a short procedure at the clinic, about 15 minutes, no anesthesia.

   Then you wait 10–14 days for a blood test. Not every transfer takes. SART's national reporting puts live-birth rates per gestational-carrier transfer at roughly half or a bit better, depending on the embryo and the clinic, so a failed first transfer is common and isn't a verdict on you. If it fails, you typically wait 1–2 months and try again with the next embryo. Your contract says how many attempts you've agreed to, usually two or three.

   What agencies won't volunteer

   The injections are real, and someone has to give them. If you can't self-inject in the hip, you'll need a partner, friend, or nurse to do it every evening for weeks. And monitoring may not be local: some clinics require you at their site for scans, which can mean travel every few days during the protocol. Ask where monitoring happens before you sign.
9. Month 8–17

   Step 9: Pregnancy About 9 months

   Pregnancy is familiar (you've done it) and different (it's not your baby, and other people are watching the calendar with you). Hormone injections usually continue through the first trimester, about 10–12 weeks. After that you transfer to your own OB, keep regular check-ins with the agency, and communicate with the intended parents as your agreement describes.

   Base compensation is paid in monthly installments once a heartbeat is confirmed. If you're carrying twins, a multiples fee applies on top of base; across our partner agencies it runs $5,000–$10,000 and is confirmed at ultrasound. It's a contingent item, so it's listed separately in your contract. Our surrogate compensation guide breaks down every base and contingent line.

   What agencies won't volunteer

   Bed rest and lost wages are contingent items too. If your contract caps lost-wage reimbursement at a number of weeks, and your OB orders more, the gap is yours. Read that clause before you sign, not at 30 weeks.
10. Month 17–18

    Step 10: Delivery and post-birth 4–8 weeks

    You deliver. In pre-birth-order states, the intended parents are already the legal parents, and the hospital treats them that way from the first minute. In post-birth states there's a court step after delivery, which your attorneys will have prepared for.

    Physical recovery is the same as any birth, longer after a C-section (which carries its own contingent fee, $3,000–$5,000 across our partners). Your monthly allowance typically continues 1–2 months postpartum. Emotional processing is normal and expected, including after a journey that went well. Good agencies offer post-birth counseling; ask whether it's included.

    What agencies won't volunteer

    Final-payment timing is where disputes happen. Your contract should state exactly when the last base installment and any delivery fees are released from escrow, and what documentation triggers it. "Within 2–4 weeks of delivery" is typical. "After the intended parents confirm" is not a date. Get a date.

Common process questions

Can I pause between steps?

Yes, at any point before you sign the surrogacy contract. Some surrogates pause for a few months between screening and matching to handle a move, a job change, or a family event. Most agencies are understanding about a reasonable pause; some will ask you to repeat parts of screening if it's been more than a year.

What if I fail medical or psychological screening?

It depends on why. A fixable medical issue (BMI, a polyp, an untreated thyroid) can be addressed and you can reapply. A psychological decline for current stress or an unsupportive home can change with time. A hard medical disqualifier, like an untreatable condition or a uterine issue the clinic won't clear, is usually permanent, and that's for your safety.

How does matching actually work?

The agency sends you one or more intended-parent profiles: family type, communication preferences, their story. If you're interested, there's a video call. Both sides then decide. It's a mutual choice, and you're allowed to pass without explaining yourself.

What if the first embryo transfer fails?

You wait 1–2 months and try again with another embryo. Most contracts specify two or three attempts. You're typically paid a transfer fee per attempt whether or not it succeeds; that fee is a contingent item and should be in your contract.

Frequently asked questions