Surrogacy in the United States is a well-established and somewhat regulated process. Commercial surrogacy has been taking place for over 30 years. Statistics from the Centers for Disease Control indicate there are approximately 8000 cases of gestational surrogacy per year (2024) in the United States. These take place in most states (44) with the exception of six states that prohibit surrogacy or severely restrict the practice. Surrogacy also takes place outside the United States for largely those who cannot afford the price of $150,000 plus dollars. Other blogs address these global surrogacy “hotspots”.
The surrogacy journey (term of art) is intricate and involves a variety of professional components that need to be interconnected and coordinated.
From selecting the right surrogacy agency to legal representation, medical experts, and even psychological support, the surrogacy journey requires the collaboration of numerous professionals to ensure a smooth and successful experience.
For Intended Parents (legal term), understanding the roles these professionals play is essential in navigating the often complex landscape of surrogacy in the U.S. Here we describe the professional components and their roles.
Those people seeking and using surrogacy include single males, single females, heterosexual couples and same sex couples. These people, termed Intended Parents (IPs) are not just from the United States. They essentially come from all countries of the world. Some notable exceptions are Greece, Georgia, and Ukraine where surrogacy is legally permitted for heterosexual couples with a medical need. To many, having a baby being a USA citizen by birth is attractive to the IPs.
In this blog, we’ll explore the key professional components that are typically involved in a U.S. surrogacy journey, explaining what each expert contributes and why they are important.
1. Surrogacy Agencies
Surrogacy agencies serve as the cornerstone for many IPs embarking on a surrogacy journey. These agencies recruit and screen potential gestational carriers (GC: surrogates) and facilitate the matching process between IPs and GC. Agencies also coordinate many of the logistical, legal, and emotional aspects of the surrogacy experience.
Agency Services
Surrogate matching: Agencies help IPs find a surrogate who is not only medically suitable but also aligns with their personal preferences (e.g., lifestyle, location, family values).
Screening and vetting: A reputable agency will thoroughly screen potential surrogates to ensure they are physically, emotionally, and mentally prepared for the surrogacy journey. This includes background checks, medical history reviews, and psychological evaluations. In my experience in screening over 100,000 candidates and speaking with other agencies less than 2% qualify.
Background Checking: A really good agency should employ a private detective to screen not only the surrogate, but her partner for criminal activity and financial liabilities.
Support and guidance: Throughout the process, agencies offer support to both the IPs and the surrogate, helping to navigate challenges and ensuring smooth communication.
Coordination of professionals: A surrogacy agency often acts as a project manager, coordinating the medical, legal, and psychological professionals involved in the journey.
Choosing a well-established and trusted surrogacy agency is crucial. Their experience can make the process less overwhelming and help IPs avoid common pitfalls.
2. Reproductive Endocrinologists, Embryologists, and Fertility Clinics
All surrogacy journeys require medical professionals, particularly reproductive endocrinologists, embryologists, and fertility specialists. These doctors and their teams are responsible for the medical procedures needed to create and implant embryos into the surrogate’s uterus. There are about 435 FDA registered IVF/Fertility clinics in the United States. The majority participate in surrogacy.
Fertility Clinic Services
In vitro fertilization (IVF): Most surrogacy journeys require IVF, a process in which eggs are retrieved from the intended mother or an egg donor, fertilized with sperm (either from the intended father or a donor), and then cultured into embryos. One or more embryos are then transferred to the surrogate. One embryo is normally transferred unless unusual circumstances prevail.
Preimplantation genetic testing (PGT): Fertility clinics often offer genetic testing of embryos to check for chromosomal abnormalities, ensuring the healthiest embryos are selected for transfer. These tests can also determine the gender of the embryo.
Surrogate medical evaluation: Before an embryo transfer can take place, the fertility clinic will thoroughly assess the surrogate’s health, evaluating her ability to carry a pregnancy to term.
Collection of gametes: Fertility clinics often screen the health of the IPs who may be donating gametes or the third parties that are donating.
Fertility clinics are the medical backbone of the surrogacy process, and IPs must choose a clinic with experienced reproductive endocrinologists, high success rates, and state-of-the-art technology.
3. Surrogacy Lawyers
Navigating the legal aspects of surrogacy is a critical component of the journey. Surrogacy laws vary significantly from state to state in the U.S., so it’s important for IPs to work with a surrogacy attorney who specializes in reproductive law and has experience in the relevant state jurisdictions.
Note that both the IPs and the GC need an attorney and these need to be separate entities. The attorney for the IP will draft or have a Gestational Surrogacy Agreement (GSA) and the GC’s attorneys role is to make sure she understands her obligations. Intended Parents are responsible for paying for the attorney for the GC.
Legal Services
Drafting and reviewing contracts: Surrogacy contracts are the backbone of the arrangement, outlining the rights and responsibilities of both the surrogate and the IPs . This legally binding document addresses compensation, medical decisions, responsibilities during pregnancy, and post-birth procedures.
Parental rights: A surrogacy attorney ensures that the Intended Parents ’ rights are protected throughout the process. In many states, a legal process called a "pre-birth order" is required to establish the IPs as the legal guardians of the child before birth, avoiding complications in the hospital or post-delivery.
Cross-state legal matters: If the surrogate lives in a different state than the Intended Parents , the surrogacy lawyer will ensure compliance with both states’ laws, ensuring there are no legal gaps or issues with parental rights.
Choosing an experienced surrogacy attorney ensures that the Intended Parents ' parental rights are secure and that the process adheres to all applicable laws. Choosing an attorney who is not experienced with surrogacy will be a waste of time and money.
4. Mental Health Professionals
Surrogacy is a deeply emotional process for both the IPs and the surrogate. Mental health professionals play a vital role in preparing all parties for the emotional challenges of surrogacy and supporting them throughout the journey.
Psychological Support Services
Screening and evaluations: Surrogates are typically required to undergo psychological evaluations to ensure they are emotionally stable and fully understand the physical and emotional challenges they will face. Best practices dictate that GCs are given both a clinical exam and a battery test.
Counseling and support: Many surrogacy agencies and fertility clinics offer ongoing counseling to both the surrogate and IPs . For surrogates, therapy can help them manage the emotional complexities of carrying a baby for someone else, while for IPs, it can help alleviate stress, anxiety, and the emotional toll of infertility.
Group support: Some professionals offer group therapy or peer support groups where IPs and surrogates can connect with others going through similar experiences. These forums can be invaluable sources of emotional support and guidance.
Including psychological support in the surrogacy process helps ensure the emotional well-being of both the surrogate and the IPs .
5. Escrow Account Management and Financial Advisors
Surrogacy involves significant financial commitments, including compensation for the surrogate, medical fees, agency fees, legal fees, and other related expenses. An escrow account manager ensures that funds are handled transparently and securely, protecting both the IPs and the surrogate.
Escrow Services
Managing funds: Escrow managers hold and disburse the funds that IPs deposit for the surrogate’s compensation and other surrogacy-related costs. Payments are made according to milestones outlined in the surrogacy contract[GSA (e.g., medical procedures, pregnancy confirmation, monthly payments)].
Dispute resolution: If there are disputes regarding compensation or other financial matters, an escrow manager can help mediate and ensure that payments are made fairly.
Working with a reputable escrow company protects all parties involved from potential financial misunderstandings or issues, offering peace of mind throughout the process.
6. Insurance Experts
Medical insurance is another crucial element of surrogacy in the United States. IPs need to ensure that the surrogate’s pregnancy and delivery are fully covered, which can be a complicated process depending on the surrogate’s existing insurance policy.
Insurance Services
Policy reviews: Insurance experts will carefully review the surrogate’s health insurance policy to determine whether it covers surrogacy-related medical expenses.
Supplemental insurance: If the surrogate’s existing insurance does not cover surrogacy, the IPs will need to purchase a separate surrogacy-specific insurance plan. An insurance expert can help find and secure the right coverage.
Life Insurance: It is common practice for the IPs to purchase two term life insurance policies on the GC. One pays the GC family and the other pays the IPs in the event of the surrogates death.
Ensuring adequate medical insurance coverage can protect IPs from unexpected costs that could arise during pregnancy and delivery.
7. Egg or Sperm Donor Agencies
In cases where IPs need a third-party egg or sperm donor, donor agencies come into play. These agencies match IPs with donors based on genetic, physical, and personal characteristics.
Donor Agency Services
Donor matching: Agencies provide a diverse pool of pre-screened donors, helping IPs find the best match.
Medical and psychological screening: Donors undergo thorough medical and psychological evaluations to ensure they are suitable candidates for donation.
Legal contracts: Like surrogates, donors must sign legal contracts outlining their rights and responsibilities, including relinquishing any parental rights to the child.
Working with a reputable donor agency ensures that Intended Parents find a healthy and suitable donor, with all legal protections in place.
Conclusion
A surrogacy journey in the United States requires the coordinated efforts of many professionals—surrogacy agencies, medical experts, legal advisors, mental health professionals, and more. Each plays an essential role in ensuring the process is legally secure, medically sound, emotionally supportive, and financially transparent.
For IPs, paying for all these professionals , understanding the roles of these professionals is the key to navigating the often-complex landscape of surrogacy, ensuring a smoother and more fulfilling experience on the path to parenthood.