The Gestational Surrogacy Process: Step by Step

If you want to grow your family but carrying a pregnancy is not feasible or possible, gestational surrogacy is one way of achieving parenthood. While the gestational surrogacy process in most fertility clinics requires multiple ethical and medical screening processes and legal requirements, the use of gestational surrogates in the U.S. increased by more than five times between 1999-2013. This is according to a study published in the American Society for Reproductive Medicine Journal. 

This promising statistic shows us that gestational surrogacy has helped many to achieve their dreams of being a parent. You, too, can make use of a gestational surrogate to reach your desired family size, regardless of whether you have a partner or not.

This article will teach you more about gestational surrogacy, the process, cost, and success rates.

What is a Gestational Carrier (Surrogate)? 

gestational carrier with gestational surrogacy pregnancy

A gestational surrogate is a woman who decides to carry and give birth to a baby for a couple or individual (known as the intended parent/s) with the help of assisted reproduction techniques (ART). She will carry a pregnancy from an embryo(s) that was created using the intended parent(s) or donated sperm and egg.

The gestational surrogate is not the baby's biological parent because they have no genetic relationship. Sometimes a sperm or egg donor will be used if not provided by the couple or intended parents. This is true for LGBTQ+ couples or individuals who want to become parents.

Note: A gestational carrier differs from a traditional surrogate, who may provide the egg and carry the pregnancy. With traditional surrogacy, the surrogate will have a genetic link to the baby - which is why surrogacy arrangements often are controversial and complex, both legally and psychologically. Because of the complexity of these issues, gestational surrogacy is by far more common in the U.S. At IHR, we only work with gestational carriers and gestational surrogacy.

When is Gestational Surrogacy an Option?

Female factor infertility is one of the primary reasons you may make use of a gestational carrier (surrogate) to grow your family. 

If you've been diagnosed with structural or functional defects of the uterus, you may not be able to carry a pregnancy successfully. For instance, females born without a uterus or a malformed uterus can not carry a pregnancy. 

Women with health conditions that make pregnancy unsafe for her or the baby benefit from the services of a gestational carrier. Also, LGBTQ+ couples or individuals looking to build their families can benefit from gestational surrogacy.

What the Gestational Surrogacy Process Entails 

The gestational surrogacy process varies from region to region, and you should find advice in your area. Professionals such as fertility doctors, lawyers, and counselors play critical roles in helping couples and individuals through surrogacy. Here are some of the fundamental components of a gestational surrogacy process:

Eligibility Criteria for the Surrogate

Before becoming a gestational carrier, gestational carrier applicants must meet some selection criteria. Medical screening guidelines recommend that surrogates should be between 21-40 years old. Also, surrogates should meet the following conditions:

  • A history of at least one healthy pregnancy and a full-term delivery without complications.
  • Medically and psychologically fit to carry a pregnancy.
  • Willing and desirous to help a couple or single individual become parents.


Generally, both the intending parent(s) and gestational carrier go through a counseling process. Careful evaluation by medical professionals, MHPs, or legal professionals is necessary, as are a careful explanation of the process and possible risks involved. The counselor also strives to provide critical details of the process and ensures that the individuals involved make informed decisions. 

Legal Requirements

An attorney familiar with the gestational carrier legal processes is necessary to draft a legal contract. The attorney will help you and the gestational carrier to understand the rights and responsibilities involved in the gestational carrier process. Generally, the intending parents and the gestational carrier should have their respective attorneys to represent and protect them during the review of the legal contract. Official documents such as proof of identity and address may be part of the legal requirements.

The attorneys will finalize the signing process once the intended parent(s) and gestational carrier are satisfied with the legal terms.

Medical Screening

Fertility doctors and other fertility experts supervise medical screening activities to ensure the gestational carrier is healthy and able to carry and deliver a baby. The fertility doctor typically takes a detailed clinical history and conducts a physical examination of the gestational carrier. This often includes a detailed obstetric history, lifestyle history, and physical exam. She should have an evaluation of her uterine cavity with HSG, SHG, or hysteroscopy. 

 Also, the doctor may order the following screening tests:

  • Human immunodeficiency virus (HIV) 
  • Hepatitis B virus surface antigen
  • Hepatitis C virus
  • Syphilis, gonorrhea, chlamydia, etc.
  • Electrocardiogram 
  • Pap smear
  • Mammogram 
  • Pelvic and abdominal ultrasound

Mental health professionals will be necessary for conducting mental health assessments to ensure the gestational carrier, her partner, and the Intended parent(s) is/are emotionally ready for the process.

After the medical screening tests and once the doctor confirms that the gestational carrier is well, she will have to sign a consent before the procedure begins.

Whoever is providing the eggs and sperm to create the embryo, whether from the intended parent(s) or from donor sperm or donor eggs, is also screened for a wide range of infectious diseases (as mandated by the FDA). This is done to protect the health of the gestational carrier and baby.

Post-birth Legal Measures

Some states require post-birth legal measures to establish parental proof as part of the gestational surrogacy procedure. The specific requirements vary by state. Examples of post-birth legal measures include filling out the following forms:

  • pre-birth order
  • post-birth order
  • an adoption form after birth.

How Do Gestational Carriers Get Pregnant?

Gestational carriers (surrogates) get pregnant using a fertility-based treatment called assisted reproduction technology (ART). Using ART techniques such as in vitro fertilization, the fertility doctor fertilizes the donor or intended parent's egg with the donor or the intended parent's sperm in the in-vitro laboratory. Fertilized eggs are then grown in the in-vitro lab under the watching eye of an embryologist.  

The fertilized egg grows and divides into over 100 cells and becomes a blastocyst stage embryo. The doctor then performs an embryo transfer of a single embryo into the gestational carrier's uterus for implantation to occur.

The gestational carrier will require close monitoring by an obstetrician throughout her pregnancy. Prenatal care benefits the carrier and fetus and reduces the risk of unhealthy events.

How to Find a Gestational Carrier?

There are numerous fertility and surrogacy agencies or programs that help intending parents find and match with an ideal gestational carrier. Once you have your ideal profile of a gestational carrier, contact a surrogacy program for the next steps. Ensure you consult licensed surrogacy programs and those with proven expertise. As a part of the Pinnacle Fertility network, IHR patients have exclusive access to gestational carriers provided by Pinnacle Surrogacy.

How Do You Choose a Gestational Carrier?

Generally, your fertility doctor can guide you in making an informed choice. The ideal gestational carrier should meet the eligibility criteria and be medically fit for the procedure. Your fertility doctor will typically counsel you on the steps to take for a successful gestational surrogacy process.

How Much Does Gestational Surrogacy Cost? 

The cost of surrogacy varies, and factors such as medical expenses, legal fees, etc., can influence the overall cost of gestational surrogacy. However, the cost of surrogacy could range between $140,000- $160,000. Your location and other factors can affect the final cost of surrogacy.

What is the Success Rate of Surrogacy?

gay men parents with baby from gestational surrogacy process

The success rate of surrogacy depends a great deal on the nature of the embryo transferred. High-quality parent or donor eggs and sperm increase the chance of a healthy embryo, which in turn increases the chance of a thriving baby. The age of the woman providing the eggs (intended parent or donor) is an important factor in the pregnancy rates.

Embryo(s) that have preimplantation genetic testing (PGT) done, and are determined to have the correct number of chromosomes (euploidy), have a live birth rate of up to 65% per embryo transfer. Other factors, such as the expertise and experience of the fertility doctor, may influence the success rate of gestational surrogacy.

Surrogacy FAQs for Intended Parents

How Long Does the Surrogacy Process Last? 

The timeline for gestational surrogacy typically lies between 12-18 months. The medical and legal requirements may delay the process and affect the actual duration.

Can a Surrogate Use Her Eggs?

In gestational surrogacy, no, the gestational carrier (surrogate) may not act as the egg donor as well as the carrier of the pregnancy. Gestational carriers only carry the pregnancy and do not provide any genetic material to the offspring.

Is a Surrogate Baby Biologically Yours as the Intended Parent?

The baby delivered by a gestation carrier is biologically yours as long as the fertility doctor obtained the sperm and/or eggs from you as the intending parent(s).

Is there a Difference Between a Gestational Carrier and a Surrogate?

A gestational carrier and surrogate are often confused and used interchangeably. The gestational carrier does not share her DNA or any genetic material with the baby, and she is not the baby's biological parent. A  gestational carrier helps to carry the pregnancy and deliver the baby. 

In contrast, a surrogate is when the same woman is both the egg donor and gestational carrier. She is biologically related to the baby. This type of "true" surrogacy is rarely done.

Do You Need Help Finding a Suitable Gestational Carrier (Surrogate)?

The gestational carrier process can give you hope of becoming a parent when you're not able to carry a pregnancy. Using the services of a mental health professional and leaning on a strong support structure is vital to pull you through the medical and legal processes of gestational surrogacy. It can take time, and having help through every step is invaluable. 

At the Institute for Human Reproduction, our experts can guide you through the gestational surrogacy process. We guide intended parents to make informed decisions in selecting a suitable surrogate carrier for their baby. With the expertise of our licensed and experienced fertility teams, we can get you started on your path to growing a family.

Take a step towards achieving your dream of being a parent by booking an appointment with one of our fertility doctors.

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