Surrogacy 101

A Step-by-Step Guide to the Surrogacy Process

Written by Caroline Shannon

July 21, 2023

We've got you covered on what to can expect throughout the surrogacy journey.

If you haven’t heard it before, we're here to remind you: Every surrogacy journey is unique and special to the people who are involved—and that’s what makes it beautiful! But if you’ve been wondering about the surrogacy process step-by-step, you aren’t alone. It’s perfectly normal to want to know what to expect as the experience unfolds. 

Keep reading to learn more about intake and screening, how to match, legal contracts, and what to plan for during pregnancy and beyond. 

1. Intake and Screening

The surrogacy intake and screening process is vital to ensuring a healthy journey—for all parties involved. While it might feel a little tedious (and lengthy!), all of the steps below are necessary and followed in the order listed:

- A personal information application. Expect to see questions related to some of the basic requirements to become a surrogate, including a surrogate's BMI (which must be less than 32), age (they must be between 21 and 43 years old to become a surrogate), and whether or not they've given birth to at least one child and are currently parenting at least one of those children.

- An identity verification. This step involves uploading documents that verify who a surrogate is. Expect to provide a selfie and a government-issued ID (like a driver’s license). 

- A background check. This is a comprehensive report on an individual's history, including any drug convictions, violent offenses, sex crimes, or instances of fraud or embezzlement that may not be revealed during an interview or reference check. Additionally, a background check may reveal bankruptcies, civil judgments, and any use of aliases. A potential surrogate will be required to complete this step, as well as their partner (if applicable) and anyone over 18 in their home. 

- Collection of medical records. Potential surrogates must gather specific medical records and forms from their healthcare providers. These records include recent pap test results within the past 12 months, prenatal records from a surrogate's previous pregnancies, and labor and delivery records from the hospitals where a surrogate gave birth. A surrogate may also be required to provide a medical clearance letter completed by their healthcare provider. 

- A psychiatric evaluation. A healthcare provider will evaluate the surrogate and their partner (if applicable) to confirm they are psychologically stable and clearly understand their responsibilities during the surrogacy process. The interview will cover topics related to the candidate's background, intentions, and expectations for the surrogacy journey and assess the surrogate’s support team.

Related: What to Expect from the Surrogacy Intake and Screening Process

2. Matching

Finding the right match is critical to a successful surrogacy journey. Before surrogates and intended parents connect on the Nodal platform, they’ll want to consider several factors, including the type of relationship they would like to develop and how often they would like to communicate. Some matches become very close throughout the journey and continue into the baby’s childhood; others develop cordial relationships that end shortly after birth, while some others prefer to set boundaries and opt out of developing personal relationships with their match.

As a surrogate, it’s important to consider:

- Are you willing to carry for a same-sex family?

- Are you open to carrying for a single parent by choice?

- Are you willing to carry for intended parent(s) who have chosen surrogacy outside of medical necessity?

- Does living near your intended parent(s) matter to you? 

Above all, it is important to find a match that shares the same values as you. With Nodal, surrogates can browse intended parents’ profiles before reaching out, allowing them to only speak with people they think might be a good fit. 

3. Medical Workup

Once a match is made, the surrogate’s medical records will be reviewed by a clinic designated by the IP(s) to ensure they are medically fit. This process also involves a medical workup at a clinic chosen by the intended parent(s). During this visit, a surrogate can expect a physical exam, pap smear, vaginal ultrasound, hysteroscopy or saline infusion sonogram, blood work and urine sample, and psychological screening. 

According to guidelines set forth by the American Society of Reproductive Medicine (ASRM), the above will be administered to run specific tests, including those for drugs, infectious diseases, cervical cancer, and blood type.

Other factors considered include a recent tattoo or piercing, which will automatically lead to a surrogate being disqualified because either could lead to infection. (But they can try again in a year!)

Related: What's Involved in Medical Screening for Surrogacy?

4. Legal Contracts

Once a surrogate passes their medical screenings, it’s time to make it official with a gestational carrier agreement (GCA). A surrogate will be represented by their own attorney (paid for by the IP(s)) who will include the surrogate compensation and benefits package as the basis for the contract. Legal steps include: (1) An initial contract created by IP(s) and their attorney, (2) a contract sent to the surrogate and their attorney to review, and (3) the contract is approved by both parties and signed.

Another legal document that will be drawn up closer to birth will be the legal parentage or pre-birth order that designates the intended parent(s) as the legal parents of the child the surrogate is carrying.

5. Embryo Transfer

Typical embryo transfer preparation protocols will include a series of pills, injections, patches, and vaginal suppositories that correspond to a surrogate's cycle. With Nodal, a surrogate can expect to be trained on administering an injection and have access to a support team who can provide additional educational resources to help guide a surrogate through the process.

While taking hormones in preparation for embryo transfer, the fertility clinic will take periodic blood tests and transvaginal ultrasounds to monitor how a surrogate's body responds to the treatment. It is normal to have adjustments made to a protocol depending on the results. A surrogate will likely have the most doctor appointments during this period. Once the uterine lining, called the endometrium, has thickened and is ready for embryo implantation, a surrogate's embryo transfer will be scheduled.

Remember: The embryo transfer isn’t always successful on the first try. It’s important not to get discouraged and understand that sometimes multiple tries are necessary before achieving a pregnancy.

Related: What to Expect for Embryo Transfer as a Surrogate

6. Pregnancy

If the embryo takes, a surrogate can expect a positive pregnancy test around four to six weeks post-transfer. If a surrogate does not live near where the embryo transfer was performed, they will visit a local monitoring clinic in the first few weeks to check ultrasounds and blood work as ordered by the fertility doctor. 

Medications are stopped once the eight- to 10-week mark arrives and a surrogate “graduates” to their chosen OB-GYN provider. At this point, a surrogacy pregnancy is monitored like any pregnancy, with routine checkups, ultrasounds, and bump updates.

Before delivery, surrogates and IPs should discuss who will be present for the birth, whether or not a surrogate is interested in pumping breast milk—or if this is something the intended parent(s) even want—and how their relationship will look post birth.

Ultimately, each experience is different. The most important part? That all parties involved feel good about the surrogacy journey. And, of course, that sweet bundle of joy that arrives at the end of it all. 

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