Becoming Parents Through Surrogacy: What Every First Time Intended Parent Needs to Know

If you’re a first-time intended parent exploring surrogacy, you probably have a million questions, and that’s completely normal. 

As the Surrogacy Insider (an independent surrogacy consultant who’s guided many parents globally), I’m here to help. 

In this friendly FAQ-style guide, I’ll answer the top 10 questions every new surrogacy parent asks. We’ll cover everything from how the process works to legal protections, costs, timelines, and the inclusivity of surrogacy for all kinds of families. This journey can feel overwhelming, but with clear answers and compassionate guidance, you’ll feel empowered and informed. Let’s dive into your questions!

1. Where do we even begin with the surrogacy process?

Starting a surrogacy journey can feel like standing at the foot of a mountain, wondering how to climb it. Take a deep breath - you don’t have to tackle everything at once. The first step is understanding the big picture of how surrogacy works. 

In a nutshell, surrogacy is a process where you create embryos via IVF (using either your own gametes or donor eggs/sperm) and a gestational surrogate carries the pregnancy for you. 

There are several key stages:

1. choose your country for surrogacy and your agency 

2. visit the clinic to provide your material for embryo creation

3. you’ll match with a surrogate

4. sign an agreement with the surrogate (in accordance with the law of your chosen country)

5. receive updates from the agency during pregnancy

6. celebrate the birth of your baby

7. prepare the documents for the “exit process”

8. go home and finalize the legal part there (if required)
   

It sounds like a lot, but knowing these stages gives you a roadmap.

So where to start? Research and support. 

Begin by gathering information about surrogacy options (domestic vs. international, agency vs. independent, etc) and the laws in your country. 

Many first-timers schedule an initial consultation with an independent consultant like me to discuss their situation. 

For example, in that first call, I talk with parents about their individual backgrounds and goals, medical or fertility factors (do you already have embryos? Do you need an egg donor or sperm donor? what are the most important decision making factors in choosing a jurisdiction or an agency for you? ) and we briefly outline some surrogacy destinations that might fit their needs. 

Don’t worry about making big decisions right away. The goal is to get informed. By understanding the overall process and talking to experienced professionals, you’ll replace that fear of the unknown with a clear plan. 

Remember, you’re not alone in this; there’s a whole community of experts and parents who have been in your shoes, ready to guide you one step at a time.

2. How much does surrogacy cost (and what should we budget for)?

Money is often the focus in the first phase. Let’s talk about it openly: surrogacy can be expensive, and the cost varies widely depending on where and how you do it. Globally, you might spend anywhere from around €50,000 to €250,000 on a full surrogacy journey. In the United States or Western Europe, a typical agency-managed journey can cost into the six figures (often over $150,000). In contrast, pursuing surrogacy in some other countries can be more affordable. For example, while surrogacy in the U.S. can run upwards of €150,000, programs in a country like Colombia might be €50,000–€65,000 for the whole process. 

These figures include many components: medical treatments (IVF, embryo creation, surrogate’s clinic procedures), the surrogate’s compensation and expenses, agency fees, legal fees, insurance, surrogate travel costs, and more.

It’s important to break down the budget piece by piece. 

Surrogate compensation is a significant chunk and can vary by tens of thousands depending on the surrogate’s experience and the local cost of living. (For instance, a first-time surrogate in one country might receive a very different amount than an experienced surrogate in another.) 

There are also one-time costs like IVF treatments or egg donor fees (if you need an egg donor, which itself can range widely). 

Don’t forget legal expenses for drafting contracts and establishing parentage, which are absolutely essential. 

Many intended parents also overlook things like surrogate insurance - ensuring the surrogate’s pregnancy and delivery are covered - which can add cost if not built into the program. 

And always have a contingency fund: if complications occur (say an extra embryo transfer, or a need to find a second surrogate, if the baby arrives early), you’ll want a financial cushion.

Some agencies will charge a new matching fee if you have to rematch with a different surrogate, so ask about policies for “what if” scenarios.

The good news is there are ways to manage and plan for these costs. Reputable agencies will often use a payment schedule tied to milestones (e.g. a portion at contract signing, more at embryo transfer, etc.) rather than demanding everything up front. 

As an independent consultant, one of my priorities is making sure parents go in with eyes wide open about all the costs involved. We’ll create a detailed budget together and I’ll point out any hidden or variable costs I’ve seen others encounter. 

Remember: the cheapest quote isn’t always the best value. Scrutinize what’s included. A program that’s, say, $20k cheaper but lacks legal safeguards or has no insurance coverage for the surrogate could cost more in the long run if things go wrong. It’s about finding a transparent, reliable program within your budget - one that doesn’t cut corners on critical aspects. 

While surrogacy is a significant financial investment, knowing the breakdown and planning for contingencies will give you peace of mind that you can see it through. And trust me, when you’re holding your baby, the cost will feel worth it.

3. How long does a surrogacy journey take from start to finish?

If only we could mark a date on the calendar for the baby's arrival right now! The reality is, surrogacy is a journey that can easily take two years or more from the time you embark until you’re home with your newborn. There’s no exact timeline that fits everyone, because so many factors play into it, but I can give you a sense of the typical range. 

In many cases, I tell intended parents to expect roughly 15 to 24 months total. I’ve seen some international surrogacy programs move quite fast, about 15–18 months from your first consultation to holding your baby. This usually assumes things go smoothly: you find a surrogate without long delays and the first or second embryo transfer leads to a pregnancy. On the other hand, if you’re pursuing surrogacy in a country with waitlists (for example, altruistic surrogacy in Canada, where you have to find a volunteer surrogate), it could take several years to match and complete the process.

Let’s break down the timeline into stages to see where the time goes. Initial preparation can take a few weeks to a few months – this includes doing your research, choosing a country/agency or consultant, and getting any preliminary medical evaluations done. 

Next, creating embryos (if you haven’t done so already) might add a few months: you’ll need to find an egg donor if using one, wait for her to go through ovarian stimulation, have the eggs retrieved, fertilized, and have the embryos sent for genetic testing. 

The surrogate matching phase is often one of the longest variables. Depending on the location and your criteria, waiting for a surrogate can range from a few weeks (if there’s a ready pool of pre-screened surrogates available) to 3–6 months or more. If you’re on a waitlist in a country with a surrogate shortage, that alone might be a year or longer.

Once you’re matched, legal contracts have to be drafted and signed before any medical procedures, as long as the country you’re in has specific surrogacy regulations.

With contracts in place, you move to the embryo transfer - having this scheduled with the fertility clinic and “preparing” the surrogate for the embryo transfer might take another month or two. Then, if all goes well, pregnancy! 

The pregnancy itself is of course ~9 months of waiting (and hoping everything progresses healthily) in an ideal scenario. During that time, you’re managing any additional legal steps (for instance, some places require a court order during pregnancy to declare you as the legal parents). 

Finally comes the birth of your baby - the moment everything has been leading to. But the journey doesn’t end there. After delivery, there’s still important post-birth paperwork: obtaining your baby’s birth certificate (with your names on it) and possibly a passport or travel documents to return home. If you’re abroad, budget some time for this — it could take a few weeks or even a couple of months of bureaucracy before you can leave with your baby.

Once you return home, there may be additional legal steps to finalize your parenthood in your own country. Depending on local law, this could include a second-parent adoption or a parental order process to ensure your parental rights are fully recognized.

All told, surrogacy is not a quick process, but every month waiting is one month closer to your dream. The key is to be patient and flexible with the timeline. I know that’s easier said than done (once you decide to have a baby, the longing is real!). To help, I encourage intended parents to start preparing emotionally and logistically for a marathon, not a sprint. 

Celebrate each milestone: first visit to the clinic, embryos created, surrogate matched, positive pregnancy test,  because they’re huge steps forward. And if there are unexpected delays (say a transfer gets postponed or a surrogate change happens), know that this is all part of the journey for many parents. In the end, whether it takes 15 months or 30, you’ll have your beautiful child and the wait will fade away.

4. Which countries or locations are best for surrogacy, and how do we choose?

Surrogacy isn’t the same everywhere. In fact, surrogacy laws and practices vary dramatically from country to country (and even state to state). Choosing where to pursue your surrogacy journey is a crucial decision, especially for international intended parents, and it usually comes down to a mix of legal eligibility, safety, cost, and practicality. 

First and foremost, you’ll need a location where surrogacy is legal and accessible for people like you. Sadly, the world is a patchwork: some places outright prohibit surrogacy, others allow it but only for married heterosexual couples, and still others warmly welcome LGBTQ+ couples, single parents, and international clients. 

For example, countries like Canada and certain U.S. states have established surrogacy frameworks that include same-sex couples, whereas other countries (such as some in Eastern Europe) only allow married male-female couples to do surrogacy. 

Many of my LGBTQ+ and single clients from Europe find they have to go abroad - places like Colombia or Mexico have programs that actively welcome international LGBTQ+ and single intended parents and give them full legal recognition as parents. 

The same goes for HIV-positive intended parents: a few destinations have clinics experienced in handling special medical protocols for HIV (more on that later). 

So, start by listing which countries or U.S. states are legally open to you given your status (marital status, sexual orientation, etc.).

Next, consider the legal process and citizenship aspects. Different locales have different ways of establishing parentage. In some U.S. states, Mexico or Ghana for instance, you can get a pre-birth court order so that you’re on the birth certificate from day one. 

In countries like Georgia or Ukraine, the birth certificate can directly name the intended parents (if heterosexual and married) and exclude the surrogate. Other places require a bit more legal work: for example, UK residents who do surrogacy abroad must apply for a parental order back home, and some countries might require you to adopt your own child if their laws don’t automatically recognize surrogacy. 

It’s super important to plan for two sets of laws: the country where the baby is born and your home country. I always tell clients to budget for two lawyers: one local in the surrogacy country and one back home, to make sure that when you return with your baby, everything is recognized and legal. You’ll also want to ask how easy it is for your child to get citizenship/passport from your home country. 

Some countries (like Canada, Mexico or Colombia) give citizenship by birth to the baby, which can simplify things; others don’t, requiring you to obtain nationality for the baby through you. Knowing families have successfully done it in your scenario is key. Ask for real examples or stats (e.g., “what percentage of your international clients from my country have returned home with the baby within a reasonable time?”). You want to avoid ending up stuck abroad with red tape.

Beyond legality, practical and ethical factors come into play. Cost is one (we discussed budgets above and indeed, some countries are more affordable). But also consider the quality of medical care and clinics available. You’ll want a place with reputable IVF clinics and hospitals (healthy baby and surrogate are the priority!). 

Think about travel and distance: are you comfortable with a 15-hour flight if needed, or would you prefer somewhere closer to home? Time zone differences for communication with doctors and surrogates can also matter over a year of process.

 Language and culture might impact your experience too. Working in a country where you speak the language (or where the agency staff speaks yours) can ease communication. And not to be overlooked: how does the program treat surrogates? 

I strongly advocate for choosing destinations and agencies/clinics that treat surrogates ethically and compassionately. Surrogates should be provided fair compensation, good medical care, and counseling/support throughout the journey. An ethical program will ensure the surrogate isn’t exploited and that she fully understands and consents to the process. This is something I research deeply for any program I recommend.

In short, to choose the right country/program, you’ll weigh a mix of legal safety, inclusivity, cost, medical quality, and ethics. 

That’s a lot of variables, I know! 

Don’t be afraid to consult with experts who know the ins and outs of surrogacy in different regions. I often compare it to finding the right “fit” - like choosing a home. We’ll look at your unique situation (say, a single dad from Armenia who needs an egg donor and a surrogate - what country would give him legal paternity easily? Or a gay couple from Kazakhstan - where can they go that will grant citizenship to the baby and accept them as parents?). 

By evaluating these factors, we can narrow down a location that checks the most boxes. Where there’s a will, there’s a way! Today’s surrogacy landscape is global, and there’s likely a good option out there for you. It’s all about finding the safest and most comfortable path to bring your baby into your world.

5. How do we find and choose the right surrogate (and egg donor if we need one)?

Finding the woman who will carry your baby is a huge deal. It makes everything feel real. First-time parents often ask, “Who will our surrogate be, and how do we know she’s the one?” 

If you’re working with an agency, they will present you with a prospective surrogate (or several) based on profiles and screening they’ve done. If you’re independent, you might find a surrogate through your own network or via surrogacy matching groups. But, even then, you’ll want professional help to vet and screen her thoroughly. Either way, the key word is screening. A reputable program will only match you with a surrogate who has passed extensive health and psychological evaluations. 

This typically includes a review of her medical history and past pregnancies (e.g., ensuring she’s had at least one uncomplicated pregnancy and no serious complications in childbirth), a full physical and reproductive health exam (checking her uterus, doing blood tests for infectious diseases, etc.), and a psychological assessment to confirm she’s mentally and emotionally prepared for surrogacy. 

For example, IVF clinics will do a panel of blood tests and screenings on a prospective surrogate and often a psych evaluation (depending on common practice in that specific country). Only women who clear these hurdles should be approved to become gestational carriers. This protects you and the surrogate - it’s about maximizing the chances of a healthy, smooth journey for all. I always encourage intended parents to ask providers about the screening process: nothing should be glossed over. (I’ve heard horror stories of skimpy screening – like a 30-minute video call – which is not enough. In contrast, thorough programs might do in-person interviews, personality questionnaires, etc., to really ensure she’s ready). The surrogate you choose will be your partner in this journey, so you want to feel confident in her health, stability, and commitment.

Now, what about an egg donor (or sperm donor)? Not all intended parents will need a donor. If you are a heterosexual couple with viable eggs and sperm, you’ll likely create embryos from your own genetics. But if you’re a single father or a gay male couple, you’ll definitely need an egg donor; likewise, a single mother by choice might need donor sperm, and some couples need a donor due to medical issues. 

Finding an egg donor typically goes through a fertility clinic or an egg bank/agency. You would look at profiles of donors (some are detailed and include photos and questionnaires filled out by the donors; in some countries, like Colombia, photos are not available), and based on the information provided about their availability and previous results, you would make your selection in consultation with the clinic or agency.

My role often involves pointing intended parents to trusted donor programs if they need them, and helping weigh factors like using an anonymous donor vs. a known donor.

Lastly, a note on ethics and surrogate care: part of choosing the “right” surrogate is making sure she’s in the right program that cares for her well-being. I can’t stress this enough! An ethical surrogacy journey treats the surrogate with respect and care. She should have, counseling available, and all her pregnancy-related expenses covered. 

The best agencies consider the surrogate’s experience just as much as the parents’. You want your surrogate to feel happy and supported in the process - it’s good for her and good for your future baby. When surrogate moms feel valued, they’re able to give the process their wholehearted care. 

So when choosing a surrogate or program, don’t be shy to ask, “How do you support and compensate your surrogates?” The answers will tell you a lot about the agency’s ethics. In sum: finding a surrogate (and donor) is about combining head and heart. Rigorous screening and a solid support system, plus a personal connection and trust. When you have those pieces in place, you can move forward knowing “Yes, this is the amazing woman who will help bring our baby into the world,” and you’ll feel good about the partnership you’ve created.

6. What legal steps do we need to take, and will we be the legal parents of the baby?

The legal side of surrogacy is crucial: it’s the foundation that ensures the baby you bring home is unquestionably yours in the eyes of the law. I often get anxious questions like, “Do we really need separate lawyers? Can the surrogate keep the baby? How do birth certificates work?” 

Let’s tackle these one by one to put your mind at ease. If you’re going through an agency program, they might offer to handle “the contract” for you, but remember: the agency’s contract protects the agency, not necessarily you. In some cases, it is a good idea to hire an independent lawyer to review the contract. While large agencies usually do not allow major changes, this step ensures that you fully understand what the agency is – and is not – liable for. I also support you in reviewing and interpreting the package details, which are often presented as annexes to these agreements, so you can clearly see what is included and where additional costs might arise.

The surrogate should have access to legal advice too, paid for by you, to ensure her interests are also protected and that she fully understands the agreement. The goal is a solid gestational carrier agreement signed by all parties before any embryo transfer takes place. This contract outlines everyone's responsibilities (e.g., that the surrogate will carry the child for you, and you will assume parental rights and financial responsibility), decisions about sensitive issues (like what happens if there’s an in-utero complication, or how many embryos you’ll transfer, etc.), and financial terms (such as the surrogate’s compensation and what extra expenses would be covered). It also typically states that the surrogate cannot change her mind and keep the baby. In fact, once the baby is born, she has a legal obligation to hand the baby to you, and you have the obligation to accept custody. 

In jurisdictions with well-defined surrogacy laws, there are legal mechanisms that ensure the surrogate has no parental claim to the child. For example, some places have statutes saying the surrogate must not be genetically related to the child (hence why gestational surrogacy uses your or donor eggs, not the surrogate’s eggs) and that the intended parents are the only legal parents. 

In practical terms, stories of surrogates “keeping the baby” are largely urban myths when proper legal steps are followed. Cases like this are practically unheard of, especially if you’re working in a surrogacy-friendly state/country, and with a screened surrogate who understands the process. 

The contract - and the law - is there to prevent that scenario. I always explain to my clients how the law in their chosen country handles parentage so they understand if they will be recognized as mom/dad de juro.

Next, how do you secure parental rights and birth certificates? 

This does depend on where the baby is born. In some countries, your attorney will file a pre-birth order or parentage action during the pregnancy so that a court decree is ready by the time of birth declaring you as the legal parent(s). Thus, the hospital will put your names on the birth certificate. 

In other countries, the birth certificate is initially issued with the surrogate listed, and then a court process later assigns parentage to you. For instance, in countries like Greece or Canada, legal orders are made so that the surrogate has no maternal rights and you are the parents. In places like Georgia and Armenia, the names of the intended parents are placed directly on the birth certificate without the need for a court process. In contrast, in Albania, the surrogate’s name appears on the birth certificate, and you must complete the legal process of revoking her maternal rights once you return to your home country.

However, if you’re a single dad or a gay couple in a country that doesn’t recognize that family structure, it can get tricky - that’s why choosing the right country is so important. One way or another, you will need to formalize the parental rights either through a local court process or back in your home country (sometimes both). 

Always plan ahead with your lawyer on how and when this will happen. For example, UK parents must apply for a parental order after returning home, within a certain timeframe, to transfer parentage from the surrogate to themselves. Irish parents doing international surrogacy might need to do a step-parent adoption if only one parent was recognized abroad. These are the nitty-gritty details that your legal counsel should map out for you in advance, so it’s all done correctly and timely.

Another legal aspect is what I call “the paperwork after birth.” If you’re from the USA, how does your baby get citizenship and permission to come home from Mexico? This is part legal, part bureaucratic. You might need to obtain a local birth certificate, then a passport or emergency travel document from your embassy for the newborn. 

Some agencies have tons of experience with this and will guide you; others might leave it to you. Ask about it up front: have they successfully gotten babies home to your country before? If an agency claims expertise, I’d ask for specifics. I’ve encountered agencies that advertised international surrogacy but later the parents discovered the agency had never navigated the passport process and the parents were stuck figuring it out on their own. 

That’s not a pleasant surprise when you’re sleep-deprived with a newborn in a hotel room abroad. 

So legally, think not just of birth but beyond birth - all the way until you’re safely home and legally recognized as the parent in your country.

One more common legal question: “What if something goes wrong or someone breaches the contract?” For example, what if an intended parent or surrogate has a change of heart midway (very rare, but people worry about it), or what if a medical complication changes the plan? This is exactly why the contract exists - to have an agreed-upon plan or remedy for various scenarios. If the surrogate, say, needs to be on bed rest for 2 months, the contract will usually stipulate additional compensation for her lost wages or childcare during that time (and you as IPs should be prepared to cover that). 

If an embryo transfer fails or miscarriage happens, the contract might outline how many pregnancies of transfer attempts are covered. If an intended parent were to divorce or pass away during the process - the contract can cover those situations too (like what happens to the obligations to the surrogate and the baby). 

I encourage you to ask those hard “could this happen?” questions - it’s better to address them than to be caught off guard.

To sum up: legally securing your parenthood is a multi-step process, but with a competent legal team it’s very manageable. Yes, you will be the legal parents - that’s the whole point of doing this by the book. My role is often to remind you to get all these ducks in a row and connect you with savvy attorneys who know surrogacy law inside out in the relevant jurisdictions. With proper contracts and court orders, your baby is 100% your baby - and you can focus on being mom or dad without legal worries hanging over your head.

7. Is surrogacy an option for LGBTQ+ couples, single parents, or HIV-positive intended parents like us?

In a word: YES! 

Surrogacy is for everyone who cannot carry a baby themselves and wishes to build their family - and that absolutely includes LGBTQ+ couples, singles, and people living with HIV.

I’m glad you asked this, because inclusivity is a core value for me. 

I’ve worked with gay dads, single fathers, single mothers, and yes, HIV-positive parents, all of whom have welcomed babies via surrogacy. 

Your dream of parenthood is valid, and there are pathways to make it happen. That said, the specific approach might vary because of legal or medical considerations, so let’s break it down:

LGBTQ+ couples: For gay male couples, surrogacy is often the only route to a biological child (since neither partner can carry). It’s very common now: entire agencies and clinics proudly serve same-sex male couples. You will need an egg donor (since neither of you has eggs), and one of you will be the genetic father (or you can fertilize half of the eggs with one dad’s sperm and the other half with the other dad’s sperm, making it possible to have siblings who are genetically related to each other through the egg donor while also being biologically connected to each of you).

Many male couples end up having two children, one genetically linked to each partner, for family balance, but that’s down the road. The main thing is choosing a country or state where two men can be recognized as the parents. In the US, many states allow two fathers on the birth cert. Internationally, some countries that used to exclude gay couples are now opening up. For example, South Africa and Canada have frameworks for gay surrogacy, and places like Colombia and Mexico explicitly welcome foreign LGBTQ+ intended parents, providing legal recognition for them. 

I recently had clients from the UK (a gay couple) who chose a surrogacy program in Colombia and were treated just like any other parents - no legal discrimination, which was a breath of fresh air for them. Lesbian couples sometimes pursue reciprocal IVF (one partner provides the egg, the other carries), but if neither can carry (or they prefer not to for medical reasons), they might use a surrogate as well, typically with one partner’s egg and donor sperm. 

In all cases, we find an LGBTQ-friendly clinic and agency. Many surrogates are actually very motivated to help LGBTQ families; they feel it’s a way to support equality. The main hurdles for LGBTQ are legal, not social, so we solve that by picking the right jurisdiction.

Single parents: Single dads and single moms are absolutely doing surrogacy, and I admire them so much for embarking on solo parenthood. The process is largely the same, except a single father will need both an egg donor and a surrogate (essentially he’s like a gay couple but just one person, so only his sperm is used). A single intended mother might need a sperm donor if she doesn’t have a partner’s sperm. Legally, some countries require intended couples, but there are plenty that allow singles. For example, some U.S. states don’t care if you’re single, and countries like Armenia allow single dads, while places like Georgia do not. Colombia’s recent surrogacy framework is open to singles; Greece allows single women (but not single men). 

HIV-positive intended parents: This is one I’m particularly passionate about, because for a long time people living with HIV were told they couldn’t have biological children safely. Thanks to medical advances, that has changed dramatically. HIV-positive men and women can have children via surrogacy without transmitting the virus to the surrogate or baby. 

The key is a process called sperm washing for biological fathers who are HIV-positive. Here’s how it works: the fertility clinic collects sperm from the HIV-positive intended father, and through a special lab technique, they separate the actual sperm cells from the semen fluid which may contain the virus. The isolated sperm (which on its own does not carry HIV) is then used for IVF. There have been large studies and thousands of cases using sperm washing, and it has resulted in zero transmissions of HIV to surrogate or baby. 

Additionally, clinics will require that an HIV-positive parent has a stable, undetectable viral load (meaning you’re on medication and the virus is suppressed in your body to levels that tests can’t detect) for typically 6 months or more before proceeding. They may also have the surrogate take antiretroviral medication as an extra precaution around the time of embryo transfer. All of this makes the risk of transmission essentially nil. 

In fact, many agencies have now worked with HIV-positive dads (often through programs like the Special Program of Assisted Reproduction, SPAR, pioneered by Dr. Ann Kiessling). If you’re HIV-positive, you should partner with a clinic experienced in these protocols. I connect clients with clinics that have done HIV-positive journeys before, so everyone (including the surrogate) is comfortable and knowledgeable. 

For HIV-positive women (which is less common in surrogacy, since if a woman could carry a pregnancy she might not need a surrogate, but some HIV-positive women might opt for a surrogate if advised against pregnancy), the considerations are a bit different but also manageable with treatment. 

The bottom line: being HIV-positive does not disqualify you from having a child through surrogacy. You just need the right medical precautions, and fortunately those are well-established now.

No matter who you are: gay, straight, trans, single, married, HIV-positive,  there is likely a surrogacy option for you somewhere. We might have to be a bit creative and perhaps travel further or work harder to find a suitable program, but I firmly believe in helping all families. 

When I say I support diverse family types, I truly mean it. I’ve seen the joy on the faces of parents who were told their whole lives that it wasn’t possible for them until it was. 

Family is for everyone. So don’t let anyone’s outdated laws or opinions stop you; with modern medicine and the right team, we can break those barriers.

8. How do we handle the emotional side – for us and our surrogate?

Embarking on surrogacy is not only a physical/medical and legal journey, but an emotional journey for everyone involved. First-time intended parents often feel a swirl of excitement, anxiety, hope, and even guilt or jealousy (it’s okay, many struggle with the fact that someone else is carrying their child). Meanwhile, surrogates have their own emotional landscape - they’re generally very compassionate, family-oriented women, but carrying a baby for someone else is a unique experience with its own emotional challenges. Taking care of everyone’s mental and emotional well-being is super important. So, what can you expect and how can you support each other through this?

For intended parents (you!), the emotional rollercoaster usually has a few key dips and peaks. The first big one is the waiting and uncertainty. Waiting for a match, waiting for the transfer, the dreaded two-week-wait after the embryo transfer to find out if it worked, etc. This part can be nerve-wracking. It’s perfectly normal to feel anxious or helpless at times, since so much is out of your direct control. 

To cope, it helps to stay informed (knowing what’s happening at each stage can reduce fear of the unknown), keep busy with your usual life and hobbies, and lean on support networks. That could be a therapist, a support group of other intended parents, or simply friends who understand. Many surrogacy agencies or consultants offer support resources.

There’s also the emotional complexity of trusting someone else with your baby’s early growth. Especially for women who intended to carry their own child but can’t, it can be emotional to watch another woman experience the pregnancy. It helps immensely to have a good relationship with your agency built on trust and communication.

Discuss communication expectations with the surrogate early on: how often you’ll talk, what milestones you want to be present for (in person or virtually), and so on, so that neither side feels anxious about too much or too little contact. And hey, if you feel a twinge of envy that she’s pregnant and you’re not, acknowledge it, then remember why she’s doing this: to help you become a parent. Focus on the end goal.

For surrogates, they should undergo rigorous psychological screening at the start to ensure they’re prepared for the emotions of surrogacy. Good programs will not accept a surrogate unless she passes a mental health evaluation confirming she’s doing this for the right reasons (altruism and fulfillment, not coercion or desperation) and that she has a stable life situation. 

Additionally, some countries also require intended parents to have a psychological consultation or evaluation - this isn’t to judge you, but to educate you on the emotional aspects and ensure you are in a good place to handle the ups and downs. I think that's great practice. It gives you a chance to discuss any fears with a professional and prepare for the relationship with your surrogate. 

Throughout the journey, the surrogate should have access to counseling if she wants, and many agencies have a coordinator checking in on her emotional state regularly. One thing intended parents worry about is, “Won’t it be hard for her to give up the baby?” Surrogates consistently report that they go into this not seeing the baby as theirs. They are excited to hand the baby to the parents because that’s the fulfillment of what they set out to do. The screening helps ensure a surrogate has this mindset. Still, it’s emotional. She might cry at delivery, but often they are happy tears seeing you with your child. Many surrogates describe it as a profound, positive emotion, rather than grief.

Emotionally, surrogacy is a leap of faith and an exercise in trust and letting go (for intended parents) and empathy and dedication (for surrogates). It’s normal to have moments of doubt or overwhelm. But I find that the vast majority of surrogacy journeys are filled with beautiful moments of connection and hope. 

Many parents tell me that working with their surrogate restored their faith in humanity - like, here’s a person doing this incredible act of kindness for them. And surrogates often say how rewarding it was to make another family. 

Focus on that positivity. And never be afraid to ask for emotional support. Whether it’s a therapist, a support group. It’s all part of taking care of your mental health on this journey. 

You’re allowed to feel whatever you feel - there’s no “right” or “wrong” emotions here. With open communication, professional support, and mutual respect, both you and your surrogate can navigate the emotional rollercoaster and reach the end of the ride with smiles (and happy tears) as you welcome that baby into the world.

9. What if things don’t go according to plan (e.g. a failed transfer, complications, or a change of plans)?

It’s wise to ask this because surrogacy, like life, can have unpredictable turns. I often tell intended parents to plan for the best, but be prepared for some bumps along the way. This is the heart of the surrogacy paradox: it is built on logistics, legal base, and of course money — but at its center is one of the most uncontrollable processes in human existence. The good news is, with preparation and the right team, most challenges can be overcome. Let’s go through a few “what if” scenarios that first-timers commonly worry about, and how they’re handled:

What if the embryo transfer doesn’t lead to a pregnancy?

This is probably the number one concern. The reality is that not every embryo transfer results in a successful pregnancy. Even with excellent medical care, sometimes the first attempt doesn’t take. In fact, many surrogacy journeys require more than one embryo transfer to achieve success. Fertility doctors often quote something like a 60-70% chance of pregnancy per transfer with a good quality embryo (varies by clinic and age of egg donor, etc.). So it’s not a guarantee on the first shot. 

How to handle it: First, you typically create multiple embryos if possible, precisely so you have backups to try again. If a transfer fails, review any insights (was the embryo genetically tested? Was the surrogate’s lining optimal? Do we try a different protocol next time?), and then you prepare for a second transfer when ready. Emotionally, it’s hard. You get your hopes up and then have to deal with disappointment. But it’s very common to need 2 or 3 transfers, so don’t be discouraged. 

From day one, I set that expectation with parents: budget-wise and hope-wise, plan for possibly a couple of cycles. Most agencies offer “guarantee programs” (for a higher cost upfront, they’ll cover multiple attempts). Whether you do that or pay-as-you-go, just know a negative beta (pregnancy test) is not the end, it’s just a setback. Many of my clients who are now proud parents went through an initial failure. Persistence and patience win here.

What if the surrogate miscarries or has a medical complication? 

This is a tough one, but again, it’s a natural possibility. Miscarriages can happen in any pregnancy, including surrogacy. The risk is usually not higher just because it’s a surrogate. It depends on factors. If an early miscarriage occurs, it’s emotionally painful for everyone. Typically, the agreement and the plan would be to allow the surrogate time to physically recover, and then try again with another embryo (either with the same surrogate if she’s willing/able, or sometimes you might need to switch if, say, it’s due to an undetected health issue). 

Surrogates are usually just as invested in success and will often happily try again if it was an early loss. Financially, ensure your contract covers what happens in these cases. For instance, if a miscarriage happens and the surrogate needs a D&C procedure, who covers it (the medical part as well as the additional compensation payable to the surrogate). 

For other complications, like if the surrogate develops a health issue during pregnancy (e.g. requires bed rest or extra medical interventions), a good contract spells out that there are additional funds or insurance to cover those needs. 

What if we have to rematch with a different surrogate?

Occasionally, a match doesn’t work out before a baby is born. This could happen if, say, the surrogate fails her medical screening after the match (maybe something comes up in labs or an issue with her uterus, etc., that wasn’t known initially). Or it could be due to life events, perhaps she has a change in circumstances that makes her unable to proceed (very uncommon once contracts are signed, but life happens). If you have to rematch, it can feel like going back to square one, but agencies will usually prioritize you for the next available match. Do ask upfront: if a rematch is needed, is there an extra fee? 

Some agencies do charge a second matching fee, while others cover it if it wasn’t anyone’s fault. Knowing this helps avoid a financial surprise. 

What if we have a personal situation change?

Life doesn’t pause because you’re doing surrogacy. I’ve seen intended parents go through job changes, moves, even divorces or breakups during the process. If something big changes on your end, communicate with your team. If a couple splits up mid-journey, it can complicate things (who will be the parent? do both still intend to proceed?). Believe it or not, I’ve seen estranged couples come together to see the surrogacy through for the sake of the child, and then sort out custody after, it can be done, but ideally avoid such situations with some soul-searching before you start the process. If a financial situation changes (job loss, etc.), talk to your agency. Sometimes payment schedules can be adjusted, or you may pause the journey until things stabilize.

The overarching theme in handling the unexpected is flexibility and support. Surrogacy is a journey with many moving parts; if one part falters, we adjust and continue. It’s much like infertility treatments – rarely a straight line, but with perseverance you get there.

When disappointments happen, remind yourself why you’re doing this and picture that baby in your arms. I’ve had intended parents who were ready to throw in the towel after a second failed transfer, feeling heartbroken. They took a pause, tried again after a while, and it worked on the third try. That child is now a toddler lighting up their life. They sometimes say, “Imagine if we had given up, we wouldn’t have him.”

One more thing: make sure you’re going into surrogacy with realistic expectations. It’s not if a bump will happen, it’s when and what. Knowing that ahead of time makes you resilient when it occurs. 

And lean on your support system: that could be your partner or a close family member or a friend, an online community of other parents.. Sometimes just hearing “Oh yeah, our first surrogate had to back out due to a health issue, but our second attempt was wonderful and now we have our baby” from someone who’s been there is incredibly reassuring.

In the end, most surrogacy “hiccups” are manageable and temporary. 

The journey might not look exactly like the straight line you imagined on day one, but it can still reach the same beautiful destination. 

Every problem has a solution, especially when the motivation is as strong as bringing your child into the world. And when that plan finally does come together, when you’re holding your baby, weathered all the storms, you’ll know that every twist in the road was worth it.

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