The Surrogacy Process, Step by Step

How the surrogacy process works

The surrogacy process has five phases: research and legal advice, medical preparation and embryo creation, surrogate matching and contracts, embryo transfer and pregnancy, then birth, parentage and travel home. In gestational surrogacy the surrogate carries an embryo created by IVF and has no genetic link to the baby. Legal planning has to come before any medical step.

Most people asking "how does surrogacy work?" picture the pregnancy itself. In practice, the nine months of pregnancy are the most predictable part. The decisions that shape your outcome come earlier: which country you work in, whether your home country will recognise you as the parents, how your embryos are created, and how carefully your surrogate is screened and supported.

This guide follows the order that experienced lawyers and clinicians recommend for intended parents doing international surrogacy. It is written for heterosexual couples, same-sex male couples and single intended parents. Where one step differs by profile, we say so. For the medical background (IVF, who gestational surrogacy is for, and the risks), read our companion guide on what gestational surrogacy involves.

What are the requirements for surrogacy?

Surrogacy requirements come from three separate sources: the destination country's law, the clinic's medical criteria, and your home country's rules on parentage and citizenship. You must meet all three. A destination may accept you, but if your home country will not recognise your parentage or pass on citizenship, your child could be left without travel documents.

Destination rules

Each country decides who may use surrogacy. Some accept only married heterosexual couples, some require a medical reason the intended mother cannot carry a pregnancy, some require residency, and some accept single men and same-sex couples. These rules have changed often in recent years. Check our country-by-country surrogacy laws guide and the current status on each destination page before you shortlist.

Medical criteria

Clinics usually ask for a medical history and tests for intended parents, including infectious disease screening of anyone providing eggs or sperm. Where a woman's own eggs will be used, the clinic will assess her ovarian reserve. Some clinics set upper age limits for intended parents. Those limits vary by clinic and by country.

Home-country requirements

Many home countries link legal parentage or citizenship to a genetic connection. In the UK, a parental order generally requires at least one applicant to be genetically related to the child and domiciled in the UK (the statutory test; GOV.UK guidance on surrogacy overseas (opens in new tab) describes it as living there permanently). The US State Department says a child born abroad through surrogacy may not acquire US citizenship at birth unless the child is genetically or gestationally linked to a US citizen parent or, for married parents, to that parent's spouse. If neither of you is a US citizen and you are considering a US surrogate, note that Executive Order 14418 (August 2026) has made the baby's US passport uncertain; see our USA page. Our citizenship, passport and parentage guide covers the US, UK, Canada, Australia and the EU in detail.

The surrogacy process, step by step

The international surrogacy journey has about thirteen steps, from research to recognition at home. The order matters: legal advice comes before any contract, embryos are created before matching in many programmes, and the surrogate's own lawyer reviews the contract before transfer. Skipping ahead is the most common cause of expensive problems later.

1. Decide and research. Talk through whether surrogacy is right for you, and how you feel about using a donor if you need one. Read widely, including evidence on outcomes for surrogates and children. Set a realistic budget with room for more than one embryo transfer. Our international surrogacy cost guide compares typical programme ranges.
2. Get legal advice in your home country first. Before you pay a deposit, ask a family lawyer in your home country three questions. Is surrogacy abroad lawful for me? How will I become the legal parent? How will my child get citizenship or a visa? UK government guidance for intended parents (opens in new tab) says legal advice is "highly recommended" before beginning.
3. Choose a destination, agency and clinic. Shortlist countries that are legally open to your profile, then compare clinics and agencies. Ask how surrogates are recruited, screened, paid and supported, and who represents them legally. Our guide on how to choose an international surrogacy agency includes a question checklist.
4. Complete the medical work-up. The clinic reviews your medical history and runs blood tests, infectious disease screening and semen analysis. If you plan to use your own eggs, the clinic tests your ovarian reserve. You may also be offered genetic carrier screening.
5. Choose an egg donor, if you need one. Gay male couples, single men and many women with low ovarian reserve use donor eggs. See the egg donor section below.
6. Create embryos, with or without PGT-A. Eggs are retrieved and fertilised, and the embryos are grown to the blastocyst stage (day 5 to 7) and frozen. Some parents choose preimplantation genetic testing for aneuploidy (PGT-A) to screen embryos for chromosome abnormalities. Its benefits are debated (see success rates).
7. Match with a surrogate and screen her. Once you are matched, the surrogate has medical, psychological and infectious disease screening. In the US, the ASRM 2022 recommendations for gestational carriers (opens in new tab) advise that she is aged 21 to 45, has had at least one term, uncomplicated pregnancy, and has had no more than five previous deliveries or three caesareans. Good programmes in other countries apply similar standards.
8. Sign contracts, with independent counsel for the surrogate. ASRM advises that each party has independent legal counsel and that a fully signed agreement is in place before treatment begins. ESHRE's 2025 ethics paper says the gestational carrier and intended parents "should receive independent legal advice" and be counselled separately. The contract covers compensation or expenses, insurance, medical decisions, the number of embryos to transfer, and what happens if plans change.
9. Embryo transfer. The surrogate takes medication to prepare her uterus, and one thawed embryo is transferred. A pregnancy test follows about 9 to 12 days later. If the transfer does not work, most programmes allow further transfers. Your contract and budget should say how many.
10. Pregnancy monitoring. The fertility clinic usually monitors the first weeks of pregnancy, then the surrogate moves to obstetric care. Agree in advance how you will receive updates and how you will stay in touch with her. Respect that decisions about her body and medical care remain hers.
11. Birth. Plan to arrive well before the due date, because babies can come early. Hospital policies on who can be present, and on newborn care, vary by country.
12. Parentage and exit documents. Depending on the destination, parentage may be set by a pre-birth order, a court ruling after birth, or registration on the birth certificate. You then apply to your own embassy for citizenship or a visa, and a passport. DNA testing may be requested, and this stage commonly takes weeks.
13. Recognition at home. Some home countries need a further step once you are back, such as a UK parental order. Do not treat the journey as finished until your home country recognises you as the legal parents.

Surrogacy with an egg donor abroad

Using an egg donor abroad is common and is the usual route for gay male couples and single men. Before you choose a donor, check three things: whether the destination allows anonymous or identity-release donors, whether you may import eggs or embryos, and whether your home country requires a genetic link to one intended parent. Donor age strongly influences success.

Donor eggs come from younger women, which is why donor-egg cycles often have higher success rates than cycles using eggs from intended mothers in their late 30s or 40s. ASRM guidance on gamete and embryo donation (opens in new tab) recommends that egg donors are preferably aged 21 to 34 and have medical, genetic and psychological screening.

Questions to ask the clinic or egg bank:

• Is the donor anonymous, or can the child learn her identity later? Some countries require anonymity, and others require identity release. Research on donor-conceived families suggests that telling children early about their origins is associated with better family relationships (see our gestational surrogacy guide).
• Are you using fresh donor eggs or frozen eggs from a bank, and how many eggs or embryos are guaranteed?
• What genetic carrier screening has the donor had, and will it be matched against the sperm provider's results?
• How is the donor compensated, and does that comply with local law and with your home country's rules?
• If you plan to create embryos in one country and transfer them in another, is shipping embryos legal at both ends?

Surrogacy timeline: how long each stage takes

From first consultation to arriving home, most international surrogacy journeys take about 15 to 30 months. Pregnancy is fixed at about nine months. Matching, failed transfers, court backlogs and exit paperwork make up most of the variation. The ranges below are editorial planning estimates, not data or guarantees. Ask your clinic and lawyers for timings in your destination.

Surrogacy success rates: what the evidence shows

In US national data for 2014 to 2020, 54.3% of embryo transfers to gestational carriers resulted in a live birth, compared with 43.6% in other IVF cycles. A carefully screened surrogate's uterus improves the odds, but the age of the eggs and the quality of the embryo still matter most. No clinic can promise a baby from any single transfer.

Clinic marketing figures are often not comparable, because they count different things. Some count a positive pregnancy test, some a heartbeat on ultrasound, and some a live birth. Some count per transfer, others per egg retrieval or per intended parent. Ask clinics for live birth rate per embryo transfer, split by egg source (own or donor) and age group, and ask whether their figures are audited by a national registry.

What affects your chances

• Egg age. Embryos from younger eggs, whether your own or a donor's, are more likely to be chromosomally normal and to implant.
• Embryo quality and number. The number of good-quality blastocysts you have frozen largely decides how many attempts you can make without another egg retrieval.
• The surrogate's health. Screening against professional criteria matters. In a Utah study, gestational carrier pregnancies that did not meet ASRM guidelines had more preterm births and newborn complications (Swanson et al., 2020 (opens in new tab)).
• Number of embryos transferred. Transferring two embryos raises the chance of a birth per transfer, but at a cost. In one US programme, 40% of births after double embryo transfer to carriers were preterm, compared with 13.4% after single transfer (Namath et al., 2021 (opens in new tab)). ASRM and ESHRE both recommend a single embryo transfer.

Does PGT-A improve success?

PGT-A use in gestational carrier cycles rose by 155.7% between 2014 and 2020 (Traub et al., 2024). The evidence for it is mixed. In 2024, the ASRM concluded (opens in new tab) that the value of PGT-A as a routine screening test for all IVF patients "has not been demonstrated". In the Namath study of carrier transfers, PGT-A did not significantly change live birth per transfer. A large registry analysis of autologous (not surrogacy) cycles linked PGT-A with lower cumulative live birth rates per retrieval in women aged 40 or under (Kucherov et al., 2023 (opens in new tab)). PGT-A may still help some people, for example older egg providers, and it can reduce the number of transfers a surrogate goes through. Discuss it with your doctor rather than accepting it as a default.

How to start the surrogacy process

To start the surrogacy process, set a budget, get a home-country legal opinion, and request a medical review before you commit to any destination or agency. In practice, the first 30 to 60 days are about ruling options out: which countries accept your profile, which your home country will recognise, and whether you need donor eggs.

1. Write down your profile and constraints. Note your relationship status, ages, whether you have frozen embryos or eggs, your budget, and your timeline.
2. Book a home-country legal consultation. Ask about parentage, citizenship and any criminal or financial restrictions on surrogacy abroad.
3. Get a fertility review. Your doctor can tell you whether your own eggs are realistic, or whether you should plan for a donor.
4. Shortlist two or three destinations. Use our destination comparison hub to filter by profile, budget and timeline.
5. Interview agencies and clinics. Ask about surrogate welfare, independent legal counsel, single embryo transfer policy, verified live birth rates and complete pricing.
6. Plan for things not going to plan. Decide in advance how many transfers you can afford, and how you would handle a pregnancy complication, a premature birth or a change in the law.

It also helps to know that there is still no international treaty on cross-border surrogacy. In March 2026, the governing council of the Hague Conference on Private International Law (opens in new tab) decided not to move ahead with drafting a convention on legal parentage "at this stage". Recognition still depends on each country's own law, which is why the legal steps above matter so much.

Common problems and how to reduce them

The most serious problems in international surrogacy are legal, not medical: a child who cannot get travel documents, parentage that is not recognised at home, or a law change partway through. Medical risks for the surrogate and baby are real but can be reduced. Careful screening, single embryo transfer and good obstetric care make the biggest difference.

For a full medical explanation of risks to surrogates and babies, read our guide to gestational surrogacy.