The Process of Becoming a Surrogate

Many women who have been considering becoming a surrogate don’t know where to start. I spent over 5 years contemplating and praying about becoming a surrogate and did a little research here and there along the way and I still felt unsure and overwhelmed when I finally made the decision to become a surrogate!

The surrogacy process is not a quick one. Although my process has gone smoothly it has still been 7 months since I applied and I am just now at the Medications/Calendar stage. It’s a “hurry up and wait” process, which I’m familiar with from our adoption! =)

Below I’ve listed out the steps in the process per my particular agency. Each agency will vary a little bit on procedures but this is generally how the process goes for a surrogate using an agency.

Initial Application

The first step to being considered as a surrogate candidate is to complete the initial screening application. You will receive an e-mail response in 1-2 business days whether you are approved or denied. This first step is to weed out people that the agency knows would not be allowed to be surrogates because of medical reasons or other life circumstances.

Surrogate Profile

Once your initial application is approved you need to complete a full surrogate profile and submit photos. This is a long, detailed application where you have to answer many questions and can even write a letter to prospective intended parents. This is the part of the process where you have to make decisions such as whether or not you would be willing to carry a baby for a gay couple, an out of state couple, a singe person, etc. You also need to make decisions about whether or not you are willing to carry multiples and how you feel about termination/reduction. Being open, honest and detailed with your profile responses is very important. The agency takes great pride in matching surrogates with intended parents that have similar responses. As a pro-life Christian I obviously had some preferences in these areas and the agency was very great at not questioning my choices and not pushing me to change. And I was able to be matched with a family who shares my convictions!

Phone Consultation

After your profile is reviewed, your Surrogate Case Manager will have a brief phone meeting with you to go over your profile and answer any questions you have regarding the process. She will also ask you to get in touch with your OB’s office to have copies of your prenatal, delivery and postpartum records as well as a recent Pap sent to the agency.

OB Records

Once the agency receives your prenatal, delivery, and postpartum records for each pregnancy their staff nurses will review and approve them. This is an important piece of the puzzle because the fertility clinics base their approval or denial of a candidate on these records. Some women may not be able to be a surrogate because of history of repeat miscarriages, gestational diabetes, or other pregnancy related health issues. Questions about any pregnancy related health issues will be asked in the initial application to help you know from the beginning whether or not you will be able to continue in the process. So, if you have been honest, OB records at this point shouldn’t cause any problems.

In-Home Consultation

Once your OB records have been approved the agency will send a social worker to your home for a casual meeting with you and your spouse to go over the paperwork. Since we live in a different State than my agency we were able to do a Skype interview. Topics to be discussed are: commitment, medication, finances, support, your concerns, travel, meetings, and what is expected of you and your intended parents.

Criminal Clearance

The agency will run a criminal background check for both you and your spouse, if applicable. The reporting covers the last 7 years.

Psychological Screening

A comprehensive evaluation of you and your spouse will be scheduled with a licensed psychologist to determine if you’re a good candidate for surrogacy. Personality testing will also be done at this time. The psychologist will give his/her recommendation to the agency about whether or not you should be allowed to continue the process.

Insurance Review

Your insurance policy will be reviewed by a licensed insurance agent to determine if surrogacy is covered within your medical benefits. If there is an exclusion, the insurance agent will schedule a consultation with you to set up a new medical policy that will cover a surrogate pregnancy.

Available Surrogate Roster

Once the agency receives criminal and psychological clearance and has completed the insurance review you are officially screened and able to be matched! Your profile, with limited information, will be added to the available surrogate roster. This means that your profile will be available for intended parents to search and decide if they would like to meet you!

Match Meeting

When intended parents show an interest in your profile you will be contacted by your case manager and have an opportunity to review the intended parents’ profile before you decide to meet with them. You will always have the choice to select the intended parents you wish to help. The case manager will schedule and facilitate the match meeting between you and the intended parents. Many matches are made with couples who live in another state so the meeting is over the phone. When the meeting is over, the case manager will ask you to notify her of your decision within 24 hours. If all parties agree to move forward, the match is made and the journey begins!

Medical Screening

A comprehensive physical evaluation, including toxicology screen, infectious disease testing and ultrasound will be performed at the intended parents’ fertility clinic. If their clinic is out of state all travel expenses will be paid for. Your spouse will also be required to have blood tests done.

Legal Consultation

Once the match is made the agency will assign you a lawyer and the intended parents will also hire a lawyer. The attorney will go over your legal contract with you and advise you of your contractual rights and obligations. A contract is important to make sure that all parties are comfortable with what is expected and are protected. As soon as the contract is finalized you can begin medication!


You will be put on a cycle calendar to start birth control pills and then hormone injections to prepare your body for the upcoming embryo transfer. Medication protocols may vary depending on the clinic you are working with. It is extremely important that the medications be taken exactly as instructed and on the appropriate days or it may disrupt the entire cycle! You will be instructed by your nurse exactly how to administer your injections. If you have a family member who will be giving you injections, they should also attend the injection training. If you are squeamish about shots this may not be the best for you! The medication part of the process requires you to give yourself a shot in the butt every day for up to 8 weeks depending on the fertility clinic! You will have multiple appointments for blood work and ultrasounds leading up to and following the embryo transfer. This is to ensure that your body is responding appropriately to the hormones necessary to support the pregnancy. These appointments will take place at a fertility clinic near you so you won’t have to travel to the intended parents’ fertility clinic.

Embryo Transfer

You will have the embryo transfer at the intended parents’ fertility clinic. The procedure is very simple and not painful. A few days of rest or mild activity afterwards is requested to give the embryo adequate opportunity to implant itself and start to grow.

Pregnancy Testing and Confirmation

About 7 days after transfer you will need to go to the local lab approved by the fertility clinic to have blood drawn. The clinic will inform you and your case manager of your hormone levels which indicate pregnancy. This is the day everyone has been waiting for! You will have repeat blood tests done at 9 days and sometimes again at 11 days after the transfer. The fertility clinic wants to see the hormone levels increasing with each test. If the numbers continue to rise, you will have an ultrasound to confirm a fetal heartbeat. You will have several monitoring ultrasounds at the clinic near you up until around 10 weeks of pregnancy. At that point, you will be released to visit your own OB for the duration of the pregnancy and several months later will hopefully deliver a healthy newborn baby for your intended parents. Your job as a surrogate is now done!