A guide to surrogacy: What intended parents need to know

Put simply, surrogacy is when you carry a baby for someone else, and upon birth, parental rights are assigned to the intended parent(s). 

Surrogacy can be a beautiful experience, but after 14 years of working as a reproductive endocrinology and infertility specialist, one of the toughest discussions I have with patients is telling them they must go down the surrogacy pathway. Because regardless of why we were having the conversation—negative embryo transfers, repeat miscarriages, same-sex couples, a lack of a uterus because of a previous medical condition—the truth remains: Surrogacy has become price-prohibitive and time-prohibitive. In fact, over the last five years, the cost of surrogacy has outpaced any average American who can afford it. (More on that later.)

I founded Nodal as an antidote to everything I couldn’t bear to witness any longer within the surrogacy industry. Our proprietary matching platform is a revolutionary product that provides transparency, empowerment, and equity to all parties involved in a journey—all elements that are sadly missing from today’s typical process. 

As the father of two little girls, I cannot teach my daughters a better lesson than if they see a problem, to take responsibility for fixing the problem. And that’s exactly what we’re doing with Nodal.

Here’s what you need to know about surrogacy—and how to tell if it’s the right journey for you.

What is surrogacy?

Surrogacy is a form of third-party reproduction in which a person consents, often by a legal agreement, to carry a pregnancy for the intended parent(s) with the understanding that custody of the child belongs to the intended parent(s). 

There are two types of surrogacy: Gestational surrogacy and traditional surrogacy.

Gestational surrogacy

This type of surrogacy occurs when a surrogate carries a baby created from the intended parent(s) sperm and egg or a donor embryo. With gestational surrogacy, there is no biological relationship between the carrier and the baby, and parental rights are assigned to the intended parent(s) before or immediately after the baby’s birth.

Worth noting? Gestational surrogacy is most often what people are referring to when they use the term “surrogacy.” Again, this is a type of surrogacy in which a surrogate carries a baby to whom they have zero biological relations.

Traditional surrogacy

This type of surrogacy occurs when a carrier provides their egg and has a genetic connection to the child. This type of surrogacy is less commonly used today, as it is much more legally complex than gestational surrogacy. 

Related: Our surrogacy journey didn’t go as planned—what we want others to know

How does surrogacy work?

Several steps must be completed before a surrogate is considered pre-screened and ready to be matched with an intended parent. These steps typically include an application, screenings (including a background check and identity verification), a medical workup, and a psychological evaluation.

When a surrogate does choose their intended parents, it’s time to begin next steps, including beginning medications that will help a surrogate prepare for embryo transfer. An embryo transfer is a process in which an embryo created in a laboratory—with no biological relation to the surrogate—is transferred into a gestational carrier’s (GC) uterus through a process better known as in vitro fertilization (IVF). Once pregnant, the surrogate will then carry and deliver the baby for the intended parents to raise.

Related: How to avoid IVF injection bruising, according to an acupuncturist

Is surrogacy right for you?

While everyone’s reason for choosing a surrogacy journey is different, a few common situations may lead a person down this particular path.

Surrogacy is an option for:

• Single fathers by choice
• Same-sex male couples
• Women who are unable to get pregnant (as a result of, for instance, infertility, a biological inability to conceive or pre-existing health conditions that could be exacerbated by pregnancy)
• Women who opt not to carry a pregnancy

How to choose a surrogacy agency

Surrogates and intended parents (IPs) should be encouraged to choose an agency based on cost and accessibility, as well as, perhaps most importantly, whether or not they are a good fit for the surrogacy journey you have in mind. For surrogates, this will mean ensuring, for instance, transparency throughout the process—this allows them to be in control of and feel empowered by their experiences—and access to resources that will help guide their journey.

Related: Actress Jamie Chung says she chose surrogacy to protect her career

How to find a surrogate

There are many ways in which intended parents can match with surrogates, including:

• Through an agency
• Through self-discovery/choosing an independent journey, which is a surrogacy experience where surrogates and IPs match without the assistance of a surrogacy matching program or surrogacy agency, like through the use of social media groups. One example of an independent journey is Ashley Gilden Spitzer, a fertility consultant and Nodal advisor, who independently matched with a surrogate for her second surrogacy experience.
• A matching platform like Nodal that can help expedite the process, no matter if you choose an agency or independent journey

The matching process: What to know

The surrogacy matching process is a complex and highly individualized journey. However, some common steps surrogates and/or intended parents can expect before matching include (1) completing applications with personal and medical histories, preferences, and expectations and (2) medical and psychological evaluations.

If the parties are working with agencies, the next phase of the journey typically entails intended parents being presented with surrogate profiles to see if any might be a match. Profiles that interest intended parents would then lead to a meeting or call where the agency would facilitate introductions and answer any questions.

In the case of Nodal, a surrogate is accepted to our platform after they have been through the intake and screening process, and it is the surrogates who then gain access to the intended parents’ profiles and begin deciding who might make a good match. During this process, surrogates control who they choose to “wave” to and, perhaps, set up a meeting via video conference. If both parties agree to the meeting, a surrogate and the intended parent(s) will sign on—along with a mentor to help guide the process—to assess whether or not they are a good match for each other. 

We’ve found this aspect of our proprietary technology allows for superior matching, leading to lower costs for intended parents and well-informed surrogates who begin their journey by making a decision that feels right for them. The result? Reduced wait times, money saved, and both parties feeling like they are in control of the process that is about to unfold.

How much does surrogacy cost?

Surrogacy costs have dramatically ballooned from $75K to $100K five years ago to as much as $250K for many intended parents today.

The pandemic caused a shortage of surrogates, leading to 12- to 18-month waitlists for intended parents. Many agencies promoted VIP programs to skip these lines and continue to charge tens of thousands of dollars for this benefit. Fewer surrogates also equate to fewer overall journeys, resulting in higher agency fees at some agencies. Additionally, the current process has added layers, such as concierge services to help intended parents match with agencies and consultants who charge for white glove hand-holding. Inflation is, of course, a factor too.

Nodal is a relatively inexpensive way to meet an amazing surrogate, and we provide recommendations to best-in-class service providers at different budget levels to complete the journey. Surrogacy will never be cheap unless a family member or friend acts altruistically as the surrogate. However, during compensated journeys, the hope is that more money goes into the surrogate’s pocket and less to ancillary service providers. 

Does insurance cover surrogacy?

Very few intended parents have any employer-based benefits that offset the cost, let alone cover the costs of surrogacy. 

Is surrogacy legal in the US?

It often surprises people that surrogacy isn’t legal or protected in all 50 states. While California is considered a surrogacy-friendly state, Nebraska, Louisiana and Michigan still classify compensated surrogacy agreements as illegal. If an intended parent in Michigan wants to have a child via surrogacy, they must work with one who resides elsewhere. Even New York State updated its surrogacy laws with the Child-Parent Security Act (CPSA) as recently as 2021.

A note on choosing surrogacy

Putting the high costs of the journey aside, surrogacy can be a beautiful way to start a family, and the resulting child will later in life be able to appreciate that their parent(s)/gestational carrier combo moved mountains to bring them into this world.

A version of this story was originally published on April 14, 2023. It has been updated.