U.S. Surrogacy Process Step by Step: What to Expect

For many intended parents, understanding the surrogacy process in the United States can feel overwhelming at first.

There are multiple steps, different professionals involved, and important decisions along the way. While every journey is unique, having a clear overview of the process can make it easier to move forward with confidence.

Based on years of experience supporting intended parents, the U.S. surrogacy process generally follows several key stages.

Step 1: Initial Consultation and Planning

The journey typically begins with an initial consultation. 
At this stage, intended parents:

• discuss goals and preferences
• understand the overall process
• review timelines and expectations
• begin financial and logistical planning

Step 2: Choosing an IVF Clinic

Selecting the right IVF clinic is an important early decision in the surrogacy process.
The IVF clinic and physician play a central role in the medical aspects of the journey.
They typically:

• perform egg retrieval (if using an egg donor or intended mother)
• conduct medical screening for both the egg donor and surrogate
• develop and manage the treatment protocol
• perform the embryo transfer
• monitor the early stages of pregnancy

After the pregnancy is established and stable, care is usually transitioned to the surrogate’s OB provider for ongoing prenatal care.

Step 3: Egg or Sperm Donor (If Needed)

If intended parents require an egg donor or sperm donor, this step involves both selection and coordination.
Typically, the process includes:

• reviewing donor profiles based on preferences
• coordinating medical screening through the IVF clinic
• aligning timing between donor availability and treatment plans

Many agencies do not maintain their own donor database and may refer intended parents to external egg donor agencies.

Some agencies, such as Second Chance Surrogacy, provide more hands-on support by assisting with donor search and coordination across different resources, particularly for intended parents seeking specific backgrounds such as Asian egg donors.

Step 4: Matching with a Surrogate

Once preparation steps are complete, intended parents are matched with a surrogate.
This includes:

• reviewing profiles
• interviews or meetings
• confirming compatibility and expectations

Step 5: Medical Screening

Before moving forward, the surrogate undergoes medical screening through the IVF clinic.
This may include:

• physical evaluation
• lab testing
• psychological screening

Approval from the clinic is required before proceeding.

Step 6: Legal Contracts and Escrow Setup

After a match is confirmed, legal agreements and financial setup take place.
Attorneys prepare and review the surrogacy contract for all parties.
At the same time, an escrow account is established. Intended parents typically fund the escrow account in advance, which allows the agency to begin coordinating necessary steps such as medical screening, scheduling, and pre-transfer arrangements.

Step 7: Embryo Transfer

Once legal clearance is completed and escrow funding is in place, the IVF clinic will begin coordinating the embryo transfer cycle.
The clinic typically prepares a treatment calendar outlining medication protocols and key dates for the surrogate.
The embryo transfer is then performed according to this schedule, followed by pregnancy testing and early monitoring.

Step 8: Pregnancy and Ongoing Coordination

If the embryo transfer is successful, the journey continues through pregnancy.
Medical care transitions from the IVF clinic to the surrogate’s OB provider, while communication continues between the surrogate and intended parents.

A full-service agency, such as Second Chance Surrogacy, may provide ongoing coordination between all parties throughout the pregnancy, helping facilitate communication and alignment.

Step 9: Legal Parentage (Pre-Birth Order)

During pregnancy, attorneys begin the process of establishing legal parentage.
This typically occurs in the second trimester and helps ensure that intended parents are legally recognized before birth.

Step 10: Delivery and Bringing Baby Home

As the due date approaches, preparation for delivery takes place.
This includes

• hospital coordination
• final legal documentation
• planning for the baby’s transition home

For international intended parents, this stage may also involve obtaining travel documents such as a passport or other required paperwork.

Some agencies, such as Second Chance Surrogacy, provide additional support by helping coordinate these steps and guiding families through the process of returning home with their baby.

A Process That Requires Clarity and Coordination

While the surrogacy process involves many steps, understanding the structure can make it more manageable.

With thoughtful coordination and clear communication, intended parents can move through each stage with greater clarity and confidence.


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About the Author

Alice is the founder of Second Chance Surrogacy. She previously worked at a leading IVF clinic in Beverly Hills, supporting many international intended parents navigating the surrogacy process.

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