Understanding surrogacy: the process, parenthood, costs and risks

The two types: using the surrogate’s own egg or someone else’s

In gestational surrogacy, an embryo created through IVF is transferred to the surrogate’s womb. The egg comes from an intended parent or an egg donor. The woman carrying the pregnancy does not provide her own egg, so she is not the child’s genetic mother.

In traditional surrogacy, the surrogate’s own egg is fertilised, for example through insemination. She both carries the child and is genetically related to them. The fertility regulator HFEA explains the two types and their medical differences.

Surrogacy therefore does not automatically mean that the child has a genetic connection to both intended parents. That depends on the eggs and sperm used. Whatever the genetic relationship, pregnancy remains a physical and personal experience for the woman carrying the child.

Altruistic and commercial: what do these terms mean?

These terms answer a different question: is the woman paid for carrying the pregnancy? In an altruistic arrangement, no such payment is planned, although certain expenses may be reimbursed depending on the rules. A commercial arrangement includes additional payment. Which payments are permitted, and what counts as an expense, varies between legal systems.

Altruistic does not therefore mean free of charge. Treatment, counselling, travel and care during pregnancy still need funding. Equally, the label commercial does not on its own explain what a price includes or what protections are in place for those involved.

Even a private arrangement between people who know one another needs clear agreements. A close relationship can help build trust, but it can also make it harder to decline a request or state a boundary.

Why people consider surrogacy

Surrogacy may be relevant to people who do not have a womb, or for whom pregnancy is medically impossible or would carry substantial risks. Male couples and single men may also consider it. Whether this route is available to them is a separate legal question.

After repeated unsuccessful treatments, it is important to establish which obstacle surrogacy is intended to overcome. It does not resolve every difficulty in creating an embryo or its development. Recommendations from the American Society for Reproductive Medicine, ASRM, describe possible medical reasons, as well as assessment and counselling for everyone involved.

The process of gestational surrogacy

Before treatment starts, medical suitability, expectations and legal requirements need to fit together. Only then is it sensible to plan how embryos will be created and transferred. If frozen embryos are already available, egg collection may not be necessary.

1. Assessment and counselling: Those involved discuss their medical history, examinations, potential pressures and expectations about pregnancy and future contact.
2. Legal preparation: Parenthood, permitted agreements, payments and representation of each person’s interests are addressed before treatment.
3. IVF in the laboratory: Eggs are collected and fertilised. A decision is then made about which embryos are suitable for transfer or freezing.
4. Embryo transfer: The clinic times the transfer to the surrogate’s cycle or prepares her womb lining with medication.
5. Pregnancy and birth: If a pregnancy develops, care, planning for the birth and the necessary legal steps follow.
6. Afterwards: The child needs care and clear responsibilities. The surrogate needs time to recover, follow-up care and additional support if needed.

Not everyone has the same treatment. Hormonal stimulation and egg collection concern the person whose eggs are being used. The surrogate has the embryo transfer and carries the pregnancy. The HFEA’s overview of IVF explains the medical process in more detail.

How long does it take, and how certain is success?

Pregnancy accounts for only part of the overall time. Finding a suitable surrogate, examinations, counselling, legal preparation and possibly several treatment attempts all add to it. In arrangements across borders, the journey home after the birth may also be delayed. It is therefore not responsible to promise a fixed timescale.

Nor is there a success rate that applies to surrogacy as a whole. Factors include the age and quality of the eggs, the embryos and the individual medical circumstances. A young, healthy surrogate cannot compensate for every problem with eggs or sperm.

When a clinic quotes success figures, ask precisely what they describe: a positive pregnancy test or a live birth? Is the figure per transfer, per egg collection or for several attempts combined? Only with that context can a figure help with your own planning.

What medical risks are involved?

The risks affect different people. Egg collection can involve hormonal side effects and ovarian hyperstimulation syndrome, among other risks. For the woman carrying the pregnancy, the concerns are the burden of treatment and the risks of pregnancy and birth.

Even a carefully selected surrogate can develop complications such as high blood pressure disorders or bleeding. For the child, premature birth is a particular risk. A 2024 cohort study found severe maternal complications more frequently in gestational carriers than in comparison pregnancies with and without IVF. A smaller, earlier study had found no clear increase in severe complications compared with similar pregnant women. The studies examined different groups and cannot predict personal risk. They do, however, give reason to take antenatal and postnatal care seriously.

One practical way to reduce risk is to avoid pregnancies involving more than one baby wherever possible. The reproductive medicine society ASRM strongly recommends single embryo transfer in gestational surrogacy. Transferring several embryos is not a harmless shortcut to a quicker result.

Who decides during the pregnancy?

Intended parents want a child and are deeply emotionally invested. Medical interventions, however, affect the surrogate’s body. Expectations around examinations, birth and possible complications therefore need to be discussed early.

The ASRM ethics opinion emphasises that the surrogate gives her own consent to medical care. Independent legal advice means having her own representative, who acts in her interests. Intended parents may pay for this without controlling the advice she receives. This is a professional ethical position; the applicable law needs separate examination.

Conversations about abnormal findings, miscarriage or differing views on ending a pregnancy are especially important. A written agreement can record expectations. It cannot replace ongoing discussion or consent to medical care. Fundamental differences that cannot be reconciled should be identified before pregnancy.

Parenthood means more than a genetic connection

Legal systems differ on whether surrogacy is permitted, who can access it and how parenthood is established. Three questions therefore need separate answers: can the treatment take place? Who is considered a parent after birth? Will that parenthood also be recognised where the family is going to live?

The answers may differ particularly across borders. The Hague Conference on Private International Law describes the resulting difficulties with parenthood, nationality and parental responsibility. A genetic connection, an agreement and a birth certificate are therefore not simply interchangeable evidence.

For any particular arrangement, legal advice belongs at the outset. It should explain the steps needed to establish parenthood securely and who may act for the child in the meantime. That includes the practical question of who will care for the newborn if the intended parents cannot be there in time for the birth. A route to parenthood involving treatment abroad also requires attention to travel documents and recognition in the country of residence.

What does surrogacy cost?

There is no reliable worldwide total price. The term can itself cover very different services: a private arrangement reimbursing expenses, medical treatment or a comprehensive programme with matching and support. A single figure tells you little while these differences remain unclear.

When preparing a budget, it is more useful to list the following separately:

• Examinations, IVF, medication, egg or sperm donation where needed, storage and further embryo transfers
• Care during pregnancy and birth, insurance and medical services that are not covered
• Permitted reimbursement of expenses or lawful payment, plus matching and support costs where applicable
• Independent legal advice, proceedings, certificates and translations
• Travel, accommodation, loss of earnings and an extended stay after the birth
• Additional needs following failed attempts, complications or hospital care for the newborn

This is a list to help you ask questions, rather than a package of services that is identical everywhere. For a specific offer, ask for a breakdown of what is included, what is charged separately and who bears each financial risk. A package advertised with a guarantee needs the same examination: a contractual refund or further treatment attempts are different from a guaranteed birth.

The relationship does not automatically end with the birth

Surrogacy connects people in a deeply personal situation. Some want close contact during pregnancy; others prefer more distance. Different expectations are not necessarily a problem, provided they are discussed.

Specific agreements help: which information will be shared? Who will attend appointments or the birth, if the surrogate wants them there? What should later contact look like? How will the surrogate’s own children be told why the baby is growing up in another family?

Postnatal care needs equally concrete planning: who arranges the surrogate’s medical care, who helps her with everyday tasks and who pays if she needs support for longer? ASRM calls for access to psychological support after the birth too. A change in wishes about contact must not mean losing agreed care.

What do we know about the children?

It is now possible to study how children experience the story of their origins over longer periods. A longitudinal study published in 2023 followed families until the children were 20. It compared 65 families formed through egg or sperm donation or surrogacy, including 22 surrogacy families, with 52 families whose children were conceived without such assistance. There were no differences between these two overall groups in the young adults’ psychological well-being or the quality of family relationships.

These findings are encouraging, but cannot be applied to every family arrangement: the subgroups were small and the focus was on mother–child relationships. Earlier disclosure about origins was associated with better relationships; this does not establish cause and effect. In practical terms, keep information about origins and consider early on how to talk about them in an age-appropriate way. The conversation develops with the child’s questions.

Which alternatives suit your circumstances?

An alternative needs to address the actual obstacle. If pregnancy is possible but someone’s own eggs cannot be used, egg donation may be an option, subject to medical and legal requirements. If no one in the planned family can carry a child, egg donation alone will not solve that problem.

Co-parenting, in contrast, means sharing parenthood with other people. The person carrying the pregnancy may remain a parent permanently; that makes it fundamentally different from surrogacy. Adoption and fostering have their own requirements and centre on the needs of children who have already been born. They are not interchangeable treatment options.

Sometimes the next step is to take a break or discuss again what family means to you. What matters is which route suits the people involved and which responsibilities they want to take on over the long term.

What to clarify before making a decision

These questions can help you come away from an initial conversation with concrete answers:

• What obstacle is surrogacy intended to overcome in our circumstances, and whose eggs and sperm would be used?
• How will the surrogate and the other people involved receive independent counselling, examinations and follow-up care?
• What happens if a transfer fails, a miscarriage occurs or there is an unexpected medical finding?
• What steps establish parenthood, and who takes responsibility for the child until then?
• Which costs are included in writing, which remain unresolved and what cover or safeguards apply if complications arise?
• What are everyone’s expectations about contact, privacy and the time after birth?

If an offer mainly stresses speed or a low starting price but leaves these questions unanswered, you do not yet have the information you need to decide.

Myths and facts about surrogacy

Myth: A young surrogate makes the age of the eggs irrelevant.

Fact: The age of the person providing the eggs remains an important influence on the chances of success. A young surrogate does not make the eggs younger. The HFEA therefore distinguishes between the effects of the eggs and those of the woman carrying the pregnancy.

Myth: Two embryos simply mean twice the chance of a child.

Fact: More than one embryo increases the risk of a multiple pregnancy. The chance of success cannot simply be doubled, while risks for the surrogate and the children may rise. This is why ASRM strongly recommends single embryo transfer in gestational surrogacy.

Myth: Without payment, nobody can be under pressure.

Fact: Pressure can also come from family expectations, loyalty or dependence. Especially in arrangements within families, ASRM stresses voluntary decisions and independent counselling. It also matters whether someone can say no without risking the relationship.

Myth: Without her own egg, there is no emotional bond.

Fact: Genetic relationships and feelings are different things. Pregnancy, birth and contact with the family can be personally meaningful without the surrogate wanting to take on the parental role herself. Equally, pregnancy does not predict what sort of contact she will want later. Expectations and support need to suit the individuals involved.

Conclusion

In surrogacy, successful treatment is only one part of the journey. The autonomy and care of the woman carrying the pregnancy, established parenthood and a secure start for the child are just as important. Anyone considering this route needs clear answers about how those responsibilities will be met before and after the birth.