How Does Surrogacy Work and What Does It Cost?

Surrogacy has become more mainstream, thanks to celebrities like Kim Kardashian West, who used a surrogate to carry baby Chicago. In fact, in an original survey conducted by Marie Claire in partnership with SurveyMonkey, 23 percent of Millennial women said they would consider surrogacy if they couldn't conceive naturally. Just 9 percent of Gen-X women said the same.

Still, the process remains mysterious.

A surrogate, also known as a gestational carrier, is a woman who carries and delivers a child for another couple or person who are that child’s intended parents; a gestational carrier can carry an embryo that is created from the intended parents’ own sperm and egg, or donated sperm and/or egg, depending on the family and the fertility issues needing to be addressed. (“Surrogate” is an older term for the same arrangement; the preferred term is gestational carrier, though, as the word surrogate traditionally implies that the woman carrying the fetus has a genetic connection to it.)

Interested couples will be referred by their fertility clinic to agencies that manage gestational carriers, says Aaron K. Styer, M.D., reproductive endocrinologist and co-medical director of CCRM Boston. “Reputable agencies, like Circle Surrogacy, Conceivabilities, and The Center for Surrogacy and Egg Donation (CSED), will have completed comprehensive medical and psychological evaluations and background checks of gestational carrier candidates,” Dr. Styer explains, adding that once the intended parents match with a gestational carrier, their infertility doctor will also evaluate her in person to ensure she is medically and psychologically ready to carry a pregnancy.

If surrogacy is legal in the state where the surrogate lives (four states expressly ban surrogacy: New York, New Jersey, Indiana, and Michigan), the intended parents and gestational carrier will likely complete a binding contract that governs the terms of the medical care during the pregnancy and explicitly states that the gestational carrier has no legal claim to the child. After that paperwork is completed, the process of trying to conceive begins.

The gestational carrier is placed on a hormonal treatment regimen to build up her uterine lining in preparation for the transfer of the embryo. An embryo created from the egg and sperm of the intended parents (or via donated eggs or sperm, when applicable) is then transferred into the uterus of the gestational carrier. In other words, in most instances, the intended female parent will go through the first half of an IVF cycle to have her eggs retrieved, while the second half of the cycle is completed by the gestational carrier to prepare her uterus for embryo transfer.

According to at least one agency, the total cost of a gestational carrier cycle can reach as high as $240,000, though other sources put the price tag at about one-fourth of that. These costs include fees to the agency that identified the gestational carrier (approximately $20,000), payment to the gestational carrier herself for her time and effort (approximately $20,000$25,000, which covers both healthcare-related expenses and, typically, an additional fee unrelated to medical costs), screening of the gestational carrier (approximately $5,000) and roughly $20,000 for the medications and procedures associated with egg retrieval, fertilization, and embryo transfer. Future parents pursuing a family via gestational carrier can purchase separate gestational carrier insurance, with premiums of approximately $10,000 and deductibles starting anywhere from $15,000 to $30,000, depending on the number of embryos being carried.

Still have questions about getting pregnant? Check out our fertility FAQ here.

Editors’ note: We use the terms “woman” and “female” in this article to refer to people with internal reproductive organs; however we understand that not everyone with internal reproductive organs identifies as a woman or a female. We use the terms “man” and “male” to refer to people with external reproductive organs; however we understand that not everyone with external reproductive organs identifies as a man or a male.