If you are considering surrogacy, understanding the surrogacy process is one of the first things you should do. But there is an important point that many intended parents overlook: there is no single surrogacy process that applies to every country.
The legal requirements, medical procedures, available services, costs, eligibility requirements, and documentation can vary significantly depending on where the surrogacy takes place.
That is why the first steps to surrogacy should not necessarily begin with finding a surrogate. They should begin with understanding where you can legally and practically pursue surrogacy.
Before continuing, we recommend reading our complete guide to Surrogacy Laws to understand how different countries approach surrogacy.
This guide explains the surrogacy process step by step, with a particular focus on international intended parents who are considering working with a surrogacy agency.
What Is the Surrogacy Process?
The process of surrogacy is a series of legal, medical, logistical, and pregnancy-related steps through which intended parents create an embryo and transfer it to a gestational surrogate who carries the pregnancy.
In modern gestational surrogacy, the surrogate does not provide the egg used to create the embryo. Instead, an embryo is created through in vitro fertilization (IVF) using the intended parents’ eggs and sperm, donor eggs or sperm, or a combination of these sources. The embryo is then transferred to the uterus of the gestational carrier.
In simple terms, the full process of surrogacy can look like this:
Country & legal assessment → Surrogacy agency consultation → Medical consultation → IVF planning → Egg retrieval or donor egg selection → Embryo creation → Surrogate screening and matching → Legal arrangements → Surrogate preparation → Embryo transfer → Pregnancy monitoring → Delivery → Post-birth legal and travel procedures
However, the exact sequence can change depending on the country, clinic, medical situation, and whether intended parents use their own eggs or donor eggs.
Step 1: Determine Where You Can Pursue Surrogacy
Before beginning the medical part of the surrogacy process, determine which country is appropriate for your situation.
This is particularly important for international intended parents because surrogacy laws are not the same everywhere.
Some jurisdictions permit gestational surrogacy under specific conditions, some have restrictions based on residency or eligibility, and others have significantly limited or prohibited commercial or international arrangements. In the United States, for example, the legal framework for gestational carrier arrangements varies by state rather than being governed by one nationwide surrogacy statute.
Other countries have changed their rules over time. Some destinations that were once well known for international surrogacy now have much more restrictive requirements.
This means that where you want to complete the surrogacy process matters from the beginning.
For international intended parents, the available options may involve:
- Pursuing surrogacy in their country of residence, if legally available
- Traveling to another country where international surrogacy is available under applicable law
- Working with an international surrogacy agency
- Coordinating fertility treatment, surrogacy, legal services, and travel in the same destination
For example, Iran is one destination that some international intended parents consider when comparing the cost and availability of fertility and surrogacy services. VitaLife was established to coordinate fertility treatment and surrogacy in Iran for international intended parents.
The important point is not to choose a destination based only on price. You should first understand the surrogacy laws, medical system, eligibility requirements, legal procedures, and total cost.
Step 2: Choose a Surrogacy Agency
Once you have identified countries where surrogacy may be available to you, the next step can be contacting a surrogacy agency.
This is especially important when you are traveling internationally.
An agency may coordinate different parts of the process, including:
- Surrogate matching
- Medical coordination
- Fertility clinic coordination
- Legal coordination
- Travel assistance
- Pregnancy support
- Communication with the surrogate
- Delivery planning
- Post-birth coordination
But not every agency provides the same services.
Before choosing an agency, receive consultations from several providers and ask them the same questions so that you can make a meaningful comparison.
Questions to Ask a Surrogacy Agency
Do not simply ask, “How much does surrogacy cost?”
Ask for the complete final cost and clarify what is and is not included.
Your questions should include:
- What is the total cost of the surrogacy package?
- Are there additional or hidden costs?
- Which country will the medical process take place in?
- Which fertility clinic will perform the IVF?
- Which doctors will be responsible for treatment?
- What is the expected age range of the surrogate?
- How are surrogates medically screened?
- How are surrogates psychologically evaluated?
- How many embryo transfers are included?
- What happens if the first embryo transfer does not result in pregnancy?
- Is egg donation available if we cannot use the intended mother’s eggs?
- Is sperm donation available if required?
- Is genetic testing of embryos available?
- Is gender selection legally and medically available?
- What prenatal care does the surrogate receive?
- Who pays for medical care during pregnancy?
- How is the surrogate supported during pregnancy?
- What kind of food and nutrition does the surrogate receive?
- How are transportation and medical appointments handled?
- What legal services are included?
- What happens if complications occur during pregnancy?
- What support is provided during delivery?
- What happens after the baby is born?
- Does the agency assist with birth documentation and travel arrangements?
These questions can reveal significant differences between agencies that may not be obvious from the advertised package price.
Step 3: Compare Agencies Before Making a Decision
One practical approach is to create an Excel spreadsheet.
Put every agency in a separate column or row and ask every agency the same questions.
For example:
| Question | Agency A | Agency B | Agency C |
|---|---|---|---|
| Total package price | |||
| Number of embryo transfers | |||
| IVF clinic | |||
| Surrogate screening | |||
| Egg donation available | |||
| Genetic testing | |||
| Prenatal care | |||
| Legal support | |||
| Pregnancy support | |||
| Delivery support | |||
| Post-birth support | |||
| Additional costs |
You can then give the completed spreadsheet to an AI assistant such as ChatGPT and ask it to organize the answers, identify differences, highlight missing information, and help you formulate follow-up questions.
The AI should be treated as a decision-support tool, not as a replacement for legal or medical advice.
The goal is to make sure you are comparing agencies based on the same information rather than choosing based only on advertising or the lowest advertised price.
Step 4: Have a Medical Consultation
After selecting an agency or fertility provider, the next stage of the surrogacy medical process is a medical evaluation.
This stage determines how your IVF treatment may need to be structured.
The medical team may need to evaluate:
- The intended mother’s ovarian reserve
- Egg quality and reproductive history
- The intended father’s sperm parameters
- Previous fertility treatments
- Medical conditions
- Genetic or infectious disease screening where indicated
- Whether IVF using the intended mother’s own eggs is appropriate
- Whether donor eggs may be necessary
For the intended mother, an AMH test may be used as part of the assessment of ovarian reserve.
For the intended father, a semen analysis can provide information about sperm concentration, motility, morphology, and other semen parameters.
The exact tests required depend on the clinic, medical history, and applicable regulations. Professional guidance for gestational-carrier programs includes medical evaluation and screening of intended parents or genetic contributors as part of the process.
This is why the ivf process for surrogacy should be planned around the actual medical situation of the intended parents rather than assuming that every couple follows exactly the same protocol.
Step 5: Decide Whether to Use Your Own Eggs or Donor Eggs
One of the major decision points in the ivf surrogacy process is determining the source of the egg.
There are two common pathways.
Option 1: Using the Intended Mother's Own Eggs
If the medical evaluation indicates that IVF using the intended mother’s eggs is appropriate, the process generally moves toward ovarian stimulation and egg retrieval.
The basic pathway is:
Ovarian stimulation → monitoring → egg retrieval → fertilization → embryo development → embryo selection/testing when applicable → embryo transfer
Option 2: Using Donor Eggs
If the intended mother cannot use her own eggs or the medical team recommends another approach, egg donation for surrogacy may be considered where legally available.
The process then becomes:
Egg donor selection → donor screening → egg retrieval or use of available donor eggs → fertilization with sperm → embryo development → embryo transfer to the surrogate
Egg donation is therefore not a completely separate form of surrogacy. It is a different pathway within the broader medical process of surrogacy.
Professional guidance recognizes that embryos used in gestational-carrier arrangements may be created using the gametes of intended parents, donors, or both.
Step 6: Begin the IVF Process
Once the medical plan is established, IVF becomes the central part of the in vitro fertilization and surrogacy process.
IVF allows an embryo to be created outside the body and subsequently transferred to the uterus of the gestational carrier.
The exact protocol varies by patient and clinic, but the IVF process commonly includes ovarian stimulation, monitoring, egg retrieval, fertilization, embryo development, and embryo transfer.
Ovarian Stimulation
If the intended mother is using her own eggs, medications may be prescribed to stimulate the ovaries and allow multiple eggs to mature during one treatment cycle.
The patient is monitored through appointments that may include ultrasound examinations and blood tests.
Egg Retrieval for Surrogacy
Once the eggs are ready, an egg retrieval procedure is performed.
The retrieved eggs can then be fertilized with sperm from the intended father or a sperm donor, depending on the treatment plan.
This is the main stage referred to as egg retrieval for surrogacy when the intended mother’s eggs are being used to create embryos for transfer to a surrogate.
Fertilization and Embryo Development
The retrieved eggs are fertilized in the laboratory.
The resulting embryos are monitored as they develop.
Depending on the medical plan and applicable regulations, embryo testing such as preimplantation genetic testing may also be considered.
Not every intended parent needs or chooses genetic testing, and the appropriate approach should be discussed with the fertility specialist.
Step 7: Complete Surrogate Screening and Matching
While embryos are being created or prepared, the agency and medical team can work through the steps to finding a surrogate.
A gestational carrier should undergo appropriate medical and psychological evaluation before proceeding.
The screening process may include:
- Medical history
- Physical examination
- Pregnancy history
- Laboratory testing
- Infectious disease screening
- Psychological evaluation
- Counseling
- Review of previous pregnancies
- Legal eligibility
- Assessment of the requirements of the intended parents and clinic
ASRM guidance emphasizes informed consent, medical and psychological evaluation, counseling, and independent legal representation for gestational carriers.
The surrogate also needs to understand the medical risks and legal terms of the arrangement before agreeing to proceed.
Step 8: Complete the Legal Process
The legal stage should not be treated as paperwork that can simply be completed at the end.
The legal requirements should be understood before the embryo transfer.
Depending on the country, this can involve:
- Surrogacy agreements
- Independent legal advice for the surrogate
- Intended-parent documentation
- Consent forms
- Parentage procedures
- Birth registration requirements
- Citizenship or nationality procedures
- Travel documentation for the newborn
The exact legal process depends on the jurisdiction.
In international surrogacy, intended parents should consider both the law of the country where the child is born and the requirements of their country of citizenship or residence.
Step 9: Prepare the Surrogate for Embryo Transfer
Once an embryo is available and the surrogate mother has completed the required screening and legal steps, the surrogate’s uterus is prepared for embryo transfer.
Depending on the protocol, hormonal medication may be used to prepare and support the endometrium.
The fertility team monitors the surrogate and determines when the uterine lining is appropriately prepared.
ASRM notes that gestational carriers commonly require hormonal support to prepare for and support pregnancy, although protocols vary.
Step 10: Embryo Transfer in Surrogate
The next major milestone is embryo transfer in the surrogate.
The selected embryo is transferred into the surrogate’s uterus using a catheter.
This is one of the most important steps in the ivf surrogate process, but it is important to understand that an embryo transfer itself does not guarantee pregnancy.
The embryo must implant and develop successfully.
Professional guidance strongly supports single-embryo transfer in gestational-carrier cycles because multiple gestation increases pregnancy-related risks for the carrier.
If the transfer does not result in pregnancy, the medical team may review the cycle and determine whether another embryo transfer is appropriate.
This is one reason intended parents should ask an agency exactly how many embryo transfers are included in their package and what happens if the first transfer fails.
Step 11: Pregnancy Confirmation and Monitoring
After embryo transfer, the next stage is the process of surrogacy pregnancy.
A pregnancy test is performed according to the clinic’s protocol.
If pregnancy is confirmed, additional monitoring follows.
Early pregnancy monitoring may include:
- Blood tests
- Ultrasound examinations
- Medication management
- Monitoring of pregnancy development
- Follow-up appointments
Once the pregnancy is established, care gradually transitions into regular prenatal care according to the medical team’s protocol.
ASRM describes gestational-carrier pregnancies as requiring follow-up after pregnancy confirmation, including laboratory investigations and ultrasound examinations before transition to regular obstetrical care.
The surrogate’s medical care remains her own medical decision-making domain. She should receive appropriate medical care and have informed consent throughout pregnancy, labor, delivery, and aftercare.
Step 12: Pregnancy Care and Support
The pregnancy stage can last many months, so the surrogacy process step by step does not end after a positive pregnancy test.
During pregnancy, intended parents and the surrogate may need coordination regarding:
- Prenatal appointments
- Ultrasound examinations
- Laboratory testing
- Medication
- Nutrition
- Transportation
- Communication
- Emergency medical situations
- Hospital planning
- Delivery arrangements
The exact level of agency support differs between providers.
This is another reason why intended parents should ask during the initial consultation:
How do you care for your surrogate throughout pregnancy?
Do not assume that every agency provides the same level of support.
Step 13: The Surrogate Delivery Process
The final medical stage is the surrogate delivery process.
The delivery plan depends on the pregnancy, medical circumstances, and recommendations of the obstetric team.
A delivery may be vaginal or by cesarean section depending on the medical situation. The decision should be made by the medical team based on the health and circumstances of the surrogate and baby.
The agency may help coordinate:
- Hospital arrangements
- Communication with intended parents
- Transportation
- Documentation
- Postpartum care
- Newborn documentation
Importantly, the surrogate retains authority over her medical care and decisions during labor and delivery.
Step 14: What Happens After the Baby Is Born?
The surrogacy process does not necessarily end at delivery.
For international intended parents, the post-birth stage can be particularly important.
Depending on the countries involved, parents may need to complete:
- Birth registration
- Parentage documentation
- Passport or travel documentation
- Citizenship or nationality procedures
- Embassy or consular procedures
- Medical records for the newborn
- Travel arrangements
- Additional legal procedures
The exact requirements can differ considerably between countries.
This is why international intended parents should understand the post-birth process before starting treatment, rather than discovering these requirements after the baby is born.
How Long Does the Surrogacy Process Take?
There is no single timeline for every surrogacy journey.
The total duration can be affected by:
- The country where treatment takes place
- Legal requirements
- Agency selection
- Medical evaluation
- IVF response
- Egg retrieval
- Embryo development
- Donor egg selection if required
- Surrogate matching
- Legal preparation
- Embryo transfer
- Pregnancy
- Delivery
- Post-birth documentation
For this reason, it is more useful to think of the full process of surrogacy as several connected stages rather than expecting a fixed number of months.
If you are traveling internationally, visa processing, travel arrangements, and documentation can add additional time.
Your agency and fertility clinic should provide a personalized timeline based on your circumstances.
If you want the entire surrogacy step by step process in a simple format, here is the complete pathway:
- Research surrogacy laws
- Choose a legally available destination
- Contact surrogacy agencies
- Ask detailed questions about price, medical care, surrogate care, IVF, legal services, and included transfers
- Compare agencies
- Choose an agency and fertility provider
- Complete the medical consultation
- Evaluate egg and sperm availability
- Choose between own eggs and donor eggs when necessary
- Complete IVF preparation
- Perform ovarian stimulation when using own eggs
- Complete egg retrieval
- Fertilize the eggs
- Develop and evaluate embryos
- Complete surrogate screening
- Match with a surrogate
- Complete legal requirements
- Prepare the surrogate’s uterus
- Transfer the embryo
- Confirm pregnancy
- Monitor the pregnancy
- Prepare for delivery
- Complete the surrogate delivery process
- Complete birth, parentage, citizenship, and travel documentation
What Is Different About the Surrogacy Process With Donor Eggs?
If you use donor eggs, the beginning of the surrogacy medical process changes.
Instead of:
Intended mother’s eggs → egg retrieval → fertilization → embryo
the pathway becomes:
Donor eggs → fertilization → embryo → surrogate
The intended father may still provide the sperm, depending on the treatment plan.
This means egg donation should be discussed during the first medical consultation rather than added unexpectedly after the IVF process has already started.
For intended parents considering Iran, access to fertility treatment and donor-egg pathways is one of the reasons it can be useful to evaluate the entire fertility and surrogacy package together, rather than treating IVF, egg donation, surrogacy, and medical coordination as completely separate services.
How to Choose the Right Surrogacy Program
When comparing programs, don’t look only at the advertised price.
Instead, compare the complete process.
Ask:
- What happens before pregnancy?
- What happens if the first embryo transfer fails?
- What medical services are included?
- How are surrogates screened and supported?
- How many embryo transfers are included?
- What happens during pregnancy?
- What happens during delivery?
- What legal support is provided after birth?
- What costs are not included in the advertised package?
These questions can give you a much clearer picture of the actual surrogacy process for intended parents.
Why Understanding the Entire Surrogacy Process Matters
Surrogacy is not simply the process of finding a surrogate and transferring an embryo.
It combines:
Law + medical treatment + IVF + embryo creation + surrogate screening + pregnancy care + delivery + post-birth documentation.
For international intended parents, there is another layer:
Travel + visa requirements + international legal considerations + newborn documentation.
Understanding these stages before making a decision can help you ask better questions, compare providers more accurately, and prepare for the practical requirements of the journey.
If you are considering surrogacy in Iran, VitaLife can help international intended parents understand the available fertility and surrogacy services and the steps involved before beginning treatment.
What is the first step in the surrogacy process?
The first step should be understanding whether surrogacy is legally and practically available to you in the country where you plan to pursue treatment. After that, you can compare agencies and arrange a medical consultation.
What is the IVF process for surrogacy?
Does the surrogate use her own egg?
How does egg retrieval work for surrogacy?
What happens if the intended mother cannot use her own eggs?
How many embryos are transferred to a surrogate?
Does embryo transfer guarantee pregnancy?
What happens after the surrogate becomes pregnant?
What happens after the surrogate gives birth?
The surrogacy process involves much more than finding a surrogate and transferring an embryo. It combines legal requirements, medical evaluation, IVF, embryo creation, surrogate screening, pregnancy care, delivery, and post-birth procedures.
For intended parents, the best place to start is by understanding where surrogacy is legally available, comparing agencies carefully, and getting a proper medical evaluation before committing to a treatment plan. If donor eggs are needed, that should also be considered early because it can change the IVF pathway.
If you are considering international surrogacy, take the time to compare the total cost, medical services, surrogate care, number of included embryo transfers, legal support, and post-birth assistance rather than focusing only on the advertised package price.
Understanding the surrogacy process step by step gives you a clearer picture of what to expect, what questions to ask, and how to prepare for each stage of your journey toward parenthood.