5 Common Questions About Surrogacy in the United States

These five questions and answers should get most gay men started on their journey to fatherhood through surrogacy. At times, surrogacy with egg donation can seem to have too many obstacles, to be too complicated, or to require too much work, but the rewards of a successful surrogacy are immeasurable!

As both a gay dad with kids who has gone through the process myself and the medical director of a large in vitro fertilization (IVF) program in Connecticut, I have counseled hundreds of patients on the best way to navigate this process.  The many steps can seem overwhelming, but it is important to note that using an egg donor and a gestational carrier has the highest pregnancy rates in any in vitro fertilization program’s practice. This is because we are maximizing the opportunity to achieve pregnancy by using healthy sperm, a young and healthy egg donor, and a woman as the carrier who has successfully delivered children in the past.

I decided to write my first blog for Gays With Kids to encourage gay men to get started in the process of bringing little people into their home.  Obviously the first step is to decide that you want to be a parent. The next step is to decide what questions to ask and where to start.

Gay dads-to-be can start the surrogacy process either with an in vitro fertilization clinic or with a surrogacy agency.  Both of these are necessary to move forward. Roughly half of my consultations are with couples starting the process without an agency; however, getting a head start by seeking and contracting with a surrogacy agency can shave time off of your family building journey.  It all depends on how much information you need before you feel comfortable taking the next step.

Below are the five most common questions that clients ask.

  1. What is the typical timeline to achieve a pregnancy?

From the time of initial consultation with the clinic or the surrogacy agency it takes about 6-12 months to achieve pregnancy.  There are multiple factors involved, including personal, medical, and financial issues. If after your initial consultation you decide to sign on with the surrogacy agency, the agency will ask for a deposit to begin the search for a carrier.

A surrogate is a woman who agrees to help another individual or couple have a baby by achieving a pregnancy using her own egg and carrying a pregnancy to term.  A gestational carrier is a woman who performs the same service using an embryo created with another woman’s egg.  As a result, a surrogate has a biological link to the baby, but a gestational carrier does not.

Every experience with an egg donor and gestational carrier (or surrogate) is unique, including the timeline. Gay couples need to select an egg donor and a gestational carrier (or a surrogate). Finding an egg donor typically takes 2-6 months, depending on the donor source (e.g., donor egg agency, known donor) and your chosen donor availability.  Finding a gestational carrier or surrogate typically takes 6–12 months, and includes interviewing the woman, her spouse or partner, medical screening, psychological screening and agreeing on a contract.

It is the responsibility of the agency to find the gestational carrier or surrogate and perform the non-medical screening.  (There are some agencies that perform the psychological screening, but most do not.)  It is the responsibility of the IVF center to perform the medical screening and the psychological screening (unless already performed by the agency). The timeline is extended if the egg donor or gestational carrier does not successfully pass the screening requirements.

  1. How are egg donors, gestational carriers and surrogates screened?

Reputable fertility practices follow the guidelines from the American Society of Reproductive Medicine (ASRM) with oversight from the (American) Food and Drug Administration (FDA).

The egg donation process starts when a young woman connects with a clinic that provides egg donation services. During the initial screening, the donor completes a thorough questionnaire cataloging her family history, personal medical history, and some of her personal achievements and lifestyle choices. It is likely that she will be asked the question why she would like to be an egg donor.

Once this initial screening is complete and the clinic or egg donor agency is comfortable with the answers about her medical, family, and social history, the potential egg donor is invited to the clinic. She is then screened for infectious diseases, genetic conditions, and gynecologic health. In addition, she completes psychological screening by a mental health professional to assess whether this is a good choice for the young woman and to rule out any mental health issues. When the medical, genetic, and mental health screenings are in order, the donor is considered part of the donor egg recipient pool. The donor is then available for matching with intended parents.  Intended fathers will choose an egg donor in part by characteristics such as ethnicity, education and physical attributes.

Gestational carriers and surrogates are women between the ages of 21 and 40 (or, depending on the clinic, 42) who have had healthy pregnancies without preterm labor, pregnancy-related diabetes or other complications of pregnancy, and who have delivered healthy children. Carriers must go through a process that reviews their physical and mental health; they are screened for gynecologic health related to their uterus and for infectious diseases. Psychological counseling is completed in order to make sure they understand the process and the implications of their decision. Prior to signing, a background check and a home study may be recommended or required.

The agency will also make sure that gestational carrier and surrogate candidates will deliver in a state deemed safe to deliver in; insurance issues will also be discussed.

  1. What are the costs of working with a gestational carrier or surrogate?

The costs of working with a gestational carrier or surrogate include many variables: (a) agency fees for finding and screening a gestational carrier or surrogate; (b) legal fees for creating the contract; (c) medical costs for the IVF treatment, which vary depending on the carrier’s or surrogate’s insurance; and (d) reimbursement of the gestational carrier or surrogate, typically $15,000-$30,000 depending on where she lives and her own expectations. The total fees for all these services range from $50,000 to $80,000.

At my practice, we assign a financial advisor to help clients determine what the medical costs will be.

Additionally, there are costs for the intended father(s) to travel to be with the gestational carrier for medical appointments and for the birth.

The costs associated with a gestational carrier therefore are her reimbursement, medical screening costs, costs of the agency to find and screen her, mental health screening and completion of contracts.

At my clinic, we have two fixed costs plans in regards to medical expenses that will be reviewed with intended fathers.

  1. Why should I use an agency rather than find a gestational carrier or surrogate on my own?

Many patients ask about looking for a gestational carrier or surrogate on their own in an effort to trim costs. I highly recommend utilizing an agency as they are specialized in finding suitable carriers and streamlining the rigorous screening process. Agencies vet their candidates with thorough initial screenings that weed out all but a fraction (about 10 percent) of the women who apply. Beyond this, agencies have experience finding a personality match with the intended parents.

  1. Should I try to find a gestational carrier or an egg donor first?

Intended parents can search for an egg donor and a gestational carrier simultaneously. Typically it takes less time to find an egg donor and create embryos. Embryos created prior to finding a gestational carrier can be cryopreserved through an advanced technology called vitrification. Once a gestational carrier is found, the best embryo(s) will then be thawed for the transfer into the carrier. If, however, the gestational carrier is found first, the intended father(s) may need to pay to keep her on hold while an egg donor is chosen and embryos are created.


Dr. Mark Leondires is board-certified in obstetrics and gynecology as well as reproductive endocrinology and infertility. For two consecutive years, Dr. Leondires has been selected through a peer-review process for "Best Doctors in America," which represents the top five percent of physicians across the country. He is also a Castle Connelly “Top Doctor” for his work in the field of reproductive endocrinology. Dr. Leondires married his husband in 2010; together they have two sons. The combination of his professional and personal experience with surrogacy makes him exceptionally qualified to help gay men become fathers through surrogacy.

Be a Part of Our Story

Join our continuously growing community of dads, families and industry experts. We’ll provide education, anecdotes and advice for wherever you might be in your journey to fatherhood. Sign up to our newsletter:

Sign up to our newsletter