Surrogate Mothers: What It Is And How Does Surrogacy Work

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Written by Rebecca Buffum Taylor, Nichole OwensMedically Reviewed by Raja Durai Sam Nishanth, MBBS, MD on January 02, 2026

• What Is a Surrogate Mother?
• Who Uses Surrogates?
• How Do You Find a Surrogate?
• How to Choose a Surrogate
• What to Expect in the Surrogacy Process
• What is the Average Cost of Surrogacy?
• What Legal Issues Should You Consider With Surrogacy?
• Takeaways
• Surrogate Mother FAQs

6 min read

If you want to have a child but can’t have one biologically, you may consider using a surrogate. But what does that mean, and how does it work? Keep reading to learn what’s involved and whether it might be an option for you to explore more.

What Is a Surrogate Mother?

A surrogate mother carries and delivers a baby for a person or couple (intended parent/parents) who wish to have children but can’t. Sometimes, a surrogacy arrangement can be nonpaid. This is called an altruistic arrangement. Often, surrogacy arrangements are done with a contract and a fee. These are called commercial arrangements.

Whether paid or nonpaid, there are two kinds of surrogates:

Traditional surrogates

A traditional surrogate provides the egg that gets artificially inseminated with the intended male parent’s sperm. She is the baby’s biological mother because she shares DNA with the baby. The surrogate carries and delivers the baby before giving it to the intended parents. For various legal reasons, traditional surrogacy is less common or recommended than the second option, gestational surrogacy.

Gestational surrogates

This is the most common type of surrogacy. A gestational surrogate doesn't share DNA with the baby because she doesn't provide the egg to be fertilized. She is called the baby’s birth mother because she carries and gives birth to a baby for another person or couple. The intended parent — or an egg donor — provides the egg. The biological mother is the woman whose egg was fertilized.

Most often, pregnancies carried by gestational surrogates happen as a result of in vitro fertilization (IVF). This is a three-step process:

1. Doctors gather eggs from the mother (or an egg donor).
2. The harvested eggs are fertilized with sperm from the father (or a sperm donor).
3. Doctors place the embryo(s) into the uterus of a gestational surrogate. 

In the U.S., gestational surrogacy is less complex legally than traditional surrogacy. That's because one of the intended parents may be genetically linked to the baby.

Who Uses Surrogates?

If you want to be a parent, you might consider surrogacy for several reasons.

If you're a woman, these reasons may include medical problems, trouble adopting because of age or marital status, or previous IVF attempts that weren't successful.

Single men, same-sex male couples, or transgender persons or couples may also consider using a surrogate.

What medical reasons lead women to consider surrogacy?

You might think about surrogacy if you have any of the following medical issues:

• A uterus that was removed due to hysterectomy or other surgery
• Structural abnormalities of the uterus
• Large/multiple fibroids
• Scarring of the uterine cavity
• Conditions that make pregnancy impossible or risky, such as severe heart disease or kidney disease
• Recurrent miscarriages

 

 

 

How Do You Find a Surrogate?

If you decide to choose the path of surrogacy, there are a couple of different ways you can go about finding a surrogate mother:

Friends or family

Sometimes, you can ask a friend or relative to be a surrogate for you. It's somewhat controversial. But because of the high cost of surrogacy and the complex legal issues it raises about parental rights, a tried-and-tested family relationship can be simpler to manage.

The American Society for Reproductive Medicine accepts certain family ties as acceptable for surrogates. But it generally discourages surrogacy if the child would carry the same genes as a child born from incest between close relatives.

A surrogacy agency

Most people work through an agency that acts as a go-between. The agency helps you find a surrogate and make arrangements. It also collects fees, including payments for the surrogate’s medical expenses.

How to Choose a Surrogate

Whether you choose a friend or family member or work with an agency to find a surrogate, experts agree that your choice should meet these basic criteria.

You should choose a surrogate who:

• Is in good health
• Is between 21 and 45 years of age
• Has already given birth to at least one healthy baby so they understand the medical risks of pregnancy and childbirth and the emotional issues of bonding with a newborn
• Has had no more than five full-term, complication-free births
• Has had no more than three C-sections
• Have passed a psychological screening by a mental health professional to uncover any issues with giving up the baby after birth
• Signs a contract about their role and responsibilities in the pregnancy, such as prenatal care, and agreeing to give you the baby after birth

What to Expect in the Surrogacy Process

The American Society for Reproductive Medicine says both the surrogate and intended parents should have full medical and psychological exams to rule out major physical and mental health conditions. The organization suggests they get tests that check for infectious diseases such as syphilis, gonorrhea, chlamydia, HIV, cytomegalovirus, and hepatitis B and C.

Surrogates should get tests to make sure they have immunity to measles, rubella (German measles), and chickenpox. You may also want to ask surrogates to get a medical procedure to visually "map" the uterus, which can help the doctor check their potential to carry a pregnancy. Surrogate mothers should have their own doctor during pregnancy rather than use yours.

What is the Average Cost of Surrogacy?

The cost can vary widely and can depend on a number of factors, such as whether the surrogates have their own medical insurance or whether you need to buy a surrogacy-pregnancy policy for them. According to some estimates, costs can range between $150,000 to $200,000.

What Legal Issues Should You Consider With Surrogacy?

Parental rights aren't guaranteed after a surrogate pregnancy. The law continues to change as reproductive technology evolves and the very definition of a "parent" changes.

There isn't a federal law on surrogacy, and state laws vary. After a surrogate pregnancy in some states, you may still have to pass adoption proceedings to gain legal custody of the child. In other states, a "declaration of parentage" before birth lets you avoid having to adopt the baby.

To protect your rights as parents-to-be — and the rights of your future child — hire an attorney who specializes in reproductive law in your state. They can write a surrogacy contract that clearly spells out what everyone needs to do.

A contract like that may help if legal issues come up after birth. It can also outline agreements about a variety of possible scenarios, such as what happens if there are twins or triplets. Decisions should be made, agreed upon, and spelled out as to the type of relationship between the surrogate, intended parents, and child. Relationships may be open, restricted, structured, or enmeshed — all with a variety of boundaries and interactions.

Takeaways

If you want to have children but can't, you may consider using a surrogate mother. There are two types of surrogates: A traditional surrogate provides the egg that is fertilized by the father's (or donor's) sperm, whereas a gestational surrogate carries an egg fertilized by the father's (or donor's) sperm. You can choose a friend or relative as a surrogate or find one through an agency. Once you choose a surrogate, they'll have to undergo a medical and psychological exam and sign a contract to address any legal issues that might arise after the baby is born.

Surrogate Mother FAQs

Do surrogate mothers breastfeed the baby when it's born?

In a traditional surrogacy (a woman provides the egg and gives birth), a surrogate can breastfeed, as her hormones naturally trigger the lactation process. In a gestational surrogacy, where the egg is fertilized in a lab (IVF), it's possible. You may have to take hormones or work with a lactation consultant weeks or months before the birth to encourage milk production. But while a surrogate mother can breastfeed, many surrogacy contracts discourage or prohibit it because of the emotional consequences for the surrogate and newborn.

What is the age limit for a surrogate mother?

The American Society for Reproductive Medicine says the ideal gestational surrogate is between the ages of 21 and 45.

Does a surrogate mother share blood with the baby?

In a gestational surrogacy, the surrogate mother has no genetic link to the baby. The baby's entire genetic makeup — including its blood and umbilical cord — comes only from the egg and sperm that fertilize it. Oxygen and nutrients pass from the surrogate's blood across the placenta to the fetus. Waste products from the fetus are passed into the surrogate's blood. But the surrogate mother's blood does not flow directly into the fetus.

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