How a US surrogacy journey works step by step (process and timescales)

Although every US surrogacy journey is unique, it will realistically take at least 18 to 36 months from start of a US surrogacy journey to bringing a baby home. 

Stage 1: Identifying the professionals to engage (1 month+)

Initial research to identify the professionals who will help with a US surrogacy journey requires care.  There will be discussions via introductory calls and then a process to formally engage the professionals chosen which can take a month or so (plus whatever time is required to consider and compare the options thoroughly). 

Stage 2: Embryo creation and surrogate match (2-18 months)

Once an agency has been identified, intended parents will either work with a case manager to create a profile and talk about the kind of surrogate they are looking for, or intended parents may have access to surrogate profiles to browse for themselves. From there, there will typically be a waiting period before being matched with a surrogate. Match times vary, not just according to the particular agency, but also the wider landscape, with global events over the past few years affecting wait times considerably. 

While waiting, intended parents will need to create or move their embryos so they are ready to proceed with treatment once they are matched.  This process can take some time, and depends on the parents’ individual circumstances. 

Stage 3: Surrogate match and medical and legal clearance (3-6 months)

Once a possible surrogate is identified who fits the intended parents’ key criteria, a case manager from the US agency will usually arrange a facilitated match call.  If everyone agrees to move forward, the surrogate will be referred to the intended parents’ fertility clinic for medical screening.  Following medical clearance, a gestational carrier agreement will be drafted by US attorneys, reviewed and possibly amended before being signed by everyone, and the clinic will then be given legal clearance.   

Stage 4: Clinical treatment to pregnancy (1-6 months)

Once a surrogate has cleared medical screening and the clinic has had legal clearance, the surrogate will begin medication to prepare her uterus for embryo transfer. She will undergo scans over a number of weeks at the fertility clinic (or a facility closer to her) to identify the optimum time for transfer. Embryo transfer is an important milestone which many parents attend virtually or even in person.   

After the embryo transfer, the surrogate will usually have a blood test one week later to assess her hormone levels, and then another blood test a week later to see if she is pregnant. This is usually followed by an early pregnancy scan at the intended parents’ fertility clinic to confirm that the embryo is developing as expected. If the treatment is not successful, there may be a wait for her next natural menstrual cycle before trying again. Although success rates in the US are excellent, it is always sensible to plan for several attempts at embryo transfer before achieving a pregnancy. 

Stage 5: Pregnancy to birth (7-10 months)

Pregnancy is of course, normally nine months, although some babies arrive late and some early. During the first trimester the surrogate will attend OB GYN appointments at a medical facility local to her, and various prenatal screenings may be carried out. During the second trimester, the US attorney will typically start preparing the court or other legal documents which will enable the intended parents to be recognised as the legal parents from birth.   

Many intended parents attend the 20 week foetal anatomy scan which is another key milestone in the journey and the opportunity for intended parents to meet their surrogate in person if they have not done so already. 

The third trimester is the time when intended parents need to start planning in earnest for the birth, including sorting travel and accommodation, and making plans for returning home and dealing with passports and any other legal issues.  Most intended parents from overseas travel to the US at least a couple of weeks before their baby’s due date. 

Stage 6: Birth to home (3-8 weeks)

Parents are responsible for their child immediately after the birth and, if the baby is well, he or she will normally be discharged from hospital 24-48 hours later.  The logistics of parents attending the birth of their child will be discussed as part of the birth planning stage to ensure that everyone is in the room at the right time. There will then be some administration to deal with in relation to hospital bills (which should be covered by insurance taken out during the pregnancy) and obtaining the child’s US birth certificate and passport which can take a few weeks, after which the parents will take their baby home to the UK or wherever they are living. 

Stage 7: UK legal process (6-12 months)

For UK-based and British parents living overseas, there is a final stage to the process which is to apply for a UK parental order to secure their parentage for the purposes of UK law.  The court application typically takes 5-12 months, after which the child will be issued with a UK birth certificate. Find out more about parental orders from our sibling organisation NGA Law.

If the parents live in another country or have other nationalities, there may be other legal processes they need to follow to secure their family’s status in those countries too.