Professionals involved in the US surrogacy process

US surrogacy journeys are typically supported and managed by paid professionals, including: 

Surrogacy and donor agencies – US surrogacy agencies find and screen surrogates, match them with the right intended parents and then support everyone through the surrogacy journey. There may be other agencies involved, for example if an agency from the intended parents’ home country is managing the overall process, or if the intended parents are using a separate donor agency.  

Fertility clinics – Fertility clinics conduct medical screening and then create embryos (either with the intended parents’ gametes or with donor eggs and/or sperm) which are transferred to the surrogate. Although the embryo transfer takes place at a US fertility clinic, some parents may have already created embryos in their home country which they wish to export to the US, in which case they will need to coordinate between clinics.  

Legal professionals – US attorneys separately represent the surrogate and the intended parents and help them put a gestational carrier agreement in place which complies with the relevant state law.  They then (either during the pregnancy or immediately post birth) manage the legal process required in the state of birth to enable the intended parents to be recorded on their child’s US birth certificate. If the parents are from outside the US and/or have other nationalities, they will also need advice on the law in the other countries with which they are connected, and may need to plan immigration issues as well.  

Insurance specialists – US health insurance is a complex area needing specialist expertise through an agency’s in-house insurance specialist and/or an independent insurance broker. Surrogates may have some form of existing health insurance which may or may not cover a surrogacy pregnancy, and top up policies are often required to ensure the surrogate’s antenatal care and the costs of delivery are covered. Intended parents from outside the US also need to consider newborn insurance options, assuming they do not have their own US healthcare insurance, to avoid exposure to significant medical costs if their child is born prematurely or with significant medical issues. Getting early advice is important as the insurance landscape often changes and some policies need to be secured before a certain stage of the process.   

Escrow agents – The finances of most US surrogacy arrangements are managed through an independent escrow account, which safeguards funds for the surrogate once a pregnancy is established as well as other costs which will be incurred.  The escrow account will be managed by either an independent escrow agent, or the agency/attorney.   

Other professionals – Some parents also seek additional support with other aspects of the process, for example employing an agency to expedite their child’s US passport application after the birth, or engaging a nanny to help with childcare in the initial weeks after the birth. 

How to choose the right US surrogacy professionals

The challenge with US surrogacy is knowing which, of the hundreds of US surrogacy professionals promoting services, can provide the right service. Research and recommendations are valuable as starting points, but everyone’s personal circumstances are different and the US surrogacy market is constantly moving, with new agencies coming into play and others evolving their practices. Cross-border surrogacy arrangements also involve very particular challenges (from legal planning to managing time differences), so intended parents who live in the UK or are British living overseas should be confident about the experience a professional has of working with international intended parents.  

Whether parents should start by choosing their agency, fertility clinic or lawyer depends on their personal needs. Some parents need to seek the best possible specialist medical expertise according to their medical and fertility history (for example if they are HIV+ or have a complex fertility history). Others are primarily concerned with which agency can match them with a surrogate within a reasonable time and budget. Others in more complex legal situations may want to start by seeking advice from an attorney to identify the viable states in which they should look for a surrogate match.  

Location is another factor, with some intended parents having personal connections or second homes in a particular state which makes a stay for the birth feel more comfortable.  However,  where an agency or fertility clinic is based does not necessarily dictate where the surrogate will be based since many recruit surrogates nationally.  Understanding the geographic reach, as well as the location, of the agency is important. 

Professionals also have different styles which will suit some intended parents more than others. British intended parents find some US agencies uncomfotably commercial in their tone and approach, while others like a direct and efficient style of communication. Many are looking for an agency which will safeguard the welfare of their surrogate, and offer support beyond a transactional match. In terms of clinicians, some parents prefer clear directive advice about medical options, while others prefer a more holistic approach in which a full range of options is presented so they can be more involved in the decision about how to proceed.  

With reputable organisations, a US surrogacy journey should be smooth, with issues pre-empted and discussed in advance as far as possible.  Gathering the right professional team for US surrogacy is like assembling a jigsaw, ensuring that each piece is the right one and that they fit together properly. It is a very personal decision, with no ‘one size fits all’ but with signifcant choices to be made among the many professionals whose experience promises assurance and reliability.