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How Does A Surrogate Pregnancy Work?

One of the best ways to describe a surrogate pregnancy is it's like a long-term babysitting agreement. A surrogate loves and cares for the baby, but ultimately she (and everyone around her) knows it isn’t her baby. 


Modern surrogacy has been developed with strong boundaries in mind.  


Your pregnancy will be different from someone else’s, but any experienced surrogate will tell you that it’s basked in a unique kind of pregnancy glow that you won’t get enough of! Below we’re breaking down the who, what, and how a surrogate pregnancy usually unfolds. 

Who Is A Part Of Surrogacy?

Dog kissing expecting mother's belly

You, the surrogate

Us, your faithful community of support

Your surrogacy agency

Your intended parents

The medical professionals

There are 5 people associated with surrogacy:

Everyone has a role in the surrogacy journey, and each depends on one another to cross the milestones that lead to the successful delivery of a healthy baby. 

How Does A Surrogate Mother Get Pregnant?

You can dive into a step-by-step guide on surrogacy here, but here are quick deets: 

You go to the intended parents' IVF clinic for a full screening to be medically approved

You begin IVF medications to ready your body for pregnancy

An IVF clinic readies an embryo (created with the biology of the intended parents or donors)

Once you get the medical green light, you will travel to the intended parents' IVF clinic for embryo transfer day — don’t forget your lucky socks!

Does A Surrogate Mother Share DNA With The Baby?

In the simplest terms, gestational surrogates do not share biological ties to the baby they are carrying. The embryo is created with the intended parents’ (or donor’s) biology. This is the type of surrogacy that you are reading about on our website and the only type of surrogacy we do. (In traditional surrogacy, the surrogate shares DNA with the baby, but that is rarely practiced these days).


While surrogacy laws vary state by state, gestational surrogacy is the go-to standard for modern surrogacy. 

While the physical pregnancy itself will feel relatively the same as with your keepers, how you get pregnant and the emotions surrounding a surrogate pregnancy are different.

Is a Surrogate Pregnancy Different From Personal Pregnancy?

Three adults chatting at a table with coffee and juice
Woman in doctor's office talking to a medical professional

Getting Pregnant

You will take IVF medications to ready your body for the pregnancy. These start prior to the embryo transfer (to get your uterus ready) and continue after the transfer until about week 10 or 12 to ensure that the little embryo is going to stick.

Emotional Differences

Emotionally, your surrogate pregnancy is a whole different ball game. There are the excited emotions over what you’re doing; there are nervous emotions that you want everything to stay positive and work out; and the compassionate emotions as you deepen your relationship with your intended parents and become even more invested in who you are helping. Then, add in almost every other emotion you can think of!

Knowing you have so much support from your agency and us – and the family and friends you’ve built up around you – we know you can handle whatever comes your way.

What Is IVFHow Does It Work For Surrogacy?

IVF (in vitro fertilization) is a multi-step process some people use to grow their families. IVF is part of a surrogacy journey because the surrogate will need to use medications to prepare her body for a pregnancy. Intended parents will work with their clinic to create embryos that will eventually be transferred into their surrogate’s uterus. In some ways, it’s like the intended parents and their clinic reach a milestone and then pass along the baton to you!


As the person who will be carrying the baby, you would focus your IVF journey on prepping your body to get pregnant and carry out a healthy pregnancy.

How Do Surrogates Go About IVF, and What Do I Need To Know?

Doctor showing her patient a paper on a clipboard

On embryo transfer day, the chosen embryo is transferred into your uterus with the hopes that you will get pregnant

An IVF clinic will monitor your IVF journey to determine when you are ready for a transfer

You will need to take shots and medications that help get your body pregnancy-ready

The short of it is this:

Each step has its own medications and requirements. But don’t worry; we’ve got you covered.

Here’s a breakdown of IVF medications. 

What IVF Medications Do I Need To Take During Surrogacy?

Surrogacy medications are hormonal medications that sync your menstrual cycle to the expected embryo transfer timeline. The medications work to up your chances of an embryo sticking and you becoming pregnant because we all want to see those two pink lines! After the embryo transfer, you’ll still continue some medications too until the clinic determines you can stop. 


A surrogate’s medications and protocol may vary by doctor or clinic, but here are the most common medications a surrogate will typically need to take:

How Long Does An Embryo Transfer Take?

An embryo transfer is one of your big surrogacy milestones! While the actual embryo transfer is a short procedure where the doctor transfers the embryo directly into your uterus, you’ll spend a few days relaxing to recoup after the transfer.

A: IVF can have short-term side effects like bloating, discomfort, or bruising in the areas where you have the shots. Our surrogate community has all sorts of tips and tricks to help get you through the IVF portion of the journey – everything from applying hot and cold patches to using baby oil to remove patch sticky residue.


IVF can indeed feel a bit intimidating, but the important thing to remember is that even the most robust process is still made up of the smallest of steps. Experienced surrogates can share tips and tricks with you about organizing your medications, setting alarms on your phone as reminders, and providing laughs about the craziest place they’ve ever given themselves a shot (can you say airplane bathroom??). When it comes to the IVF process for surrogacy, those steps involve a checklist of IVF medications you can learn more about as you need them.

Will There Be Side Effects From IVF Medications?

Doctor talking to female patient in doctor's office

Birth Control Pills

While birth control pills may seem counterintuitive to getting pregnant, they are used during surrogacy to help get your cycle on a specific schedule.


Lupron is a shot that ensures that your cycle doesn’t start at the wrong time by suppressing your ovaries so you do not ovulate while cycling on fertility medications.


Estrogen is prescribed during the IVF cycle to help your uterine lining reach its ideal thickness ahead of implantation. This may be in the form of a pill, patch or injection.


Each hormone you take is used to promote the best environment for a successful pregnancy, and taking progesterone is no different. Progesterone will ready your body to think it's pregnant before the transfer, so it (fingers crossed!) accepts the embryo. You start this med before the transfer and usually will continue until 8-10 weeks of pregnancy. This is usually in the form of an injection.

Sticky note that says "The medications prepare your body to help an embryo stick and you become pregnant because what we all want to see are those two pink lines!"

Your Emotional Well-Being As A Surrogate

Being a surrogate will bring on all the feels: excitement about helping intended parents, nerves about the medications and process, and worry if you'll be able to juggle a surrogacy with your day-to-day life.


But here's the thing, you're never alone! Our team of experienced surrogates will be by your side, as well as other surrogates you meet along your journey. We'll share the good, the unknown and the hard, openly and honestly. We want you to go into this journey fully prepared for all that's ahead.


Don’t take our word for it. Mandi, an experienced surrogate, had this to share:

Pregnant woman sitting on the couch listening to music

One of the ways we make sure that you’re able to balance it all is by making sure you’re prioritizing your emotional well-being just as much as your physical health. Good news: we’re here to help you with that!

Since the day you officially become a surrogate (which is way before the day you become pregnant), your main goal should be to cultivate a support system that will walk this path with you. They can’t take away the emotionally difficult parts or do any of the hard work for you, but they can help make sure you 

“When I thought about becoming a surrogate, I envisioned the end, and watching my intended parents come together to hold their baby. I wanted to be a surrogate for someone else, for that dream to come true for them…Feeling him in my tummy, I felt like a protector. So during the pregnancy I didn’t get attached because I had built a relationship with my intended parents, and I was doing this for them.”

Your emotional wellbeing is important, and we want to be sure you’re prioritizing yourself throughout the journey.

never feel alone.
  • It’s easy to forget that being a surrogate involves pregnancy's hormonal roller coaster, like happiness that comes out of nowhere or crying at Hallmark movies. Think back to your last pregnancy; what did you do to help balance those hormones? A walk to relax? Calming music? Coloring with the kiddos? Bake those habits into your surrogate pregnancy routine!

  • It’s normal to have questions and concerns about how attached to the baby you’re supposed to feel. Once pregnant and throughout your pregnancy, we’re here with your agency to guide you through those big feelings.

  • One of your saving graces during your surrogacy that will help ensure your emotional wellbeing is your relationship with your intended parents. Like Mandi mentioned above, getting to know them will help remind you who you are carrying the baby for, which will help you set the right boundaries for you and baby!

  • On any day in your surrogacy journey, you are still you! Just because you’re a surrogate doesn’t mean you stop being a mom, partner, boss, etc! All of the other parts of your life that are not pregnancy or surrogacy related, can help ground you so that your emotional wellbeing is taken care of and your connection to baby isn’t muddled.

  • While some aspects of life are unavoidable and unpredictable — moving homes or changing a job, for instance — you can build a support system that won’t waver no matter what life throws your way! (Count us as proud members of Team You!) That same support system can help keep you in check during your surrogacy journey and remind you why and for who you are doing this for!

  • The next time you’re prepping for a milestone trip, and life is a little hectic at home, focus on why you’re taking the trip in the first place and how this trip will fill your cup. Not only will you be helping grow a family, but hey, you’ll also get to sleep in a hotel and experience a new city!

7 Facts About Surrogacy Health Insurance

If you’re wondering about surrogate health insurance and how it works, you’re not alone! Navigating who pays for surrogacy insurance doesn’t have to be as confusing as building a bookcase from IKEA. We’re here to explain insurance in a way that’s easy to understand:

Here are seven things to know about surrogacy insurance as you learn about surrogacy. 

Health insurance is tricky, even if you’re not considering becoming a surrogate. We’re here to answer your questions about insurance to help you make informed decisions about your future. When you’re matched with an agency, part of their job is handling all of the particulars around medical expenses, insurance, and other financial and journey details. So you can focus on a healthy pregnancy and getting to know your intended parents.

How to make the process as easy as possible for you and your intended parents

When to expect a medical plan to be in place

How surrogate insurance works

Mom working on her laptop next to a toddler wearing glasses
  • The most important fact is that surrogacy should not cost you a dime. Your intended parents will pay for everything associated with your surrogacy.

  • We’ll dive into what happens if you have health insurance below, but for now, know that your intended parents will guarantee an insurance policy is in place to cover whatever medical costs you incur during your surrogacy.

  • When applying to become a surrogate, you can share if you have personal health insurance. Your health plan will be reviewed to determine if your insurance covers a surrogacy pregnancy. If your insurance plan cannot be used, the agency will work with your intended parents to put an insurance policy in place to cover you and the baby during pregnancy.

  • No health insurance? No need to worry. Your surrogacy agency and intended parents will ensure a surrogacy health insurance policy is put in place before you become pregnant. The insurance will cover all surrogacy-related medical expenses, so you’ll be covered and cared for.

  • Most insurances, even those established by an agency or intended parents, won’t cover IVF cycles. In this case, intended parents are tasked with covering all expenses. Again, these details will get worked out with your intended parents and your agency, so you don’t have to give this a second thought!

  • The minute the baby is born, the baby becomes the intended parents’ financial and medical responsibility. It is the intended parents’ job to ensure their baby has health insurance when they are born.

  • During pregnancy, you should focus on your physical and mental health and baby’s growth. Your agency advocates zero in on making this the best experience for you, including communicating with intended parents about money and you don't have to.

  • While things may arise during your surrogacy, many financial guardrails will be baked into your contract. The surrogacy contract is pulled together before any medical steps are taken. You can learn more about what goes into that surrogacy agreement here.

Sticky note that says, "As a surrogate, you should never be responsible for medical bills or health insurance coverage for your surrogacy."
Two smiling women taking a selfie while holding up an ultrasound photo

What Are The Risks Of Surrogacy?

The gap in surrogacy’s “Instagram vs Reality” isn’t that wide. Surrogacy is as beautiful, fulfilling, and meaningful as it looks from the outside. Just ask any of the thousands of women who are a part of the surrogacy sisterhood! 


It’s natural, however, to consider the risks of surrogacy if you’re considering this as your path. Below we’ll dish out some of the risks associated with surrogacy (most of which are the same risks that popped up during your past pregnancies) and walk through how we, as a surrogacy team, are here to support you. 


For starters, when we get on the phone, don’t be afraid to ask incredibly specific questions about surrogacy's hard and real parts during our surrogacy interviews. We’ve been through it, and we’ll give you the real answers you’re looking for, no sugar coating.

Surrogacy And Pregnancy Share The Same Risks

Toddler using a stethoscope on his expecting mother's belly

While not all pregnancy experiences are surrogacy experiences, all surrogacy experiences include pregnancy. And you’re already a pro at being pregnant, so you know that pregnancy risks can include everything from persistent morning sickness to preeclampsia.

While you can control some aspects of surrogacy, how long it takes to arrive at a viable pregnancy is not one of them. It may take more than one transfer for you to become pregnant…and that is completely normal. We like to tell women to plan for up to 24 months for a full surrogate pregnancy, including all appointments, etc. Sometimes, the process can take some time.

Surrogacy May Take More Time Than You First Planned For

Surrogacy depends on the IVF process (in vitro fertilization) for a surrogate to become pregnant. Surrogates must take prescribed hormones in the weeks leading up to and after embryo transfer day. Those extra good hormones that help get your body ready for the embryo and help a pregnancy stick can also cause side effects like bloating, nausea, cramping, bruising, or pain and tenderness. (Nothing you can’t handle, though!) Plus, the good (and hard) part is that not everyone responds to the hormones similarly, so you won’t know how your body will react until you’re doing it! 

IVF Has Side Effects That Vary In Intensity

In some cases, surrogates will agree to carry twins, or (in rare cases) a single embryo transfer can split into a twin pregnancy. If it’s a twin pregnancy, it’s double the love and a little more to consider to keep yourself and babies healthy. With a multiples pregnancy, a surrogate can have a higher risk of developing preeclampsia, giving birth prematurely, or having gestational diabetes, for instance. All real, new realities that a dedicated care team will be there to

The Possibility Of A Twin Pregnancy

Main takeaway? No matter the side effects or risks, you are strong and determined and can face whatever comes your way; after all, you’re a surrogate. Plus, your cheerleaders will be behind you every step of the way (that’s us, btw).

support you through each step of the way! 
Sticky note that says "Surrogacy is as beautiful, fulfilling, and meaningful as it looks from the outside. Just ask any of the thousands of women who are a part of the surrogacy sisterhood!"

The Emotional & Physical Realities Of Surrogacy

Mom and son reading picture book


Sticky note that says "We'll give you the low-down on all the medical stuff - shots, anyone?"

Blog Posts

LGBTQ Surrogacy: How Surrogates Make Dreams Come True

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Being a Surrogate If You’re Single

You don't need to be in a relationship to become a surrogate, but you DO need a strong support system! Learn more about being a single surrogate in our blog post.

9 Reasons Becoming a Surrogate Is So Rewarding

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How Do Surrogacy Requirements Protect You?

Surrogacy requirements serve a vital function: they protect you, the baby, and your intended parents. Learn about some of the basic requirements for surrogacy and how they can keep you safe during your surrogacy experience.

Why Is BMI Important When Becoming a Surrogate?

How does body mass index (BMI) affect fertility and pregnancy outcomes, and why does it matter for surrogates? breaks down what you need to know about this often misunderstood metric and why it's so important.

5 Things To Do Before Becoming a Surrogate

Surrogacy is life-changing—not just for you and the parents you are helping but for your family and loved ones. Before you start your journey, do these 5 things to make sure you are mentally and physically ready for this amazing experience.

What Are the Requirements for Becoming a Surrogate?

The path to becoming a surrogate begins with meeting the medical, legal, and social/lifestyle requirements. Learn what those requirements are and why they're in place. 

Who Are The Intended Parents That Surrogates Help?

Throughout the surrogacy process, we talk a lot about the surrogate (you!) and baby, but the other essential party involved in this journey are the intended parents.

What Happens During A Surrogate Pregnancy?

One of the best ways to describe surrogacy pregnancy is like a long-term babysitting agreement. A surrogate loves and cares for the baby, but ultimately she (and everyone around her) knows it isn’t her baby.

What Happens After A Surrogate Gives Birth?

No one’s surrogacy fourth trimester is the same, but the one common thread we’ve always heard from past surrogates is just how fulfilled they feel as they reflect upon the past few months of their life!

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