Surrogate Preparation Made Simple: What to Expect & How to Prepare

Picture standing at the edge of a decision that will forever change a family’s world. You’re not just considering a commitment—you’re contemplating becoming the bridge between longing and love, between waiting and welcoming. For many women, the journey to becoming a surrogate begins with a simple question: “Could I do this?” followed quickly by “What does it actually take?”

The path to surrogacy isn’t shrouded in mystery, though it might feel that way at first. Prospective surrogates often wonder about the medical procedures, the time commitment, and the emotional aspects they’ll navigate. Meanwhile, intended parents—whether facing infertility, LGBTQ+ couples, or single parents by choice—seek confidence that their surrogate will be thoroughly prepared for the road ahead.

Here’s what makes surrogacy preparation less daunting than you might think: it’s a structured, well-supported process with clear milestones. From your initial application through medical screening, legal agreements, and finally pregnancy and birth, each phase builds on the last.

At Pathways to Parenthood, we guide surrogates through every step, so you’re never alone in the process. When you understand what’s coming, you can prepare your body, your schedule, and your heart for one of the most meaningful experiences of your life.

This guide walks you through the complete preparation process—the screenings you’ll undergo, the lifestyle adjustments you’ll make, the relationships you’ll build, and the profound rewards waiting at the end. Whether you’re just starting to explore surrogacy or you’re ready to take the next step, you’ll find practical answers to help you move forward with confidence.

Key Takeaways

• Surrogate preparation typically takes 18-24 months from application to birth, with thorough screening in the first 4-8 weeks covering medical history, psychological evaluation, and physical health assessments.
• You’ll need to meet specific requirements: age 21-40, at least one previous successful pregnancy, healthy BMI, stable lifestyle, and strong emotional support system.
• Medical preparation for embryo transfer involves 15-18 days of hormone medications to optimize your uterine lining, followed by monitoring appointments and the transfer procedure itself.
• Legal contracts are finalized before any medical procedures begin, with independent attorneys representing both surrogate and intended parents to protect everyone’s rights and clarify compensation.
• Comprehensive support throughout your experience—including medical coordination, psychological counseling, and relationship guidance—helps you prepare for each phase.
• The surrogate-intended parent relationship is collaborative and supportive, with opportunities to create lasting bonds through shared milestones and open communication.
• Proper preparation leads to confidence, better outcomes, and the profound satisfaction of giving the gift of parenthood to a family who cannot achieve it alone.

Understanding Surrogate Requirements: Are You Ready?

Becoming a surrogate represents a significant commitment, and agencies establish specific requirements not to create barriers, but to protect your health and provide the best possible outcomes for everyone involved. Understanding these qualifications helps you assess whether you’re ready for this experience.

Age matters in surrogacy for important medical reasons. Most programs require surrogates to be between 21 and 40 years old, ensuring surrogate eligibility criteria are met. This range reflects optimal reproductive health and pregnancy outcomes. Women in their twenties and thirties typically experience fewer pregnancy complications and respond better to fertility medications. At 21, you’ve had time to establish your own family and make an informed decision about carrying for someone else. The upper age limit of 40 reflects medical data showing that pregnancy risks increase beyond this point.

Previous pregnancy experience stands as one of the most critical requirements. You must have successfully carried and delivered at least one child without significant complications, demonstrating successful pregnancy history. This requirement serves multiple purposes beyond proving your fertility:

• It demonstrates your body’s ability to handle pregnancy
• It gives you realistic expectations about what you’re committing to
• It confirms you enjoy pregnancy enough to be pregnant again

Women who have experienced pregnancy understand the physical demands, emotional changes, and daily realities of carrying a child. You can’t truly consent to something you’ve never experienced.

Physical and Lifestyle Requirements

Physical health criteria extend beyond basic wellness. Your body mass index (BMI) typically needs to fall within a specific range—usually between 19 and 32, though some programs have stricter limits for surrogate health requirements. This isn’t about appearance; it’s about medical safety. Women outside this range face higher risks for pregnancy complications like gestational diabetes, preeclampsia, and difficulties during delivery.

Your overall health matters too. You’ll need to be free from chronic conditions that could complicate pregnancy or require medications that might affect a developing baby.

Lifestyle factors play a substantial role in surrogate eligibility:

• You must be a non-smoker, as smoking dramatically increases pregnancy risks
• Alcohol consumption needs to be minimal or absent
• Your living situation should be stable—meaning you have secure housing
• You shouldn’t be experiencing major life upheavals like divorce, recent deaths in the family, or financial crisis

These requirements protect your ability to focus on a healthy pregnancy without overwhelming stress.

Emotional readiness proves just as important as physical health when considering the surrogacy process. You need psychological stability and a strong support system. That means no untreated mental health conditions, no history of severe postpartum depression, and access to family or friends who will support you through this experience. If you have a partner or spouse, their support is necessary. They’ll be affected by your commitment too—from fertility medications that may cause mood swings to the physical limitations of late pregnancy.

Legal and Financial Considerations

Legal considerations include U.S. citizenship or legal permanent residency, as international surrogacy laws create complications. You’ll need to pass background checks to maintain child safety. Financial stability requirements might seem counterintuitive since surrogacy provides compensation, but they exist to confirm you’re choosing surrogacy for the right reasons rather than out of desperation.

The commitment timeline deserves serious consideration. From application to holding the baby at delivery, you’re looking at 18-24 months minimum. This includes:

• Several months of screening and matching
• Weeks of medical preparation
• Nine months of pregnancy
• Recovery time afterward

During this period, you’ll attend numerous medical appointments, take daily medications, follow pregnancy restrictions, and maintain regular communication with intended parents. You need flexibility in your schedule and understanding employers if you work outside the home.

These requirements exist to protect you, the baby you’ll carry, and the intended parents who are placing their trust in you. Meeting these qualifications doesn’t just make you eligible—it positions you for a positive, healthy surrogacy experience.

The Surrogate Application and Screening Process

Once you’ve decided to pursue surrogacy, the screening process becomes your gateway to this experience. This comprehensive evaluation typically takes 4-8 weeks and examines every aspect of your readiness to carry a pregnancy for another family through surrogate screening requirements. Rather than viewing screening as an obstacle, think of it as a protective framework for everyone’s best interests.

The process begins with your initial application, which gathers detailed information about your background. You’ll provide your pregnancy history, including any complications or special circumstances from previous deliveries. The application asks about your current health status, medications, lifestyle habits, and family medical history. You’ll also answer questions about your motivations for becoming a surrogate and your preferences for intended parents.

Medical History and Evaluation

Medical history review comes next. The agency and fertility clinic will request records from your previous pregnancies and deliveries, often going back to your OB-GYN or the hospitals where you gave birth. They’re looking for documentation of healthy, full-term pregnancies without significant complications.

If you had a C-section, the number of previous cesarean deliveries matters because most doctors limit how many a woman should undergo. If you had gestational diabetes that resolved after pregnancy or mild preeclampsia that was successfully managed, these won’t necessarily disqualify you, but they require thorough evaluation.

Psychological evaluation serves as a cornerstone of the screening process. A licensed mental health professional specializing in reproductive psychology will meet with you, typically for 1-2 hours, as part of psychological evaluation for surrogates. This isn’t an interrogation—it’s a thoughtful conversation about your emotional readiness.

The psychologist assesses:

• Your understanding of what surrogacy entails
• Your motivations for choosing this path
• Your support system
• How you cope with stress
• Your history of mental health treatment
• Your ability to maintain appropriate boundaries while building a relationship with intended parents

If you’re married or in a committed relationship, your partner will usually participate in part of this evaluation since their support is necessary to your success.

Background Checks and Medical Screening

Background checks and home assessments protect the baby you’ll carry. You’ll undergo criminal background screening and child abuse registry checks. A social worker may visit your home to confirm it’s a safe, stable environment. This visit isn’t about judging your housekeeping or décor—they’re confirming you have adequate housing, a supportive family environment, and the stability needed for the road ahead.

Medical screening with fertility specialists represents the most intensive phase of evaluation. You’ll meet with a reproductive endocrinologist who will perform a complete physical examination focused on reproductive health during medical screening.

Blood work tests:

• Your hormone levels
• Blood type
• Screens for infectious diseases including HIV, hepatitis B and C, syphilis, and other sexually transmitted infections

These tests protect both you and the baby, and they’re repeated throughout the process to maintain ongoing health.

Your uterus undergoes thorough evaluation through transvaginal ultrasound. The doctor examines your uterine cavity for fibroids, polyps, or structural abnormalities that could interfere with embryo implantation or pregnancy. They measure your ovarian reserve and assess your overall reproductive anatomy.

Many clinics perform a mock embryo transfer during this phase. This procedure simulates the actual transfer process, allowing the doctor to map the best pathway to your uterus and identify any potential difficulties before the real transfer day.

Partner and Genetic Screening

If you have a partner or spouse, they’ll undergo some screening too. They’ll need infectious disease testing to protect you and the baby, and they’ll participate in psychological evaluation and background checks. Their understanding and support of your surrogacy experience directly affects your outcome, so their buy-in matters tremendously.

Pathways to Parenthood coordinates this entire screening process, scheduling appointments, collecting results, and communicating with all the professionals involved. You’re not navigating a maze of doctors and clinics alone—your agency serves as the central hub, confirming nothing falls through the cracks.

Transparency about approval rates helps set realistic expectations. Not everyone who applies will be approved, and that’s okay. Common reasons for disqualification include undisclosed medical issues that surface during screening, BMI outside the acceptable range, insufficient support system, or psychological factors that suggest someone isn’t ready for the demands of surrogacy.

If you’re not approved initially, it doesn’t mean never—sometimes it means not right now.

Addressing the issue (like losing weight, completing mental health treatment, or waiting until your home life stabilizes) might make you eligible in the future.

This thorough screening benefits everyone. For you as a prospective surrogate, it confirms you’re physically and emotionally prepared for the experience. For intended parents, it provides assurance that their surrogate meets the highest standards. For the baby, it creates the safest possible environment for development and birth. 

Navigating the Legal Requirements and Contracts

Once you’ve been approved through screening and matched with intended parents through the matching process, legal work becomes the next milestone. No medical procedures can begin until you’ve signed a comprehensive surrogacy contract. This legal framework protects everyone involved by clearly defining rights, responsibilities, and expectations.

The surrogacy contract serves as the foundational document for your entire experience, outlining surrogacy legal requirements. Think of it as a detailed roadmap that addresses every possible scenario you might encounter. This isn’t just paperwork—it’s your protection and your guide when questions arise about compensation, medical decisions, or relationship expectations.

Independent Legal Representation

Independent legal representation for both parties stands as an absolute requirement and an ethical necessity. You and the intended parents must have separate attorneys who specialize in reproductive law. Your attorney represents only your interests, while the intended parents’ attorney represents only theirs.

This separation prevents conflicts of interest and confirms both parties receive objective legal advice. Most surrogacy arrangements have the intended parents pay for both attorneys’ fees, though this is negotiated and specified in the contract.

Your attorney will meet with you privately before the contract is drafted and again after receiving the draft from the intended parents’ lawyer. These meetings provide opportunities to discuss every aspect of the agreement in detail. Your lawyer explains legal terms, confirms you understand each clause, and verifies that the contract reflects what you and the intended parents discussed during matching.

Key Contract Elements

Key elements covered in surrogacy agreements span a wide range of topics:

Compensation Structure:

• Your base compensation amount
• When payments begin (typically after heartbeat confirmation around 6 weeks)
• The payment schedule through surrogate compensation structure (usually monthly throughout pregnancy)
• Additional compensation for multiple pregnancies, cesarean delivery, invasive procedures, or other circumstances requiring extra compensation

Everything gets documented clearly so no confusion arises later.

Expense Reimbursement: You’ll be reimbursed for medical appointments, travel to the fertility clinic, maternity clothing, prenatal vitamins, health insurance premiums or copays, life insurance premiums, and childcare costs when you attend appointments. The contract establishes how these reimbursements work—whether you submit receipts for payment or receive a monthly allowance to cover these costs.

Medical Decision-Making Authority: The contract specifies who makes decisions about prenatal testing, procedures, and medical interventions during pregnancy. It addresses sensitive topics like selective reduction (if multiple embryos implant) and pregnancy termination for severe fetal abnormalities or risks to your health.

While intended parents have significant input since it’s their baby, your bodily autonomy is protected. These discussions happen before pregnancy so everyone understands the decision-making framework if difficult situations arise.

Relationship and Timeline Considerations

Relationship expectations during pregnancy get outlined too. How often will you communicate with intended parents? Will they attend prenatal appointments with you? Can they be in the delivery room? What level of contact do you want after birth?

These details create clarity and prevent misunderstandings. Some surrogates want very close relationships with frequent video calls and shared experiences. Others prefer more independence with regular updates at scheduled intervals. Neither approach is wrong—what matters is that the contract reflects what you and the intended parents agreed upon.

Timeline for contract negotiation and signing varies based on how quickly both parties review and approve the terms. Simple, straightforward agreements might be finalized in 2-3 weeks. More situations with circumstances or extensive negotiations can take 4-6 weeks or longer.

Patience during this phase pays off—a well-drafted contract that everyone understands and agrees to prevents problems throughout the experience.

Once both attorneys approve the final contract and you and the intended parents sign, the agreement becomes legally binding. At this point, you typically begin receiving your monthly allowance to cover incurred expenses. This payment begins even before medical procedures start, acknowledging that you’re already investing time and effort into the surrogacy.

Establishing Parental Rights

Establishing parental rights through pre-birth orders is a critical legal step for intended parents. After your first trimester, their attorney will file a petition with the court in your state seeking a pre-birth order to establish parental rights. This court order legally declares the intended parents as the legal parents of the child you’re carrying, even before birth. It ensures their names appear on the birth certificate and you have no legal parental rights or responsibilities for the baby.

Pre-birth orders provide legal clarity and peace of mind for everyone. The process and availability of these orders vary by state, which is why working with attorneys experienced in reproductive law in your jurisdiction is essential.

Lifestyle Adjustments During Medical Preparation

Preparing for surrogacy involves more than medical appointments—it often means making small but meaningful lifestyle changes to ensure your body is in the best condition for pregnancy. Once legal contracts are finalized, you’ll begin the medical preparation phase at your fertility clinic.

Medication & Monitoring: Most surrogates follow a 15–18 day protocol of hormone medications to prepare the uterine lining for embryo transfer. These may include estrogen and progesterone, taken through pills, patches, or injections. You’ll attend several monitoring appointments for bloodwork and ultrasounds to confirm your body’s readiness for implantation.

Diet & Exercise: Your fertility team will recommend a balanced diet rich in protein, leafy greens, and hydration while limiting caffeine and alcohol. Light exercise like walking or yoga is encouraged, but high-intensity workouts, hot tubs, and saunas should be avoided.

Daily Life & Work Balance: The medical prep phase can require flexibility in your schedule. Communicate early with your employer or family about time off for appointments and procedures. Organizing childcare and transportation in advance helps reduce stress.

Managing Medication Side Effects: Hormone medications can cause bloating, mood swings, or mild discomfort at injection sites. Many surrogates find relief with heating pads, hydration, and gentle activity. Remember—your clinic and agency team are available if side effects become difficult to manage.

Emotional and Lifestyle Preparation for the Surrogacy Journey: The emotional journey of surrogacy begins long before pregnancy. You’re giving an incredible gift, and it’s essential to nurture your mental and emotional wellbeing throughout the process.

Building a Support Network: Having the encouragement of your partner, family, and friends will help you stay grounded. Be open about your reasons for becoming a surrogate and the time commitment it involves. If you have children, prepare them with age-appropriate conversations about what surrogacy means.

Setting Realistic Expectations: While most surrogacies go smoothly, it’s important to prepare for both the joys and the challenges. There may be delays, failed transfers, or physical fatigue. Being mentally ready for these possibilities allows you to remain positive and flexible.

Financial & Practical Planning: Even with compensation, consider how time off work, travel, or recovery may temporarily affect your income. Setting aside an emergency fund or using part of your surrogate allowance for practical needs can provide peace of mind.

Ongoing Self-Care: Surrogates benefit from maintaining self-care routines—rest, nutrition, counseling, and mindfulness. Pathways to Parenthood encourages regular check-ins with mental health professionals who understand third-party reproduction.

Building Your Relationship with Intended Parents

One of the most meaningful parts of the surrogacy experience is the relationship you form with the intended parents. This connection, built on trust and communication, transforms the process into something deeply personal.

The Matching Process

Once medically and legally cleared, you’ll be matched with intended parents whose goals, expectations, and personalities align with yours. You’ll have an opportunity to meet—virtually or in person—to establish rapport and discuss how you’ll communicate throughout the journey.

Communication & Boundaries

Some surrogates and parents connect daily, while others prefer weekly updates. Establishing your preferences early avoids misunderstandings. Sharing pregnancy milestones, photos, and appointment updates helps intended parents feel included, even from afar.

During Pregnancy and Beyond

As the pregnancy progresses, many surrogates develop close friendships with the families they’re helping. Pathways to Parenthood provides guidance if differences arise and encourages open dialogue so everyone feels respected. After birth, ongoing contact varies—some families stay closely connected, while others maintain occasional updates.

The bond formed through surrogacy is often lifelong—built on shared gratitude, respect, and the miracle of new life.

Conclusion

Preparing to become a surrogate is a journey of courage, compassion, and commitment. While the process includes many steps—screening, medical evaluations, legal agreements, and emotional preparation—each stage brings you closer to changing a family’s future forever.

At Pathways to Parenthood, surrogates receive personalized guidance at every step, from your first conversation through delivery and beyond. By understanding what to expect, you can move forward with confidence, knowing you’re supported, protected, and valued for the incredible gift you’re giving.

If you’re ready to take the next step, contact Pathways to Parenthood today to start your application or ask questions about becoming a surrogate. The journey ahead may be one of the most meaningful experiences of your life.

Frequently Asked Questions

How long does the surrogacy process take?
The full journey usually lasts 18-24 months, including screening, matching, medical preparation, pregnancy, and recovery.

When do surrogates start receiving compensation?
Base compensation typically begins after heartbeat confirmation, about six weeks into pregnancy, with monthly payments thereafter.

Can I become a surrogate if I’ve had a C-section or tubal ligation?
Yes. Most surrogates with up to three previous C-sections or a prior tubal ligation qualify, provided medical evaluations confirm uterine health.

What happens if the first embryo transfer doesn’t work?
It’s common to need more than one attempt. Most contracts allow two to three transfer cycles, and clinics adjust treatment protocols between attempts.

How much will surrogacy affect my daily life?

Appointments are most frequent during the medical prep and early pregnancy phases. With planning and agency support, most surrogates balance work, family, and appointments comfortably.