Why Work With A Surrogacy Agency?

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Working with an Agency offers three primary advantages. Firstly, agencies are typically experts in the field, ensuring comprehensive support and guidance throughout the surrogacy journey. Secondly, they possess a proven track record in recruiting surrogates, skillfully matching intended parents with surrogates, and connecting them with appropriate professionals and services.  Lastly, agencies efficiently coordinate all the steps in the surrogacy process, streamlining the experience and providing invaluable assistance at every stage.


The Benefits of Hiring Experts


It is sometimes easy to be influenced by high-quality brochures or websites, but an important fact can sometimes be overlooked.  An important first question you should ask is whether the agency you select is an expert in the field. 


This next section may sound complicated, but hang in there, as it will ultimately become clear. Before starting your life-changing journey, focusing on the difference between knowledge, skills, and experience is vital.  


As we all know, knowledge can be acquired by reading books, analyzing studies, observing life, etc. (which includes on-the-job learning).   Knowledge emphasizes the theory of a subject matter or learning information or ideas. 

On the other hand, skills are acquired through and after obtaining knowledge and ultimately reflect the ability to do something well.   These skills make a person confident in performing their job – because they know they can do it.


Experience, however, is gained through the application and practice of that knowledge, coupled with the implementation of their skills over a period.   A surgeon (or lawyer or counselor, etc.) can learn the theory on how to do a particular procedure or process and subsequently become technically competent in applying it, but does that mean that they have the experience to deal with anything that falls outside of their training?   It is no coincidence that people generally search for someone with a combination of all three attributes when making important choices – which is why we emphasized the need to differentiate between them when choosing which agency to work with.





If you were an intended parent who was fortunate enough to become a parent via surrogacy or a surrogate who successfully delivered a baby for an intended parent, then “yes,” you certainly would have the knowledge to open an agency.   They could enhance that knowledge further by attending conferences, reading articles, and doing online research.  They will also have some experience since they have participated in the field, but their experience is narrow and focused on their journey only.   Over time, they will all clearly acquire and gain additional skills to assist others in their journey, but would you consider that to be optimum? 


Another example could be someone who worked for a surrogacy or egg donor agency for a few years. They, too, may have valuable experience, knowledge, and skills, but this may be limited to their role in their prior agency.  You will typically entrust significant time, emotion, and money to these people.  Be sure to determine if they know how to run a business, what insurance coverage they should carry to protect all their clients, or how to run payroll and organize their staff.  Again, this can be learned and mastered with time and sufficient clientele – all of which will enable them to practice their skills and knowledge to gain experience, but it needs to be factored into your decision.





Understanding an agency’s knowledge, skills, and experience is a priority when evaluating and comparing its services.  Experience generally comes with a price tag because it can take years to achieve.   Experience is often gained over time, and agencies with staff with years of relevant expertise will likely offer more valuable services.  It is important to remember that the lowest-priced option may only sometimes yield the best long-term results.  Consider price differences among agencies’ fees considering the expertise and quality of services they provide.  Making an informed decision based on these factors will help ensure a successful and satisfying surrogacy journey.


Proven Ability to Recruit Surrogates & Do Matching


  • Pre-Screening
  • Matching and Rematches





Every agency pre-screens its surrogates.   The issue, however, is that there is no one definition for “pre-screening.”  Some agencies will interview a surrogate over the phone or Zoom and review her written application, while others may undertake a more comprehensive process.  This can include obtaining medical approval from an infertility doctor, conducting extensive social disease testing, obtaining psychological clearance through in-person interviews and testing, conducting criminal background research, and verifying appropriate medical insurance coverage for the pregnancy.  As you can see, the differences in what ‘pre-screening’ means can be immense, and it’s important for intended parents to understand the level of screening each agency performs to make an informed decision.


So why is pre-screening so especially important?   Pre-screening is important because this can and will determine what charges an intended parent will be responsible for. Thorough pre-screening will mean the Intended Parent must wait longer to be matched.  This is an important factor to consider. 


Typical costs to prescreen a surrogate in the United States range from $2,500 to $4,000. Some agencies offer an inclusive rate, where if the surrogate does not gain medical approval and cannot be matched with an intended parent, the agency incurs the costs of that dropped surrogate.  Some agencies do not do intensive pre-screening before the intended parent is matched with that surrogate.  In such cases, the screening will occur after the match is confirmed.   If the selected surrogate later becomes unsuitable, the intended parents may be out-of-pocket and without a surrogate, having to restart the entire process.


Also, consider when the agency requests payment.  Some agencies will require a payment before you are presented with a candidate (albeit fully screened), whereas others will only require a payment when you have agreed to be matched with a surrogate. 

Screening List


Application:  Intended Parent should receive a copy of a completed and signed application from the surrogate and her partner.  This application will provide details about the surrogate, such as:


Nationality, age, weight, number of children and their ages and health, pregnancy history and possible complications, marital status, how many cesarean sections she has had (should be no more than 3, but 2 is preferred), details of her income, current employment, educational level, languages spoken, the answer to a series of questions about any criminal history (surrogate and partner), health, vaccinations, mental health, exposure to social diseases, countries traveled to in the last five years, any exposure to COVID-19 and Zika. A variety of other personal answers to questions should be included, such as why she wants to be a surrogate, what kind of family and friends support she can expect, what characteristics she is looking for in her intended parent(s), her opinions about terminating a pregnancy in the event of medical complications, etc.


Interview with Staff:

A record of who conducted the interview, how long it lasted, and the topics covered.


Identification Verification:

What documents were verified, the process used, and by whom?


Current Pap & Obstetrician Physical: 

Does she have her own Obstetrician’s approval to carry another pregnancy?  Has she recently undergone an obstetric screening, and are the records in her file?


Criminal Background:

It is strongly recommended that a criminal background be undertaken on the surrogate and her partner for at least the last seven years. A copy of this background clearance should be viewable by the intended parent(s).


Drivers’ License: 

If she drives, does she have a valid driver’s license?  Check the address on the driver’s license with that on her application.


Psychological Interview:

A psychological clearance letter should be in her file and viewable by the intended parent.  The intended parents should be entitled to speak to the counselor about the surrogate.  Was this a one-time meeting, or did the parties meet more than once?


Psychological Testing:

There is a note in the file that testing was performed and reviewed by the counselor who issued the psychological clearance letter. 


Social Disease Testing:

Both the surrogate and her active sexual partner must undergo social disease testing that is no more than one year old. This testing should be repeated within 30 days of the transfer to ensure the baby’s safety. The typical tests include HIV, syphilis, herpes, hepatitis, cytomegalovirus (CMV), gonorrhea, and chlamydia, as well as drug, tobacco, and alcohol screening. If the surrogate’s blood type and RH Factor are unknown, they should also be tested.


Obstetrician Records Review: 

Records pertaining to all obstetric and gynecological history, pregnancy, and delivery of all babies should be reviewed for any health and physical complications that could have ramifications for a future pregnancy.   It is important to obtain her obstetrician records and the records from the hospital where she was delivered.


Financial Considerations:

Intended parents should be presented with the financial package requested by the surrogate and signed by her.  This should include her compensation, if any, and what expenses the intended parents will be responsible for, including estimated costs in the event of bedrest or other pregnancy complications.


Medical Insurance Coverage

Verification in writing of the surrogate’s medical insurance coverage for the pregnancy and delivery is essential.  Even if the surrogate is eligible for nationalized healthcare, we recommend verifying coverage and obtaining written evidence.  Even in countries with nationalized healthcare, a baby born through a surrogacy arrangement to non-citizens is unlikely to be covered.  Some agencies can secure medical coverage through loopholes.  We encourage the intended parent(s) to discuss coverage options with their agency and legal counsel.  Be prepared to pay for newborn care after birth; however, this risk can be minimized by working with a skilled agency, lawyer, or insurance broker.


To protect yourself, carefully document the insurance coverage offered for your newborn baby.  If the agency, lawyer, or insurance broker needs to provide written documentation, email them confirming your conversation and ask for clarification.  In most written agreements with an agency, medical insurance for the surrogate, her delivery, and the newborn baby is often excluded from services due to its complexity and specialized training requirements.  However, it is crucial to understand the available options before proceeding with a pregnancy.  Also, inquire about who pays the monthly insurance premiums – the intended parents, the surrogate, or the agency.  We recommend prepaying insurance premiums by at least one month to avoid delays in payment processing.




The matching process is usually well-handled by most agencies.  To assist you, here is a list of items that you should confirm before signing any legal contracts or incurring costs to meet your surrogate:


  1. Determine what pre-screening has been completed on the surrogate and which items still need to be completed by you. Assess the risk of that candidate not passing all the screening steps and determine the wait time to be matched with a different surrogate.
  2. Do the laws of where she will deliver permit you to be legally recognized as the parents? If yes, what is the legal process?  If no, ask for a different match.
  3. Is the location where she presently resides the same or different from where the delivery is anticipated? What are the laws of both locations regarding surrogacy and establishing parental rights for the intended parents?
  4. Is there any expectation that she or her spouse will move locations or change jobs in the next one to two years?
  5. Is there any expectation of travel for a vacation or family meeting, such as a wedding in a different county, state, territory, or country to where she currently resides?
  6. Does she have at least one child of her own that she raised herself? This is important because a woman who has never carried a pregnancy or raised a child will have no experience on which to draw to decide if surrogacy is the right option for her.  In addition, the psychological impact may not have been fully understood and considered if she had never carried a pregnancy.  How do you know she can become pregnant and carry a healthy baby?
  7. Have you agreed to the costs expected to be incurred if you work with her? Your agency should provide you with a forecast of these costs and expenses.
  8. Will the surrogate meet you? This meeting could be in person, but a video conference call is acceptable.
  9. What kind of support is likely from her family, friends, and colleagues
  10. Does she speak your language?  If not, who will undertake the translation task, and what costs are associated with translation services?   Is there a limitation on the amount of translation services offered?
  11.  Before the birth, discussing with the surrogate whether you can be present in the delivery room or participate via video conference call is important. Ensure that you and the surrogate agree regarding your preferred level of involvement in the birth process.  Confirming that the surrogate agrees with your decision is equally important if you choose not to participate.
  12. What is the surrogate’s expectation of contact before, during, and after the birth, and does it coincide with your expectations?
  13.  Has she agreed to the implantation of one embryo or multiple embryos? How many embryo transfers is she willing to commit to if the first does not result in an ongoing pregnancy?
  14. What are her thoughts on the circumstances under which she would agree to terminate a pregnancy?
  15. What will the intended parents expect from their surrogate during this pregnancy, and what are the surrogate’s expectations of the intended parent? For example, do the intended parents want their surrogate to eat only organic food, drink specific water, or refrain from going to the gym?  Will the surrogate expect the intended parents to visit her, pay for spa treatments and pregnancy massages, and pay for her children to visit her if she is away from them in the hospital or otherwise?


Co-Ordination of the Various Steps of this Journey


Surrogacy agencies help coordinate the entire journey, making the process as stress-free and straightforward as possible for intended parents.  From the initial matching process to facilitating the embryo transfer and overseeing the pregnancy and birth, agencies ensure a smooth and well-managed experience.

One of the significant benefits of working with an agency is their ability to handle communication and coordination with all the professionals involved in the surrogacy process.  This includes liaising with the legal team to draft the surrogacy contract and ensure all necessary legal steps are taken to establish the intended parent’s rights.

Agencies may offer different levels of coordination services.  By partnering with a reputable surrogacy agency, intended parents can ensure their journey will be well-guided, supported, and organized. This allows them to focus on the joy and excitement of becoming parents through surrogacy.


a.  Mental Health Professional


There are two options for counseling services: Ongoing Case Counseling and As Needed Counseling.


Ongoing Case Counseling is when a counselor is assigned to the case from the time of the match (perhaps involved in the surrogate screening), throughout the pregnancy, and a few months after the birth.  This continuity allows the counselor to understand the parties involved deeply, the terms of the relationship, and any unique circumstances.  Consequently, they can readily provide guidance, preemptively address potential issues, and offer advice and options, preventing escalations.


On the other hand, As Needed Counseling is a more reactive approach where a counselor is consulted only after a situation has escalated, and assistance is urgently sought by one or all parties involved.  While this option may be more cost-effective, it does pose potential challenges.  Delayed identification of issues and needing time to update the counselor on the background and circumstances can hinder swift resolution. Furthermore, gaining mutual agreement and trust in the advice offered might take longer, potentially straining the relationship between the parties. 


It is recommended that each intended parent and surrogate identify the counseling the agency offers and the associated costs.  It may also benefit the intended parent(s) and the surrogate if the mental health professional who screened and approved the surrogate can be available to everyone if her assistance is needed during the journey.  To avoid a conflict of interest, it may also be helpful to determine if the mental health professional is a staff member or independent of the agency.  If the professional is a staff member, their priority may lean towards the agency’s well-being rather than exclusively focusing on the emotional well-being of the intended parents and surrogate.


b.  Legal Counsel


Some surrogacy agencies offer in-house legal counsel, with one lawyer representing the surrogate and the intended parents, while others refer all parties to independent attorneys.  When an agency has an in-house legal team, legal fees are often included in the agency fee or provided at a reduced rate.  However, it’s important to consider the potential disadvantages of this arrangement.  The legal team primarily owes allegiance to their employer, the agency, rather than solely prioritizing the intended parent’s or surrogate’s interests. Additionally, the concept of attorney-client privilege between the client and their attorney may only partially apply in such cases.


On the other hand, choosing an independent attorney may be more expensive. Still, it comes with the benefit of attorney-client privilege, ensuring that communications remain confidential and that the attorney’s loyalty is exclusively to their client.  When the agency and attorney are separate entities, the agency becomes instrumental in facilitating communication and coordination between the intended parent’s legal counsel and the surrogate’s legal counsel.  In many jurisdictions in the United States, the law requires that separate legal counsel represent the surrogate and intended parent to protect the interests of all parties involved.


c.  Infertility Clinic


Certain fertility clinics offer in-house surrogacy agencies, which can lead to more cost-effective agency fees.  However, it’s essential to consider the potential implications of this arrangement.  In-house services might result in less impartiality, as decisions could be influenced by inherent conflicts of interest, prioritizing the benefits of the fertility clinic over the best interests of the intended parent or surrogate.


A benefit of such an arrangement is that the fertility clinic may have its standards that surrogates must meet to be medically approved.  All surrogates affiliated with the in-house agency will automatically pre-qualify on a medical basis.  However, most in-house agencies are small and have few surrogates to choose from.  Independent surrogacy agencies often have a larger pool of surrogates for intended parents to select from.   Intended parents should weigh the benefits and drawbacks of an in-house agency and carefully evaluate whether it aligns with their needs and preferences.


d.  Medical Insurance Broker


Some surrogates may have medical insurance in place either through work or because of national insurance coverage.  Some agencies charge a surcharge for a surrogate with existing insurance coverage.  In such a case, the surcharge is added to their agency fee.  In the United States, some insurance brokers specialize in obtaining insurance policies for the surrogate – from pregnancy to delivery and for newborn babies.  These policies can be expensive but may be the only viable option.  Some agencies use their expertise in the field and know which policies have been successfully used, and often these are less expensive.  Be sure to ask if the insurance company is affiliated with the agency.  While such an affiliation could reduce overall costs to the intended parent, there may be inherent conflicts of interest in having the intended parent purchase an expensive policy instead of using her existing policy or purchasing a cheaper alternative.  Take your time to understand the insurance aspects of surrogacy, as this area is where there is the most risk to the intended parent of substantial unforeseen costs. 


Surrogacy agencies offer a huge advantage in providing their skills to coordinate with all parties involved in the surrogacy journey.  In addition, in an emergency, the agency should be able to assist in securing second medical opinions and those hard-to-get medical appointments on short notice. 


These are some reasons why every intended parent should consider working with a surrogacy agency. 


Author: Karen Synesiou, Infertility Portal, Inc.