How to Become a Surrogate: The Journey of Carrying Life for Another Family

The decision to carry a child for someone else sits at the intersection of profound generosity and complex personal choice. I've spent years talking with surrogates, intended parents, and fertility specialists, and what strikes me most isn't the medical complexity—it's the emotional depth of this journey. Every surrogate I've met describes a moment when they realized they could give someone the one thing they desperately wanted but couldn't achieve alone: a family.

The Heart of the Matter

Surrogacy isn't about renting your womb—that's a crude oversimplification that misses the entire point. It's about recognizing that your body can do something extraordinary for someone who's likely spent years, maybe decades, trying everything else. The women who choose this path aren't motivated by money alone, despite what critics might suggest. They're motivated by something harder to quantify: the memory of their own pregnancies, the ease with which they conceived, and a genuine desire to help.

I remember sitting with Sarah, a two-time surrogate from California, as she explained her reasoning. "I loved being pregnant," she said, stirring her coffee thoughtfully. "My pregnancies were textbook perfect. Meanwhile, my sister struggled for seven years with infertility. Watching her pain while knowing how easily pregnancy came to me—it changed something in me."

Understanding What You're Really Signing Up For

Before diving into requirements and applications, let's be honest about what surrogacy actually involves. You're committing to roughly 15-18 months of your life, from the initial screening through postpartum recovery. During this time, your body becomes a shared space in ways that can feel both empowering and challenging.

The medical side alone is intense. We're talking daily injections for weeks, sometimes months. Hormone medications that can make you feel like you're riding an emotional rollercoaster designed by someone with a twisted sense of humor. Multiple medical appointments that require you to rearrange your life around ultrasound wands and blood draws.

But here's what they don't tell you in the glossy agency brochures: the hardest part often isn't physical. It's navigating the relationship with intended parents who might want to be involved in every doctor's appointment, every food choice, every prenatal decision. Some surrogates thrive with highly involved intended parents. Others find it suffocating. There's no right answer, just what works for you.

The Non-Negotiable Requirements

Let me save you some time if you're just starting to explore this. The requirements for surrogacy are strict, and for good reason. This isn't discrimination—it's about ensuring the best possible outcome for everyone involved, especially the baby.

You need to be between 21 and 45 years old, though most agencies prefer surrogates under 40. You must have given birth to at least one child that you're currently raising. This isn't just about proving your fertility; it's about understanding what pregnancy entails and demonstrating your ability to separate from a child you've carried.

Your BMI needs to be under 33 in most cases, though some clinics set it at 30. Your reproductive history should be uncomplicated—no more than two C-sections, no major pregnancy complications. You can't be on government assistance or have any major financial stressors, because financial desperation and surrogacy make terrible bedfellows.

The psychological requirements are equally stringent. No history of major mental illness, no current use of antidepressants or anti-anxiety medications. You'll undergo extensive psychological evaluation, and they're not just checking boxes. They're looking for emotional stability, clear boundaries, and realistic expectations.

The Application Marathon

Once you've determined you meet the basic requirements, the real process begins. And let me tell you, if you thought buying a house involved a lot of paperwork, surrogacy will make that look like filling out a postcard.

First comes the initial application with an agency or fertility clinic. This isn't a simple form—it's an exhaustive questionnaire covering everything from your menstrual history to your relationship dynamics. They want to know about every pregnancy, every miscarriage, every medical procedure you've ever had. They'll ask about your support system, your partner's feelings about surrogacy (if you have one), and how your children feel about mommy carrying a baby for another family.

The medical screening phase feels invasive because it is invasive. Full physical exam, infectious disease testing, drug screening, genetic testing. They'll examine your uterus with more attention than it's probably ever received. Hysteroscopy, where they insert a small camera to check for abnormalities. Blood tests that seem to require half your blood volume.

The psychological evaluation deserves its own discussion. You'll meet with a mental health professional who specializes in reproductive psychology. They're not trying to trip you up, but they are trying to ensure you understand the emotional complexities ahead. They'll explore your motivations, your expectations, your ability to maintain appropriate boundaries. If you're married or partnered, they'll want to evaluate your partner too.

Matching: The Strangest Dating Game

After you've jumped through all the medical and psychological hoops, you enter what I call the strangest dating game ever invented: matching with intended parents. This process varies wildly depending on whether you're working with an agency or going independent.

With an agency, you'll create a profile—think online dating meets job application. Photos of your family, a letter explaining your motivation, your preferences for communication and involvement. Then you wait. Intended parents review profiles, looking for someone who feels right. It's deeply personal and weirdly impersonal at the same time.

Some matches happen quickly. Others take months. I've known surrogates who matched with the first couple they met, feeling an instant connection. Others went through multiple meetings before finding the right fit. And just like dating, sometimes what looks perfect on paper feels wrong in person.

The matching process forces you to think about boundaries you've never considered. How do you feel about carrying multiples? What about selective reduction if too many embryos implant? How involved do you want the intended parents during pregnancy? Do you want contact after birth? These aren't hypothetical questions—they're decisions that will shape your experience.

The Legal Labyrinth

Here's where surrogacy gets genuinely complicated. The legal landscape varies dramatically by state, and if you're in a state unfriendly to surrogacy, you might need to travel for the embryo transfer and delivery.

The contract phase isn't something to rush through. You need your own lawyer—not one recommended by the agency or the intended parents. This contract will cover everything from your compensation to what happens if you miscarry to who makes decisions if there's a medical emergency during delivery.

Compensation structures vary wildly. Base compensation for first-time surrogates ranges from $30,000 to $60,000, depending on location and circumstances. But that's just the beginning. There's monthly allowances, maternity clothing allowances, compensation for invasive procedures, lost wages, childcare during appointments. Some contracts include provisions I never would have thought of—like who pays if you need a breast pump because the intended parents want you to pump colostrum.

The contract also addresses the elephant in the room: what happens in worst-case scenarios. Severe disability detected in the fetus. Life-threatening complications for you. Divorce or death of intended parents during pregnancy. These conversations are uncomfortable but necessary.

The Transfer and Beyond

Once contracts are signed, the medical protocol begins in earnest. If you're doing gestational surrogacy (using an embryo created from egg and sperm that aren't yours), you'll start with birth control pills to sync your cycle with the egg donor or intended mother. Then come the injections—estrogen to build your uterine lining, progesterone to maintain it.

The embryo transfer itself is anticlimactic. It takes maybe 15 minutes. You lie on a table while a doctor threads a catheter through your cervix and deposits a microscopic embryo into your uterus. Then you wait. The two-week wait between transfer and pregnancy test might be the longest two weeks of your life.

If the transfer works, you're pregnant with someone else's baby. This reality hits different people at different times. Some surrogates feel it immediately. Others don't fully grasp it until they're handing the baby to the intended parents in the delivery room.

The Pregnancy Experience

Being pregnant as a surrogate is simultaneously exactly like and nothing like being pregnant with your own child. Physically, pregnancy is pregnancy. The morning sickness doesn't care whose baby you're carrying. Your back hurts the same way. The baby kicks just as hard.

But everything else is different. Doctor's appointments might include intended parents on speakerphone or sitting beside you. You might text ultrasound photos to people across the country instead of hanging them on your fridge. The nursery preparation happening isn't in your house.

The relationship dynamics during pregnancy vary enormously. Some surrogates develop deep friendships with their intended parents. Others maintain professional distance. I've known surrogates who talked to intended parents daily and others who provided weekly email updates and nothing more. Neither approach is wrong.

What surprises many surrogates is how their own families adapt. Children ask questions you don't expect. "Why is the baby going to live with them instead of us?" Partners struggle with the emotional complexity of supporting you through a pregnancy that isn't expanding your family.

Delivery Day Dynamics

Labor and delivery as a surrogate requires choreography that would make a Broadway director nervous. Who's in the room? Who cuts the cord? Who holds the baby first? These decisions, ideally made months in advance, suddenly become real.

Most surrogates describe delivery day as emotionally intense but not in the way outsiders expect. The overwhelming feeling isn't sadness at "giving up" the baby—it's joy at completing your purpose. Watching intended parents meet their child for the first time provides a high that no amount of money could replicate.

But let's be realistic. Recovery from childbirth doesn't care that the baby isn't going home with you. You still have the physical recovery, the hormone crash, the milk coming in with no baby to feed. Some surrogates find this part harder than expected. Your body doesn't understand the arrangement you've made.

The Aftermath No One Discusses

Here's what the agencies don't emphasize: the journey doesn't end at delivery. There's a strange emptiness that follows—not emotional emptiness from missing the baby, but purposelessness after being so intensely focused on this goal for over a year.

Some surrogates struggle with the transition back to normal life. You've been special, important, doing something extraordinary. Then suddenly you're just another mom at school pickup. The intended parents, understandably, are focused on their new baby. The agency moves on to other surrogates. You're left processing an experience that few people understand.

This is why the surrogate community becomes so important. Online groups, local meetups, friendships forged through shared experience. These women understand the specific cocktail of pride, purpose, and peculiarity that defines the surrogacy experience.

The Repeat Question

Many surrogates face a question they didn't expect: would you do it again? The answer often surprises them. Despite the challenges, the invasiveness, the physical toll, many say yes. Not immediately—most need time to recover physically and emotionally. But the pull returns.

Second-time surrogates often report easier experiences. You know what to expect. You can set better boundaries. The fear of the unknown disappears. But the compensation typically increases too, acknowledging your proven track record.

Some surrogates become almost addicted to the purpose and structure surrogacy provides. Others complete one journey and know with certainty they're done. Both responses are valid.

The Uncomfortable Truths

Let's address what polite surrogacy discussions often avoid. The industry has problems. Some agencies prioritize profit over people. Some intended parents view surrogates as incubators rather than human beings deserving respect and autonomy. International surrogacy raises ethical questions about exploitation and power dynamics that can't be ignored.

The commercialization of surrogacy makes some people deeply uncomfortable, and honestly, it should. When we create markets around pregnancy, we risk reducing profound human experiences to transactions. The challenge is balancing legitimate concerns about commodification with respect for women's autonomy to make decisions about their own bodies.

Financial motivation doesn't negate altruistic intention, but we need honest conversations about how money shapes these relationships. A surrogate earning $40,000 might be doubling her annual income. That creates power dynamics that ethical agencies and intended parents must actively address.

Making the Decision

If you've read this far and still feel called to surrogacy, sit with that feeling. Talk to surrogates—not just the ones agencies connect you with, but independent voices in online communities. Talk to your partner, your children, your support system. Consider not just whether you meet the requirements, but whether this journey aligns with your values, your family's needs, and your life circumstances.

Think about your why. If it's purely financial, reconsider. The money alone isn't worth what you'll go through. If it's purely altruistic, examine that too. The best surrogates I've known acknowledge both motivations—the desire to help and the practical benefits the compensation provides.

Consider timing. Surrogacy isn't compatible with major life transitions. If you're planning to move, change jobs, or go through any significant changes, wait. This journey requires stability.

Most importantly, trust your gut. If something feels wrong during the matching process, speak up. If an agency seems more interested in their commission than your wellbeing, walk away. If intended parents push boundaries you've set, stand firm. Your body, your choice, even when carrying someone else's child.

The path to becoming a surrogate isn't just about meeting requirements and signing contracts. It's about understanding yourself well enough to know whether you can navigate the emotional complexity of carrying a child you won't parent. It's about being honest about your motivations and clear about your boundaries. It's about recognizing that you're not just growing a baby—you're helping to create a family, with all the messy, beautiful, complicated humanity that entails.

This choice changes you. Not in the Hallmark movie way where everything is beautiful and everyone cries happy tears (though there's plenty of that). It changes you in the way that all profound experiences do—by showing you capabilities you didn't know you had and teaching you lessons you didn't know you needed.

Whether you ultimately choose this path or not, the exploration itself teaches you something valuable about your own values, boundaries, and capacity for both sacrifice and self-advocacy. And in a world that often asks women to be either entirely selfless or entirely self-focused, surrogacy offers a rare opportunity to be both.

Authoritative Sources:

American Society for Reproductive Medicine. Third-Party Reproduction: A Guide for Patients. ASRM, 2018.

Berend, Zsuzsa. The Online World of Surrogacy. Berghahn Books, 2016.

Centers for Disease Control and Prevention. "ART Success Rates." CDC.gov, U.S. Department of Health and Human Services, 2023.

Jacobson, Heather. Labor of Love: The Story of One Woman's Extraordinary Pregnancy. Seal Press, 2016.

Markens, Susan. Surrogate Motherhood and the Politics of Reproduction. University of California Press, 2007.

Society for Assisted Reproductive Technology. "A Patient's Guide to Assisted Reproductive Technology." SART.org, 2023.

Twine, France Winddance. Outsourcing the Womb: Race, Class and Gestational Surrogacy in a Global Market. Routledge, 2015.