How Does Surrogacy Work? The Complete Process in Five Steps

Surrogacy can seem complicated and daunting to those who are uneducated about its exact process. And rightly so—surrogacy is one of the most complex of all fertility options. However, it is also one of the most rewarding and personally satisfying. Understanding the details of what it entails is key to having a successful journey.

Note that while the basic method of surrogacy is generally consistent, the legal requirements that must be fulfilled do vary from country to country.

Step 1: The Surrogacy Decision

Same-sex couple, opposite-sex couple, single: no matter your status, understanding the basics of surrogacy is essential before your commitment. The great reward of a new baby is exciting and life-changing, but the road to get there requires time, patience, and great responsibility.

Major travel plans will be on hold during this process, as will any intense activities. Emotional and financial planning is requisite, and the need for professional assistance is consistent both before and during the pregnancy.

Once it has been decided that surrogacy is the best fit, decisions about the type of surrogacy experience desired must be made, and plans must be put into place. These decisions include pursuing traditional vs. gestational surrogacy, as well as the involvement of a surrogacy agency.

Step 2: Finding Your Surrogate Mother

One of the most exciting parts of surrogacy is finding the woman who will step in to be your surrogate mother. For most intended parents, this step requires a timetable unique to their needs.

Healthy and happy surrogate relationships are characterised by easy and open communication. Surrogates are women who’ve chosen to commit a year of their lives to help others become parents, and their expectations for a relationship with you vary just as much as yours will. It’s important to clarify the level of involvement you both wish to have in each other’s lives during this time. Having an agency support you through this journey only contributes towards its success.

Once all parties agree, a legal contract is issued, binding the agreement.

Step 3: The Surrogacy Contract and Legal Issues

Protecting the rights of all involved in the surrogacy process is vital. For this reason, a fertility lawyer must be retained to draft up a mutually agreed upon contract. The process of any embryo transfer can only begin once this contract has been carefully reviewed and signed by all involved. Completion of this step is exciting because it means that the medical process of surrogacy is about to begin!

Step 4: Getting Pregnant

The first step on the road to a healthy pregnancy involves IVF (in vitro fertilization), which typically produces several viable embryos. The strongest will be used first, and the others will be frozen for safekeeping in the event that additional transfers occur. The surrogate mother then begins the process of endometrial stimulation, meaning her womb is prepared to accept a pregnancy. For her, this involves two to three weeks of fertility treatments, as well as monitoring of her endometrial lining until the desired readiness. Successful achievement of pregnancy, therefore, heavily relies on these two factors, plus a measure of luck.

Step 5: The Pregnancy and Birth

A successful transfer that results in a viable pregnancy is an achievement to be celebrated! Now it is the job of your agency to support all of you until delivery. Intended parents generally wish to be present for the birth; moreover, their attendance in the hospital setting is necessary for the proper handling of the documents that establish parental rights. Your lawyer will see to it that all essential legal documentation is accounted for.

As the birth approaches, the intended parents are acutely aware of the window of time in which delivery is likely to happen. In places where surrogacy is more commonplace, the baby’s birth certificate will be issued to the intended parents outright.

By law, the surrogate mother and her husband/partner must be domiciled in South Africa. However, this is not a strict requirement, as the Court has the discretion to dispose of this requirement. This should, however, be discussed with your lawyer, in the application process.

It is important to note here that the surrogate mother does not have the option to cancel the agreement and obtain parental responsibilities and rights in a gestational surrogacy arrangement. The parental rights of the commissioning parents are confirmed by the Court.

It is a requirement of South African surrogacy law, that at least one of the commissioning parents be genetically linked to the child. This was recently confirmed in 2015 by the Constitutional Court in the case of AB and Other v Minister of Social Development.


The prospect of surrogacy—whether becoming a surrogate yourself or enlisting a surrogate to help build your family—is exciting. The experiences by all involved, though challenging, can be some of the most rewarding of your life. Taking the process one step at a time, especially when facilitated by caring professionals, ensures your understanding of what exactly is and is not involved. Ask yourself this: what other questions do I need to be answered in order to decide if this is the right path for me? Find out more about the surrogacy process here, should you wish to embark on the journey of a lifetime!

David Bull is the founder of MySurrogateMom, an online surrogacy community dedicated to everyone considering pursuing a surrogacy process in the US and Canada. He is a passionate advocate of surrogacy education and access for all seeking their third-party path to parenthood.