When intended parents first start speaking with surrogacy agencies, the conversation usually begins with two practical questions: what will this cost, and how long will it take to find a surrogate? Those questions are important, of course, but over the years I have come to believe that they tell you very little about what the experience of working with an agency will actually be like once the journey begins.
Surrogacy is not simply a matter of finding a woman who is willing to carry a pregnancy. It involves medical records, fertility treatment, insurance, attorneys, escrow, psychological evaluation, communication between the intended parents and surrogate, and a great deal of coordination behind the scenes. For LGBTQ+ intended parents, there can also be questions about egg donation, legal parentage and how the laws of the state where the surrogate lives may affect the process.
I have worked with intended parents for more than 25 years, and one thing I have learned is that families are usually better served when they take some time at the beginning to understand how an agency operates rather than focusing only on how quickly the agency says it can get them started. Different agencies have different ways of working, and there is nothing wrong with that. What matters is whether you understand those differences well enough to decide what is right for you.
There are eight questions I think are especially useful when you are having those conversations.
1. What does your agency mean when it says a surrogate has been screened?
The word “screened” is used so often in surrogacy that intended parents can easily assume everyone means the same thing by it, when in reality that is not always the case.
If I were an intended parent reviewing a surrogate profile, I would want to know what the agency has actually looked at before deciding to present that person to me. Has her pregnancy history been reviewed? Have relevant medical records been requested or examined? Has the agency discussed her current health, medications, family support and whether she is genuinely ready to go through another pregnancy? Those details tell you much more than the word “screened” by itself.
It is just as important to understand what still needs to happen after a potential match is identified. Psychological evaluation, background checks, insurance review and the fertility clinic’s own medical evaluation may come later in the process. The fertility clinic ultimately determines whether a gestational carrier is medically cleared for embryo transfer, so an agency’s preliminary review should not be confused with final medical clearance.
I have seen intended parents become very excited about a profile before realizing that several important steps were still ahead. That does not necessarily mean there was a problem with the candidate. It simply means the family did not fully understand where she was in the process, which is why I think this question is worth asking very clearly at the beginning.
2. Why are you presenting this particular surrogate to us?
There is a big emotional difference between waiting for a surrogate and suddenly receiving a profile, especially for intended parents who may already have gone through years of fertility treatment. Once that profile arrives, it is understandable to feel that the journey is finally moving forward and to want to move quickly.
Still, I think it is worth asking why the agency chose to make that particular introduction.
There should be more to the answer than the fact that the surrogate is available. Where she lives, whether travel may be required, the support she has at home, her expectations about communication, her views about GWK Academy Contributor Article | Parham Zar | 2
appointments and delivery, and the kind of relationship she hopes to have with the intended parents can all become important as the journey develops.
I have seen families reach a point where they are so tired of waiting that almost any available match starts to feel like the right one. That reaction is completely understandable, but a thoughtful agency should be able to explain why it believes the people involved may actually work well together rather than simply bringing together two parties who happen to be ready at the same time.
3. How do you help intended parents and surrogates decide whether they are compatible?
Medical eligibility is one thing. Personal compatibility is something else entirely.
Two people can both be perfectly appropriate for a surrogacy journey and still have very different ideas about what that journey should look like. Some intended parents want frequent contact and hope to attend as many appointments as possible. Others are comfortable with a relationship that is warm but somewhat more independent. A surrogate may have her own expectations about communication, travel, who will be present at appointments, how delivery will be handled and what kind of relationship she would like to maintain after the baby is born.
There is no single correct way for that relationship to look. What matters is whether everyone has talked honestly enough to know what the other side expects.
Over the years I have found that many of the difficult moments in surrogacy do not begin with a major disagreement. More often, they begin with small assumptions that were never discussed because everyone believed they were on the same page. Taking the time to talk through those issues before matching may feel unnecessary when everyone is excited, but it can make an enormous difference later.
4. What happens if the original plan does not work out?
No one begins a surrogacy journey hoping to talk about failed transfers, rematching or unexpected changes, but these are exactly the things that should be understood before signing an agreement.
A potential match may decide not to proceed. An embryo transfer may not result in a pregnancy. A surrogate may become unable to continue with the journey, or the intended parents and surrogate may simply realize before transfer that the relationship is not the right fit.
Programs can handle these situations very differently, so I would want to know what happens if another match becomes necessary. Does the program include a rematch, and under what circumstances? Would there be another agency fee? Is there a limit on the number of embryo transfers included? If a family needs a different surrogate, does the existing program continue or does the process essentially start again?
It is much easier to have this conversation when everything is going well than when a family has just experienced a disappointment. In my experience, one of the best ways to understand a surrogacy program is to ask the agency to explain not only how things work when everything goes according to plan, but also what happens when they do not.
5. How will the money for the journey be managed?
Intended parents naturally spend a great deal of time thinking about the surrogate match, because that is the most personal part of the process. Financial administration often feels much less interesting, but it deserves the same attention.
I would want to understand who holds the funds intended for surrogate compensation and expenses, whether an independent escrow provider is involved, how payments are authorized and what type of accounting information the intended parents will receive along the way. It is also useful to know how reimbursements are submitted and what happens if there is a question or disagreement about an expense.
The important issue is not simply the name of the escrow company. Intended parents should understand where their money is being held, who has authority to release it and how they will be able to follow what is happening with those funds throughout the journey.GWK Academy Contributor Article | Parham Zar | 3
Most of the time, these procedures happen quietly in the background, but when something unexpected occurs, having a clear financial structure can prevent a great deal of unnecessary confusion.
6. How will the legal and parentage process be coordinated for us?
For LGBTQ+ intended parents, I think legal planning should be discussed relatively early rather than treated as something that can wait until pregnancy.
Where a surrogate lives can affect how the legal process is handled, and the circumstances of the intended parents may also affect the parentage work that needs to be completed. That is one of the reasons I believe geography is more than just a question of travel convenience when considering a potential match.
The agency should not be giving legal advice. That belongs to qualified reproductive attorneys, and the surrogate should have appropriate independent legal representation as well. What the agency should be able to explain is how the legal process fits into the broader journey and when the different professionals become involved.
As an intended parent, I would want to know when attorneys are brought into the process, how the contract stage is coordinated, when parentage planning begins and what needs to be completed before the fertility clinic can proceed with embryo transfer.
LGBTQ+ parents have already had to navigate many systems that were not originally designed with their families in mind, so there is no reason for important questions about parentage to come as a surprise halfway through a surrogacy journey.
7. Who will actually be managing our journey once we sign?
This is a very practical question, and I think it is one that intended parents sometimes forget to ask because they naturally focus on the person sitting across from them during the initial consultation.
The person who introduces the agency may not be the person handling the day-to-day work after you become a client. I would want to know who my primary contact will be, how that person communicates with the surrogate, who follows up with the fertility clinic, and who keeps track of legal, insurance and escrow milestones as the journey moves forward.
It is also worth asking what happens if there is a misunderstanding between the parties, if an important document is delayed or if the primary coordinator is unavailable.
Some of the best work an agency does is almost invisible. A medical record is followed up on before anyone has to ask about it. The clinic receives the information it needs before the next appointment. An attorney, surrogate and intended parent are all working from the same information before an important deadline.
After many years in this field, I have found that delays and frustration are often caused not by one dramatic mistake, but by small gaps in communication between people who each assumed someone else was handling the next step. That is why the quality of day-to-day coordination matters so much.
8. Which parts of the budget may change during the journey?
When intended parents compare agency estimates, it is very easy to focus on the final number at the bottom of the page. The problem is that two estimates can be prepared in very different ways, so comparing those totals alone may not tell you which journey is actually likely to cost less.
I would ask which expenses are fixed, which are estimates and which depend on circumstances that cannot be known at the beginning. Insurance, travel, lost wages, childcare, legal work, pregnancy-related expenses, additional embryo transfers and rematching may all be handled differently depending on the program.
Families are sometimes surprised by costs that were always possible but were not discussed clearly at the beginning. Often it is not one large expense that changes the budget, but several smaller ones that accumulate over time.
If one estimate looks significantly lower than another, that does not automatically mean there is anything wrong with it, but I would want to understand why the difference exists. Sometimes the program really is less GWK Academy Contributor Article | Parham Zar | 4
expensive. In other cases, certain expenses may simply appear elsewhere or may not have been included in the initial estimate.
The purpose of a budget should be to help intended parents understand what they may realistically encounter, not simply to present the most attractive number during the first meeting.
Making the Final Decision
After you have asked these questions and compared the answers, there is still a part of choosing an agency that is difficult to put into a spreadsheet.
You are deciding who you may be speaking with for a year or longer, through periods of excitement, waiting, uncertainty and sometimes disappointment. I would pay close attention to whether the people you are speaking with are willing to explain complicated issues rather than giving you easy answers, and whether what they tell you during the consultation is consistent with what you later see in the written agreement.
I also think it is useful to imagine the relationship several months into the future. If something unexpected happened, would you feel comfortable calling these people and having a difficult conversation with them? Would you trust them to explain what had happened and what the realistic options were?
Different families will ultimately choose different agencies, and that is as it should be. There are many ways to structure a successful surrogacy journey. The important thing is to understand the process you are entering, feel comfortable with the people who will be coordinating it and know enough to make the decision with your eyes open.
About the Author
Parham Zar is the founder of Egg Donor & Surrogacy Institute (EDSI), a U.S. surrogacy and egg donation agency that has helped support family building journeys for more than two decades. He works closely with intended parents, surrogates, reproductive attorneys, fertility clinics, and escrow providers throughout the United States and internationally.
Learn more at https://eggdonorandsurrogacy.com
