How Does Surrogacy Work? The Basics

Deciding to start a family is, for the majority of couples, a traditional and very conventional process. All it requires is the woman in the relationship to allow herself to become pregnant. Nine months later, an infant is born, and a new life can start together as a family.

Unfortunately, not every couple can follow this path, as there may be other factors that become challenging or even impossible obstacles to overcome. Same-sex partnerships with men, for example, mean that neither partner is biologically capable of carrying a baby through conventional pregnancy. In other circumstances, a woman may have a medical consideration, such as a heart condition, which means undertaking a pregnancy presents huge medical risks that would put both her and the baby in peril if attempted.

However, we don’t live in a world where couples in these situations must accept a life without children. Adoption is an ancient practice that is still very much in use today, and similar to it is the concept of surrogacy, but how does surrogacy work, especially in the 21st century?

Another Woman Helps

Adoption is the process of taking legal custody of a child that is already born. Surrogacy differs in that this practice is about another woman agreeing to become pregnant on behalf of a hopeful couple and then allowing the newborn to be introduced to that couple and become their child. Similar to adoption, this is a well-established practice dating back millennia and is even acknowledged as being in use in religious texts such as the Bible.

In the traditional practice of surrogacy, a woman who agreed to become a surrogate would use her own egg for fertilization and, back before the medical technology was perfected, was required to have sexual intercourse with the man in the couple to get the sperm necessary for fertilization and the development of an embryo that would eventually become a baby.

Today, however, the basics of surrogacy differ a lot from past practices.

Artificial Insemination

One of the biggest changes is the use of artificial insemination, which means that only donor sperm, not actual sexual intercourse, is now required. While the technique is now well documented, and it is even possible to attempt this at home, the best results still occur when using medical-grade equipment and experienced medical professionals.

Today, donor sperm can come from any desired source, including the hopeful father in the couple, another sperm donor entirely, or even sperm that has been cryogenically preserved because medical considerations require a man to have surgery that would make sperm generation no longer possible, so the surviving sperm was collected for future use.

In Vitro Fertilization

Another major change in modern surrogacy is what is known as the IVF technique. With IVF, both the sperm and egg come from a donor and are fertilized in a laboratory. Once fertilization has been confirmed, the egg is then implanted in a surrogate mother, and the conventional pregnancy path progresses from there.

This technique has two advantages. The key appeal is that it allows hopeful parents to have a baby that is an exact genetic descendant, just as through traditional childbirth, only the baby was carried to term in a surrogate mother’s body. The other advantage is with additional services, such as Preimplantation Genetic Diagnosis, multiple fertilized eggs can be screened for congenital diseases like sickle cell anemia or cystic fibrosis, ensuring that only an egg devoid of these family-passed conditions is used.

Surrogacy Types

Today, there are two types of surrogacy, but they are not legal in every country. “Altruistic surrogacy” is when a surrogate mother volunteers her role out of sheer generosity. Aside from having some living expenses and medical costs covered, she gets no financial gain from the surrogacy. 

“Compensated surrogacy,” however, means the surrogate mother gets significant financial recognition for her role. Generally, far more available candidates are found in those countries that permit compensated surrogacy, as there is a greater incentive to participate.

Travel Options

This leads to another major factor in surrogacy today, and that is how common it is for hopeful families to travel to other countries for surrogacy. In some cases, such as in the United Kingdom or Canada, this may be because a couple wants compensated surrogacy, but only altruistic surrogacies are permitted in their country. In other circumstances, cost may be a driving factor.

The United States, for example, has world-class medical facilities and staff, but at prohibitive price points for many. However, other countries offer competitive levels of quality medical care and staff, but at much lower prices due to economic, currency, and living standard differences.


Because of the greater frequency of couples undertaking surrogacy in other countries, proper legal protocol is more important than ever. By choosing to deal with a surrogacy center experienced in working with foreign couples, hopeful families can avoid the potential headache of returning home with a newborn only to find the child is not recognized as a citizen of the country and thus not allowed entry or residency.