Gestational surrogacy has become more visible and more frequently used in the United States. At the same time, the process has become more complex.
Intended parents are being asked to compare agency fees, surrogate compensation packages, insurance assumptions, legal procedures, candidate availability and reported success rates. Those comparisons are difficult because the same terms are not always defined in the same way.
A candidate profile may not show whether medical records have been collected.
A quoted price may not identify the costs most likely to change.
A “screened” surrogate may not yet have been reviewed by the intended parents’ fertility clinic.
A success rate may not explain whether it counts matches, embryo transfers, pregnancies, deliveries or babies.
The most important trend in 2026 is therefore not only the continued use of gestational surrogacy. It is the growing demand for clearer information, better-prepared candidates and more reliable coordination across the entire journey.
This overview examines the trends most relevant to intended parents considering a U.S. surrogacy journey.
Originally published May 19, 2026. Substantially updated July 29, 2026.
Research reviewed through July 24, 2026
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U.S. gestational carrier activity has increased substantially
Reported gestational carrier activity has increased over the long term.
SART figures published by the American Society for Reproductive Medicine increased from 1,539 reported gestational carrier cycles in 2004 to 11,515 in 2023.
That represents an increase of approximately 648 percent across the period.
These numbers show substantial growth, but they require context.
A cycle does not necessarily represent:
- One unique intended-parent family
- One gestational carrier
- One match
- One pregnancy
- One delivery
- One baby
- One completed surrogacy journey
One family may be associated with more than one embryo-transfer cycle, and one cycle may not result in pregnancy or delivery.
Historical growth also does not prove that activity will continue increasing at the same rate. Future use may be affected by intended-parent demand, gestational carrier availability, fertility-clinic capacity, insurance, state law, economic conditions and changes in reproductive medicine.
View the ASRM Gestational Carrier Policy Report
Important national figures
The latest finalized CDC national assisted reproductive technology data available at the research cutoff cover 2022.
The CDC reported:
- 435,426 ART cycles
- 94,039 live-birth deliveries
- 98,289 live-born infants
- 9,734 embryo-transfer cycles involving gestational carriers
- Gestational carriers used in 4.7 percent of reported embryo-transfer cycles
- An overall single-embryo-transfer rate of 85.9 percent
The 85.9 percent single-embryo-transfer figure applies to all reported ART transfers. It is not a gestational-carrier-specific success rate.
Review the CDC National ART Summary
Explore CDC Assisted Reproductive Technology Surveillance
Intended parents represent many different circumstances and family structures
Gestational surrogacy is not limited to one diagnosis or one type of family.
Intended parents may include:
- People who do not have a uterus
- People with uterine conditions that prevent or complicate pregnancy
- People for whom pregnancy would create a serious health risk
- People who have experienced repeated pregnancy loss
- People who have experienced unsuccessful fertility treatment
- Couples using donor eggs, donor sperm or donor embryos
- LGBTQIA+ families
- Single parents
- Intended parents who already have embryos
- Intended parents who still need egg donation and embryo creation
- International intended parents pursuing treatment in the United States
Available national data do not provide a complete count of unique intended-parent families or consistently identify relationship status, sexual orientation, gender identity, citizenship, income, donor use or whether a treatment cycle ultimately became a completed journey.
The important trend is not that one intended-parent group has replaced another.
It is that the U.S. surrogacy process must now support a wide range of medical histories, embryo circumstances, family structures, communication preferences and legal needs.
Families who are still determining their pathway can review the U.S. surrogacy process for intended parents.
International intended parents remain part of the U.S. surrogacy landscape
International participation is one component of the broader intended-parent population.
A published SART study examining 40,177 gestational carrier embryo transfers from 2014 through 2020 found that international intended parents accounted for 32 percent of the transfers included in that study.
Their share increased from 22 percent in 2014 to 39.8 percent in 2019, before declining to 31.8 percent in 2020.
These figures describe the study population and period. They are not a current 2026 market-share estimate and should not be used to describe every U.S. surrogacy arrangement.
International journeys may involve additional coordination concerning:
- U.S. state law
- Home-country legal requirements
- Citizenship
- Passports
- Travel
- Birth certificates
- Newborn insurance
- Immigration documents
- Clinic selection
- Communication across time zones
- Return-home planning
International intended parents are important, but this article and the complete report are not written only for international families.
The larger trends involving candidate readiness, medical review, costs, compensation, insurance, escrow, legal procedures and agency transparency affect both U.S. and international intended parents.
Read EDSI’s Guide to International Surrogacy in the United States
Candidate preparation matters more than profile volume
Intended parents are often encouraged to compare agencies by the number of surrogate profiles available.
Profile volume may be relevant, but it does not show whether a candidate’s pregnancy history has been reviewed, whether supporting records have been collected, or whether she appears compatible with the intended parents’ fertility clinic.
Before recommending a candidate, an agency should be able to explain:
- What pregnancy and delivery information has been reviewed
- Which records have been collected and which remain missing
- Whether prior pregnancy complications require further review
- Why the candidate may fit the intended parents’ circumstances
- What still needs to be decided by the fertility clinic and other independent professionals
The strongest matching process is not simply a marketplace with the greatest number of profiles. It is a structured recommendation process that explains why a candidate is being presented, what information is available, and what questions remain unresolved.
Learn How to Find a Surrogate in the United States
Review the Questions Intended Parents Should Ask a Surrogacy Agency
A surrogate profile is not the same as a clinic-ready file
Terms such as “screened,” “approved,” “qualified” and “available” are sometimes used as though they mean the same thing.
They do not.
An applicant is someone who has expressed interest or submitted an application.
Agency preliminary qualification means the candidate appears to meet the agency’s initial program criteria.
A match means the intended parents and candidate have agreed to explore a journey together.
A clinic-ready file is an organized submission that gives the intended parents’ fertility clinic enough available information to begin a meaningful medical review.
Medical clearance means the fertility clinic has completed the review required under its standards and has determined whether the candidate may proceed.
A clinic-ready file is not medical clearance.
Depending on the candidate and the clinic, a prepared file may include:
- Pregnancy and delivery history
- Obstetric records
- Hospital records
- Current health disclosures
- Medication information
- Prior pregnancy complications
- Pap smear documentation
- OB clearance documentation
- Insurance information
- Lifestyle disclosures
- Missing records
- Questions requiring clinic review
The fertility clinic determines medical eligibility.
An agency can prepare the file, identify missing information and coordinate communication. It should not represent its preliminary review as the clinic’s medical decision.
Medical screening reduces avoidable risk, but pregnancy is never risk-free
Gestational carriers are generally considered because they have previously experienced pregnancy and have a history that may be appropriate for another pregnancy.
Careful screening can identify medical histories, pregnancy complications and other factors requiring additional review.
It cannot guarantee that a future pregnancy will be uncomplicated.
Potential pregnancy, delivery and postpartum concerns may include:
- Hypertensive disorders
- Placental complications
- Preterm delivery
- Cesarean delivery
- Postpartum hemorrhage
- Pregnancy loss
- Severe maternal complications
- Postpartum recovery needs
Published studies use different populations, countries, definitions and comparison groups. Their findings should not be treated as an individual prediction for one gestational carrier.
They do support the importance of:
- Complete pregnancy and delivery records
- Individualized fertility-clinic review
- Specialist consultation when appropriate
- Informed participation
- Insurance review
- Clear communication
- Delivery planning
- Postpartum follow-up
The gestational carrier remains the source of consent for her medical care during fertility treatment, pregnancy, delivery and aftercare.
Read the ASRM Recommendations for Practices Using Gestational Carriers
Review the ASRM Ethics Opinion on Gestational Carriers
Single embryo transfer remains an important safety trend
The assisted reproductive technology field has moved substantially toward transferring one embryo at a time.
The CDC reported that the percentage of embryo transfers involving one embryo increased from 20.6 percent in 2011 to 85.9 percent in 2022.
This is a national measure for all reported ART embryo transfers. It is not specific to gestational carrier cycles.
Single embryo transfer is important because transferring more than one embryo increases the possibility of multiple pregnancy. Multiple pregnancy can increase health risks for the person carrying the pregnancy and for the resulting infants.
The treating fertility physician determines the appropriate embryo-transfer plan for each case.
There is no single authoritative national average for surrogacy cost
One of the most important findings for intended parents is that there is no authoritative national average for the complete cost of a U.S. gestational surrogacy journey.
Published totals often use different assumptions.
One estimate may include embryo creation. Another may assume the intended parents already have embryos.
One estimate may include insurance premiums, deductibles, travel, legal work, escrow, lost wages and newborn expenses. Another may exclude several of those categories.
One estimate may assume a successful first embryo transfer. Another may account for additional transfers or a rematch.
A headline number has limited value unless the assumptions behind it are visible.
A clearer estimate should identify:
- The program scenario
- Services included
- Services excluded
- Number of embryo transfers assumed
- Gestational carrier compensation
- Legal expenses
- Escrow expenses
- Insurance assumptions
- Travel
- Newborn-related expenses
- Rematch expenses
- Additional-transfer expenses
- Funding schedule
- Costs that may not have a reliable maximum
For a detailed explanation of the categories involved, read EDSI’s U.S. Surrogacy Cost Guide.
Five useful cost categories
A transparent estimate separates expenses into five groups.
Fixed costs
Costs established by an agreement or fee schedule.
Expected costs
Expenses normally anticipated for the selected journey scenario.
Variable costs
Expenses that may change based on the candidate, clinic, location, insurance or treatment plan.
Contingent costs
Expenses triggered by a particular event, such as additional transfers, bed rest, lost wages, complications or a rematch.
Costs without a reliable maximum
Expenses for which a reliable maximum may not be available, including certain medical, hospital, newborn, travel or complication-related costs.
Surrogate compensation cannot be compared by base pay alone
Gestational carrier compensation is one component of the total journey budget.
A complete package may include:
- Base compensation
- Monthly allowances
- Medication or transfer payments
- Maternity clothing
- Travel
- Childcare
- Lost wages
- Partner travel or lost wages
- Bed-rest support
- Multiple-pregnancy compensation
- Cesarean-delivery compensation
- Life insurance
- Health-insurance premiums
- Postpartum expenses
- Other reimbursements required under the agreement
Published compensation figures are difficult to compare when one agency advertises only base compensation and another combines base compensation, allowances, reimbursements and conditional benefits.
There is no authoritative national 2026 compensation average that consistently compares every part of the package.
Intended parents and prospective gestational carriers should therefore ask:
- What amount is base compensation?
- Which payments are guaranteed?
- Which payments depend on an event?
- Which items are reimbursements rather than compensation?
- What is available only after confirmed pregnancy?
- What changes for an experienced carrier?
- What expenses require documentation?
- How and when are payments released from escrow?
Insurance requires three separate reviews
The phrase “surrogacy insurance” can be misleading because several separate coverage questions are involved.
Gestational carrier maternity coverage
This concerns prenatal care, pregnancy, delivery and postpartum medical care for the gestational carrier.
Intended-parent fertility benefits
This concerns IVF, embryo creation, medication, testing, laboratory services and embryo transfer.
Newborn coverage
This concerns medical care for the baby after birth.
A policy that covers one category does not necessarily cover the other two.
Insurance review may require examination of:
- The actual policy or plan documents
- Exclusions
- Enrollment periods
- Deductibles
- Co-insurance
- Network requirements
- Employer-plan rules
- Maternity provisions
- Newborn enrollment requirements
- Coverage changes during the journey
An agency may help gather information and coordinate the review. It should not guarantee that a policy will provide coverage.
Read EDSI’s Guide to Insurance in Surrogacy
Independent escrow remains an important financial safeguard
Journey funds should be administered through an independent third-party escrow arrangement under the applicable agreements.
The escrow provider’s role is separate from the agency’s role.
Independent escrow can support:
- Separation of responsibilities
- Documented payment procedures
- Timely payments
- Clear account records
- Reduced conflicts of interest
- Expense reconciliation
- Greater visibility for intended parents and the gestational carrier
The exact funding requirements and payment procedures depend on the legal agreements and the escrow provider.
The agency may coordinate milestones and documentation. It should not be the only party controlling, approving and distributing the journey funds.
U.S. surrogacy law remains state-specific
The United States does not have one comprehensive federal gestational surrogacy statute.
Legal feasibility and parentage procedures may be affected by:
- The gestational carrier’s state
- The intended parents’ residence
- The fertility clinic’s location
- The expected place of delivery
- The genetic relationship of the parties
- Marital or relationship status
- Citizenship
- International considerations
- State statutes
- State court procedures
- Hospital documentation requirements
Some states have detailed laws governing gestational carrier agreements.
Other states have limited statutory guidance or rely more heavily on court procedures.
Certain jurisdictions restrict particular arrangements or may treat some agreements as void or unenforceable.
A simple list of “surrogacy-friendly states” cannot replace review by a qualified reproductive attorney.
The intended parents and the gestational carrier should have independent legal representation.
Attorneys determine contract requirements, legal feasibility and parentage procedures. An agency coordinates communication and tracks milestones but does not provide legal advice.
Journey timing should be explained as stages, not one guaranteed average
There is no authoritative national dataset establishing one average amount of time from the first intended-parent consultation through delivery.
The timeline can be affected by:
- Candidate availability
- Intended-parent preferences
- Fertility-clinic criteria
- Medical-record collection
- Candidate medical review
- Psychological evaluation
- Legal agreements
- Insurance
- Escrow funding
- Cycle scheduling
- Embryo-transfer results
- Pregnancy loss
- Rematching
- Pregnancy and delivery circumstances
A more useful timeline explains the stages of the process without promising that every family will complete them within the same number of months.
Major stages of a U.S. surrogacy journey
- Intended-parent consultation
- Candidate search and recommendation
- Candidate introduction and mutual match
- Fertility-clinic review
- Psychological and legal processes
- Insurance and escrow preparation
- Cycle preparation
- Embryo transfer
- Pregnancy
- Delivery and parentage procedures
- Postpartum follow-up
Review the Complete U.S. Surrogacy Process
Agency transparency is becoming more important
Terms such as “success rate,” “match rate,” “screening rate” and “average time to match” may sound objective.
They are meaningful only when the organization explains:
- What was counted
- The denominator
- Reporting dates
- Inclusion criteria
- Exclusion criteria
- Treatment of pending cases
- Treatment of rematches
- Treatment of unsuccessful transfers
- Treatment of duplicate participants
- Missing data
- Correction procedures
For example, a high “match rate” could mean:
- The percentage of accepted intended parents who eventually matched
- The percentage of candidates who matched
- The percentage of introductions that became matches
- The percentage of profiles viewed that received interest
Those are different measures.
Intended parents should ask agencies to define claims rather than relying only on the percentage displayed.
Intended parents who are comparing programs can also review EDSI’s guide to leading surrogacy agencies in the United States and the screening, matching, financial, legal, and communication standards that can help distinguish one agency structure from another.
The strongest agency model is not simply a profile marketplace
The central question is not how many profiles an agency can display.
It is whether the organization can prepare, explain, coordinate and follow through.
A strong coordination model should help intended parents understand:
- Why a candidate is being recommended
- What information has been reviewed
- What records remain missing
- Which questions remain unresolved
- Which professional is responsible for each decision
- What happens when information changes
- How legal, insurance and escrow milestones are tracked
- What happens after an unsuccessful transfer
- What happens if a rematch becomes necessary
- Whether support continues through delivery and postpartum follow-up
A fertility clinic determines medical eligibility.
Attorneys determine legal rights and procedures.
Mental health professionals conduct their professional assessments.
Insurance professionals evaluate coverage.
Escrow providers administer journey funds.
The agency’s responsibility is to prepare information, coordinate communication, track milestones and help make the handoffs between those professionals more reliable.
Read About the Architecture of Protection in Surrogacy
The EDSI Coordination Model
Egg Donor & Surrogacy Institute operates through a structured, transparency-focused coordination model.
Preparation before presentation
EDSI conducts a preliminary candidate review and organizes available pregnancy, delivery and supporting records before fertility-clinic review.
Personalized candidate recommendations
Candidates are considered in relation to the intended parents’ circumstances, fertility-clinic criteria, communication preferences, location, timing and practical needs.
Clear professional responsibilities
EDSI distinguishes its coordination work from the decisions made by fertility clinics, attorneys, mental health professionals, insurance professionals, escrow providers and other independent professionals.
Reliable handoffs
Important information, unanswered questions and professional milestones are tracked across the journey.
Transparent cost communication
Financial discussions identify assumptions, inclusions, exclusions and contingencies rather than relying only on one unexplained total.
Continued involvement
EDSI remains involved through matching, professional review, treatment, pregnancy, delivery and postpartum follow-up.
Respect for autonomy and privacy
The gestational carrier remains responsible for decisions concerning her medical care. Participant information should be handled carefully and shared only as appropriate for the journey.
What the 2026 trends mean for intended parents
The most useful questions in 2026 are more specific than:
- How many surrogates do you have?
- How quickly can I match?
- What is the total cost?
- What is your success rate?
Intended parents should also ask:
- How does the agency decide which candidate to recommend?
- What records are collected before presentation?
- What does “screened” mean at this agency?
- Which costs are fixed, variable or contingent?
- Who holds and administers the journey funds?
- What happens after an unsuccessful transfer or rematch?
- Who coordinates clinic, legal, insurance and escrow milestones?
- Does the agency remain involved through delivery and postpartum follow-up?
These questions do not eliminate uncertainty.
They make the uncertainty easier to see before the intended parents make a commitment.
Download the Intended Parent Surrogacy Readiness Checklist
Request the complete 2026 report
This article provides an overview of the developments affecting U.S. gestational surrogacy.
The complete EDSI 2026 U.S. Gestational Surrogacy Trends and Transparency Report examines:
- National gestational carrier activity
- Intended-parent demographics
- Gestational carrier participation
- Medical screening
- Clinic-ready files
- Matching and case coordination
- Costs and compensation
- Insurance
- Escrow
- State-law variation
- Parentage
- Pregnancy and delivery outcomes
- Postpartum care
- Ethics and consumer protection
- Agency measurement
- Privacy and responsible AI use
- The evolving U.S. surrogacy model
The report includes 11 chapters, consolidated findings, figures, methodology, data limitations, operational frameworks and references.
It was prepared for intended parents, gestational carriers, fertility clinics, professional partners, journalists and others seeking a more transparent view of U.S. gestational surrogacy.
Request the Complete 2026 U.S. Gestational Surrogacy Trends and Transparency Report
Frequently asked questions
Is gestational surrogacy increasing in the United States?
Reported gestational carrier activity has increased substantially over the long term.
SART figures published by ASRM increased from 1,539 reported gestational carrier cycles in 2004 to 11,515 in 2023.
These figures count cycles. They do not represent 11,515 unique families or completed journeys.
What is the average cost of surrogacy in the United States in 2026?
There is no authoritative national average covering every U.S. surrogacy journey.
The total depends on the program scenario, embryo status, compensation package, fertility treatment, insurance, legal work, escrow, travel, number of transfers, pregnancy events, delivery expenses and whether a rematch becomes necessary.
A useful estimate should clearly identify its assumptions, inclusions, exclusions and contingencies.
What is the average surrogate compensation in 2026?
There is no authoritative national average that consistently compares base compensation, allowances, benefits, reimbursements and contingent payments.
Base compensation alone does not describe the complete package.
Does an agency medically clear a surrogate?
No.
An agency may conduct a preliminary review and organize the candidate’s information and records.
The fertility clinic determines medical eligibility and treatment clearance.
What is a clinic-ready file?
A clinic-ready file is an organized submission that gives the intended parents’ fertility clinic enough available information to begin a meaningful medical review.
It is not medical clearance.
Are surrogacy laws the same in every state?
No.
The United States does not have one comprehensive federal gestational surrogacy statute. Contracts, legal feasibility and parentage procedures depend on the jurisdictions connected to the arrangement.
Does insurance cover a surrogate pregnancy?
Coverage depends on the specific policy, plan documents and circumstances.
Carrier maternity coverage, intended-parent fertility coverage and newborn coverage are separate questions.
Who is this report intended for?
The report was prepared for U.S.-based and international intended parents, gestational carriers, fertility clinics, professional partners, journalists and others seeking a clearer understanding of U.S. gestational surrogacy. It addresses couples, single parents, LGBTQIA+ families, people with existing embryos and families who still require egg donation or embryo creation.
How long does a surrogacy journey take?
There is no single national timeline that applies to every case.
Timing can be affected by the candidate search, medical-record preparation, clinic review, legal agreements, insurance, embryo-transfer outcomes, rematching, pregnancy and delivery circumstances.
What should intended parents compare when selecting an agency?
Intended parents should compare more than available profile volume.
They should examine candidate preparation, clinic compatibility, recommendations, cost assumptions, insurance coordination, independent escrow, legal handoffs, rematch procedures, pregnancy support and how the agency defines its performance claims.
Speak with Egg Donor & Surrogacy Institute
A private consultation gives intended parents an opportunity to discuss:
- Their family-building circumstances
- Embryo status
- Fertility-clinic requirements
- Candidate preferences
- Timing
- Financial considerations
- Communication expectations
- The type of relationship they hope to have with a gestational carrier
EDSI can also explain its candidate-preparation, recommendation, matching and journey-coordination process.
Begin with a Private Consultation
Learn About EDSI’s Services for Intended Parents
About Parham Zar
Parham Zar is the Managing Director of Egg Donor & Surrogacy Institute.
His work focuses on intended-parent education, candidate preparation, personalized recommendations, gestational carrier support and coordination among the independent professionals involved in egg donation and surrogacy journeys.
Sources and further reading
CDC Assisted Reproductive Technology Surveillance
ASRM Gestational Carrier Policy in the United States
ASRM Recommendations for Practices Using Gestational Carriers
ASRM Ethics Opinion on Gestational Carriers
This article is an educational overview. Medical eligibility and treatment decisions are made by the fertility clinic. Legal advice and parentage planning are provided by qualified independent attorneys. Insurance coverage is determined by the governing plan and the responsible insurance professionals.
