How surrogacy agencies manage surrogates and intended parents: the 2026 guide
A surrogacy journey runs for a year or more and involves a surrogate, her family, one or two intended parents, a clinic, two attorneys, an escrow company, insurers and a hospital. The agency is the one party that holds it all together. This is how well-run agencies do it, stage by stage.
Short answer: Surrogacy agencies manage surrogates and intended parents as two parallel journeys that join at the match. Each side moves through seven stages: intake, screening, matching, legal and contracts, medical, pregnancy, and delivery and post-birth. A coordinator or case manager owns each journey, keeps a checklist of every step, document and payment, and communicates on a set rhythm with both sides. Good agencies keep everything about a person in one record (applications, documents, messages, appointments and history), give surrogates and intended parents their own portal, and use a surrogacy and egg donor agency platform or CRM so the next step starts on time instead of living in someone's inbox.
The model: two journeys and a match
The most useful way to think about surrogacy operations is that the agency is running two journeys at once. The surrogate's journey starts the day she applies and ends weeks after delivery, when she has recovered and been paid in full. The intended parents' journey starts with their first inquiry and ends when they take their baby home with the right legal paperwork. For a while the two run separately; then the match joins them, and from that point most steps involve both sides.
Agencies that run egg donation add a third journey, the donor's, which may join the same intended parents. Treating each person as their own record, and the match as a record that links them, is what keeps a growing caseload manageable. When the match is only a note on the surrogate's file, things fall through the cracks: whose turn it is, which contract version was signed, which payment is due.
The seven stages, step by step
1. Intake
Surrogates usually arrive through ads, search, referrals or recruiters and fill in an application. The best agencies reply the same day, often within minutes, with a welcome message and a link to book an intake call. The application asks the disqualifying questions early (age, BMI, at least one healthy pregnancy and delivery, smoking, stable home and support) so applicants who do not qualify find out quickly and kindly.
Intended parents arrive through inquiries, referrals from clinics and attorneys, or word of mouth. Intake is a consultation: their story, timeline, budget, whether they already have embryos, which clinic they use, and what they hope for in a surrogate. Many agencies sign a service agreement and take a retainer before matching.
2. Screening
For a surrogate, screening happens in layers: the intake call, prior pregnancy and delivery records, background checks for her and other adults in the home, often a home visit or video interview, and a psychological evaluation. Medical screening by the IVF clinic usually comes after the match, because the intended parents' clinic is the one that clears her. Most agencies follow the American Society for Reproductive Medicine (ASRM) recommendations for gestational carriers and add their own rules. Here is the screening process in detail.
For intended parents, "screening" is mostly readiness: embryos created or planned, a clinic chosen, the financial plan in place (most programs fund an escrow account), and, where the agency requires it, a consultation with a counsellor.
3. Matching
Coordinators compare both sides on the questions that cannot be compromised: views on termination and selective reduction, number of embryos to transfer, location and travel, insurance, compensation, and how much contact each side wants during and after the pregnancy. Profiles are shared, an introduction call is arranged (usually with a coordinator present), and each side tells the agency privately whether to proceed. When both say yes, the match is confirmed. More on how matching works.
4. Legal and contracts
After the match, the gestational carrier agreement is negotiated between the surrogate's attorney and the intended parents' attorney. ASRM recommends that each side has independent legal counsel, and most agencies require it. Alongside it: the agency's own agreements with each party, the escrow agreement, a review of the surrogate's health insurance (or a separate surrogacy policy), and often a life insurance policy for her. Medical steps that involve medication generally wait until the contract is signed and the escrow is funded.
5. Medical
The clinic medically clears the surrogate, then sets a calendar: medications, monitoring appointments, the embryo transfer, the pregnancy (beta) test, and early ultrasounds. Coordinators keep both sides informed, make sure the surrogate has her medications and travel arranged, and track each date. After a confirmed heartbeat and the first weeks of care, the clinic releases her to her own OB.
6. Pregnancy
This is the longest stage and the easiest to under-manage. Agencies check in with the surrogate on a set rhythm, keep the intended parents updated after each appointment, and confirm that compensation and reimbursements go out from escrow on schedule. Legal parentage is established before the birth where the law allows it (a pre-birth order in many US states; the process differs by state and country), and the agency helps both sides prepare a birth plan and a hospital plan: who will be in the room, who holds the baby first, where the intended parents will stay.
7. Delivery and post-birth
Around the due date the coordinator is on call, confirms the hospital has the parentage paperwork, and helps the intended parents with travel. After delivery come the birth certificate, any travel documents for international parents, the surrogate's postpartum care and recovery, final payments and reimbursements from escrow, and the close-out of the escrow account. Good agencies also follow up with the surrogate weeks later, send anniversary messages, and ask happy surrogates and families for referrals.
Who does what
- Intake coordinator: answers new applicants and inquiries, runs intake calls, and moves people through screening.
- Case manager or journey coordinator: owns a match from introduction to delivery and is the main contact for both sides.
- Matching lead (often the owner or director in smaller agencies): decides which profiles to share and makes introductions.
- Independent attorneys, one for each side: draft and negotiate the gestational carrier agreement and handle parentage.
- IVF clinic: medical screening, the transfer and early pregnancy care.
- Escrow company: holds the intended parents' funds and pays compensation and expenses.
- Mental health professional: the psychological evaluation, and support during the journey.
- Insurance specialist: reviews coverage and arranges policies where needed.
In a small agency one person may wear four of these hats. That is fine, as long as every step has a named owner and a due date, so the work does not depend on anyone's memory.
What to track at each stage
| Stage | Surrogate | Intended parents |
|---|---|---|
| Intake | Source (ad, recruiter, referral), application answers, flags, intake call booked | Inquiry source, consultation notes, service agreement, retainer |
| Screening | Records requested and received, background checks, home visit, psych evaluation | Embryo status, clinic, escrow plan, counselling |
| Matching | Profiles shared, viewed, interest, introduction call, decision | Profiles shared, viewed, interest, introduction call, decision |
| Legal | Attorney, contract drafts and signature, insurance review | Attorney, contract, escrow funded |
| Medical | Clearance, medications, appointments, transfer and beta dates | Clinic updates, embryo transfer plan |
| Pregnancy | Check-ins, OB appointments, payments and reimbursements | Updates sent, parentage order, birth and hospital plan |
| Post-birth | Recovery, final payments, follow-up, referral | Birth certificate, travel documents, escrow close-out |
Two things deserve tracking all the way through: where every person came from (so you know which recruiting brings surrogates who actually match and deliver, not just applications), and a full history of who did what and when (so a new coordinator can pick up a file without a handover call).
Communication and portals
Most complaints about agencies are really complaints about communication: "I haven't heard anything in two weeks." A few habits prevent almost all of them:
- A set rhythm. Agree how often each side hears from you at each stage (for example weekly during legal and medical, after every appointment during pregnancy) and stick to it, even when the update is "nothing new yet".
- One thread per person. Texts and emails with a surrogate belong on her record, not in a coordinator's personal phone, so anyone on the team can see the full conversation.
- Their language. Many surrogates and international intended parents are more comfortable in a language other than English. Translated messages build trust quickly.
- Reminders that send themselves. Appointment and medication reminders the day before and the day of, sent automatically, prevent missed dates.
- Portals. A private portal where surrogates, intended parents and donors see their own checklist, upload documents, sign contracts and message the team cuts the "any update?" messages dramatically, because the answer is already there.
Where journeys go wrong
- Slow first replies. An applicant who waits two days has usually applied somewhere else.
- Information in too many places. The application in a form tool, the contract in an e-sign tool, messages in three inboxes and the status in a spreadsheet. Every handover loses something.
- Steps with no owner. "Someone" requesting records means nobody does. Each step needs a person and a due date.
- Stale profiles. Intended parents judge an agency by the profiles it shares. Outdated photos and half-finished letters slow every match.
- Unmanaged waiting. Contracts, escrow and clinic calendars all involve waiting on someone else. Without a reminder, a two-week wait becomes six.
- Sensitive data handled casually. Medical records sent as email attachments and shared drive links that anyone can open put the agency and its clients at risk.
- Nobody measuring recruiting. Agencies that count leads instead of matched surrogates keep paying for the wrong ads.
The tools agencies use
Agencies run this work on one of three setups: spreadsheets, email and shared drives; a general CRM such as HubSpot, Salesforce, Zoho or Airtable with separate tools for forms, e-signatures, scheduling and texting; or purpose-built software made for surrogacy and egg donation. Whatever you choose, it should hold the seven stages above for each person, link the match, keep every message and document on the record, and give surrogates and intended parents a portal. See the options in detail.
How SurroHub handles it
SurroHub is a surrogacy and egg donor agency platform, built by people who run a surrogacy agency, for exactly the journey described above.
- Four profiles, one place. Surrogates, intended parents, egg donors and matches each get a complete profile: stage and sub-steps, every answer, document and message.
- Workflows that run themselves. Tick a step and the next one starts, messages go out on their own, and late steps are flagged before anyone has to ask.
- Profile sharing. Intended parents browse the surrogates and egg donors you share in their portal; surrogates browse families on their phone.
- Profiles that build themselves. Surro, the built-in AI assistant, lays out a polished profile from what is on file, ready to share as a link or PDF.
- Contracts and e-signatures, messaging in 38 languages, scheduling, and branded portals for surrogates, intended parents and egg donors.
- Live in about a week. Send your spreadsheets, files and forms in any format; we import them and set you up.
Want the facts in one place? SurroHub by the numbers: what it is, who built it, and what agencies run on it today.
See SurroHub for yourself
The surrogacy and egg donor agency platform: one place for surrogates, intended parents, egg donors and matches, with branded portals, workflows, e-sign contracts and a built-in AI assistant.
Frequently asked questions
How do surrogacy agencies manage surrogates and intended parents?
As two parallel journeys joined by a match. Each moves through intake, screening, matching, legal and contracts, medical, pregnancy, and delivery and post-birth. A coordinator owns each journey, tracks every step, document and payment, and keeps both sides updated on a set rhythm, usually in a surrogacy and egg donor agency platform or CRM with portals for each side.
How long does a surrogacy journey take from start to finish?
Often 12 to 24 months from a surrogate's application or an intended parent's first inquiry to delivery, depending on screening, how quickly a match is found, legal and clinic timelines, and whether the first transfer succeeds.
Who is the main contact during a surrogacy journey?
Usually the agency's case manager or journey coordinator, who is the point of contact for both the surrogate and the intended parents from the match through delivery.
Do surrogates and intended parents talk directly?
Many do, as much as both sides want. Agencies usually agree the level of contact during matching and stay involved in the conversation, especially around medical and legal steps.
What software do surrogacy agencies use to manage cases?
Spreadsheets, general CRMs adapted for surrogacy, or purpose-built surrogacy software such as SurroHub, which manages surrogates, intended parents, egg donors and matches in one system with workflows, e-sign contracts and portals.