Surrogacy: costs, countries, and what to prepare for

In 2023, an estimated 20,000 to 25,000 children were born through surrogacy worldwide. The exact figure is unknown — there is no global registry. That fact alone says something about the industry: it is global, poorly standardised, and regulated in radically different ways from one country to the next. For male same-sex couples, surrogacy isn’t just a medical procedure. It’s a legal, financial, and emotional project that typically spans eighteen months to two years — with the medicine being just one part of it. And the first thing to understand is this: the country where you live and the country where the procedure happens are two separate legal spaces, each with its own rules. How it works: the medical side Surrogacy for a male couple almost always involves two donors: an egg donor and a surrogate (who carries the pregnancy but has no genetic connection to the child). This is called gestational surrogacy. The standard sequence: Egg donor selection — through a bank or agency. The donor undergoes medical and genetic screening, ovarian stimulation, and egg retrieval. Fertilisation — sperm from one or both partners (separately or mixed, depending on preference) fertilises the donor’s eggs in a laboratory. IVF and preimplantation testing — embryos are cultured for 5–6 days and, if needed, undergo PGT-A (chromosomal screening) or PGT-M (testing for specific genetic conditions). Embryo transfer to the surrogate — after her endometrium has been prepared. Usually a single embryo is transferred. Pregnancy and birth — in the country where the procedure takes place. Parents typically travel closer to the due date. Documentation — obtaining the child’s birth certificate and passport in the birth country, then establishing legal parenthood in the home country. Each of these steps is a separate procedure, a separate contract, and a separate set of costs. Where it’s possible for same-sex couples Data as of early 2025. Laws change — consult a lawyer in both the country where the procedure will take place and your country of residence before making any decisions. ‘Available’ and ‘safe’ are not the same thing. Countries with lower-cost programmes often offer fewer legal protections. That’s not an argument against them — it’s an argument for thorough legal preparation. What the costs actually include The price tag on surrogacy is one of the most confusing parts of the whole process, because agencies often publish a ‘base’ cost that leaves out half of what you’ll actually spend. Here’s what goes into the real total: Medical costs Egg donor stimulation and retrieval: $3,000–8,000 Fertilisation and embryo culture: $3,000–6,000 PGT-A (if performed): $2,000–4,000 per batch of embryos Endometrial preparation and embryo transfer: $2,000–4,000 Surrogate’s prenatal care: included or billed separately — always check Delivery: $2,000–15,000 depending on country and whether a C-section is involved Compensation and reimbursements Surrogate’s compensation: $15,000–40,000 (country-dependent; altruistic programmes cover expenses only) Egg donor compensation: $5,000–20,000 Surrogate’s health insurance for the pregnancy: $2,000–8,000 Legal and agency fees Agency fees (coordination, surrogate matching): $15,000–35,000 Legal fees in the country of procedure: $3,000–8,000 Legal fees in your home country: $2,000–6,000 Additional documentation costs: variable Everything else Flights and accommodation (multiple trips): $3,000–10,000 Contingency reserve: advisable to set aside $10,000–20,000 Realistic total in the US: $120,000–180,000. In Canada and the UK — lower, partly because the surrogate receives no commercial payment, but with higher operational costs. In countries with less developed regulatory frameworks — lower entry cost, higher legal and contingency risk. The part most people get wrong: recognition at home This is where most couples make their most expensive mistake: they research the law in the country where the procedure will take place, and don’t research the law in the country where they plan to live. A German couple completes a surrogacy arrangement in California. The child is born in California with two legal fathers — established by US court order before birth. The couple returns to Germany. Germany does not recognise surrogacy — and does not automatically recognise the American court order establishing fatherhood. The biological father is recognised as a parent through DNA testing. The non-biological father must adopt the child through German family courts. This takes between one and one and a half years. During that time, he has no legal parental status on German soil. The same dynamic plays out in France, Spain (for surrogacy specifically), and Belgium. Every country has its own rules for recognising parenthood established abroad. A consultation with a lawyer in your home country is not optional. It’s a required step — one to take before starting any procedure, not after. The emotional side: what the brochures don’t say The surrogacy process is long and full of uncertainty. It’s not a straight line from A to B — it’s a journey with pauses, setbacks, and a lot of waiting. Finding a surrogate can take weeks or months. Not every candidate meets the medical criteria; not every match feels right. The first embryo transfer may not result in pregnancy. Success rates per transfer run at roughly 40–60%, depending on donor age and embryo quality. Prepare for the possibility of a second attempt. Distance and control. For most of the pregnancy, you’ll be in another country — dependent on someone you barely know, in a situation you can’t directly manage. That’s a particular kind of hard. The relationship with the surrogate is its own conversation. Expectations vary enormously: some surrogates want to stay in touch after birth; others prefer not to. This should be discussed and written into the contract before anything begins. Studies consistently find that couples who go through surrogacy describe it as harder than they expected — and more right than they could have imagined. Three things to do before you start Consult a lawyer in your home country about how parenthood will be recognised when you return. Before the process begins, not after. Both partners should do expanded carrier screening — the results affect which egg donor you choose (see our article on carrier screening). Get multiple independent quotes from agencies — and ask for a complete breakdown of all costs, not just the headline figure. The gaps between what’s included and what isn’t can run to tens of thousands of dollars. This article is for educational purposes only and does not constitute medical or legal advice. Costs and legislation are as of early 2025.