Many individuals and families around the world use surrogacy to start a family. From 1999 to 2013, nearly 31,000 Americans had a baby through surrogacy. There are many reasons people choose surrogacy, including infertility, health complications, being in a same-sex relationship, or being single.
“The average cost of surrogacy for U.S.-based intended parents is $100,000, but it can cost as little as $15,000 or as much as $250,000,” says MaryJane Carnahan, a former intended parent and the founder of The Biggest Ask, a surrogacy advocacy community. According to surrogacy lawyer Amira Hasenbush, J.D., MPH, the total cost “varies significantly by many different factors,” like location, insurance coverage, and whether you use an agency.
- In the United States, surrogacy can cost upwards of $100,000.
- Health insurance for the intended parents does not extend to a surrogate. Also, many health plans exclude coverage for gestational carriers.
- Fertility grants can help offset some of the costs associated with infertility and adoption.
Average Cost of Having a Baby via Surrogacy
There are two types of surrogacy: traditional and gestational. A gestational carrier is not biologically related to the child; they carry the fetus through pregnancy and give birth to the baby for the intended parent(s). The gestational carrier is compensated by the intended parent(s) and does not have any parental rights to the child. A traditional surrogate contributes their own egg and, therefore, is considered one of the child’s biological parents. Traditional surrogacy is less common because of the legal and psychological complexities, but it can be less expensive.
The average cost of having a baby via surrogate will vary widely based on a variety of factors like location, age, and insurance coverage. For Hasenbush’s clients based in Los Angeles, surrogacy can cost $100,000 to $200,000.
The two types of surrogacy each require their own procedures that affect the overall cost. Egg retrieval and embryo transfer are required for gestational carriers but not traditional surrogacy. Traditional surrogacy, on the other hand, may require additional legal fees to make adoption and custody arrangements.
Breakdown of Typical Surrogacy Costs
Medical expenses, compensation, and legal fees are all significant factors that affect the total cost of surrogacy. Many surrogacy processes begin with some form of egg or sperm freezing, then in vitro fertilization (IVF). Some families require multiple rounds before they are successful in conceiving. These combined costs contribute to the overall price.
Fertility Tests and Treatments
Some surrogacies begin with a series of fertility tests for intended parents and health screenings for gestational carriers. “Screening and health tests for the surrogate are completed by the intended parents’ fertility clinic and are about $4,000–$7,000. This is never covered by the intended parents’ medical insurance,” Carnahan explains.
In surrogacy, eggs can be fertilized via IVF, mentioned above, or intrauterine insemination (IUI). Generally, IUI is significantly less expensive than IVF, which is a complicated, resource-intensive procedure that involves several steps, like egg collection and fertilization in a laboratory, that IUI does not. For that reason, one round of IUI costs $500 to $4,000, while IVF can cost $20,000.
Intended parents pursuing traditional surrogacy can use either IUI or IVF. Gestational surrogacy, however, requires in vitro fertilization.
If the intended parents need to also pay for egg donation, Hasenbush notes that part can cost more than $7,000. The Advanced Fertility Center of Chicago advertises an egg donor fee of $7,000 to $9,000, plus $400 for short-term health insurance for the donor. On top of that, intended parents may need to pay storage fees until the eggs are used. Some companies will offer one year of free egg storage and charge up to $500 for every subsequent year. Having family or friends donate eggs or sperm can help reduce these costs.
Surrogate Compensation and Insurance
This fee can also vary widely. According to Hasenbush, “Surrogate base compensation can vary from free, if they are a friend or family member, to upwards of $50,000 for an experienced surrogate.” Different regions across America have different compensation trends. In Hasenbush’s experience, “West Coast surrogates tend to have higher base compensations than those in the South or Midwest.” The hopeful parents may be asked to pay the surrogate’s insurance premiums, which could run $500 to $1,000 a month.
Some states, like Michigan, expressly prohibit gestational surrogate compensation. Others, like Louisiana, do not explicitly prohibit compensation but enforce laws that make it impracticable. Make sure to consult state laws before entering any surrogacy agreement.
Surrogacy agencies offer a variety of services. Agencies match surrogates to intended parents, offer screening services to ensure both parties are mentally, physically, and emotionally prepared for the process, and coordinate logistics between medical professionals and attorneys. While it is optional to work with a surrogacy agency, those who choose to use one should expect to spend $15,000 to $30,000, according to Hasenbush.
Attorneys draft the surrogacy contract, which outlines each party’s financial and behavioral obligations. For example, the contract may oblige intended parents to reimburse the surrogate for maternity wear or require that the surrogate abstains from cigarettes and alcohol for the duration of the pregnancy. Attorneys also arrange legal custody.
Legal fees vary based on the type of agreements needed, and each law practice can charge as much or as little as they like. Hasenbush says families should budget around $6,000 to $10,000 for legal fees, “depending on whether they need an egg donor agreement” and any state requirements.
Labor and Delivery
The average cost of childbirth in a U.S. hospital is about $14,000. If the surrogate has health insurance, much of that will be covered by the insurance company, but the intended parent(s) will typically pay deductibles, co-pays, and co-insurance. If the surrogate does not have insurance, the intended parents can purchase a maternity-only or short-term policy.
Becoming pregnant is not a qualifying life event, meaning that it will not make an uninsured surrogate eligible to enroll in coverage through the Health Insurance Marketplace outside of the annual open enrollment period.
There are many other small factors to consider that can add up. Having multiple children like twins or triplets will increase costs significantly, as will a cesarean birth, hospitalization for the surrogate or infant, travel or transport, and any postpartum complications. Hasenbush adds that if the surrogate works, they may require compensation for lost wages and may ask the intended parents to pay for life insurance.
What Does Health Insurance Cover?
Health insurance companies are starting to expand coverage to fertility treatments, but many require a physician’s confirmation that the insured is experiencing infertility.
Fifteen states require insurers to cover infertility treatment, and two states require insurers to offer coverage, though there’s no guarantee that the exact services you need will be covered, and your plan being subject to those laws depends on factors like the size of your employer and where your policy was written. Instead, health insurance plans may cover just one of the steps in the surrogacy process, such as fertility tests, egg or sperm freezing, implantation, or artificial insemination. These procedures, like any other medically necessary procedure, are subject to deductibles, co-pays, and co-insurance, and may be less expensive with an in-network provider.
These days, an increasing number of employers are adding fertility coverage to their health plans. Fertility benefits are more common among large employers with 20,000 or more employees, and almost all plans impose caps like lifetime maximum dollar benefits or a limit on the number of covered IVF cycles.
A gestational carrier covered by Medicaid should be aware that their compensation may make them ineligible for subsidized insurance. However, if they do lose Medicaid coverage, they would qualify for an Affordable Care Act special enrollment period.
To learn more about whether your insurance covers infertility treatments, contact your insurance provider’s Member Services. Note that even major insurance carriers have different websites based on the state and the plan, so look specifically for the websites that apply to your coverage.
If the surrogate already has health insurance, their insurance may cover their own prenatal care and birth costs. However, some insurance providers exclude gestational surrogate charges, in which case the intended parents could provide the surrogate coverage. According to ART Risk Solutions, intended parents could purchase a short-term policy for $2,400 to cover the surrogate until marketplace open enrollment, or a maternity-only policy that costs $25,000 to $35,000 for one baby and $40,000 to $50,000 for twins.
How to Pay for a Surrogate
Many couples save for years before they feel financially fit to pay for surrogacy. Many surrogacy agents also have financial counselors who help parents weigh their options among savings, loans, and grants.
Surrogacy expenses are not eligible for reimbursement with a flexible spending arrangement (FSA) or a health savings account (HSA).
Despite hefty penalties, some people choose to dip into their retirement savings, like 401(k) plans or thrift savings plans (TSPs), to cover surrogacy costs. Others may choose to borrow against their home, either with a home equity line of credit (HELOC) or a home equity loan. These options may be tempting because they seem to be less expensive than paying with a credit card, but they can jeopardize the financial security of both parent(s) and child.
If borrowing is the only way to finance surrogacy, it is best to look for low-interest unsecured personal loans with a realistic repayment period. Fertility financing is available from a variety of lenders.
Grants can also help people to expand their families by assisting with some surrogacy expenses. Fertility Within Reach has a comprehensive list of available grants. For LGBTQIA+ couples and individuals, Family Equality maintains a list of family-building grants that assist with the costs of adoption or assisted reproductive technology (ART). And The Broken Brown Egg awards an annual $10,000 grant to defray the costs of adoption or fertility treatments for one Black, Indigenous, and people of color (BIPOC) couple or individual.