Understanding the Different Types of Surrogacy
Surrogacy is an incredible way for families to grow, but it’s also often misunderstood. Whether you’re considering becoming a surrogate or exploring surrogacy as an intended parent, let us help you understand what the different types are, how they work, and what to expect medically and legally.
Here’s a clear breakdown of the most common forms of surrogacy and how they differ.
1. Gestational Surrogacy (the standard today)
This is the type used by almost all American surrogacy agencies, including Cove Family Co.
What it is:
The surrogate (sometimes called a gestational carrier) is not genetically related to the baby. Embryos are created through IVF using:
the intended parents’ genetic material, or
donor eggs and/or donor sperm, or
adopted embryos.
Medical requirements:
Gestational surrogates undergo:
A full medical screening at the intended parents’ IVF clinic
IVF medications to prepare the uterus for transfer
An embryo transfer procedure
Routine OB care throughout pregnancy
Why families choose it:
When intended parents are unable to carry for whatever reason they arrive at surrogacy, modern gestational surrogacy is legally clear and medically safe, and, because the carrier has no genetic tie to the child, avoids some of the pitfalls of traditional surrogacy.
2. Traditional Surrogacy (rare in the U.S.)
What it is:
The surrogate is genetically related to the baby - her own egg is used, and she becomes pregnant through IUI or IVF.
Medical requirements:
Depends on method:
IUI: fewer medications or none at all
IVF: similar medical process to gestational surrogacy
Why it’s rare:
More complex legal process
Higher emotional risk
Limited agency and clinic support, as most clinics and agencies in the U.S. do not offer traditional surrogacy
3. Compensated Surrogacy (most common in the U.S.)
What it is:
The surrogate receives base compensation for her time, commitment, and physical/emotional commitment to the process, along with reimbursement for pregnancy-related expenses.
Compensation recognizes:
lost wages
childcare needs during the journey
travel
maternity clothing
medical appointments
the physical demands of pregnancy
Medical requirements:
Same as gestational surrogacy (medical screening, embryo transfer, OB care).
Why families choose it:
This is the norm in the United States, and the process involves a clear, structured legal agreement that protects both surrogate and intended parents.
4. Altruistic Surrogacy (unpaid base compensation)
What it is:
The surrogate does not receive base compensation. She may still be reimbursed for pregnancy-related expenses like:
maternity clothes
lost wages
medical costs
travel
This type is typically seen in:
countries where compensated surrogacy is not legal (like Canada)
situations where a surrogate prefers not to be paid
close personal relationships (family-based or friend-based surrogacy)
Medical requirements:
Identical to compensated gestational surrogacy.
Considerations:
Even when unpaid, a legal contract and proper medical screening are absolutely essential.
5. Family or Friend Surrogacy (known surrogacy)
What it is:
The surrogate is someone who already has a personal relationship with the intended parents, like a sister, cousin, friend, coworker, or community member.
This can be either compensated or altruistic.
Medical requirements:
Similar to any gestational surrogacy journey: clinics still require full medical screening to ensure safety, but may be more lenient on the surrogate’s age.
Unique considerations:
Family/friend surrogacy can be deeply meaningful, but it’s essential to:
Have separate, independent legal counsel for both sides
Build a clear communication plan
Involve a mental health professional for psychological clearance
Boundaries and expectations matter even more when the relationship already exists.
Which Type Is Right for You?
Gestational Surrogacy
Genetic Link: No
Paid?: Usually yes
How Common?: Most common
Medical Process: IVF by IPs; full GC medical screening
Traditional Surrogacy
Genetic Link: Yes
Paid?: Either
How Common?: Rare
Medical Process: IUI or IVF; full screening
Compensated Surrogacy
Genetic Link: No
Paid?: Yes
How Common?: Most common
Medical Process: IVF by IPs; full GC medical screening
Altruistic Surrogacy
Genetic Link: No
Paid?: No
How Common?: Less common
Medical Process: IVF by IPs; full GC medical screening
Family/Friend Surrogacy
Genetic Link: Depends
Paid?: Either
How Common?: Less common
Medical Process: IVF by IPs; full GC medical screening
For most intended parents and surrogates in the U.S., compensated gestational surrogacy offers:
a legal framework
strong medical oversight
structured support for both parties
But for some families, altruistic or family/friend surrogacy offers an equally meaningful and more personal path.
At Cove, we help surrogates and intended parents understand their options, navigate requirements, and choose the best path for their individual circumstances. Connect with us to discuss your options today.
