How to Choose an Ethical Surrogacy Agency

Choosing a surrogacy agency is a big decision. Whether you’re someone considering becoming a Surrogate or an Intended Parent hoping to grow your family, you’re not just choosing a company to help you through the process; you’re choosing the people who will be beside you through one of the most personal, emotional, and sometimes unpredictable experiences of your life.

I say that as someone who has been on both sides of the process. Before I ever worked in the surrogacy field, I was a Surrogate myself. I remember what it felt like to put my trust in an agency and hope that the people behind the scenes would be there when I needed them. Now that I work in the field, I have a completely different appreciation for everything that goes into supporting a Surrogate and Intended Parents throughout a journey.

One of the biggest things I’ve learned is that an ethical surrogacy agency isn't necessarily the agency with the flashiest website, the biggest promises, or even the highest compensation. It’s the agency that has built its entire process around protecting the people involved. It's easy for an agency to tell you what you want to hear during an initial consultation. What matters much more is what actually happens after you've signed on and the journey gets real.

So, What Actually Makes a Surrogacy Agency Ethical?

The word ethical gets used a lot in surrogacy, but I think it’s important to really think about what it means. To me, ethical surrogacy means transparency, informed consent, appropriate screening, fair treatment, respect for medical autonomy, and having support available when things don't go exactly as planned. Surrogacy isn't predictable. You can have a wonderful match, a great plan, and everything lined up perfectly, and then a transfer doesn't work. A pregnancy can become more complicated than expected, communication can become difficult, or a medical decision can bring up emotions that nobody anticipated.

That’s why I always tell people to look beyond how an agency presents itself when everything is going well. The real test is how an agency shows up when things get hard. When you're interviewing agencies, don't just listen to what they promise. Pay attention to the systems they have in place to support you, protect you financially, and make sure you understand what you're agreeing to before you ever move forward.

Start With Financial Transparency

For a Surrogate, compensation is obviously an important part of the decision. You are committing your time, your body, your pregnancy, and potentially dealing with appointments, medications, time away from work, and all of the other realities that come with being pregnant. But I would encourage you not to choose an agency simply because it advertises the highest compensation number. Take the time to understand what that number actually includes, how payments are protected, who manages the escrow account, and what happens if something unexpected occurs during your pregnancy.

For Intended Parents, financial transparency is just as important. You want to know where your money is going, what is included in your program, and what expenses could potentially come up along the way. This is why I think it’s worth asking whether an agency uses an independent, licensed and bonded escrow provider and whether it offers an all-inclusive or fixed-fee program designed to provide greater financial certainty throughout the journey.

An all-inclusive program doesn't mean you should skip the fine print, though. You should still understand exactly what is covered, what isn't, and what happens if the journey takes an unexpected turn. You should ask what happens financially if a medical complication arises, a transfer doesn't work, or a match needs to be changed. Nobody wants to think about those possibilities when they're just getting started, but they are important questions to ask before signing anything. You want to know what protections are in place and whether you could suddenly be responsible for expenses you weren't expecting.

The goal isn't necessarily to find the most affordable agency or the agency with the biggest number attached to it. The goal is to understand your financial commitment before you sign anything. You should never feel like you're going to discover surprise expenses months into your journey that nobody explained to you in the beginning.

Screening Matters More Than a Checkbox

One of the biggest concerns I hear from Intended Parents is, "How do I know the agency isn't overlooking something just to get us matched?" That's a completely fair question, and it's one that agencies should be comfortable answering.

When an agency tells you a Surrogate is "fully screened," you should be able to understand what that actually means. Medical screening should involve a thorough review of pregnancy and delivery history, reproductive health, medical records, infectious-disease testing, and other factors that may affect someone's ability to safely carry a pregnancy. Psychological screening is also an important part of the process, because surrogacy isn't just a physical commitment. It is a major emotional and psychological decision, and prospective Surrogates should have the opportunity to understand the experience and make an informed choice.

I also think it's worth asking whether an agency has multiple layers of screening rather than having one person review an application and check a box. At Hatch, for example, medical records are reviewed as part of the screening process, including pregnancy, delivery, fertility treatment, and gynecological records, with involvement from medical professionals including a reproductive endocrinologist. That kind of additional review can provide another layer of confidence that important information isn't being missed.

It's also okay to ask what happens if something concerning comes up during screening. Who reviews it? Is additional information requested? Are medical professionals involved? An agency should be comfortable explaining its process. Thorough screening shouldn't be about getting someone matched as quickly as possible. It's about making sure everyone has the information they need to make an informed decision.

Of course, no screening process can guarantee that a pregnancy will be complication-free. That's simply not realistic. What thorough screening can do is identify known concerns, make sure appropriate professionals have reviewed the information, and allow both the Surrogate and Intended Parents to make decisions with as much information as possible. If you're a woman considering becoming a Surrogate and are still learning about the process, reading more about how to become a Surrogate can also help you understand what screening and the overall journey may look like.

The same philosophy should apply when egg donation is part of the journey. Intended Parents should feel comfortable asking how egg donors are screened medically, genetically, and psychologically, who reviews those results, and what happens if additional information comes to light. Good screening isn't about finding a "perfect" person; it's about making sure the people involved have the information they need to make informed decisions.

Your Attorney Should Be Looking Out for You

Another area where I don't think there should be any gray area is legal representation. The Surrogate and Intended Parents should have separate, independent attorneys. Even though everyone is working toward the same ultimate goal, each person has different interests and needs to protect, and your attorney's job should be to look out for you.

Surrogacy contracts can cover compensation, medical decisions, insurance, expenses, parentage, travel, pregnancy complications, and much more. Surrogacy laws can also vary significantly from state to state, which is why having an attorney who understands reproductive law and the laws applicable to your specific journey is so important. An agency can help coordinate the legal process, but it should never replace your ability to receive independent legal advice.

It's also worth asking how the agency handles state-specific parentage orders and other legal documents after the baby is born. These details may not be the first thing you think about when you're dreaming about the journey ahead, but they matter. Having the right legal professionals involved from the beginning can help everyone understand what to expect and avoid unnecessary surprises later.

The Support You Receive Can Make All the Difference

This is probably one of the biggest lessons I took away from being a Surrogate myself. You don't always realize how important support is until you actually need it. When you're comparing agencies, it's easy to focus on compensation, matching timelines, agency fees, and success stories. Those things matter, but I would also want to know who is going to be there when something unexpected happens.

Who is your case manager? Who do you call when you have a question? How involved is the agency once you've been matched? What happens if you're placed on bed rest? What if a transfer doesn't work? What if you're having a difficult time emotionally? What if communication between the Surrogate and Intended Parents becomes strained?

A strong agency should have dedicated support systems and experienced professionals who understand the medical side of surrogacy. Clinical coordinators can help keep the many moving pieces of a journey organized and communicate with fertility clinics and reproductive endocrinologists, while still allowing the medical professionals to make the actual medical decisions. Emotional support is important, too. Surrogacy can be an incredibly positive experience, but that doesn't mean every moment is easy, and an ethical agency should recognize that.

When you're interviewing agencies, don't be afraid to ask what support looks like after the match is made. Anyone can make you feel important during the initial consultation. What matters is whether you continue to feel supported once the journey is actually underway. I would even ask what happens if there is a crisis in the middle of the journey. Who do you call? How quickly does someone respond? Is there someone who can help coordinate the different pieces if something becomes complicated?

You don't need an agency to promise that nothing will go wrong. You just want to know that if something does happen, you won't suddenly be left trying to figure everything out on your own.

The Right Match Is About More Than Availability

Matching is another area where an agency's philosophy really becomes apparent. A Surrogate shouldn't feel like she's being presented with the first Intended Parents who happen to be available, and Intended Parents shouldn't feel like they're being handed a Surrogate and told to make it work.

A thoughtful matching process considers things like communication styles, personalities, expectations, medical and legal considerations, and what everyone hopes their relationship will look like. Shared-values questionnaires and conversations can help identify those areas before people commit to moving forward. At Hatch, the matching process considers compatibility and shared preferences rather than simply matching people based on availability.

I think that's incredibly important because both sides need to be comfortable saying yes. A match shouldn't feel like a sales pitch where everyone is trying to convince you that this is the person you need to choose. It should feel like the beginning of a relationship that both sides have had an opportunity to consider and genuinely want.

And if either side isn't comfortable, they should be able to say no without feeling guilty or pressured. Mutual consent should be at the center of the matching process.

Don't Forget to Pay Attention to How the Agency Treats Surrogates

This is something I notice differently now because I've lived it. Listen to how an agency talks about its Surrogates. Are they treated as partners in the process? Does the agency respect their medical autonomy? Are they encouraged to ask questions and speak up when something doesn't feel right? Are they allowed to say, "I'm not comfortable with that," without feeling like they're putting the entire journey at risk?

An ethical surrogacy agency understands that the Surrogate isn't simply the person carrying a baby for someone else. She is a patient, a person, and an active participant in the journey. Her health, her informed consent, and her voice should remain important throughout the entire pregnancy. That should never be something she has to negotiate for.

Fair treatment also means making sure a Surrogate understands her compensation, her contract, her responsibilities, and her rights before she agrees to move forward. She should have independent legal representation and should never feel pressured to accept something simply because she is worried about losing a match. At the same time, Intended Parents deserve to know that the Surrogate they are matched with has entered the process willingly and with a clear understanding of what she's agreeing to.

At the same time, Intended Parents deserve to feel respected and protected, too. Ethical surrogacy isn't about one side "winning." It's about creating a process where everyone understands their rights, responsibilities, and choices and feels comfortable moving forward.

Ask What Happens When Things Don't Go According to Plan

This may be my favorite piece of advice for anyone interviewing agencies: don't just ask about their success stories. Ask what happens when things go wrong.

What happens if the first transfer doesn't work? What happens if a match falls apart? What happens if a Surrogate develops a medical complication? What happens if someone needs additional emotional support? What happens if the journey takes longer or costs more than expected?

You don't need an agency to promise that nothing will ever go wrong. In fact, I'd be more comfortable with an agency that acknowledges that unexpected things can happen and can clearly explain how they handle them. That's what you want to hear. Not promises of perfection, but a plan.

A good agency should be able to explain how it handles rematching, additional medical needs, financial changes, communication challenges, and other situations that can arise. You don't have to assume something will go wrong, but you should know that if it does, you won't suddenly be left trying to figure everything out on your own.

This is also where an all-inclusive program can be worth looking at closely. If an agency offers one, ask exactly what is included, what isn't, and how unexpected situations are handled. An all-inclusive program can provide greater financial predictability, but you should still understand the terms before signing anything. The important thing is knowing what you're paying for and what protections are available if the journey takes an unexpected turn.

Take Your Time Choosing

If there's one thing I would tell my former-Surrogate self or anyone starting this process today it would be this: you don't have to choose an agency just because you're excited to get started.

Interview more than one. Ask questions. Understand the fees. Find out how screening works. Ask who will actually be there for you. And pay attention to how you feel during those conversations. Do you feel heard? Do you feel rushed? Do you feel like you're being given honest answers, even when those answers aren't necessarily what you hoped to hear? Those little things can tell you a lot.

If you're an Intended Parent and you're still figuring out whether surrogacy is the right path for your family, it can also be helpful to learn more about the pros and cons of surrogacy and how surrogacy compares with other family-building options, such as surrogacy versus adoption. And if you're an Intended Parent getting ready to begin the process, a surrogacy requirements checklist for Intended Parents can help you understand what to expect before getting started.

Choosing an Agency Is Really About Trust

At the end of the day, choosing an ethical surrogacy agency isn't about finding the agency that says all the right things. It's about finding an agency that has built its process around doing the right things and, just as importantly, continues to be there when things don't go exactly as planned.

For Intended Parents, I think it's helpful to look at the whole picture rather than focusing on one number or one promise. How long has the agency been doing this? How thorough is its screening process? Who are the medical and legal professionals involved? How are finances handled? And what kind of support can you expect once the journey actually begins?

Those are some of the things that stand out to me about Hatch. With more than 35 years of experience, a reported 99%+ success rate, top-5% screening of Surrogates and egg donors, partnerships with world-renowned reproductive doctors, and an all-inclusive Peace of Mind Program, Hatch has built its program around many of the areas I believe Intended Parents should consider when choosing an agency. No agency can promise that every journey will be perfect, and no amount of experience can eliminate the unexpected. What matters is having the experience, systems, professionals, and support in place to help navigate those moments when they happen.

As a former Surrogate, I know what it feels like to put your trust into this process. Now, working on the professional side, I have an even greater appreciation for how much goes on behind the scenes to support a successful journey. There are medical professionals, attorneys, escrow professionals, coordinators, counselors, fertility clinics, and so many other people involved in making this process work. But at the center of all of it are real people who deserve to feel protected, respected, informed, and heard.

That's really what ethical surrogacy comes down to for me. It's a partnership where the Surrogate deserves to feel supported and valued, Intended Parents deserve to feel informed and confident in the process, and everyone deserves to know that when something unexpected happens, they won't be left to figure everything out alone. I wouldn't look for perfection, because no surrogacy journey can promise that. I would look for trust, transparency, support, and an agency that has the experience and commitment to still be there if the journey gets complicated.