How Does the U.S. Surrogacy Process Proceed After Matching With a Surrogate? A Complete Guide From Medical Screening and Legal Agreements to Embryo Transfer

After matching with a surrogate, the journey continues through five stages: medical screening and evaluation (approximately 4–5 months), the legal agreement and notarization, medication and uterine lining preparation, embryo transfer, and finally prenatal care and delivery.

Author: RSMC Editorial Team | Medically reviewed by Dr. David Harari, President and Chief Medical Officer | Last updated: August 14, 2026

• Step 1: Surrogate Medical Screening and Evaluation

• Step 2: Legal Agreement and Notarization

• Step 3: Medication and Uterine Lining Preparation

• Step 4: Embryo Transfer

• Step 5: Prenatal Care and Delivery

• Frequently Asked Questions About U.S. Surrogacy Matching

Successfully matching with an ideal gestational surrogate is one of the moments prospective parents look forward to most. However, matching is actually the beginning of the formal surrogacy process—not the end.

After a successful match, the surrogate must complete medical screening, the intended parents and surrogate must finalize the legal agreement, medications and uterine lining preparation must be completed, and only then can the embryo transfer take place.

Understanding what happens after matching can help prospective parents know what to expect at every stage. At RSMC, a dedicated team coordinates each step and helps ensure that the entire process is connected and well managed.

Step 1: Surrogate Medical Screening and Evaluation

After a successful match, the surrogate will undergo comprehensive medical examinations and evaluations over approximately 4–5 months. Her physicians will assess her overall health and determine whether she is medically suitable for pregnancy.

This step is critical to ensuring a safe and successful pregnancy journey. If the surrogate does not pass the required medical screening, RSMC—an organization with its own surrogate candidate database—will provide a replacement at no additional matching fee, helping ensure that the pregnancy is entrusted to a medically qualified surrogate.

Step 2: Legal Agreement and Notarization

Once the surrogate successfully completes the medical screening, both parties proceed to the legal process. Experienced attorneys will assist the intended parents and surrogate in drafting and signing the surrogacy agreement, clearly defining the rights, responsibilities, and protections of both parties. The necessary notarization and legal procedures will then be completed.

This stage establishes important legal protections, including the intended parents’ parental rights and responsibilities concerning the baby. The legal process is one of the most important foundations of a U.S. surrogacy arrangement. It should never be skipped or rushed.

Step 3: Medication and Uterine Lining Preparation

After the legal agreement and required legal procedures have been completed, the physician can begin preparing the surrogate for embryo transfer. During this stage, medications are used to prepare and regulate the surrogate’s uterine lining so that it reaches an appropriate condition for embryo implantation. Medication preparation follows a specific treatment schedule and must be coordinated closely with the fertility clinic.

Step 4: Embryo Transfer

Once the surrogate’s uterine lining is ready, the embryo transfer will be scheduled. After the transfer, the surrogate enters the waiting period before pregnancy testing. Blood tests and follow-up ultrasound examinations are then used to determine whether implantation has occurred and to monitor for the development of a fetal heartbeat.

Step 5: Prenatal Care and Delivery

Once pregnancy is confirmed, routine prenatal care and delivery will generally take place at a hospital or medical facility in the surrogate’s local area. RSMC’s dedicated client manager provides weekly pregnancy updates in Chinese, allowing intended parents to stay informed about the surrogate’s latest pregnancy status.

RSMC also helps intended parents keep track of important prenatal milestones, supports appropriate communication between the intended parents and surrogate, and assists with preparations for traveling to the United States to welcome the baby as the due date approaches.

Frequently Asked Questions About U.S. Surrogacy Matching

Q1: What is the first step after successfully matching with a surrogate?

A: After a successful match, the first step is generally to confirm the surrogate’s medical screening and evaluation. This process takes approximately 4–5 months.

Once she is confirmed to meet the medical requirements, the parties proceed to the legal agreement process. After the necessary legal procedures are completed, the surrogate can begin medication preparation, uterine lining preparation, and eventually embryo transfer.

In simple terms: Surrogate Matching → Medical Screening → Legal Process → Medication Preparation → Embryo Transfer

Q2: What happens if the surrogate does not pass the medical screening? Can I change surrogates after she passes?

A: The purpose of medical screening is to help ensure the safety of the pregnancy journey. If a surrogate does not pass the required medical evaluation, RSMC will assist in selecting a replacement surrogate at no additional matching fee.

Even after the medical screening has been successfully completed, a replacement may generally still be requested before the legal process begins, without an additional replacement fee. Specific terms should be confirmed according to the applicable service agreement.

Q3: If I have special requirements for the surrogacy arrangement, can the attorney include them in the contract?

A: Yes. If intended parents have specific requests concerning pregnancy-related lifestyle matters, medical arrangements, or other aspects of the surrogacy arrangement, these can be raised during the legal contract discussion.

The attorney will evaluate the request based on applicable local laws, the terms of the agreement, and the specific circumstances. If both parties reach an agreement, appropriate provisions may be incorporated into the surrogacy contract.

However, not every request can automatically be included in a contract, and the intended parents cannot unilaterally require a surrogate to accept particular terms.

Whether a provision can be included, how it should be worded, and what remedies may apply in the event of a breach should be determined by qualified legal counsel based on the individual case and applicable law.

For this reason, intended parents with specific requirements should raise them before signing the agreement, rather than waiting until after pregnancy has begun.

Q4: Can I choose which embryo to transfer?

A: Yes. Before the transfer, the fertility clinic will generally ask the intended parents to confirm which embryo is planned for transfer.

In the United States, embryo selection based on sex may be legally permitted in certain circumstances, including when conducted in accordance with applicable laws and medical considerations. If the intended parents do not make a specific selection, the clinic may generally recommend an embryo based on embryo quality and the physician’s assessment.

A single-embryo transfer is generally preferred to reduce pregnancy-related risks. If intended parents are considering a twin pregnancy, they should discuss this with their fertility physician in advance and confirm that the selected surrogate is medically appropriate and willing to carry a twin pregnancy.

Q5: What happens if the embryo transfer is unsuccessful?

A: If pregnancy does not occur following embryo transfer, the medical team will first evaluate the outcome and then discuss the next treatment steps with the intended parents.

Depending on the circumstances, another cycle of preparation may be required before a subsequent embryo transfer. The specific approach will depend on the surrogate’s health, the embryos remaining, and the physician’s medical assessment.

Therefore, an unsuccessful transfer does not necessarily mean that the entire surrogacy journey has failed. It may simply mean that additional medical evaluation and another transfer are needed.

The timing, costs, and arrangements associated with another transfer should be determined according to the individual service agreement and treatment plan.

Under RSMC’s standard surrogacy program, an additional transfer fee may apply following an unsuccessful transfer. If a surrogate replacement is required, additional legal fees and reimbursement of certain surrogate-related expenses already incurred may also apply.

For families who choose RSMC’s surrogacy success program, additional costs following an unsuccessful transfer may be substantially reduced or covered under the terms of the program. For detailed information, please contact our consultant.

Q6: What happens if the surrogate becomes pregnant but the pregnancy does not proceed normally?

A: If the pregnancy involves a miscarriage, pregnancy loss, fetal development issues, or another medical complication, the surrogate’s medical team will first conduct the necessary medical evaluation and treatment.

Whether another embryo transfer should be scheduled after a recovery period, whether additional testing is needed, and how the next stage should proceed will depend on the surrogate’s recovery, the physician’s recommendations, and the status of the remaining embryos.

Intended parents should also review their surrogacy agreement or service plan to understand what provisions apply in situations involving unsuccessful implantation, miscarriage, or the need for another embryo transfer, including any applicable costs and subsequent arrangements.

Q7: Can I meet the surrogate in person?

A: To protect the privacy of both surrogates and intended parents, communication is generally coordinated through a dedicated client manager rather than through direct contact. During pregnancy, intended parents can communicate their thoughts, concerns, and care for the surrogate through the client manager.

Before the surrogate begins her approximately 4–5 months of medical screening, RSMC can arrange a video call between the intended parents and the surrogate. This gives both parties an opportunity to discuss how they would like to communicate in the future, their expectations during pregnancy, and their thoughts regarding pregnancy-related lifestyle matters.

If the expectations or communication styles of both parties are not compatible, RSMC can assist with selecting another surrogate. For many intended parents, establishing good communication and mutual trust is ultimately more important than whether they meet in person.

Q8: How can I make sure the surrogate does not smoke or drink alcohol and maintains a healthy diet and lifestyle during pregnancy?

A: This is an important concern for many intended parents. Before entering the treatment process, surrogates generally undergo relevant background and medical evaluations. Once pregnancy begins, they continue to receive regular prenatal medical care.

Smoking, alcohol consumption, and the use of illegal drugs are prohibited under applicable laws and contractual requirements. Other matters concerning diet and lifestyle can be discussed in advance and, where legally and practically appropriate, addressed through the surrogacy agreement and pregnancy management process.

It is important to remember that the surrogate remains an autonomous adult. Pregnancy should not be viewed as a situation in which intended parents have complete control over every aspect of the surrogate’s life. Instead, appropriate pregnancy management should be established through mutual agreement, legal provisions, medical supervision, and ongoing communication.

Q9: What happens if the surrogate does not follow the pregnancy-related requirements in the contract?

A: If there is a suspected violation of the surrogacy agreement, intended parents should avoid directly confronting the surrogate and should notify the service team and relevant legal counsel as soon as possible.

The attorney can review the agreement and applicable local laws to determine whether a breach has occurred and what actions may be available.

This is why it is particularly important to clearly define important pregnancy-related requirements before the contract is signed, including which matters constitute agreed-upon obligations and how disputes should be handled if they arise.

Let RSMC Guide You Through Every Step

From matching and medical screening to legal agreements and embryo transfer, every stage of U.S. surrogacy has its own professional requirements and timeline.

With nearly 30 years of experience in assisted reproductive medicine, RSMC Reproductive Science Medical Center works with professional medical and legal teams to coordinate each stage of the journey.

A dedicated team keeps you informed of important milestones and proactively coordinates the process, allowing you to move forward with greater confidence and peace of mind throughout this important journey.

Please feel free to contact us anytime; let us help fulfill your dream of motherhood. Please add us on: Line/WeChat: rsmctw, WhatsApp: +1 858-342-6046.