A gestational surrogacy journey involves overlapping medical, practical, emotional and legal processes. Fertility clinics and surrogacy agencies often work closely, but they perform different jobs. Understanding where one organisation’s role ends and another begins helps intended parents and prospective surrogates choose the right team and avoid dangerous gaps.
The short answer: The fertility clinic manages medical screening, embryos, medication and embryo transfer. The surrogacy agency usually manages introductions, logistics, professional coordination and ongoing support. They exchange authorised information, track milestones and help ensure that medical, psychological and legal requirements are complete before treatment.
Neither organisation should replace independent lawyers, mental-health professionals, obstetric clinicians, insurance specialists or an independent escrow provider where those services are required.
Different roles within one journey
The clinic and agency work toward the same overall objective, but their professional responsibilities are distinct.
- Fertility clinic: determines medical eligibility, manages assisted-reproduction treatment, handles embryos and provides clinical consent and care.
- Surrogacy agency: recruits or introduces potential matches, conducts initial pre-screening, coordinates appointments and provides case-management support.
- Independent lawyers: advise each party separately, prepare or review the agreement and plan legal parentage.
- Mental-health professional: provides evaluation, implications counselling and ongoing emotional support within their scope.
- Escrow and insurance specialists: manage financial administration and insurance questions when engaged.
Our guide to what a surrogacy agency does explains these boundaries in more detail.
Stage one: initial planning and referrals
Intended parents may approach either an agency or a clinic first. An agency can help them understand the broad journey, identify professionals and prepare for matching. A clinic can review reproductive history, discuss embryo creation or existing embryos and explain its gestational-carrier requirements.
When organisations have worked together before, they may already understand each other’s documents and timelines. That can improve administration, but it should not restrict choice. Ask whether referral relationships involve fees or commercial arrangements and whether you may choose other qualified providers.
Stage two: agency pre-screening
Before a prospective surrogate is introduced, the agency may review identity, age, location, pregnancy history, motivation, lifestyle, support and practical availability. Depending on its policies and local law, it may also coordinate background checks and request pregnancy records.
This is an initial eligibility review, not medical clearance. The agency should clearly describe what “pre-screened” means and which assessments remain outstanding. Read how agencies screen intended parents and surrogates for a complete overview.
Stage three: matching and clinic requirements
Once intended parents and a prospective surrogate wish to explore a match, the agency usually shares the clinic’s requirements and gathers the documents needed for review. The clinic may have eligibility criteria covering previous pregnancies, medical history, age, medication use and other risk factors.
The agency can organise records and appointments, but it should not promise that a candidate will be approved. A fertility specialist must review the individual evidence and decide whether further information or assessment is needed.
Stage four: medical screening and clearance
The clinic typically reviews obstetric records and conducts the examinations, imaging and laboratory testing required for treatment. It may also screen the surrogate’s partner and the people providing eggs or sperm in accordance with applicable clinical and regulatory requirements.
The agency may help with scheduling, travel and document collection. Medical results remain subject to privacy and consent rules; the clinic should only share information with the agency or intended parents when authorised and appropriate.
The American Society for Reproductive Medicine recommends structured medical screening, psychological evaluation and legal counselling for gestational-carrier arrangements. Our guide to medical tests for prospective surrogates provides further detail.
Stage five: psychological evaluation and expectations
The agency may refer participants to a qualified mental-health professional experienced in third-party reproduction. The clinic may require written confirmation that its psychological requirements have been satisfied before treatment.
Counselling can explore communication, pregnancy expectations, prenatal testing, pregnancy loss, termination, multiple pregnancy, contact after birth, disclosure to the child and the effect of treatment on partners and families. A joint session can identify differences before they become conflicts.
The counsellor should retain professional independence. Their role is not simply to produce a clearance letter for the agency or clinic.
Stage six: independent legal clearance
Before medication or embryo transfer, the clinic commonly requires confirmation that a surrogacy agreement has been completed and that each party has received independent legal advice. The agency may coordinate introductions and track progress, but it should not give legal advice unless separately qualified and authorised to do so.
Legal clearance may address consent, medical decision-making, expenses or compensation, insurance, confidentiality, embryo disposition, parentage and the responsibilities of each party. The relevant jurisdictions must be assessed before treatment, particularly in cross-border journeys.
Stage seven: treatment preparation
After the required clearances, the clinic creates the medical calendar. It tells the surrogate which medication to take, arranges monitoring and sets the transfer date. The agency can help coordinate travel, accommodation, reimbursements and communication with the intended parents.
The surrogate is the clinic’s patient for her medication and procedure. She should receive instructions directly, have access to the clinical team and provide her own informed consent. The agency should support this relationship rather than act as a gatekeeper for medical information.
Stage eight: embryo transfer
The clinic assesses the embryos and decides which are suitable for transfer in discussion with the relevant patients. ASRM strongly recommends single-embryo transfer in gestational-carrier cycles because multiple pregnancy increases health risks.
The agency may confirm travel and appointment logistics, but clinical decisions remain with the treating team and the people giving consent. Our article about embryo transfer to a surrogate explains the procedure and early follow-up.
Stage nine: pregnancy confirmation and handover
The clinic usually arranges blood tests and early ultrasound scans. If the pregnancy progresses, care is transferred to an obstetric provider at the point specified by the clinic. Records and medication instructions should be shared securely with the new clinical team.
The agency may continue providing case management, help with communication, coordinate agreed expenses and support birth planning. It should not direct prenatal care or interfere with the surrogate’s relationship with her obstetric clinicians.
Information sharing and privacy
Good coordination requires enough information to keep the journey moving, but not every person is entitled to every medical detail. The clinic should obtain appropriate consent and explain:
- which information belongs to the surrogate, intended parents or genetic contributors;
- which updates may be shared with the agency;
- how records and test results are transmitted securely;
- who receives urgent medical information;
- how consent to share information can be changed;
- how long documents are retained.
Agencies should collect only information needed for their service and use secure systems for sensitive documents.
Communication between the clinic and agency
Strong teams agree on a communication plan early. It should identify a main clinic coordinator and agency case manager, list required milestones and specify who informs each participant when a task is complete.
A shared checklist may track records, clinic clearance, counselling, legal clearance, financial arrangements, medication dates, monitoring, transfer and pregnancy confirmation. However, the checklist should record completion rather than exposing confidential clinical details unnecessarily.
Ask what happens outside normal hours and who handles urgent medical, emotional, legal or financial problems. One person should not be expected to answer questions outside their professional role.
Costs and financial coordination
The clinic bills for medical consultations, testing, treatment, laboratory work, embryo storage and related services. The agency charges for its own matching and case-management services. Other providers bill separately.
Ask for itemised estimates from both organisations and check for duplicated administrative charges. Clarify who pays each invoice, whether funds are held in independent escrow, what happens after a cancelled cycle and whether a new clinic or match creates additional fees. Our guide to surrogacy costs outlines the wider budget.
Independent journeys without an agency
An agency is not involved in every journey. Intended parents and prospective surrogates who meet independently may coordinate directly with a fertility clinic and assemble their own legal, psychological, insurance and financial team.
SurrogateFinder is an online matching platform, not a surrogacy agency or clinic. Users can connect directly and browse surrogacy agencies and fertility clinics if they want professional support. Independent matching does not remove the need for careful screening, informed consent and separate legal advice.
Questions to ask about the working relationship
- Has the clinic worked with this agency before?
- Who is the primary contact at each organisation?
- Which documents does the clinic require from the agency?
- Which milestones will the clinic confirm to the agency?
- How is permission to share information recorded?
- Who coordinates outside monitoring and travel?
- Who confirms legal clearance before medication or transfer?
- How are disagreements or delays escalated?
- Are there referral fees or other commercial relationships?
- Can participants choose different professionals?
- Who provides support after the clinic hands care to the obstetric team?
For a broader clinic checklist, read questions to ask a fertility clinic about surrogacy.
Warning signs in clinic-agency coordination
Be cautious if roles are unclear, important instructions are passed only through the agency, the surrogate cannot contact the clinic directly or treatment is scheduled before required clearances are complete.
Other concerns include pressure to use connected providers, undisclosed referral arrangements, weak privacy practices, conflicting fee information, guarantees of medical success or pressure to transfer multiple embryos. Reputable organisations should welcome independent advice and explain professional boundaries clearly.
Frequently asked questions
Does a fertility clinic find surrogates?
Some clinics maintain referral relationships or provide limited matching support, but many rely on agencies or independently matched candidates. Ask exactly which services the clinic provides and which organisation is responsible for screening coordination and matching.
Who decides whether a surrogate is medically approved?
The fertility clinic and appropriately qualified clinicians should make the medical-clearance decision after reviewing records and completing the required evaluation. Agency pre-screening does not replace clinical approval.
Can a surrogacy agency choose the fertility clinic?
An agency may recommend experienced clinics, but intended parents should understand whether they are free to choose another qualified provider. Any referral fees or commercial relationships should be disclosed.
When does the clinic require legal clearance?
Requirements vary, but clinics commonly require written confirmation that the agreement and independent legal review are complete before medication or embryo transfer. Ask the clinic and lawyers to confirm the exact milestone.
Does the agency receive the surrogate’s medical results?
Only information that may lawfully and appropriately be shared with permission should be provided. The clinic should explain what information is shared, why it is needed and how consent and privacy are protected.
Sources and further guidance
- American Society for Reproductive Medicine: recommendations for practices using gestational carriers
- American Society for Reproductive Medicine: ethical considerations for gestational carriers
- Human Fertilisation and Embryology Authority: surrogacy guidance
- GOV.UK: having a child through surrogacy
Important: This article provides general information, not medical, legal or psychological advice. Responsibilities and requirements vary between organisations and jurisdictions. Obtain advice from qualified professionals familiar with your circumstances.