The Cost of Surrogacy

I was diagnosed with cervical cancer a few years ago, when I was 29, and at that time I wasn't sure if I was going to be able to conceive naturally. 

I actually found out while I was on a bachelorette trip in the Dominican Republic. My doctor called me and asked where I was, and I immediately sensed something was off - the dial tone sounded different because I was international. 

She said, “I don’t know if I should tell you this right now.” I told her to just tell me. Looking back, if I had to find out I had cancer anywhere, the Dominican Republic wasn’t the worst place. I was with my best friend and having that support—along with the distraction of the trip—made it a little easier to process. 

My husband and I were trying to get pregnant, and I started experiencing  excessive bleeding during sex. I remember thinking, something’s not right.  I immediately went to my gynecologist and she said, “Let’s get you a Pap smear.” I probably hadn’t had one in about three years, since that’s typically the recommended timing. She got the results back quickly, and they were abnormal. 

She ordered additional testing and that’s when it came back that I had cervical cancer. After that, she referred  me to a specialist who performed a procedure to determine the stage and size of the tumor. He told me I would need a radical trachelectomy, which essentially removes the entire cervix and reconstructs the uterus. I just thought, this is too much information right now. Let me get a second opinion. I went to another doctor who suggested a more conservative approach because I was right on the border of how this type of cancer is typically treated. 

Then I met with the second doctor who confirmed it was stage 1B1. After consulting with his entire team at MSK, he presented me with two options—one which meant we could take a more conservative route. His plan was to remove additional portions of the cervix to ensure clear margins and confirm that the cancer hadn’t spread.

I felt really good about that approach. He was very clear that we shouldn’t remove more than necessary. But he also explained that when I eventually tried to get pregnant, I would need a procedure that essentially reinforces and closes the cervix during pregnancy, because mine would be so short that it wouldn’t be able to support the baby otherwise. The operation is called a transabdominal cerclage. 

There were some unexpected costs, like medications, but overall the majority of the process was covered, which was a huge help. I eventually became pregnant through IVF. It wasn’t the easiest pregnancy—I developed preeclampsia and had to be closely monitored throughout.

When it came time to deliver, I needed a C-section because I couldn’t give birth vaginally due to the cervical closure. During the delivery, the doctors discovered that I developed placenta accreta, something I had never heard of before, which meant that my placenta had grown into my uterus. When my daughter Sadie was delivered, my uterus was no longer viable and I began hemorrhaging. I lost liters of blood and had to go into emergency surgery for a hysterectomy.

Throughout the entire process, I did everything I possibly could to carry my pregnancy myself. I’m so happy I pushed for that because I really wanted the experience, and I know not everyone gets that opportunity. I feel incredibly grateful that I did. But in the back of my mind I knew that if we wanted another child, it wouldn’t be as simple. It can be really intense—and truthfully, it was.

But a friend connected me with a concierge agency called Family Match Consulting, based in Los Angeles, and that’s where my surrogacy process began. The fee was around $3,000 to $4,000. What they essentially do is bypass the traditional agency waitlist. When you work directly with an agency, it can take up to a year to match with a surrogate. This concierge service helps accelerate that process significantly.

The financial side of surrogacy is extensive. I have a spreadsheet tracking everything because the numbers can quickly become overwhelming. 

There are agency fees, the surrogate’s compensation, monthly allowances, and additional costs that come up throughout the process. For example, you pay a monthly allowance, maternity clothing expenses, transportation for medical appointments, gas reimbursement, lost wages if they have to miss work, and sometimes compensation for their partner if they attend appointments. Cleaning services are also often included in their monthly support. 

On top of that, when she started medications, I had to pay for those. I had to pay my clinic for the embryo transfer. Because the first transfer resulted in a miscarriage, I had to pay for the entire process again for the second transfer.

Payments are structured around milestones—when a heartbeat is detected, and again at later stages of the pregnancy. And if there are complications during birth, there are additional costs associated with that as well.

Health insurance is another factor. Our surrogate has her own insurance through work that covers surrogacy, which was important to us when we were searching. Not every surrogate has that, and sometimes intended parents need to pay for separate surrogacy-friendly insurance.

Even with insurance, it’s hard to predict the final cost. For my own delivery, the hospital bill was probably around $80,000 before insurance, but after coverage I personally paid about $1,500. With surrogacy, the final hospital costs can vary significantly.

At the same time, our attorney followed up about the birth order I mentioned earlier. There’s a new judge in our surrogate’s county in York who is now reviewing these cases, which added another layer to the legal process. Because of that, we also had to change where she receives care and where she’ll ultimately deliver. The hospital we’re now working with is about 30 minutes from where she lives, which added another logistical piece for all of us to navigate.When you file for a birth order, it has to be filed in one of three places: where the surrogate lives, where the baby will be born, or where the intended parents live. Filing where the intended parents live can sometimes lead to it being denied.

[At the time of this interview], our surrogate is 22 weeks pregnant, so we’re about halfway through. It’s definitely been a process emotionally. She actually had the flu last week and had to be hospitalized. She called me in the middle of the night asking if it was okay for her to get a chest X-ray. I told her of course.

Moments like that really highlight how different this experience is. You’re not just thinking about the baby—you’re also thinking about the person carrying the baby. It feels very heavy at times because you’re responsible for the wellbeing of two people.

You can define the type of relationship you want with your surrogate from the beginning. We text probably every other day. We also use an app called Our Journey, where she logs how she’s feeling, any cravings she has, and updates from doctor’s appointments if we aren’t there. She can upload photos and notes, so we stay very connected throughout the pregnancy.

When she’s admitted for the delivery at this specific hospital the intended parents are actually given their own room attached to the delivery space. Ideally we’ll be there for the entire labor, although you never really know how labor will unfold.

After the baby is born, we can stay in the hospital for about 48 hours. Once the baby is cleared (after the standard newborn tests like the car seat test and general monitoring) we’ll be able to take him home.

One thing I’ve been thinking about a lot lately is how conversations around surrogacy are evolving. I wouldn’t say it’s becoming “common,” but more people are pursuing it for different reasons.

At the same time, there’s also a lot of backlash and misunderstanding. When celebrities talk about surrogacy, people often make really harsh assumptions. I wish more people understood the realities behind it before passing judgment.

No one chooses this path lightly. If I had been able to carry another child myself, I absolutely would have. Surrogacy is emotionally intense, financially demanding, and incredibly complex.

That’s why I’m grateful more people are creating space to talk about this honestly. There are so many different reasons families pursue surrogacy, and sharing those experiences helps people understand what the process is actually like.

Surrogacy is so much harder than people think. A lot of people assume it’s the easy way out, but it really isn’t. It’s definitely not a cop-out, and I hate when people assume that. It’s actually incredibly complicated.

I’m obviously very grateful that it’s an option for us, because I know it isn’t accessible to everyone. The financial burden alone is enormous. By the end of the process, it will probably cost more than $200,000.

Not everyone has that kind of money, and I’m incredibly grateful that we’ve had support from family while also contributing our own savings. We’ve had to make major financial decisions because of it. 

One thing I do wish existed is more institutional support for people pursuing fertility treatment. My IVF was covered by insurance, but that was specifically because of my cancer diagnosis.

My employer has a program through an insurance provider called Progyny, which can reimburse up to $20,000 in fertility-related expenses. After completing treatment, employees can submit their expenses and potentially receive reimbursement. It’s an incredible benefit, but unfortunately not many companies offer programs like that.

There are also nonprofit organizations advocating for more support. One that I’ve followed closely is Chick Mission, which helps cancer patients preserve their fertility and advocate for better insurance coverage. They also provide grants to help patients cover fertility preservation and treatment.

Even with programs like that, though, the financial burden can still be overwhelming. That’s one of the reasons I’m so open about talking about this experience. I think people often judge surrogacy without understanding the realities behind it. 

But sharing these stories matters. The more people understand the emotional, financial, and medical realities behind fertility journeys, the more compassion there can be for the families going through them. And hopefully I can help someone else feel a little less alone in the process.