How to Spot a Surrogacy Agency that Actually Lives "Surrogate-First"

We've been running surrogacy journeys since 2015. We've helped build over 500 families. And one of the clearest patterns we've seen is that journeys succeed or fall apart based on the health of the surrogate relationship—and that relationship starts with how the agency treats her before you ever meet.

What Does "Surrogate-First" Actually Mean?

It doesn't mean surrogates come before intended parents. It means the agency has built its entire model around recruiting, vetting, supporting, and retaining high-quality surrogates—because without great surrogates, there is no journey for anyone.

A surrogate-first agency:

• Screens rigorously, so the women who reach you are genuinely ready
• Compensates fairly, so surrogates choose the agency for the right reasons
• Supports surrogates emotionally and logistically throughout the entire pregnancy—not just until the match is made
• Treats surrogates as partners in the process, not a commodity to be placed

When an agency does all of that well, you benefit directly. You get a surrogate who is educated, committed, emotionally stable, and genuinely invested in your journey—not just in the compensation.

Why This Matters More Than You Think

Here's what we see happen at agencies that aren't surrogate-first:

• Surrogates are matched quickly without adequate vetting, leading to mismatched expectations, communication breakdowns, or medical complications that could have been caught earlier
• Surrogates feel unsupported mid-journey and disengage—leaving intended parents anxious and without clear answers
• High surrogate turnover means agencies are constantly recruiting from a shallow pool, which drives up wait times and lowers match quality
• Surrogates choose agencies based on compensation alone, without alignment on values, communication style, or relationship expectations

None of that is good for you. A surrogate who feels unseen or undervalued is a surrogate who may not show up the way you need her to.

A surrogate who feels respected, supported, and fairly compensated? She shows up fully. Every time.

How Roots Vets Surrogates—And Why the Bar Is High

We only end up partnering with about 1% of the surrogates who apply to us. That's not a marketing number—that's the result of a four-month vetting process that we take seriously because your family depends on it.

Here's what that process includes:

1. Education and preparation — Before a surrogate is ever introduced to an intended parent, she's been fully educated on the process: timelines, medications, IVF procedures, legal agreements, and what to expect emotionally. She knows what she's committing to.
2. Complete medical history and record review — We review her full obstetric history, looking for uncomplicated pregnancies, healthy deliveries, and no significant medical risks.
3. Lab work and health screening — Comprehensive labs including STI screening and toxicology. She needs to be in optimal health before we move forward.
4. Background investigation — We use a private investigator and run checks on every adult in her household. We also pull her driving record. No shortcuts.
5. Social media audit — We follow her social media throughout the process. This isn't surveillance—it's due diligence. We want to make sure the person you're matched with is who she says she is.
6. Two-part psychological evaluation — A licensed mental health professional conducts both an in-depth interview and formal psychological testing. We're assessing emotional readiness, stability, and motivation. This isn't a checkbox. It's a real evaluation.

By the time a surrogate profile reaches you, she has been vetted for four months across every dimension that matters. You're not choosing from a database. You're meeting a woman who has already proven she's ready.

The Matching Process: One Profile at a Time

We don't give you a database to scroll through. We don't send you five profiles and ask you to rank them.

When you reach the top of our waitlist, we identify one surrogate who fits your specific needs—your clinic's requirements, your communication preferences, your values, your timeline. Her profile is shared with you. You review it carefully. If you want to move forward, your profile is shared with her.

This is a two-way relationship. She is choosing you just as much as you are choosing her. We've found that this approach—intentional, mutual, unhurried—produces matches that actually hold. Matches where both parties feel genuinely connected, not just logistically compatible.

If you pass on a profile, you remain at the top of the list. But the surrogate moves to the next family. There's no going back to reconsider. That's intentional—it keeps the process fair for surrogates, and it keeps you focused on what matters.

What to Look for in a Surrogate Profile

When you're evaluating a potential match, here's how we guide intended parents to think about it:

Non-negotiables — These are things your agency and clinic should already have screened for:

• Healthy pregnancy history with full-term, uncomplicated deliveries
• No smoking, drug use, or significant health risks
• Clean background check
• A strong personal support system at home
• Medical clearance from your clinic

Nice-to-haves — These are personal preferences worth naming, but not dealbreakers:

• Geographic proximity
• Communication frequency preferences
• Relationship style (close and ongoing vs. professional and boundaried)
• Shared values or lifestyle alignment

The most successful journeys we've seen come from intended parents who are clear about their Non-negotiables and flexible about Nice-to-haves. No surrogate will check every box. The ones who matter most are already checked before you see her profile.

What Happens After the Match

This is where a lot of agencies drop the ball—and where being surrogate-first really shows up.

After matching, your surrogate will:

• Attend a medical screening at your IVF clinic (transvaginal ultrasound and labs)
• Move through the legal contract phase with her own independent attorney
• Begin medications to prepare her body for the embryo transfer
• Transfer the embryo at your clinic
• Be tested for pregnancy 10 days post-transfer

During her first trimester, she remains under the care of your IVF physician. At approximately 12 weeks, she transitions to her OB and is treated like any other pregnancy for the remaining two trimesters.

Throughout all of it, we are in contact with her every week. Not just when there's a problem. Not just at milestones. Every week, through our 5 Touchpoint system—because consistent communication is how you prevent problems, not just respond to them.

You'll receive updates too. You'll never be left wondering what's happening or who to call.

Plans and Pricing: What Your Investment Covers

We don't gatekeep this information. Our fees & pricing information is readily available on the Pricing page.

Every plan is full-service. There is no plan where you're on your own. The difference between plans is primarily wait time, level of executive involvement, and what's included versus coordinated.

The Red Flags to Watch for at Other Agencies

We're not here to tear anyone down. But we do think you deserve to know what "not surrogate-first" looks like in practice, so you can ask the right questions.

Ask any agency you're considering:

• What percentage of surrogate applicants do you accept? (If the answer is high, the bar is low.)
• How long does your vetting process take? (Anything under 60 days should raise questions.)
• Who supports the surrogate during pregnancy if there's a conflict or concern? (If the answer is unclear, that's a problem.)
• What is your surrogate-to-case-manager ratio? (More than 8–10 active cases per coordinator is a red flag.)
• Do surrogates have an independent attorney? (They should. Always.)
• What happens if the match doesn't work out? (You need a clear answer, not a vague reassurance.)

At Roots, we're comfortable answering all of these. If an agency isn't, keep asking.

Why 95% Domestic Intended Parents Matters

Nearly all of our intended parents are U.S.-based. This matters for your surrogate relationship in ways that are easy to underestimate.

When your surrogate knows she can call you, meet you, and build a real relationship with you—not just exchange translated emails—the dynamic changes. She's not just carrying a baby for a file number. She's carrying a baby for people she knows and cares about.

That emotional investment shows up in how she communicates, how she handles hard moments, and how she approaches the birth. The families we've seen build the strongest bonds with their surrogates are the ones who show up as real people—and our domestic-first model makes that easier.

Your Journey Starts With the Right Foundation

The question isn't just which agency has the best marketing. The question is: which agency has built a model where surrogates want to be, surrogates are prepared to succeed, and surrogates feel supported enough to show up fully for your family?

That's what surrogate-first means. And that's what protects your journey.

We've been doing this for a decade. We've seen what works and what doesn't. And we built Roots to be the agency we would have wanted to use—whether we were the surrogate or the parent.

If you're ready to talk through what your journey might look like, we'd love to connect.

Schedule a call with Brooke →

No pressure. No pitch. Just a real conversation about your path to parenthood.