Beyond Rankings: What Really Matters When Choosing a Surrogacy Agency
Why Surrogacy Agency Rankings Tell Only Part of the Story
Not all rankings are created equal. This particular list—compiled by an international surrogacy agency—relies on U.S. agency websites, online reviews, and self-reported estimates for cost and match time. While that might give a surface-level view, there’s a lot we still don’t know, like:
- How were agencies selected for inclusion?
- Were the numbers verified, or just taken at face value?
- Were agencies ranked just by lower cost, regardless of what’s actually included in that fee?
- Did agencies pay to be featured, or submit their own info?
It’s important to remember that cost alone doesn’t tell the whole story. Agencies vary widely in the level of service they provide for their fees, like how thorough their screening process is, the experience and support offered throughout the journey, and whether essential services like legal, psychological, or medical care are included or billed separately. Without this context, rankings based solely on cost can be misleading and leave intended parents unprepared for the true financial and emotional investment.
Some highly experienced agencies are notably absent, while others that many in the field may not be familiar with are included. That doesn’t make it wrong, but it does mean intended parents should take these rankings as one small piece of the puzzle, not the full picture.
Instead of relying on someone else’s list, I’d love to share some insights and key questions you can ask to build your own rankings based on your values, your needs, and what really matters to your journey. (And just for context: I’ve worked in surrogacy since 2009 and have seen both the beautiful outcomes and the avoidable heartbreaks.)
Match Time: What Does It Really Mean?
“Faster match time” sounds great—especially if you’ve been waiting years to grow your family. But here’s the part no one likes to say out loud:
Anyone can match you today… if you’re okay being matched with someone who hasn’t been screened yet.
That kind of match might look exciting on paper, but behind the scenes? It could just mean a short application and a Zoom chat, no records, no labs, no confirmation she’s truly ready to move forward.
So instead of asking how fast, ask how thorough.
🧩 Questions to Ask About Matching:
- At what point in her intake process would you show me a surrogate’s profile?
- What exactly has been done at that point, just background checks? Or are there medical records, psych assessments, lab work?
- When is screening done, before or after matching?
- What percentage of surrogate applicants actually pass screening?
- Do you match based on compatibility and shared values, or is it “first in, first out”?
If these answers are vague or unclear, that’s a red flag. A “fast” match can cost you months—and thousands of dollars if that person doesn’t make it through screening.
Only 1–3% of Surrogacy Applicants Are Fully Approved
This is a critical stat few people realize. Most agencies receive hundreds of applications, but only 1–3% ultimately qualify after thorough screening.
At Fairfax Surrogacy, we do this screening before introducing a potential match. That means:
- Nationwide background checks
- Full medical records review by an OBGYN nurse practitioner
- Psychological evaluation by an independent mental health professional
- Comprehensive pre-pregnancy lab panel
If you don’t complete this level of screening prior to matching, there is a high possibility your surrogate may fall in the 97–99% of candidates who are not approved to proceed or don’t end up making it to the embryo transfer.
And even then, some candidates will still drop out voluntarily—they may realize the timeline doesn’t work, support from family changes, or the process feels too overwhelming. That’s why doing the work upfront matters. You want someone who’s not just medically eligible, but emotionally and logistically prepared, too.
What Happens to Your Money If She Doesn’t Pass Screening?
This is one of the most important (but often overlooked) questions to ask:
- Do I have to pay for screening of every candidate I agree to match with?
- If she doesn’t pass screening at any stage, am I responsible for those costs—or do I lose that money?
- If the surrogate doesn’t pass, is rematching covered in the agency fee, or will I be responsible for a rematch fee in addition to screening costs, essentially starting over both financially and emotionally?
- When do those rematch fees kick in?
It’s easy to feel like “I just need someone to say yes,” but chasing a quick match can lead to bigger delays and unexpected expenses later. Screening costs add up fast, and if they’re not included in your agency fee, you might end up spending thousands on candidates who were never truly viable.
At Fairfax Surrogacy, we’ve designed a fixed-fee model that covers the cost of every single prescreened candidate. That means you won’t be billed again if a surrogate doesn’t make it to transfer. We take on that risk, so you don’t have to.
The reality is, even fully prescreened surrogates may not pass your clinic’s screening when they go in person. But by doing most of the prescreening upfront, we all have more confidence in your match and greatly reduce the chance that a match will fall through, saving you time, money, and heartache. Compare that to a pay-as-you-go model, where each failed match could be an unexpected hit to your budget.
Questions to Ask Any Agency
Here are some thoughtful, must-ask questions to guide your search:
On Matching + Screening:
- When would you present a surrogate profile and what’s been done by then?
- Is screening done before or after matching?
- What does your prescreening include (specifically)?
- What % of your applicants make it through the full screening process?
- How do you determine compatibility? Is the match based on shared preferences, or just who’s next?
On Experience + Support:
- How many babies have you helped create?
- What’s the experience level of your team (coordinators, leadership, legal, psych, etc.)?
- Are you locked into specific provider, can I choose my own?
- Will I have a dedicated coordinator? What exactly will they handle?
- How many cases does each coordinator manage at one time?
- What happens if someone on my team is out sick or leaves?
- Do you offer in-person support?
- How are unexpected events (withdrawals, failed screenings, rematches) handled financially?
Final Thoughts
I completely understand the appeal of rankings, they feel like shortcuts in a space that’s often overwhelming. But surrogacy is too personal, too emotional, and too important to reduce to a spreadsheet.
So instead of asking “How fast can I match?”, try asking:
- How well is this surrogate screened?
- What happens if something changes?
- Is this agency experienced, honest, and prepared to support me the whole way?
If you’re just starting out and want clarity, real talk, and honest guidance, please reach out. There is no cost and no pressure, just a chance to get your questions answered and understand what path is right for you.
Written by Perla Piekutowski, Director of Growth and Engagement at Fairfax Surrogacy
Helping families grow through surrogacy since 2009.
Schedule a free consultation