What questions should you ask a surrogacy agency?

Questions about screening and medical review

Question 1: What is your surrogate screening process, and who reads the medical records?

Why it matters: a surrogate who fails clinic screening after you have matched costs you months. Screening done properly before match is the single biggest protection against that.

A strong answer lists every step, in order, and names who does each one. A weak answer is "our surrogates are thoroughly screened" with no detail, or records that go to the clinic without anyone reading them first.

PLS answer: seven steps, all completed before a profile is shown to you:

1. Application.
2. Interview.
3. Records review: Mark Silverberg, DDS, MD, reads her prenatal and delivery records and writes a physician medical summary for your clinic.
4. Background check.
5. Insurance review, to check her health plan for surrogacy exclusions.
6. Psychological evaluation by an independent licensed professional, not a PLS employee.
7. Clinic medical screening.

PLS surrogates are 21 to 43, US citizens or permanent residents, with a BMI under 33, at least one healthy full-term pregnancy, and currently raising a child. They are non-smokers, do not receive government assistance, and live in a stable home. See surrogate medical screening.

Questions about results and how they are counted

Question 2: How many journeys did you complete last year, and how do you define success?

Why it matters: "success rate" can mean three different things. Live birth rate per embryo transfer is a clinical number. Live birth rate per journey is the share of matched parents who bring a baby home. Match rate is the share of signed parents who were matched, and says nothing about births.

A strong answer gives counts with definitions and dates. A weak answer is a single high percentage with no denominator.

PLS answer: PLS completed more than 100 journeys and more than 60 births since 2017. PLS reports counts with their definitions and does not publish a blended percentage. Nancy Block's own career includes more than 2,500 matches since 2000. See success rates, defined.

Questions about fees and third-party costs

Question 3: What does your fee include, and what is paid to third parties?

Why it matters: an agency fee can look low because costs are moved elsewhere, or high because third-party costs are folded in. You need the line items to compare.

A strong answer is an itemized budget. A weak answer is one all-in number.

PLS answer: the program fee covers PLS's work: recruiting and screening surrogates, matching, and coordinating the journey through birth. The program fee is $47,500. It is paid $22,500 at signing, $20,000 at surrogate acceptance and $5,000 at medical clearance. Third-party costs are separate and total $15,300 to $29,000: attorneys for both sides, escrow administration, the psychological evaluation, background checks, insurance review, surrogate travel and local monitoring. A surrogate health policy, if needed, is $5,000 to $40,000. IVF and clinic fees are paid to your clinic. The whole journey typically runs $150,000 to $210,000 all in, including clinic fees and insurance.

Questions about matching and wait time

Question 4: How does matching work, who does it, and what is the current wait?

Why it matters: matching is the decision that shapes the next year and a half. You want to know whether a person or a system makes it, and what the wait actually measures.

A strong answer names the person who matches, explains how both sides agree, and gives a dated wait time with a stated start and end. A weak answer is "it depends" or a short wait that counts from when profiles are first shown.

PLS answer: Nancy Block, RN, personally runs matching. You are introduced to a surrogate who has already completed screening, and the match becomes official only when both sides accept. Today the wait from signing to surrogate introduction is about 9 months, with a target of 6 months or fewer, and every surrogate has completed screening before introduction. The whole journey typically takes 18 to 24 months. See wait times, defined.

Questions about legal and escrow independence

Question 5: Which independent attorneys do you refer, and are they required for both sides?

A strong answer: each side has its own reproductive-law attorney, you may choose your own, and the agency does not employ them. A weak answer: one attorney for both sides, or an in-house lawyer.

PLS answer: PLS refers to independent attorneys and does not employ any. The surrogate has her own attorney, which you pay for. You may use any attorney who practices reproductive law in the relevant state.

Question 6: Who holds escrow, and are they licensed and independent of you?

A strong answer: an independent licensed escrow agent with no link to the agency, statements sent directly to you, and the right to choose your own escrow company. A weak answer: the agency holds funds, or uses an affiliated company.

PLS answer: an independent licensed escrow agent. You fund $10,000 at match and the balance before medications start. You may choose your own escrow company. PLS has never held client funds. For the full set of money questions, see money questions to ask before signing.

Questions about support, clinic coordination and complications

Question 7: What support exists after hours, and who answers?

A strong answer names who answers and how. A weak answer is an email address and office hours.

PLS answer: an after-hours team answers urgent calls from surrogates and parents. One night, that team rebooked a stranded surrogate's hotel, car and flight while another PLS surrogate was delivering twins. The two case managers who carry active matches, Natalie Gaudio-Fricano and Jenni Symons, are both former surrogates.

Question 8: How do you coordinate with my clinic?

A strong answer explains who talks to the clinic, what documents the clinic receives, and how travel and monitoring are scheduled.

PLS answer: PLS works with 14 partner fertility centers, including Kindbody, Shady Grove Fertility, Fertility Centers of Illinois and Oregon Reproductive Medicine, and coordinates with any clinic you choose. Your clinic receives Dr. Silverberg's physician medical summary. Jan Telman Berman, Global Surrogacy Coordinator, manages national and international cycles.

Question 9: What happens if the match ends, the transfer fails or a complication arises?

A strong answer points to written terms and describes who does what. A weak answer is "we handle it case by case."

PLS answer: [Refund and rematch terms to be stated from the agreement.] The Assured tier ($62,500) adds priority matching, unlimited rematches and no new agency fee if the first surrogate does not succeed. Medically, complications are handled by the surrogate's obstetric team and your clinic; PLS coordinates the people and the paperwork.

Questions about references

Question 10: May I speak with recent parents and surrogates?

A strong answer is yes, without a script. An agency that treats surrogates as partners will connect you with a surrogate who has delivered.

PLS answer: [Reference process to be confirmed with Nancy.]

How to score the answers across agencies

Send the same ten questions to three to five agencies, in writing, before you call. Then score each answer as strong, weak or missing.

Weight questions 1, 5 and 6 most heavily. They decide whether your money is safe and whether the surrogate is ready. The rest tell you how the agency works day to day.

Sources

• SART, Society for Assisted Reproductive Technology, for how per-transfer live birth rates are reported.
• SEEDS, Society for Ethics in Egg Donation and Surrogacy, of which Nancy Block, RN, is a former President.
• Private Label Surrogacy fee schedule, screening process and escrow policy.