When gay men begin exploring surrogacy, they’re often told a version of the story that sounds reassuringly straightforward: Find an egg donor. Create embryos. Match with a surrogate. Transfer embryo. Pregnancy. Baby.

Sometimes it does happen that way, but more often it does not. 

Related

These 10 banned LGBTQ+ books for teens and young adults teach resilience & authenticity

As someone who has spent years guiding LGBTQ+ people through their paths to parenthood, I have seen many surrogacy journeys take unexpected turns, not because something was done wrong, but because it is a complex medical, legal, and deeply human process. Most hopeful parents do not fully understand that complexity at the outset, or recognize what can happen until they encounter it firsthand.

That is why this conversation matters. And that’s why I’ve outlined most of these challenges below, so you’ll be better prepared and more resilient when navigating them along the way. 

Never Miss a Beat

Subscribe to our newsletter to stay ahead of the latest LGBTQ+ political news and insights.
Subscribe to our Newsletter today

1. Early medical screening can reveal unexpected delays

Fertility testing is the very first step in the surrogacy process. This includes bloodwork and a semen analysis, and it is where the first surprises can emerge. Intended parents may discover lower than expected sperm count or motility, underlying health or genetic concerns, or the need for additional testing or medical intervention. These results can shift timelines, introduce new decisions, or require more medical support than anticipated.

2. Egg donor matching can take longer than expected

Finding the right egg donor is a deeply personal process and often takes more time than people expect. In many cases, it can stretch over several months. This may be due to specific preferences that narrow the pool, preferred donors already being committed to other cycles, medical records that raise questions during review, or genetic and psychological screenings that ultimately disqualify a match. There are also multiple platforms and pathways to finding a donor, which can add complexity to the process.

Just as important is alignment on expectations. This includes whether the donation will be anonymous, open, or somewhere in between, as well as comfort with future contact, information sharing, and each party’s role over time. These are not small details, and differences in expectations can slow the process or require starting over.

For those considering a known donor, often a friend or family member, it is important to understand that only a small percentage of women ultimately meet the criteria required to move forward. Based on conversations I have had over the years with fertility doctors and egg donor programs, only 1 to 5 percent of women are approved after completing a rigorous medical, genetic, and psychological screening process.

3. Embryo creation doesn’t always go as planned

One of the earliest and most important realities to understand is that the creation of an embryo is not guaranteed. Even when you are working with a strong fertility clinic and a carefully selected egg donor, IVF outcomes can vary from cycle to cycle. Egg retrieval may produce fewer mature eggs than expected. Fertilization rates may be lower than anticipated. Some embryos may stop developing before reaching the blastocyst stage, and genetic testing can show that few or none are chromosomally normal.

When this happens, it often requires more than just patience. You may need to repeat a cycle, pursue another egg retrieval, or rematch with a different donor. Each of these steps can extend your timeline and increase costs, sometimes significantly. It can also be emotionally challenging, especially if expectations were set around a more straightforward path. This is why it is so important to approach embryo creation with both optimism and a clear understanding that variability is part of the process.

4. Finding the right surrogate can take time

When it comes to matching with a surrogate, it is important to understand that most agencies will not begin the process until embryos have been created. Delays in earlier steps, such as donor matching or embryo development, can push everything else back and extend your overall timeline.

Once you’re ready to match, timelines can vary widely. Some agencies quote minimal or short wait times, while others may project several months to a year or more. These differences often reflect how many qualified candidates an agency has available at a given time.

Another important factor is that not everyone who applies is accepted. Again, based on conversations I have had with agencies and fertility clinics, I have found only about 2 to 5 percent of applicants are approved after completing a rigorous screening process that includes medical, psychological, and lifestyle criteria. This level of screening supports safer pregnancies and stronger outcomes, but it also limits the available pool. It is also an important consideration for those thinking about asking a friend or family member to take on this role.

Your own preferences can further influence timing. These may include geographic location and state laws, insurance compatibility, medical history, prior pregnancy experience, and alignment on communication style and expectations.

A strong match is not just about availability. It is about finding the right fit. While the waiting period can feel frustrating, it often plays an important role in setting the journey up for success.

5. Transfers don’t always work

Even with a healthy surrogate and a genetically healthy embryo, there is no guarantee that a transfer will result in a successful pregnancy. Some journeys include failed transfers with no implantation, chemical pregnancies, or miscarriages. (A chemical pregnancy is an early loss that happens shortly after implantation. Initially, you may get a positive pregnancy test, but the pregnancy ends before it can be seen on an ultrasound, usually within the first few weeks.)

When any of these occur, it often means trying again. This can involve waiting for the next cycle, taking on additional medical costs, and allowing time to recover emotionally before moving forward. 

6. Pregnancy isn’t the finish line

Even after a successful transfer, the journey is not always straightforward. Pregnancy is complex, and complications can still arise. These may include high-risk conditions, bed rest requirements, preterm labor or early delivery, and medical decisions that need to be made quickly and collaboratively.

Surrogates are carefully screened, but no pregnancy is without risk. Understanding that reality does not remove the challenges, but it can help ensure they are not unexpected.

7. Legal and logistical delays happen

Surrogacy is not just a medical process; it is also a legal one, which adds another layer of complexity. Delays can arise during contract negotiations between intended parents and the surrogate, escrow setup and financial coordination, insurance reviews and approvals, or during the process of securing pre-birth parentage orders, depending on the state.

One of the most common misconceptions is that the legal process is tied to where you live. In most cases, it is tied to where the surrogate lives and gives birth. This can introduce unfamiliar laws and additional timelines that need to be carefully navigated.

8. Timelines and costs can shift – a lot

At the outset, many intended parents hear that surrogacy takes about two years and costs between $150,000 and $250,000. These are reasonable estimates, but they are not guarantees. This range reflects a typical journey with some built-in variability, but it does not fully account for additional embryo creation cycles, multiple transfers, or unexpected complications.

Delays in matching, additional cycles, or multiple transfers can extend timelines and increase costs. Even small changes at each stage can add up over time.

For this reason, many intended parents benefit from planning an additional financial buffer of $25,000 to $50,000. This added flexibility, both emotionally and financially, can make it easier to navigate the unexpected and continue moving forward.

What this means for LGBTQ+ intended parents

If all of this feels overwhelming, it is important to put it into context. This is not about discouraging you from pursuing surrogacy; it is about making sure you are fully prepared.

Many hopeful parents begin their journey believing they have already chosen the right path without fully understanding what that path entails. They may not compare options, anticipate challenges, or ask the questions that could better prepare them. When something doesn’t go as planned, it can feel like everything is unraveling.

The bottom line

Surrogacy can be an extraordinary path to parenthood. It is also complex, and the journey is not always predictable or linear. Setbacks can and do happen.

The more you understand this before you begin, the better equipped you will be to navigate whatever comes your way. The goal is not just to reach the finish line. It is to move through the journey with clarity, confidence, and the support you need at each step.

Education and the right partners make all the difference

One of the most important things you can do before and during your surrogacy journey is to make sure you are fully educated and supported by the right professionals. This means understanding not just the path you think you want to take, but also fully comprehending all of your options, and working with experienced, reputable partners who can guide you through each step.

At GWK Academy, our mission is to ensure that LGBTQ+ people have access to the education, guidance, and trusted partners they need to navigate every path to parenthood. When you have the right information and the right team around you, you are not just reacting to challenges as they arise. You are prepared for them.

Visit GWK Academy today, and take your first step toward becoming a parent. We’re with you the whole way. And don’t forget to come back to LGBTQ Nation for monthly family-building insights and support from your friends at GWK Academy.

Subscribe to the LGBTQ Nation newsletter and be the first to know about the latest headlines shaping LGBTQ+ communities worldwide.