Traditional vs. Gestational Surrogacy

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Traditional vs. Gestational Surrogacy

When growing one’s family through surrogacy, one of the first and most important decisions the intended parents will have to make is what type of surrogacy to pursue.

The two main types of surrogacy are gestational and traditional.

  • In traditional surrogacy, the surrogate’s own eggs are used, making her the biological mother of the surrogate baby.
  • In gestational surrogacy, the intended mother’s or donor’s eggs are used, meaning the surrogate is not the baby’s biological mother.

While this distinction is simple, this small difference leads to a number of very important differences that all intended parents should consider carefully when deciding between traditional and gestational surrogacy.

The remainder of this article will explore all the key differences and things to consider to help determine which type of surrogacy is right for you. Of course, we also welcome you to contact our team of surrogacy professionals to discuss this important decision.

Traditional vs. Gestational Surrogacy

While traditional and gestational surrogacy both involve carrying a pregnancy for another couple, they have important differences, including the egg source, genetics, emotional complexity, medical procedures, legal processes, finding a surrogate agency, wait times, management, costs, and risk.

Let’s consider each of these important differences in detail so we can further understand the differences between traditional and gestational surrogacy.

Egg Source

As mentioned, the primary driver of all differences between traditional and gestational surrogacy is the source of the egg.

In traditional surrogacy, the surrogate’s own eggs are used in establishing the surrogacy pregnancy.

In gestational surrogacy, the egg used may come from the intended mother or an egg donor.

If it is possible to use an egg from the intended parents, they will usually do so. If the intended mother has poor egg quality or the intended parent(s) are a m/m same-sex couple or a single man, then an egg donor is typically used.


Like all babies, the surrogate baby’s genetics are driven by the sperm and egg source.

In traditional surrogacy, the surrogate is the child’s biological mother. While many people assume this means that the intended mother will not share DNA with the baby in traditional surrogacy, this is not necessarily the case, as siblings and cousins are sometimes the surrogates in a traditional surrogacy arrangement.

In gestational surrogacy, the surrogate is not the baby’s biological mother. Instead, the intended mother or an egg donor is the biological mother and shares DNA with the baby.

Of curse, 50% of the baby’s genetic makeup comes from the biological father, which may be the intended father or sperm donor.

Emotional Complexity

Whether the intended parents have struggled with infertility for years or it’s the individual or couple’s first attempt at bringing a child into the world, surrogacy is an emotional process.

However, there are differences in the emotional complexities arising from each type of surrogacy due to traditional surrogates’ strong genetic connection with the baby.

Being genetically related to the baby may make it exceptionally difficult for the surrogate to give up the child, as the famous Baby M Case demonstrates.   This can lead to immense emotional turmoil for both the surrogate and intended parent(s).

Medical Procedures

Traditional and gestational surrogacy often involve different medical procedures.

In traditional surrogacy, the pregnancy is usually established via intrauterine insemination (IUI).

That said, the defining aspect of traditional surrogacy is the carrier being the baby’s biological mother, so technically, any method of establishing a pregnancy can be used, including home intravaginal insemination or IVF.

In gestational surrogacy, in vitro fertilization (IVF) is the only possible method of establishing the pregnancy. In IVF, an embryo is created using the intended mother’s (or donor’s egg) and the intended father’s (or donor’s sperm) in a lab. After growing in the lab for a few days, one or two embryos are transferred to the surrogate’s uterus to establish the pregnancy.

Legal Process

Laws surrounding all types of surrogacy are complex and vary by state. That said, laws surrounding traditional surrogacy tend to be less favorable to the intended parents, more complicated, and sometimes even illegal.

As a traditional surrogate is the baby’s biological mother, her parental rights must usually be legally terminated AFTER the baby is born. This means that in many states, a stepparent adoption must be used for the intended parents to gain custody of the child (if possible).

On the other hand, the legal proceedings to establish legal parental rights in gestational surrogacy are much safer and done before the birth using a pre-birth order.

Because of this, it is important to understand your state’s surrogacy laws and work closely with an experienced agency or reproductive attorney. Our team at Surrogate Steps is led by Yifat Shaltiel, a renowned reproductive attorney who has a deep understanding of surrogacy law.

Finding an Surrogacy Agency

Due to the emotional and legal benefits of gestational surrogacy, very few professionals offer traditional surrogacy.

Intended parents who choose traditional surrogacy will either have very limited options in working with an agency or need to pursue independent surrogacy without the support and management of an agency.

Finding a Surrogate and Wait Times

Most surrogates prefer gestational surrogacy as it is less emotionally challenging.

In traditional surrogacy, the surrogate is the biological mother of the child, which can make it incredibly difficult to relinquish the baby to the intended parents.

This makes it very difficult for intended parents to find traditional surrogates, which usually leads to long wait times.

On the other hand, agencies are routinely recruiting gestational surrogates, making it easy to find and match with a gestational surrogate with little to no wait time.

Managing the Surrogacy

As very few surrogacy agencies support traditional surrogacy arrangements, managing the logistics of the surrogate treatment, pregnancy, and legalities is usually left up to the intended parents. It is doable for some, but with the high levels of emotions and complexities of the treatment and laws, it can be very difficult.


Upon initial examination, most assume that traditional surrogacy is less expensive as a single IUI procedure is less expensive than IVF.  Depending on whether or not the intended mother has healthy, viable eggs or not, there may also be cost savings in having the egg donor and surrogate as the same person.

That said, IUI success rates are much lower, meaning it is not uncommon to have to do 3-6 IUIs to establish a single pregnancy, which can quickly add up. Additionally, the potential for legal issues with traditional surrogacy increases the risk of large legal bills, which could, in the end, make traditional surrogacy more expensive than gestational surrogacy.

Choosing the right type of surrogacy for you

While both traditional and gestational surrogacy have their pros and cons, there is a reason why approximately 90% of intended parents in the USA opt for gestational surrogacy.

Below, we will explore a few questions that can help you choose between gestational and traditional surrogacy.

Are you interested in using the intended mother’s eggs?

If the intended mother has healthy eggs and a strong desire to be the child’s biological mother, then gestational surrogacy is the likely choice.

Both are potential options if you need an egg donor.

How much time do you have?

As mentioned, finding an agency and surrogate willing to take on traditional surrogacy can be very difficult. That often leads to a very long wait time/time to pregnancy that many hopeful parents do not want to endure.

If you want to have a child as soon as possible and you don’t already have a traditional surrogate lined up, gestational surrogacy is likely the best choice.

What kind of relationship do you want with your surrogate following the birth of your child?

Traditional surrogates often want to have a more involved relationship with the intended parents post-birth as they are the biological mother of the child, so make sure you’re comfortable with that should you choose the traditional route.

How risk-averse and stress-tolerant are you?

Traditional surrogacy is certainly more risky and often more stressful due to the unique legal challenges brought about by the biological connection between the surrogate and the baby.

Are you willing to take on these risks and handle the additional stress?

What state does the surrogate live in?

Traditional surrogacy is illegal in many states in which gestational surrogacy is legal. Make sure you know your state laws and talk to a reproductive attorney before making any commitments on any surrogacy.

The bottom line about traditional vs. gestational surrogacy

Traditional and gestational surrogacy are the two primary types of surrogacy. While the defining line between the two starts small – whether or not the surrogate is biologically related to the child, it greatly impacts much of the surrogacy process.

While the logistical, emotional, and legal difficulties of traditional surrogacy usually guide people into traditional surrogacy the decision always boils down to:

  • Can you/do you want to use your own eggs?
  • How much time do you have?
  • What sort of relationship do you want to have with the surrogate post-birth?
  • How risk avers,e and stress-tolerant are you?
  • What state do you live in?

Most importantly, these two forms of surrogacy are a beautiful way for hopeful intended parents to fulfill their dreams of growing their family.

We hope this article was helpful.  If you’d like to discuss your options or learn more about our gestational surrogacy program, we encourage you to request a free intended parent consultation.

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