Gestational surrogacy arrangements have been documented throughout history, but more recent technological advances in assisted reproductive technologies (ART) have made it possible for a woman, referred to as a gestational carrier (GC), to gestate and give birth to a child that is not genetically related to her on behalf of the intended parents (IPs) who are to be the legal, rearing parents. This chapter considers the multifaceted role of the fertility counselor, as well as both the complexity of these arrangements and issues of competence in fertility counseling. It moves beyond a “how to” guide and addresses the delicate balance of a multitude of psychological and ethical factors that the fertility counselor must consider for all parties involved. The assessment process, facilitated by the fertility counselor, aids in helping all participants in these arrangements make sound decisions. Fertility counselors provide accurate information to all parties, facilitate relationships between parties, and create a basis for informed consent. Thus, how these arrangements and relationships are facilitated become crucial in their success. Due to the number of participants in these arrangements and the competing vulnerabilities and needs of each, there is a vital role for the fertility counselor in surrogacy screenings.