Kim Kardashian, Khloé Kardashian, Paris Hilton, Jimmy Fallon, Neil Patrick Harris, Chrissy Teigan, Tyra Banks, and countless other celebrities are all tied together by a choice to use gestational surrogacy to grow their families. We often hear their stories in the news, usually accompanied by their sentiments of gratitude towards their surrogates (and, less often, including honest feelings of detachment from their biological children). Now, we even see viral clips of TikTok stars receiving newborns they paid a surrogate to create, laying down on a hospital bed as if they themselves are the patient—usually with the woman who just gave birth nowhere to be seen.
While the media often celebrates these stories and frames them as celebrities ‘opening up’ about the difficult decision to use gestational surrogacy to create their families, an uncomfortable piece of the equation is often left out of the cultural conversation: what has become of the physical and emotional health of the women who carried these pregnancies, and that of the children who resulted from them? As we’ll discuss, these pregnancies are high risk by definition, and so it’s only normal to wonder whether the surrogates or the babies may suffer any ill effects from the process. But what, exactly, makes surrogate pregnancies so different (and far riskier) from a natural pregnancy, or another pregnancy achieved using in vitro fertilization (IVF)?
These are difficult questions, and by and large they are still being answered given the relatively new phenomenon of gestational surrogacy. While this article will not delve heavily into the ethical concerns around surrogacy, it will offer an honest and frank evaluation of the current surrogacy market and examine what we know about how both women and babies are physically and emotionally affected by surrogacy pregnancies.
The risks of gestational surrogacy for women
Medical risks of surrogacy
Researchers generally acknowledge that the elevated risks for a surrogacy pregnancy are likely due to the fact that the woman carrying the child has no genetic relation to the baby [1]. But surrogacy is not possible without in vitro fertilization (IVF), which itself carries risks. Because of this, many of the known risks of surrogacy are similar to the risks that accompany IVF. With surrogacy, however, the IVF process is split (and the risks distributed) across different women.
Surrogacy is not possible without in vitro fertilization (IVF), which itself carries risks. Because of this, many of the known risks of surrogacy are similar to the risks that accompany IVF. With surrogacy, however, the IVF process is split (and the risks distributed) across different women.
In the case of gestational surrogacy (by far the most common kind of surrogacy today), the eggs do not come from the surrogate herself, but from a different woman (either a female donor, or the intended mother), while the sperm comes from the intended father (or male donor)[2]. This is why the surrogate, who has not contributed any raw genetic material to the creation of the embryo, is called a “gestational carrier.” While the egg donor or intended mother will undergo the risks of egg retrieval, the gestational carrier will assume the risks of carrying the child–beginning with receiving multiple doses of the medications Lupron and Syranel. These medications “pause” the surrogate’s menstrual cycle, so her body can be put into sync with the woman who is being primed for egg retrieval.
It should be noted that neither Syranel nor Lupron have been approved by the FDA for use in IVF. Lupron, in particular, carries a category X classification during pregnancy, meaning that it is not to be used by pregnant women due to the risk of birth defects. Additionally, both of these medicines are known to carry significant side effects for the women who use them.
Surrogacy pregnancies are more likely to have worse outcomes than spontaneously-conceived pregnancies
Once an embryo is transferred to the surrogate, and if it successfully implants, the woman will face a pregnancy that is statistically riskier than natural, spontaneously-conceived pregnancies. A comprehensive study by researchers at the Center for Bioethics and Culture found that surrogate pregnancies were significantly more likely than non-surrogate pregnancies to develop complications such as high blood pressure, hemorrhage, preterm labor, postpartum depression, and postpartum high blood pressure [3]. Surrogates also had nearly triple the rate of C-sections, and many of the women studied also reported suffering chronic health conditions after their pregnancies.
A comprehensive study by researchers at the Center for Bioethics and Culture found that surrogate pregnancies were significantly more likely than non-surrogate pregnancies to develop complications such as high blood pressure, hemorrhage, preterm labor, postpartum depression, and postpartum high blood pressure.
Another study examined complication rates in women who conceived on their own and later on became gestational carriers [4]. Fascinatingly, the researchers found that even in women who had had previous, healthy, uncomplicated pregnancies, subsequent surrogate pregnancies led to more adverse maternal and neonatal outcomes, including preterm birth, low birth weight, gestational hypertension, placenta previa, Cesarean birth, and gestational diabetes.
Given that the science behind gestational surrogacy is still relatively new, these findings are still largely preliminary. Furthermore, many of the studies done on surrogacy include small sample sizes, and are marred by “serious methodological limitations.” Case in point, only one of 30 cohort studies included in a 2016 systematic review was considered high quality, while 16 were of moderate quality and 13 were of low quality [5]. In many ways, surrogates are “flying blind” when accepting the risks (known and unknown) that accompany surrogacy. Surrogacy is also not without the potential for high emotional costs for surrogate mothers.
The risks of gestational surrogacy for babies
Potential for abandonment and abuse
The most immediate risk to the children born via surrogacy is the potential for abuse or neglect. Because many countries have little to no restrictions on who can pay for a surrogate, disturbing cases have come to light over the past few years, such as the recent discovery of 21 babies and children in the California home of a 65- and 38-year-old Chinese couple, many of whom appear to have been carried via several different surrogates. In 2024, a man was found to have paid for a baby boy to be born via surrogacy, whom he planned to later sexually abuse (Notably, child abuse is notoriously more common when the caregiver is male and unrelated to the child.) In another case, a baby who was born with Down syndrome was abandoned in a foreign country, as she was unwanted by her intended parents due to her disability.
Because many countries have little to no restrictions on who can pay for a surrogate, disturbing cases have come to light over the past few years, such as the recent discovery of 21 babies and children in the California home of a 65- and 38-year-old Chinese couple, many of whom appear to have been carried via several different surrogates.
Unlike in cases of adoption, where prospective parents are thoroughly vetted, there are no (U.S.) federal laws regulating surrogacy, and only patchwork regulations of widely varying strictness at the state level. In many U.S. states (especially California) and countries across the globe, surrogacy is a legal free-for-all for whoever has the money to pay for it. And while many of these children may ultimately be born into loving families, the demonstrated potential for abuse and neglect poses grave concerns.
Medical risks
Even when surrogacy-created children are born into loving homes, they still face other risks. Research points to health risks faced by newborns conceived via surrogacy, such as increased risk of cardiovascular disease, metabolic dysfunction, and thyroid issues [6]. Many of these health issues arise for all children conceived via IVF, as IVF children historically have higher rates of low birth weight and preterm delivery, and sometimes suffer other chronic health issues as a result [7].
Specific to gestational surrogacy, research also posits that surrogacy-born children could have further health issues due to the increased stress of the surrogate mother during pregnancy, but there is a dearth of research in this area thus far [6]. And while a gestational surrogate provides no raw genetic material for the creation of the embryo, the nascent field of epigenetics indicates that she can still profoundly impact the child’s lifelong health [8].
Emotional trauma
Finally, babies born to surrogate mothers begin their lives experiencing the heartbreaking loss of all they have ever known: the woman who carried them. Many experts believe that babies experience trauma when they are separated from their gestational mother, as babies instinctively recognize (and are comforted by) the voice and smell of their mother immediately after birth [9][10]. This essentially means that surrogacy separates a child from the only comfort he has ever known to put him into the arms of strangers, sometimes only minutes after birth. Unfortunately, little in-depth research exists on the subject of the emotional effects experienced by children delivered via surrogacy, though we do know that adoptees often experience trauma or identity issues after being adopted at birth.
This essentially means that surrogacy separates a child from the only comfort he has ever known to put him into the arms of strangers, sometimes only minutes after birth.
Going forward
It is still unclear just how much and in what ways surrogacy affects both surrogate mothers and the children they carry, as research on the subject is preliminary and sparse. Due to the fact that gestational surrogacy is inextricably linked to IVF, more research is also needed to fully understand the medical risks faced by women who undergo that process.
To learn more about the potential body literacy holds for discouraging surrogacy, check out Natural Womanhood’s podcast episode with researcher Jennifer Lahl on the subject. And to learn more about what restorative reproductive medicine (RRM) offers women and couples with previously “unexplained fertility,” check out Natural Womanhood’s RRM extensive content.
References:
[1] McCoy DE, Haig D, Kotler J. Egg donation and gestational surrogacy: Pregnancy is riskier with an unrelated embryo. Early Hum Dev. 2024 Sep;196:106072. doi: 10.1016/j.earlhumdev.2024.106072. Epub 2024 Jul 2. PMID: 39106717. [2] Fuchs EL, Berenson AB. Outcomes for Gestational Carriers Versus Traditional Surrogates in the United States. J Womens Health (Larchmt). 2018 May;27(5):640-645. doi: 10.1089/jwh.2017.6540. Epub 2018 Jan 11. PMID: 29323605; PMCID: PMC5962328. [3] Lahl, Jennifer & Fell, Kallie & Bassett, Kate & Broghammer, Frances & Briggs, William. (2022). A Comparison of American Women’s Experiences with Both Gestational Surrogate Pregnancies and Spontaneous Pregnancies. Dignity: A Journal of Analysis of Exploitation and Violence. 7. 10.23860/dignity.2022.07.03.01. [4] Woo I, et al. Perinatal outcomes after natural conception versus in vitro fertilization (IVF) in gestational surrogates: a model to evaluate IVF treatment versus maternal effects. Fertil Steril. 2017 Dec;108(6):993-998. doi: 10.1016/j.fertnstert.2017.09.014. PMID: 29202976. [5] Viveca Söderström-Anttila, et al. Surrogacy: outcomes for surrogate mothers, children and the resulting families—a systematic review, Human Reproduction Update, Volume 22, Issue 2, March/April 2016, Pages 260–276, https://doi.org/10.1093/humupd/dmv046References, cont.
[6] Simopoulou M, et al. Risks in Surrogacy Considering the Embryo: From the Preimplantation to the Gestational and Neonatal Period. Biomed Res Int. 2018 Jul 17;2018:6287507. doi: 10.1155/2018/6287507. PMID: 30112409; PMCID: PMC6077588. [7] Wisborg K, Ingerslev HJ, Henriksen TB. In vitro fertilization and preterm delivery, low birth weight, and admission to the neonatal intensive care unit: a prospective follow-up study. Fertil Steril. 2010 Nov;94(6):2102-6. doi: 10.1016/j.fertnstert.2010.01.014. Epub 2010 Feb 26. PMID: 20188361. [8] Negahdari, Samira & Valiyari, Samira. (2022). Evaluation of Epigenetic Factors in Surrogacy: A Mini-Review. Journal of Obstetrics Gynecology and Cancer Research. [9] Mehler J, Bertoncini J, Barriere M. Infant recognition of mother’s voice. Perception. 1978;7(5):491-7. doi: 10.1068/p070491. PMID: 733440.[10] Sullivan RM, Toubas P. Clinical usefulness of maternal odor in newborns: soothing and feeding preparatory responses. Biol Neonate. 1998 Dec;74(6):402-8. doi: 10.1159/000014061. PMID: 9784631; PMCID: PMC2046216.
