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What Are the Risks of Surrogacy? Medical, Legal and Emotional

August 18, 2026

The question usually arrives late at night, somewhere between wanting to help and wondering what it will cost her. Nobody asks about the risks of surrogacy hoping someone will talk them out of it. Women ask because they want the truth before deciding.

Most surrogate pregnancies end with a healthy baby and a healthy carrier. Even so, the data shows measurably higher rates of certain complications, and pretending otherwise helps nobody. What the research found, the medical and emotional risks a surrogate carries, the risks intended parents take on, the legal exposure, and how screening reduces both: each part gets covered below.

What the Research Says About Surrogate Pregnancy Risk

What Severe Maternal Morbidity Actually Measures

Before any number means anything, the term behind it needs unpacking. Researchers treat severe maternal morbidity as a composite measure rather than a single event.

The definition covers unexpected outcomes with significant consequences for a woman’s health. That list runs from blood transfusion and eclampsia through to intensive care admission and hysterectomy.

Range matters when weighing the risks of surrogacy. A rate of 7.8 percent does not describe 7.8 percent catastrophes, and quoting the figure without explaining it sells alarm rather than information.

What the Ontario Cohort Found

A 2024 study followed every singleton birth in Ontario past twenty weeks, from 2012 through 2021. Three groups came out of it: 846,124 unassisted conceptions, 16,087 IVF pregnancies, and 806 gestational carrier pregnancies.

Rates of severe complication differed across the three. Unassisted conceptions sat at 2.3 percent, IVF at 4.3 percent, and gestational carriers at 7.8 percent.

After adjustment, researchers reported a risk ratio of 3.30 for carriers against unassisted conception, and 1.86 against IVF. Hypertensive disorders, postpartum hemorrhage and preterm birth before 37 weeks were all more common among carriers in this cohort.

One caution belongs alongside those numbers. This is an observational cohort, so it shows an association rather than proof that gestational surrogacy causes the difference.

What the Study Did Not Find

Neonatal outcomes told a different story. Severe neonatal morbidity reached 6.6 percent among carrier pregnancies, against 5.9 percent for unassisted conceptions and 8.9 percent for IVF.

Researchers did not detect a statistically significant difference between carriers and unassisted conceptions. The adjusted risk ratio came out at 1.20, with a confidence interval running from 0.92 to 1.55.

That interval deserves attention rather than a victory lap. With only 806 carrier pregnancies in the sample, the study lacked the power to rule out a modest increase, and no detected difference is not the same as no difference.

Read fairly, the clearest increase this cohort found concerned the women carrying rather than the babies.

What May Contribute to Higher Risk in Carrier Pregnancies

Researchers have put forward several explanations, none of them settled.

Frozen embryo transfer in a medicated cycle leaves no corpus luteum, a factor associated with higher rates of hypertensive disorders. Carriers also tend to be older than first time mothers and to have delivered more times.

An oddity sits inside the data. Every carrier enters pregnancy already screened and healthy, which makes the gap harder to explain by health status alone.

Each of these is a candidate explanation rather than a demonstrated cause. No study has yet shown which factor drives the difference, and the medical screening a carrier completes arguably makes the finding harder to explain, not easier.

Medical Risks for the Surrogate

High Blood Pressure and Preeclampsia

Blood pressure disorders were among the outcomes that rose most clearly in the Ontario data. Symptoms often appear after week twenty, and sometimes only after delivery.

Clinical guidance sets out the diagnostic criteria for preeclampsia and the warning signs worth reporting the same day: severe headache, visual changes, upper abdominal pain, sudden swelling.

Screening takes this seriously for a reason. A history of preeclampsia is one of the more common medical disqualifiers, because a prior episode raises the odds of a repeat.

Postpartum Hemorrhage

Heavy bleeding after delivery also appeared more often among carriers in the cohort. Most cases respond to medication and standard obstetric management.

Where a surrogate delivers matters more than most people realise. Clinical bodies classify hospitals by levels of maternal care, and matching a pregnancy to a facility resourced for its risk profile is the established principle behind that system.

Delivery hospital choice therefore belongs in the conversation early, not in the third trimester.

Preterm Birth and Cesarean Delivery

Birth before 37 weeks was more frequent among carriers in this cohort. Preterm delivery carries consequences for the baby and a longer recovery for the carrier.

Repeat cesarean brings its own surgical and recovery risk, which is why agencies screen prior section count carefully. Scar tissue and placental complications both increase with each procedure.

Contracts address a cesarean delivery explicitly, covering recovery time, lost wages and additional compensation.

Side Effects of IVF Medication

Preparing for a transfer means several weeks of hormones. Estrogen comes first, progesterone follows, and injections often continue into the tenth week of pregnancy.

Common effects include injection site reactions, bloating, headaches and mood changes. Most surrogates describe the IVF medication protocol as the physically demanding part of the whole journey.

Duration runs roughly six to ten weeks around the transfer. Side effects pass, though they are real while they last.

Carrying Twins

Twin pregnancies increase several pregnancy and delivery risks at once, including preterm birth, hypertensive disorders and cesarean delivery.

Professional guidance on how many embryos to transfer exists precisely to limit multiple pregnancy. Transfer practice has shifted accordingly over the last decade.

Any contract should state clearly what happens if a surrogate carries twins, including additional compensation and the position on selective reduction.

Pregnancy Loss and Ectopic Pregnancy

Loss rates after transfer track ordinary IVF rates. The emotional weight differs, though, when the pregnancy belongs to someone else.

Surrogates who go through a miscarriage often describe grief complicated by a sense of having failed the intended parents. That reaction is common and deserves support rather than reassurance.

An ectopic pregnancy remains rare after embryo transfer. Treatment is urgent when it happens, and it can affect future fertility.

Rare but Serious Complications

Some outcomes are uncommon enough to feel remote and serious enough that a woman deserves to hear them named. Pregnancy can, rarely, produce complications that threaten future fertility or life itself.

Hysterectomy to control bleeding, major transfusion and intensive care admission all sit inside the severe maternal morbidity composite described earlier. Rates are low, and the possibility is not zero.

Contracts address this directly rather than stepping around it. Intended parents fund a life insurance policy and complication coverage before any transfer, which is standard practice rather than a warning sign.

Emotional Risks for the Surrogate

Anxiety During the Pregnancy

Carrying for someone else adds a layer of responsibility that an ordinary pregnancy does not. Every scan carries weight that is not entirely hers.

Common triggers include the early ultrasounds, glucose testing and any bleeding at all. Mental health during a journey needs the same attention as the physical side, and good agencies check in on it deliberately.

Anxiety of this kind is normal rather than a sign that something has gone wrong.

Postpartum Depression After Delivery

The hormonal drop after birth happens whether or not the baby goes home with her. Surrogates are not exempt from postpartum mood disorders, and assuming otherwise leaves women unsupported.

Warning signs to watch include persistent low mood, difficulty sleeping when the baby is not waking her, and withdrawal from her own family. Postpartum depression responds well to treatment when someone catches it early.

A six week checkup on its own rarely catches it. Support after delivery should run for months, not weeks.

Strain on Her Own Family

Bed rest, extra appointments and a difficult recovery all land on the household. Partners absorb childcare, driving and the emotional weight alongside her.

Screening includes her spouse for exactly this reason. A journey that the partner has not genuinely agreed to becomes a source of conflict rather than pride.

Explaining the pregnancy to her own children is its own task. Most families handle it well with age appropriate language planned in advance.

Risks of Surrogacy for Intended Parents

Failed Transfers and Lost Cycles

Not every transfer results in a pregnancy. Each failure costs money, months and sometimes an embryo the family cannot replace.

Families who study why transfers do not result in pregnancy tend to plan for two or three attempts rather than one.

Budgeting for a single transfer is the most common financial mistake families make.

Financial Exposure

Money moves through a surrogacy journey for well over a year. An independent escrow account protects both parties from significant financial risk by holding funds outside the agency’s control.

Insurance gaps can also create substantial unexpected costs. Policies carrying a surrogacy exclusion sometimes surface only after a pregnancy test comes back positive, which is far too late.

Reviewing insurance coverage before matching removes one of the larger avoidable exposures.

A Match That Ends Before Transfer

Before either side signs the contract, both can step away without consequence. That happens more often than agencies advertise, usually after deeper conversations reveal a mismatch.

Nothing binds a surrogate until both sides execute the agreement, so a surrogate changing her mind at that stage costs time rather than money.

Emotionally the cost is higher, particularly for families who have already waited years.

Legal Risks of Surrogacy

States Without a Clear Surrogacy Statute

Some states have written surrogacy law and some have not. Where no statute exists, parentage rests on case law and on local court practice, which varies considerably.

Checking surrogacy laws by state before matching is not optional, since the surrogate’s state governs much of what follows.

Legal ground shifts over time too, so any journey crossing state lines needs current advice rather than an article read last year.

Parentage Orders Filed Too Late

Timing decides whether intended parents appear on the original birth certificate. Attorneys generally file a pre-birth order during the second trimester so a judge signs it well ahead of delivery.

Filings that slip past that window can land after the birth. Sorting parentage retroactively takes longer and costs more.

Court calendars vary by county, which is why attorneys build in weeks of margin.

Contract Gaps That Cause Disputes

Most disputes trace back to something the contract failed to address. Silence on a difficult scenario is what turns it into a conflict later.

Terms that belong in the surrogacy contract explicitly: termination, selective reduction, bed rest, lost wages, travel, contact after birth, and the number of transfers covered.

Separate attorneys for each side exist to catch exactly these gaps.

How Screening and Contracts Reduce These Risks

What Eligibility Criteria Are Designed to Do

Screening exists to lower the risks of surrogacy, not to gatekeep. Criteria look arbitrary from outside and rarely are. Agencies design them to identify candidates whose pregnancy history is associated with safer outcomes.

Prior uncomplicated deliveries, a recent enough pregnancy for the uterus to have recovered, and a body mass index within range all sit in that category. Meeting surrogate requirements shifts the odds rather than removing risk.

No single criterion maps neatly onto one complication. Screening works as a whole picture, not as a checklist where each box cancels a specific outcome.

Transferring One Embryo at a Time

Single embryo transfer substantially reduces the risk of multiple pregnancy, which carries higher obstetric risk for both carrier and babies.

Success rates per transfer have improved enough that transferring two embryos is no longer the trade off it once was.

Intended parents sometimes push for two, hoping to shorten the journey. Clinics increasingly decline, and the reasoning sits in the paragraph above.

Frequently Asked Questions About the Risks of Surrogacy

Is a Surrogate Pregnancy Considered High Risk?

Not automatically. Agencies screen carriers for a history of uncomplicated pregnancies, so most start from a favorable position. Rates of certain complications still run higher than in unassisted pregnancy, which is why monitoring tends to be closer than a carrier may be used to.

Can Being a Surrogate Affect My Ability to Have More Children?

Usually not. Rare complications, including hysterectomy to control bleeding, can end fertility, and that possibility is one reason agencies limit the number of journeys a woman completes. Discussing family plans honestly during screening matters.

Are Babies Born Through Surrogacy Less Healthy?

The Ontario cohort did not detect a statistically significant difference in severe neonatal morbidity between carrier pregnancies and unassisted conceptions. With only 806 carrier pregnancies studied, the result cannot rule out a modest difference either.

Do Surrogates Get Attached to the Baby?

Feelings after birth vary widely from one woman to the next. Gestational carriers generally enter the process understanding their role clearly, and counselling supports that understanding throughout. A difficult separation is not the default outcome.

What Happens If a Surrogate Needs a Hysterectomy After Delivery?

Contracts address this before any transfer takes place, through life insurance and complication coverage funded by the intended parents. Compensation agreements also specify what happens to remaining payments.

What Happens If the Surrogate Becomes Seriously Ill During the Pregnancy?

Her medical team decides treatment, and her health takes priority over the pregnancy in any genuine emergency. Contracts set this out in advance so nobody negotiates it during a crisis.

How Surrogacy by Faith Manages Surrogacy Risk

Screening at Surrogacy by Faith follows the criteria described above, applied case by case rather than as a pass or fail checklist. Candidates who fall outside one criterion get a conversation, not an automatic rejection.

Intended parents fund life insurance and complication coverage before any transfer, and an independent escrow account holds every payment. Support continues after delivery rather than ending at the hospital door.

Most team members have been surrogates themselves, with a combined 8 babies between them. Women who have carried recognise the hard parts of a journey earlier than a coordinator reading from a script.

Intended parents ready to begin can start the intended parent application, and women considering carrying can open the surrogate application in a few minutes.