Medical and mental health implications of gestational surrogacy

Published:April 08, 2021DOI:
      Gestational surrogacy in the United States has quadrupled since 1999, but to date, only a few states explicitly permit compensated gestational surrogacy. Current legal prohibitions are often influenced by outdated and stereotyped understandings of surrogacy. It is increasingly important to understand the current literature about the medical and mental health impacts of surrogacy and how state legislatures have addressed compensated gestational surrogacy in recent years. Based on this review, we found no evidence of substantial adverse medical or psychological outcomes among women who are gestational carriers or among the children they give birth to. The literature suggests that gestational surrogacy is a safe and increasingly popular option for families as long as rigorous screening and medical, psychological, and social supports are equitably provided. As states move to responsibly legalize and regulate gestational surrogacy, there is a continued need for further longitudinal studies on the health and psychological outcomes of gestational surrogacy.

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        • Perkins K.M.
        • Boulet S.L.
        • Jamieson D.J.
        • Kissin D.M.
        • National Assisted Reproductive Technology Surveillance System (NASS) Group
        Trends and outcomes of gestational surrogacy in the United States.
        Fertil Steril. 2016; 106: 435-442.e2
        • Birenbaum-Carmeli D.
        • Montebruno P.
        Incidence of surrogacy in the USA and Israel and implications on women’s health: a quantitative comparison.
        J Assist Reprod Genet. 2019; 36: 2459-2469
        • National Summary Report
        Final National summary report for 2016. 2017.
        (Available at:)
        • Shenfield F.
        • Pennings G.
        • Cohen J.
        • et al.
        ESHRE Task Force on Ethics and Law. ESHRE Task Force on Ethics and Law 10: surrogacy.
        Hum Reprod. 2005; 20: 2705-2707
        • FIGO Committee for Ethical Aspects of Human Reproduction and Women’s Health
        FIGO committee report: surrogacy.
        Int J Gynaecol Obstet. 2008; 102: 312-313
        • Practice Committee of the American Society for Reproductive Medicine and Practice Committee of the Society for Assisted Reproductive Technology. Electronic address: [email protected]; Practice Committee of the American Society for Reproductive Medicine and Practice Committee of the Society for Assisted Reproductive Technology
        Recommendations for practices utilizing gestational carriers: a committee opinion.
        Fertil Steril. 2017; 107: e3-e10
        • Tsai S.
        • Shaia K.
        • Woodward J.T.
        • Sun M.Y.
        • Muasher S.J.
        Surrogacy laws in the United States: what obstetrician-gynecologists need to know.
        Obstet Gynecol. 2020; 135: 717-722
        • Fuchs E.L.
        • Berenson A.B.
        Screening of gestational carriers in the United States.
        Fertil Steril. 2016; 106: 1496-1502
        • Centers for Disease Control and Prevention, American Society for Reproductive Medicine, Society for Assisted Reproductive Technology
        2016 Assisted Reproductive Technology National Summary Report.
        US Deptartment of Health and Human Services, Atlanta, GA2018
        • Murugappan G.
        • Farland L.V.
        • Missmer S.A.
        • Correia K.F.
        • Anchan R.M.
        • Ginsburg E.S.
        Gestational carrier in assisted reproductive technology.
        Fertil Steril. 2018; 109: 420-428
        • Committee on Practice Bulletins—Obstetrics; Society for Maternal–Fetal Medicine
        Practice Bulletin No. 169: Multifetal gestations: twin, triplet, and higher-order multifetal pregnancies..
        Obstet Gynecol. 2016; 128: e131-e146
        • Söderström-Anttila V.
        • Wennerholm U.B.
        • Loft A.
        • et al.
        Surrogacy: outcomes for surrogate mothers, children and the resulting families-a systematic review.
        Hum Reprod Update. 2016; 22: 260-276
        • Schieve L.A.
        • Ferre C.
        • Peterson H.B.
        • Macaluso M.
        • Reynolds M.A.
        • Wright V.C.
        Perinatal outcome among singleton infants conceived through assisted reproductive technology in the United States.
        Obstet Gynecol. 2004; 103: 1144-1153
        • Woo I.
        • Hindoyan R.
        • Landay M.
        • 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; 108: 993-998
        • Pavlovic Z.
        • Hammer K.C.
        • Raff M.
        • et al.
        Comparison of perinatal outcomes between spontaneous vs. commissioned cycles in gestational carriers for single and same-sex male intended parents.
        J Assist Reprod Genet. 2020; 37: 953-962
        • Sha T.
        • Yin X.
        • Cheng W.
        • Massey I.Y.
        Pregnancy-related complications and perinatal outcomes resulting from transfer of cryopreserved versus fresh embryos in vitro fertilization: a meta-analysis.
        Fertil Steril. 2018; 109: 330-342.e9
        • Teman E.
        • Berend Z.
        Surrogate non-motherhood: Israeli and US surrogates speak about kinship and parenthood.
        Anthropol Med. 2018; 25: 296-310
        • Imrie S.
        • Jadva V.
        The long-term experiences of surrogates: relationships and contact with surrogacy families in genetic and gestational surrogacy arrangements.
        Reprod Biomed Online. 2014; 29: 424-435
        • van den Akker O.B.A.
        Psychological trait and state characteristics, social support and attitudes to the surrogate pregnancy and baby.
        Hum Reprod. 2007; 22: 2287-2295
        • Blake L.
        • Carone N.
        • Slutsky J.
        • Raffanello E.
        • Ehrhardt A.A.
        • Golombok S.
        Gay father surrogacy families: relationships with surrogates and egg donors and parental disclosure of children’s origins.
        Fertil Steril. 2016; 106: 1503-1509
        • Van Rijn-van Gelderen L.
        • Bos H.W.M.
        • Jorgensen T.D.
        • et al.
        Wellbeing of gay fathers with children born through surrogacy: a comparison with lesbian-mother families and heterosexual IVF parent families.
        Hum Reprod. 2018; 33: 101-108
        • Yee S.
        • Hemalal S.
        • Librach C.L.
        “Not my child to give away”: a qualitative analysis of gestational surrogates’ experiences.
        Women Birth. 2020; 33: e256-e265
        • Deonandan R.
        Recent trends in reproductive tourism and international surrogacy: ethical considerations and challenges for policy.
        Risk Manag Healthc Policy. 2015; 8: 111-119
        • Karandikar S.
        • Gezinski L.B.
        • Carter J.R.
        • Kaloga M.
        Economic necessity or noble cause? A qualitative study exploring motivations for gestational surrogacy in Gujarat, India.
        Affilia. 2014; 29: 224-236
        • Jadva V.
        • Imrie S.
        • Golombok S.
        Surrogate mothers 10 years on: a longitudinal study of psychological well-being and relationships with the parents and child.
        Hum Reprod. 2015; 30: 373-379