Understanding the Risks and Complications of Surrogacy

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The Complex Beauty of Surrogacy

Surrogacy, in essence, is a testament to the power of human compassion—a journey that offers hope where nature has faltered, allowing families to be created through modern reproductive medicine. However, beyond the beauty of helping others, surrogacy—particularly gestational surrogacy—comes with significant challenges that deserve thoughtful consideration.

Whether you’re a prospective surrogate or one of the hopeful intended parents, understanding the complexities and risks is crucial.

In recent years, gestational surrogacy has garnered increasing attention due to both advances in reproductive medicine and shifting societal norms. As more individuals and couples seek alternative paths to parenthood, surrogacy has become a viable, albeit complex, option. And yet, like any path to parenthood, gestational surrogacy carries inherent risks—emotional, legal, and medical.

This article delves into the intricate web of potential risks associated with gestational surrogacy, unraveling the complications that could arise for both gestational carriers and intended parents, all while underscoring the importance of informed choices.

What is Gestational Surrogacy? A Quick Primer

Gestational surrogacy involves a surrogate carrying a child conceived through in vitro fertilization (IVF), using an egg and sperm from the intended parents or donors. Unlike traditional surrogacy where the surrogate’s egg is used, a gestational surrogate has no genetic connection to the child. The pregnancy is facilitated by transferring an embryo into the surrogate’s uterus after a series of medical processes that prepare her body for the pregnancy.

While the science behind gestational surrogacy has advanced, which has reduced many complications, it doesn’t erase the risks involved. These risks—emotional, physical, and financial—are something every party must weigh carefully.

Surrogacy Complications: Medical Risks

At its core, pregnancy is never without its medical risks, whether traditional or surrogate. For gestational surrogates, many of these risks are familiar, including weight gain, back pain, nausea, and fatigue—routine symptoms of pregnancy. 

However, gestational surrogacy presents additional complexities that might not be immediately apparent, especially when fertility drugs and advanced medical procedures come into play. Because of this, it is important that the gestational surrogate be able to consult with a reproductive endocrinologist in order to understand the additional risks associated with the IVF process. 

The process is not the same as a natural pregnancy. The physicians our clients work with are all members of the American Society for Reproductive Medicine (ASRM), which provides a summary of these medical processes.

Health Risks During Pregnancy

Even after a successful embryo transfer, the pregnancy can present unique health challenges. Like any pregnant woman, surrogates are at risk for gestational diabetes, high blood pressure, and preeclampsia. Multiple pregnancies, more common with IVF, increase the likelihood of complications such as placental abruption or preterm labor.

The surrogate also faces a risk of serious complications during delivery. These risks demand a high level of medical care and continuous monitoring by an experienced team of medical professionals.

The Emotional Risks: Navigating a Complex Relationship

The physical toll is only one part of the equation. The emotional risks of surrogacy are equally significant for the surrogate and the intended parents. While many assume that the most pressing emotional concern for a surrogate is becoming “attached” to the child she carries, this is often not the case. 

In fact, many gestational surrogates see themselves as “babysitters” during the pregnancy, happy to assist but relieved not to have to raise the child themselves. That doesn’t mean the emotional journey is smooth, however.

For the Surrogate: Balancing Emotion and Obligation

Surrogacy demands a delicate balance. Carrying someone else’s child is an act of generosity, but it can also feel overwhelming, particularly when combined with the demands of one’s personal life. Pregnant women often face heightened emotional states due to hormonal changes, and when you add the complexity of managing relationships with the intended parents and the expectations surrounding the surrogacy arrangement, it can lead to emotional stress.

There is also the potential for postpartum depression after the surrogate delivers the baby. Although she may not be biologically tied to the child, the hormonal shifts that accompany birth can trigger feelings of sadness or loss, a significant emotional toll that surrogates must be prepared to handle.

For Intended Parents: Anxiety and the Fear of the Unknown

The emotional challenges for intended parents are no less significant. Throughout the pregnancy, intended parents often experience anxiety, wondering about the health of the child and whether everything will go according to plan. This emotional strain is amplified if the surrogate faces complications during pregnancy.

Legal Risks: Navigating a Labyrinth of Rules and Contracts

One of the most complicated aspects of surrogacy is the legal landscape. Surrogacy laws vary greatly across states and countries, creating a minefield of legal issues that must be meticulously navigated. For example, in South Carolina, there currently are no specific laws regarding surrogacy. As a result, the reproductive law attorneys have cobbled together a combination of parentage statutes and case law in order to secure the intended parents’ parental rights. It takes an experienced legal professional to guide intended parents through this legal labyrinth.

Surrogacy Contracts: The Fine Print Matters

Before any surrogacy journey begins, a legally binding contract is drawn up to protect both the surrogate and the intended parents. These surrogacy contracts detail everything from financial compensation to what happens in the event of medical complications. However, despite these agreements, legal disputes can arise. Additionally, these contracts are necessary to memorialize the parties’ intentions prior to conception, which is an important step in establishing the intended parents’ parental rights and obligations.

Medical Screening: Mitigating Risks from the Start

Despite the challenges, many surrogacy programs, such as those run by Palmetto Surrogacy and other leading agencies, have developed rigorous screening processes based on best practice methods. These are set forth by the American Society for Reproductive Medicine and designed to minimize risks for everyone involved. Prospective surrogates must meet strict criteria: typically between 21–38 years old and having previously carried a pregnancy to term without significant complications.

Before the surrogacy process begins, surrogates undergo a comprehensive medical screening that often includes a physical exam, lab tests, and a review of their pregnancy and relevant medical history. This screening ensures that the surrogate is healthy enough to carry a pregnancy, thereby reducing the likelihood of severe medical complications later on.

Psychological Screening: Preparing for the Emotional Toll

Equally important is the psychological screening that every surrogate undergoes before beginning the process. Mental health professionals assess the surrogate’s emotional readiness and resilience, ensuring she fully understands the challenges ahead. This includes conversations with the surrogate’s spouse or partner (if applicable) who is integral to supporting her during the pregnancy.

For intended parents, psychological support is also critical. Many agencies recommend counseling for all parties involved, offering a space to navigate the inevitable stresses and ensure everyone is emotionally prepared for the journey. 

Additionally, programs like Palmetto Surrogacy also recommend a group support session with a mental health professional. The professional will guide the intended parents and surrogate (and spouse, if applicable) through important discussions in order to ensure that the parties’ views and expectations align with each other. This includes discussions regarding how everyone will respond when making important medical decisions when issues arise.

The Financial Risks of Surrogacy: More Than Just Agency Fees

Surrogacy is expensive—there’s no way around it. Intended parents face financial risks that go far beyond paying the surrogate. Unforeseen medical expenses, complications that require additional treatments, and the cost of IVF procedures can cause the costs of surrogacy to skyrocket unexpectedly. While surrogacy agencies often provide cost estimates, the reality is that medical risks can lead to unexpected bills.

Beyond the medical realm, there’s also the risk of working with an agency that is unreliable or that does not follow best practice methods. The rise of commercial surrogacy has seen a corresponding increase in dubious surrogacy arrangements where hopeful parents are left without a child and without the tens of thousands of dollars they’ve invested. 

Most intended parents and surrogates do not realize that the term “agency” is one that any business can use. There are no licensing requirements or government oversight restricting businesses from calling itself an “agency,” with the exception of those located in New York state. Unlike an adoption agency, which is generally heavily regulated by the state, there is no regulation or oversight for surrogacy “agencies.” 

In almost all states, anyone can obtain a business license and call themselves a “surrogacy agency” despite having minimal to no experience in surrogacy, including no educational requirements.

Ethical Dilemmas: Navigating the Morality of Surrogacy

Ethics play a significant role in the surrogacy debate. Critics argue that commercial surrogacy can exploit economically vulnerable women, turning them into reproductive vessels for wealthier individuals. This ethical quandary is particularly troubling in international surrogacy arrangements where gestational carriers in developing countries might be coerced into surrogacy for financial reasons. 

Even in the United States, this is something agencies and programs need to be aware of, and it’s one of the reasons why a surrogate applicant typically needs to demonstrate financial stability—that she is not relying on the financial benefits associated with gestational surrogacy.

Reducing the Risks: The Role of Surrogacy Professionals

Reputable surrogacy agencies and programs and experienced surrogacy professionals are instrumental in minimizing the risks associated with surrogacy. By providing detailed information, offering emotional support, and ensuring proper medical and psychological screenings, programs like Palmetto Surrogacy aim to make the surrogacy process as smooth and safe as possible.

The relationship between the surrogate, the intended parents, and the surrogacy program is fundamental to reducing risks. By fostering transparency and open communication, surrogacy professionals help all parties navigate this complex journey with greater confidence.

Weighing the Risks for a Life-Altering Decision

There is no denying the risks associated with gestational surrogacy. Whether it’s the medical risks, the emotional toll, the financial burden, or the legal uncertainties, the surrogacy journey requires careful consideration and preparation. Yet for many, these risks are worth it, offering the incredible reward of creating a family where one might not have otherwise existed.

For those considering surrogacy—whether as a surrogate mother or intended parents—it is essential to do the research, ask the hard questions, and surround yourself with a supportive team. The risks of surrogacy are real, but with careful planning and the guidance of experienced professionals, they can be managed, leading to a fulfilling and life-changing outcome for everyone involved.

Download Our Free Guide

Are you curious about surrogacy? We’ve created a guide that answers the most frequently asked questions, like “How much do surrogates make?” “What is the age limit for surrogacy?” and “How can I become a surrogate.”

Learn everything you need to know about becoming a surrogate and how to supplement your current income by as much as $6,000 per month.

A silhouetted pregnant woman stands in a sunlit field, holding her belly. The text promotes a free guide about gestational surrogacy, highlighting financial benefits, personal stories, and its impact on modern families. Logos and additional text are visible. Featured on the Thompson Dove Law Group website which specializes in adoptions, matters of assisted reproduction, and surrogacy programs.

Do You Live In South Carolina?

If you live in the state of South Carolina and would like to be a surrogate (gestational carrier) for a couple struggling with fertility, click here to take a 3-minute quiz to see if you qualify to be a surrogate with Palmetto Surrogacy. Surrogates are in high demand. We would love to get you started on this fulfilling journey.

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