What Are the Risks of Being a Surrogate?
The honest version: the risks of pregnancy itself, what research says about carriers specifically, and the emotional, legal and financial risks, plus the protections ASRM says should be in place.
Being a surrogate carries the same risks as any pregnancy, plus a few that come with IVF medications and the embryo transfer, and research suggests gestational carriers have higher rates of some complications than women who conceive on their own. Most arrangements go well, but ASRM says you have a right to be fully informed of the physical, psychological and social risks before you agree, so here is the plain version.
We get some version of this question on almost every screening call, usually asked a little nervously, as if it's the wrong thing to ask. It's the right thing to ask. A surrogate pregnancy is one you choose to take on for someone else, and you deserve to hear about the hard parts from the people recruiting you, not after you've signed.
The risks of pregnancy itself
The biggest risks of surrogacy are the risks of being pregnant and giving birth. That includes high blood pressure and preeclampsia, gestational diabetes, a cesarean birth, heavy bleeding after delivery, and, rarely, complications serious enough to affect your own future fertility. ASRM's Practice Committee lists "the potential complications of pregnancy and the potential loss of own fertility" among the topics a carrier and her partner should explore in counseling before anything is signed.
Having carried before helps you judge this. ASRM says a carrier should ideally have had at least one term, uncomplicated pregnancy, and its Ethics Committee explains why: giving true informed consent without having been through a pregnancy and delivery is problematic. Your history also gives the clinic real information about how a new pregnancy is likely to go.
What the research says about carriers specifically
Two studies are worth knowing about, because they're the ones that come up most.
- A large Canadian study. Published in the Annals of Internal Medicine in 2024, it looked at births in Ontario from 2012 to 2021, including 806 births to gestational carriers. Severe maternal morbidity, meaning a serious, potentially life-threatening complication, happened in 7.8% of carrier births, compared with 4.3% of IVF births and 2.3% of unassisted births. Carriers also had higher rates of high blood pressure disorders, heavy bleeding after delivery and preterm birth.
- A study comparing carriers with themselves. Researchers in Los Angeles, publishing in Fertility and Sterility in 2017, compared women's surrogate pregnancies with their own previous, naturally conceived pregnancies. The surrogate pregnancies had higher rates of gestational diabetes, high blood pressure, placenta previa, preterm birth and cesarean delivery.
Two things can be true at once here. The risk is real, and it appears to be higher than in an ordinary pregnancy. And in the Canadian study, about 92 out of 100 carrier births did not involve a severe complication. The authors concluded that a careful selection of carriers may be warranted, and that's what ASRM's screening criteria are meant to support.
The medications and the transfer
Before transfer, you'll usually take estrogen and progesterone to prepare your uterine lining, often continuing progesterone into early pregnancy, commonly somewhere around 8 to 12 weeks depending on your clinic. Many women find the injections are the least fun part: sore spots, bloating and mood swings are common complaints. The transfer itself is quick and usually feels a lot like a Pap smear.
The bigger medical decision is how many embryos go in. ASRM strongly recommends single embryo transfer in all gestational carrier cycles because of the health risks of carrying multiples. Twins raise the chance of preterm birth, high blood pressure and cesarean delivery for you, so ask about this early, and read our article on carrying twins as a surrogate if a double transfer is ever on the table.
The emotional and relationship risks
These are quieter but just as real: how you'll feel at the birth and afterward, the strain of appointments and pregnancy on your partner and children, a relationship with the intended parents that doesn't turn out the way you hoped, or grief if a transfer fails or a pregnancy is lost. Postpartum mood changes can happen after any birth, including this one.
ASRM takes this seriously. Its guidance calls for a psychological evaluation and counseling for you and your partner or support person before any legal contract, and ASRM's Ethics Committee says carriers should have access to counseling during and after the journey, not just at the start. It also notes that the published research, while limited, has found most arrangements are successful overall and appear to be a positive experience for carriers, without harm to their children. Our article on what the psychological evaluation covers explains what that conversation looks like.
The legal and financial risks
Surrogacy law varies from state to state, and it can change. A poorly drafted contract, or one that doesn't fit your state's law, can leave you exposed. ASRM's guidance is clear on the protections that should be in place:
- Your own independent attorney, licensed in the relevant state, who you're free to choose, even though it's common for the intended parents to pay for them.
- A fully executed contract and legal clearance before any medical treatment starts.
- Health coverage for your pregnancy care and for treating any complications, with the terms spelled out in the contract.
- Compensation for your time, inconvenience and risk, never made contingent on the birth of a healthy baby.
Increasingly, compensation is held in an escrow account, so payments don't depend on anyone's goodwill in the moment. Details such as life insurance, lost-wage coverage and what happens if you need bed rest typically vary by contract, so read those sections closely.
ASRM's Ethics Committee says a carrier is the sole source of consent for her own medical care, from embryo transfer through delivery and aftercare. ASRM says you can't be compelled to have, or refuse, a procedure on your own body, whatever the contract says, though your contract may spell out the consequences of refusing a procedure you agreed to in advance. Ask your attorney how yours handles this.
Questions worth asking before you sign
- How many embryos will be transferred, and is that in the contract?
- What health coverage pays for complications, and for how long after delivery?
- What happens to my compensation if the pregnancy ends early or I'm put on bed rest?
- Who is my attorney, and did I choose them?
- What counseling is available to me during the pregnancy and after the birth?
Where this comes up with Borne
We'd rather a woman walk away informed than sign up uninformed. On the screening call we'll talk through your past pregnancies and anything that worries you, and we'll be straight with you if something in your history makes the risk higher than usual. The final medical decision always belongs to the clinic's doctor, and the final decision to go ahead always belongs to you.
Common questions
Is being a surrogate dangerous?
Being a surrogate carries the risks of any pregnancy and birth, and research suggests gestational carriers have higher rates of some complications than women who conceive on their own. In a 2024 Ontario study, 7.8% of carrier births involved a severe complication, compared with 2.3% of unassisted births, which is why careful screening matters.
What are the disadvantages of being a surrogate?
The main disadvantages are the physical risks of pregnancy and delivery, the medications and appointments before and during pregnancy, the time commitment, and the emotional strain on you and your family. ASRM recommends psychological evaluation and counseling so you can weigh these before signing a contract.
Can being a surrogate affect your future fertility?
It can in rare cases, because serious pregnancy or delivery complications can affect your own future fertility. ASRM lists the potential loss of your own fertility among the topics a carrier and her partner should discuss in counseling before the arrangement goes ahead.
Do surrogates have more pregnancy complications?
Studies suggest they do. A 2017 Fertility and Sterility study found that women's surrogate pregnancies had higher rates of gestational diabetes, high blood pressure, placenta previa, preterm birth and cesarean delivery than their own naturally conceived pregnancies.
Who pays if a surrogate has complications?
The intended parents are typically responsible for the medical costs of the surrogacy pregnancy, through your insurance, a separate policy or direct payment depending on the contract, and your contract should spell out coverage for complications. ASRM's Ethics Committee says carriers should receive adequate health care coverage for pregnancy care and for treating complications of pregnancy.
Start with the questionnaire, then ask us anything.
Our questionnaire takes about 10 minutes and asks about your pregnancy history, your health, and where you live. If you have questions about the risks, the screening call is where we answer them honestly.
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