Medical FAQ

Surrogate candidates undergo comprehensive medical screenings, including physical exams, blood tests, genetic screenings, and psychological evaluations to ensure their suitability for surrogacy. 

Medical screenings for surrogacy are thorough and designed to ensure the health and safety of the surrogate, as well as the best possible outcome for the pregnancy and the health of the baby. These screenings are conducted before a surrogate is officially accepted into a surrogacy program and often include:

General Health and Fertility Assessments

  • Physical Examination: A comprehensive physical exam to assess the overall health of the surrogate.
  • Reproductive Health Assessment: Includes a detailed gynecological examination to evaluate the surrogate’s uterus and reproductive system, ensuring they are capable of carrying a pregnancy.
  • Blood Tests: To check for infectious diseases (such as HIV, hepatitis B and C, syphilis), immunity to certain diseases (like chickenpox and measles), and overall health markers (such as hemoglobin levels, blood type, and Rh factor).
  • Fertility Tests: Although not always necessary, especially for surrogates who have previously had successful pregnancies, fertility assessments may be conducted.

Screening for Sexually Transmitted Infections (STIs)

  • Comprehensive testing for STIs is crucial to prevent transmission to the baby.

Drug and Nicotine Tests

  • Tests to ensure the surrogate does not use illegal drugs, abuse prescription drugs, or use tobacco, all of which can negatively affect pregnancy outcomes.

Psychological Evaluation

  • Mental Health Screening: A psychological assessment to evaluate the surrogate’s mental and emotional health, ensuring she is psychologically prepared for the surrogacy journey.
  • Counseling Sessions: Might be conducted to discuss the emotional implications of surrogacy and to ensure the surrogate fully understands and is prepared for the emotional journey ahead.

Genetic Testing

  • While not always standard, genetic testing might be considered, depending on the arrangement and the use of the surrogate’s eggs in traditional surrogacy scenarios.

Lifestyle Evaluation

  • Discussion of the surrogate’s lifestyle, including diet, exercise, and support system, to assess her readiness and suitability for maintaining a healthy pregnancy.

Infectious Disease Immunizations

  • Verification of up-to-date vaccinations to protect both the surrogate and the baby from preventable diseases.

In traditional surrogacy, the surrogate uses her own eggs, whereas in gestational surrogacy, the surrogate carries an embryo created using either the intended parents’ or donor eggs and sperm. 

The surrogate can use her own eggs in what is known as traditional surrogacy. In traditional surrogacy, the surrogate’s egg is fertilized with the sperm of the intended father or a sperm donor, making the surrogate the biological mother of the child she is carrying. This method was more common before advances in assisted reproductive technologies made gestational surrogacy more accessible. The following are aspects associated with traditional surrogacy:

  • Biological Connection: Because the surrogate uses her own egg, she has a genetic link to the child. This can raise complex emotional and legal issues, as the surrogate is the biological mother.
  • Insemination Fertilization typically occurs through intrauterine insemination (IUI), where sperm is directly inserted into the uterus, making the process less invasive and costly than IVF, which is used in gestational surrogacy.
  • Legal and Emotional Considerations: The genetic connection between the surrogate and the baby can complicate the legal process of establishing the intended parents’ parental rights. It may also intensify the emotional aspects of the surrogacy arrangement for all parties involved.

Medical risks for surrogates may include complications from pregnancy, such as gestational diabetes, preeclampsia, and cesarean section delivery, as well as psychological challenges.

Surrogacy involves medical risks similar to those of any pregnancy, with some additional considerations due to the nature of assisted reproductive technologies (ART) like in vitro fertilization (IVF). Here are the primary medical risks for surrogates:

Pregnancy-Related Health Risks

  • Gestational Diabetes: An increase in blood sugar levels during pregnancy, which can pose risks to both the surrogate and the baby.
  • High Blood Pressure (Preeclampsia): This condition can lead to serious, life-threatening complications if not managed properly.
  • Miscarriage: The risk of miscarriage varies by age and health status but is a potential risk in all pregnancies.
  • Ectopic Pregnancy: Although rare, especially in gestational surrogacy where embryos are placed directly in the uterus, there’s a small risk of ectopic pregnancy, where the embryo implants outside the uterus.
  • Preterm Labor: Surrogates may have a slightly increased risk of preterm labor, particularly if multiple embryos are transferred, leading to a multiple pregnancy.

IVF and Embryo Transfer-Related Risks

  • Ovarian Hyperstimulation Syndrome (OHSS): Surrogates who use their own eggs (in traditional surrogacy) may undergo ovarian stimulation, which can lead to OHSS, a condition where the ovaries become swollen and painful.
  • Infection or Complications from Procedures: Procedures involved in ART, such as egg retrieval (in traditional surrogacy) and embryo transfer, carry risks of infection or complications.

Multiple Pregnancies

  • Increased Risk with Multiples: If more than one embryo is transferred, there’s an increased risk of multiple pregnancies, which come with higher risks of complications such as gestational diabetes, preeclampsia, and preterm birth.

Emotional and Psychological Risks

  • Emotional Impact: Surrogates may experience emotional stress or postpartum depression. Psychological support during and after pregnancy is crucial to mitigate these risks.

Long-Term Health Risks

  • The majority of surrogates recover from pregnancies without long-term health issues, but as with any pregnancy, there are risks of lasting changes to the body or fertility.

Embryos for surrogacy are typically created through in vitro fertilization (IVF), where eggs retrieved from either the intended mother or an egg donor are fertilized with sperm from either the intended father or a sperm donor. 

Embryos for surrogacy are created using a process called In Vitro Fertilization (IVF), a type of Assisted Reproductive Technology (ART). The IVF process involves several steps designed to fertilize an egg with sperm outside the body and then transfer the resulting embryo into the surrogate’s uterus. Here’s a breakdown of the process, in order:

  • Ovarian Stimulation: The egg donor (who can be the intended mother or a separate donor) undergoes ovarian stimulation through the administration of fertility drugs. These drugs encourage the ovaries to produce multiple eggs simultaneously.
  • Egg Retrieval: Once the eggs are mature, they are retrieved from the donor’s ovaries in a minor surgical procedure called follicular aspiration. This procedure is typically done under sedation or anesthesia.
  • Sperm Collection: Sperm is collected from the intended father or a sperm donor. The sperm may be fresh or previously frozen.
  • Fertilization: The retrieved eggs are fertilized with the collected sperm in a laboratory setting. Fertilization can be done by simply mixing sperm and eggs together in a petri dish (conventional insemination) or by directly injecting a single sperm into an egg using a technique called Intracytoplasmic Sperm Injection (ICSI), which is often used when there are concerns about sperm quality or previous fertilization attempts have failed.
  • Embryo Culture: Fertilized eggs, now embryos, are monitored and cultured in the lab for several days. During this time, they are assessed for quality and development. Some embryos may be subjected to Preimplantation Genetic Diagnosis (PGD) or Preimplantation Genetic Screening (PGS) to test for specific genetic conditions or chromosomal normalcy.
  • Embryo Transfer: One or more embryos are selected for transfer into the surrogate’s uterus. The decision on the number of embryos to transfer depends on various factors, including the quality of the embryos, the age of the egg donor, and specific policies of the fertility clinic or legal regulations. The transfer is a minimally invasive procedure that does not typically require anesthesia. A thin catheter is used to place the embryo(s) directly into the surrogate’s uterus through the cervix.
  • Supporting Implantation: After the embryo transfer, the surrogate may be given progesterone and possibly other medications to help support the uterine lining and encourage implantation.
  • Pregnancy Test: Approximately two weeks after the embryo transfer, the surrogate will take a pregnancy test to determine if the IVF process was successful and if a viable pregnancy has been achieved.

In the event of a failed pregnancy, the intended parents and the surrogate may decide whether to pursue additional attempts or explore alternative options such as adoption or embryo donation. 

If a pregnancy fails during a surrogacy arrangement, it can be a deeply emotional and challenging time for both the surrogate and the intended parents. The specific steps and decisions following a failed pregnancy largely depend on the circumstances of the failure, the terms of the surrogacy agreement, and the desires of both parties to continue with surrogacy. Here are the general steps and considerations in such situations:

Review and Emotional Support

  • Emotional Support: Recognizing and addressing the emotional impact on both the surrogate and the intended parents is crucial. Counseling and support services can be beneficial.
  • Medical Review: A thorough medical review is often conducted to understand the reasons behind the pregnancy failure. This can include reviewing the surrogate’s health, the quality of the embryos, and the success of the implantation process.

Considering Next Steps

  • Reevaluation: The intended parents and the surrogate, often with the guidance of their medical team and surrogacy agency, will reevaluate their options and decide whether to attempt another cycle of IVF and surrogacy. This decision can depend on several factors, including the emotional and physical readiness of the surrogate, the availability of more embryos for transfer, and financial considerations.
  • Contractual Agreements: The surrogacy agreement may outline specific steps or conditions in the event of a pregnancy failure, including financial aspects and whether multiple attempts are covered under the original terms.

Legal and Financial Considerations

  • Financial Impact: Depending on the surrogacy agreement, there may be financial implications of a failed pregnancy attempt. Some or additional costs may be incurred if another attempt is made.
  • Legal Advice: Consulting with legal counsel can help clarify the legal aspects of attempting another pregnancy, adjusting the surrogacy agreement, or, if necessary, discontinuing the surrogacy journey.

Planning for Another Attempt

  • Medical Adjustments: Based on the reasons for the failed pregnancy, the medical team may suggest adjustments to the treatment plan, such as using different medications, changing the embryo transfer strategy, or considering a different surrogate if there are concerns about the surrogate’s ability to carry a pregnancy.
  • Emotional Readiness: Both the surrogate and the intended parents must be emotionally ready to undergo another surrogacy attempt. Emotional counseling and support groups can be instrumental during this time.

Moving Forward

  • Alternative Paths to Parenthood: If the intended parents decide not to continue with surrogacy, they might consider other paths to parenthood, such as adoption or exploring other assisted reproductive technologies.
  • Continuing the Journey: If all parties agree to proceed with another surrogacy attempt, they will prepare for another cycle of IVF and embryo transfer, taking into account any medical or strategic adjustments recommended by their healthcare providers.

Yes, genetic testing can be performed during surrogacy to screen for genetic disorders, ensure embryo viability, and provide information about the baby’s health and development.

Genetic testing can be done during surrogacy as part of the in vitro fertilization (IVF) process, providing valuable information about the health and genetic status of embryos before they are transferred to the surrogate. There are two primary types of genetic testing used:

  • Preimplantation Genetic Diagnosis (PGD): PGD is used to test embryos for specific known genetic conditions. This is particularly useful for intended parents who are carriers of or have a family history of genetic disorders and want to reduce the risk of passing these conditions onto their child. PGD involves removing a few cells from an embryo and testing those cells for the presence of genetic abnormalities associated with specific diseases.
  • Preimplantation Genetic Screening (PGS): PGS, also known as preimplantation genetic testing for aneuploidy (PGT-A), screens embryos for chromosomal abnormalities without looking for specific genetic disorders. PGS can identify embryos with the correct number of chromosomes, which increases the chances of a successful pregnancy and decreases the risk of miscarriage. This type of testing is often recommended for older intended mothers, those with a history of miscarriages, or when previous IVF cycles have failed.

Procedure for Genetic Testing

  • Embryo Biopsy: A few cells are removed from each embryo, typically on the fifth or sixth day of development when the embryo reaches the blastocyst stage.
  • Genetic Analysis: The cells are analyzed using advanced genetic testing techniques.
  • Selection of Embryos: Based on the test results, embryos without genetic abnormalities are selected for transfer to the surrogate’s uterus.


  • Ethical and Legal Aspects: Genetic testing raises ethical questions, such as the selection of embryos based on genetic characteristics. Legal regulations regarding these practices vary by country and region.
  • Timing and Logistics: Genetic testing requires additional time and planning within the IVF cycle. Embryos may be frozen while awaiting test results, to be thawed and transferred in a subsequent cycle.
  • Costs: Genetic testing adds to the cost of the IVF and surrogacy process. Intended parents should consider this when planning financially for surrogacy.

Fertility clinics often adhere to guidelines recommending the transfer of a limited number of embryos to minimize the risk of multiple pregnancies and associated complications. 

Yes, there are restrictions and guidelines concerning the number of embryos transferred during assisted reproductive procedures like in vitro fertilization (IVF). These restrictions aim to reduce the risks associated with multiple pregnancies, which include preterm birth, low birth weight, and increased maternal complications.

The specific number of embryos transferred typically depends on several factors, including the patient’s age, the quality of the embryos, previous IVF attempts, and specific medical conditions. Guidelines vary by country and are often set by medical associations or regulatory agencies.

For example:

  • In the United States, the American Society for Reproductive Medicine (ASRM) provides guidelines suggesting the transfer of one to two embryos for most patients, particularly in those under the age of 35.
  • In Europe, similar guidelines by the European Society of Human Reproduction and Embryology (ESHRE) recommend single embryo transfer (SET) in cases where the likelihood of success is high to avoid the risks of twin pregnancies.
  • Some countries have even stricter regulations, allowing only single embryo transfers in most cases.

In the case of multiple embryos, intended parents and the surrogate may decide whether to transfer all embryos or select a specific number based on medical recommendations and personal preferences. 

When multiple embryos are transferred during an IVF procedure, there’s a possibility that more than one embryo will implant in the uterus, leading to a multiple pregnancy (e.g., twins, triplets, or more). Multiple pregnancies carry higher risks and implications for both the mother and the babies compared to singleton pregnancies. Here are some of the key concerns and outcomes:

Increased Health Risks for the Mother

  • Physical complications: These can include high blood pressure, gestational diabetes, preeclampsia, and increased likelihood of requiring a cesarean section.
  • Mental and emotional stress: The physical demands and potential complications of a multiple pregnancy can lead to increased psychological stress.

Risks to Babies

  • Premature birth: This is more common in multiple pregnancies and can lead to complications such as respiratory distress syndrome, intraventricular hemorrhage, and other long-term health issues.
  • Low birth weight: Babies born from multiple pregnancies often weigh less than those from singleton pregnancies, which can lead to additional health problems.
  • Increased risk of disability: Prematurity and low birth weight are associated with a higher risk of developmental delays and disabilities.

Economic and Social Impact

  • Higher medical costs: Care for multiple babies can be significantly more expensive due to increased medical needs and potential extended hospital stays.
  • Greater caregiving demands: Multiple infants can place higher demands on caregivers, affecting parental well-being and family dynamics.

Long-term Development

  • Children born from multiple pregnancies may face challenges such as developmental delays and educational difficulties.
Babies born via surrogacy generally have similar health outcomes to naturally conceived babies, although they may face unique challenges related to the surrogacy process and genetic factors. Babies born via surrogacy generally face the same health risks as those conceived naturally or through in vitro fertilization (IVF) and carried by their biological mother. However, certain factors related to surrogacy and assisted reproductive technologies (ART) can influence the health risks for the baby:
  • Premature Birth and Low Birth Weight: There is a higher likelihood of premature birth and low birth weight in pregnancies achieved through IVF, which is commonly used in gestational surrogacy. These conditions can lead to further health complications for the baby.
  • Multiple Births: Surrogacy often uses IVF, which can increase the chances of multiple births (twins, triplets, etc.) if more than one embryo is implanted to increase the odds of a successful pregnancy. Multiple births carry higher risks of premature delivery, low birth weight, and complications during delivery.
  • Genetic Screening: With surrogacy, there is often the opportunity for genetic screening of embryos before implantation. This can potentially reduce the risk of certain genetic conditions, depending on the quality of the embryos and the genetic material from the egg and sperm donors.
  • Health of the Surrogate: The surrogate’s health and lifestyle choices during pregnancy can affect the health of the baby. Comprehensive medical and psychological screening processes for surrogates aim to minimize these risks by ensuring the surrogate is in good health, understands the importance of prenatal care, and is committed to maintaining a healthy lifestyle during pregnancy.

Surrogates typically undergo medical evaluations to ensure they meet certain health criteria, including being of reproductive age, having a healthy uterus, and being free from certain medical conditions. 

The medical qualifications for being a surrogate are designed to ensure that the surrogate is capable of safely carrying and delivering a healthy baby, while also maintaining her own health. These criteria can vary slightly depending on the fertility clinic or surrogacy agency, but generally include:

  • Age: Surrogates are typically required to be between 21 and 45 years old, with some agencies preferring surrogates under the age of 40 due to lower pregnancy risks.
  • Previous Successful Pregnancies: Surrogates should have at least one previous successful pregnancy and delivery without significant complications, demonstrating their ability to carry a pregnancy to term.
  • Healthy Physical Condition: Surrogates must undergo a thorough medical examination, including a pelvic exam, blood tests, and sometimes a uterine evaluation to ensure they are physically capable of carrying a pregnancy. This includes being within a healthy weight range (often indicated by a Body Mass Index (BMI) within specific limits) to reduce the risk of pregnancy-related complications.
  • Absence of STDs: Surrogates must be free from sexually transmitted diseases (STDs) that could be passed on to the baby.
  • Non-smoker and Drug-free: Surrogates must not use tobacco, illegal drugs, or be a heavy alcohol user, as these substances can harm the developing fetus.
  • Psychological Screening: Mental health screenings are conducted to ensure the surrogate can handle the emotional aspects of surrogacy, including handing the baby over after birth.
  • Stable Lifestyle: Surrogates should have a stable living situation and support system. Some agencies also require that surrogates have completed their families.
  • No Complications in Previous Pregnancies: The surrogate’s previous pregnancies should have been without significant complications, such as severe pre-eclampsia, gestational diabetes that required insulin, or preterm birth before 37 weeks, unless deemed acceptable by a healthcare provider.
  • Immunization: Up to date on all relevant immunizations to protect both the surrogate and the baby during pregnancy.

Surrogates prepare for pregnancy by following medical advice, adopting a healthy lifestyle, and adhering to any prescribed medications or treatments to optimize their chances of a successful pregnancy. 

Preparing for a surrogacy pregnancy involves several steps, both medical and legal, to ensure the health and well-being of the surrogate and the baby. Here’s a general overview of the process:

Medical Preparation

  • Medical Screening: Comprehensive medical exams are conducted to assess the surrogate’s physical health, including fertility assessments, blood tests, and screenings for infectious diseases.
  • Psychological Screening: Surrogates undergo psychological evaluations to ensure they are mentally and emotionally prepared for the surrogacy journey and understand the emotional implications of carrying and then handing over the baby to the intended parents.
  • Legal Agreements: A legal contract is drawn up between the surrogate and the intended parents, outlining each party’s responsibilities, financial agreements, and plans for potential pregnancy outcomes. It’s crucial for all parties to understand and agree to these terms before proceeding.
  • Fertility Treatments: If the surrogacy is gestational, the surrogate undergoes fertility treatments to prepare her body for pregnancy. This usually involves hormone therapy to synchronize her menstrual cycle with the egg donor’s cycle (if using a donor) and to prepare her uterus to receive the embryo.
  • Embryo Transfer: Once the surrogate’s body is prepared, and the embryos are created and ready (either from the intended parents or donors), an embryo transfer procedure is performed. This is a relatively simple and painless process but requires precise timing for the best chances of success.

Lifestyle and Health Preparation

  • Healthy Lifestyle: Surrogates are advised to maintain a healthy lifestyle, including a balanced diet, regular exercise, and avoiding tobacco, alcohol, and illicit drugs. Some agencies or fertility clinics may provide specific guidelines or support for nutrition and health.
  • Support System: Establishing a strong support system is important. This can include family, friends, and support groups who understand and support the surrogate’s journey.
  • Counseling and Support: Many surrogates and intended parents engage in counseling throughout the surrogacy process to address any emotional or psychological challenges that arise. Surrogacy agencies often provide access to counseling services.
  • Educational Resources: Surrogates may be provided with educational resources to learn more about the medical procedures, pregnancy, childbirth, and postpartum recovery related to surrogacy.

Surrogates receive regular prenatal care, including doctor’s visits, ultrasounds, and prenatal screenings, to monitor the health and development of the baby and address any potential concerns. 

Medical care during pregnancy is crucial for monitoring the health of both the surrogate (or pregnant individual) and the fetus, and for managing any pregnancy-related complications that may arise. This care typically involves a series of scheduled appointments with healthcare providers, such as obstetricians or midwives, and may include:

1. Initial Prenatal Visit

  • Confirmation of Pregnancy: Often includes a urine or blood test.
  • Comprehensive Health Check: Assessment of health history, including previous pregnancies, surgeries, and any chronic conditions.
  • Physical Exam: Including a pelvic exam and Pap smear.
  • Blood and Urine Tests: To check for infections, blood type, Rh factor, and other health indicators.
  • Counseling: On nutrition, exercise, and lifestyle adjustments necessary for a healthy pregnancy.

2. Regular Prenatal Visits

  • Frequency: Typically, visits are monthly for the first 28 weeks, biweekly from weeks 28 to 36, and weekly from week 36 until delivery.
  • Checkups: Include monitoring blood pressure, weight, and the growth and position of the fetus. The healthcare provider will listen to the fetal heartbeat and may measure the height of the uterus.
  • Screening Tests: Various screening tests are offered throughout pregnancy to assess the risk of genetic conditions or birth defects. These can include blood tests, ultrasounds, and, in some cases, amniocentesis or chorionic villus sampling (CVS).

3. Glucose Screening

  • Tests for gestational diabetes, typically conducted between 24 and 28 weeks of pregnancy.

4. Group B Streptococcus Screening

  • Conducted between 35 and 37 weeks to check for the presence of Group B strep bacteria, which can be harmful to the newborn if transmitted during delivery.

5. Ultrasounds

  • Used to monitor the development and health of the fetus, check for congenital anomalies, and determine the due date. Additional ultrasounds may be performed based on medical necessity.

6. Nutritional and Lifestyle Counseling

  • Guidance on diet, prenatal vitamins, exercise, and avoiding harmful substances.

7. Preparation for Childbirth

  • Discussions about labor and delivery options, creating a birth plan, and recognizing the signs of labor.

8. Postpartum Care

  • Follow-up appointments after delivery to check on the surrogate’s physical and emotional recovery, manage breastfeeding (if applicable), and address any complications.

Special Considerations for Surrogacy:

  • In a surrogacy arrangement, medical care also involves coordination with the intended parents regarding updates on the pregnancy’s progress and decisions about the birth plan. Legal considerations may dictate who is authorized to make medical decisions for the fetus.

In the event of pregnancy complications, the surrogate receives specialized medical care and may require additional monitoring, interventions, or even bed rest to ensure the safety of both her and the baby. 

If complications arise during pregnancy, the approach to management and treatment will depend on the type of complication, its severity, and the stage of pregnancy. Healthcare providers are trained to monitor for and address a wide range of pregnancy-related complications, working closely with the pregnant individual to manage their health and the health of the fetus. Here’s an overview of how some common and serious complications might be handled:

Common Complications

  • Gestational Diabetes: Managed through diet, exercise, and sometimes medication to control blood sugar levels.
  • High Blood Pressure (Preeclampsia): Monitoring blood pressure closely, prescribing medication if necessary, and in severe cases, considering early delivery.
  • Placenta Previa: Depending on the severity, it might require reduced physical activity, bed rest, or planning for a cesarean delivery if the placenta covers the cervix.

Serious Complications

  • Preterm Labor: Attempts to delay labor through medication that may include corticosteroids to help mature the baby’s lungs.
  • Severe Preeclampsia or Eclampsia: May necessitate hospitalization and, in some cases, early delivery to prevent serious health risks to the mother and baby.
  • Intrauterine Growth Restriction (IUGR): Close monitoring of the fetus’s growth, adjusting diet and lifestyle, and in some cases, early delivery.

Special Considerations in Surrogacy

  • Communication: It’s vital that the surrogate maintains open communication with the intended parents about her health and any complications.
  • Legal and Ethical Decisions: The surrogacy agreement and applicable laws should outline how decisions are made regarding the pregnancy, including handling complications and decisions about the welfare of the fetus.
  • Support System: Both the surrogate and intended parents may need additional emotional and psychological support during this time.

Monitoring and Intervention

  • Frequent Check-ups: More frequent prenatal visits or referrals to specialists, such as maternal-fetal medicine (MFM) physicians, might be necessary.
  • Hospitalization: For severe complications, hospitalization may provide closer monitoring and immediate treatment.
  • Delivery Plan: Complications may affect the delivery plan, including the timing and method of delivery (e.g., cesarean section).

Postpartum Care

  • Recovery: After a complication, the postpartum period may involve additional medical care for the surrogate to manage any lingering health issues.
  • Psychological Support: Addressing the emotional impact of pregnancy complications is important for the surrogate’s well-being.

Medical expenses during surrogacy are typically covered by the intended parents, including costs associated with fertility treatments, prenatal care, delivery, and any necessary medical interventions.

In surrogacy arrangements, covering medical expenses is a key consideration, and the approach can vary widely based on the location, the specific terms of the surrogacy agreement, and the insurance policies involved. Here’s a general overview of how medical expenses are typically handled:

Surrogacy Agreement

  • Detailed Agreements: The surrogacy contract should clearly outline who is responsible for the medical expenses associated with the pregnancy. Typically, the intended parents are responsible for all medical costs related to the surrogacy process, including prenatal care, delivery, and any complications that arise.
  • Insurance Coverage: The agreement might specify whether the surrogate’s existing health insurance will be used (if her policy covers surrogacy, which is not always the case) or if the intended parents will procure a surrogacy-specific insurance policy for her.

Health Insurance

  • Surrogate’s Insurance: If the surrogate’s existing health insurance policy covers surrogacy-related medical expenses, this can be a primary source of coverage. However, it’s essential to thoroughly review the policy to understand what is and isn’t covered and whether surrogacy is excluded.
  • Surrogacy-Specific Insurance Policies: In cases where the surrogate’s insurance does not cover surrogacy, or to ensure comprehensive coverage, the intended parents may need to purchase a surrogacy-specific health insurance policy or a supplemental policy for the surrogate.
  • Escrow Accounts: Often, intended parents will fund an escrow account managed by a third party to ensure medical and other surrogacy-related expenses are paid in a timely and transparent manner.

Out-of-Pocket Expenses

  • Reimbursements: The surrogacy agreement usually includes provisions for reimbursing the surrogate for out-of-pocket medical expenses, such as co-pays, medications, and any travel costs associated with medical appointments.
  • Complications: The contract should also address how expenses related to pregnancy complications, or additional medical needs of the surrogate, will be handled.

International Surrogacy Arrangements

  • Complexities of International Surrogacy: When surrogacy crosses international borders, the intended parents must navigate the healthcare system of the surrogate’s country, which can add complexity to covering medical expenses. Legal advice and assistance from a reputable surrogacy agency are crucial in these cases.

Legal and Financial Planning

  • Professional Guidance: Engaging legal and financial professionals experienced in surrogacy arrangements can help ensure that all parties have a clear understanding of the financial responsibilities, especially concerning medical expenses.
  • Contingency Planning: It’s wise for intended parents to plan for contingencies, including setting aside funds for unexpected medical costs or complications.

Surrogates undergo regular medical check-ups, including physical exams, blood tests, and ultrasounds, to monitor their health and the progress of the pregnancy, ensuring optimal outcomes for both parties. 

The health of the surrogate during pregnancy is monitored closely to ensure both her well-being and the health of the baby she is carrying. This monitoring generally follows standard prenatal care protocols, with additional considerations specific to surrogacy. Here’s an overview of how the surrogate’s health is typically monitored:

Regular Prenatal Visits

  • Scheduled Check-ups: The surrogate will have regular appointments with an obstetrician or a maternal-fetal medicine specialist. These visits become more frequent as the pregnancy progresses.
  • Vital Signs Monitoring: Blood pressure and weight are checked to monitor for signs of gestational hypertension, preeclampsia, or other health issues.
  • Uterine and Fetal Growth: The growth of the uterus and the baby’s development are monitored through physical exams and measurements.

Laboratory Tests and Screenings

  • Blood and Urine Tests: Routine tests check for anemia, gestational diabetes, infections, and other potential health concerns.
  • Ultrasound Exams: Ultrasounds are performed at various stages to assess the baby’s development, placental position, and amniotic fluid levels.
  • Genetic Screening and Diagnostic Tests: Depending on the surrogate’s and the baby’s risk factors, genetic screenings or diagnostic tests like amniocentesis may be recommended.

Specialized Monitoring if Needed

  • High-Risk Pregnancies: If the pregnancy is considered high-risk, due to the surrogate’s health, age, or pregnancy complications, more specialized care and monitoring will be required. This might include more frequent ultrasounds, non-stress tests, and consultations with specialists.

Lifestyle and Well-being Checks

  • Nutritional Counseling: Advice on diet and supplements to support a healthy pregnancy.
  • Mental Health Support: Mental health is an important aspect of care, with support provided as needed to address the emotional aspects of surrogacy.
  • Physical Activity Recommendations: Guidelines on safe physical activity and rest throughout the pregnancy.

Communication with Intended Parents

  • Regular Updates: Surrogates and intended parents often agree on the level of communication regarding the pregnancy, including updates after medical appointments.
  • Medical Emergencies: The surrogacy agreement usually outlines protocols for handling medical emergencies or unexpected health issues, ensuring that the surrogate can receive immediate care if needed.

Postpartum Care

  • Follow-up Visits: After delivery, the surrogate will have follow-up visits to ensure her recovery is progressing well.
  • Psychological Support: Continued support to address any emotional or psychological needs following the birth.

Surrogates receive postpartum care and support to facilitate their recovery, including medical follow-ups, counseling, and assistance with any physical or emotional challenges they may face.

If the surrogate requires medical assistance after birth, the approach to her care will depend on the nature of her needs, whether they are physical or emotional. Here’s how postpartum support and medical assistance are typically addressed: 

Physical Health Support

  • Immediate Postpartum Care: Immediately after delivery, the surrogate will receive standard postpartum care, which includes monitoring for complications such as excessive bleeding (postpartum hemorrhage), infection, and issues related to any tears or a cesarean section wound.
  • Follow-Up Medical Visits: The surrogate will have follow-up appointments with her obstetrician or healthcare provider to ensure her physical recovery is on track. These visits are crucial for addressing any complications arising from the birth.
  • Extended Medical Care: If the surrogate experiences specific medical issues related to the pregnancy or delivery, such as postpartum depression, infections, or recovery from a cesarean section, additional medical care, medications, or treatments may be necessary. The surrogacy agreement often covers the costs of any medical care required due to pregnancy or childbirth.

Emotional and Psychological Support

  • Mental Health Services: The surrogate might have access to counseling or mental health services to help her cope with the emotional aspects of her experience, including postpartum depression or anxiety.
  • Support Groups: Participation in support groups with other surrogates can provide emotional support and a sense of community.

Surrogacy Agreement Considerations

  • Agreement Provisions: The surrogacy contract typically outlines provisions for the surrogate’s postpartum care, specifying who is responsible for associated costs. It’s important that this agreement includes comprehensive coverage for any postpartum complications.
  • Insurance Coverage: The surrogate’s health insurance or a policy provided by the intended parents (as stipulated in the surrogacy agreement) should cover medical care needed after birth. It’s crucial to verify that postpartum care is included and understand the extent of the coverage.

Ongoing Communication with Intended Parents

  • Reporting Requirements: The surrogate and intended parents may agree on communication protocols regarding the surrogate’s health status after the birth. While the primary focus post-birth shifts to the baby and the intended parents, maintaining a supportive relationship can be beneficial for all parties involved, especially in managing any unforeseen postpartum needs.

Legal and Ethical Considerations

  • Ethical Care: It’s ethically imperative that the surrogate receives the care and support she needs after birth, recognizing the significant contribution she has made to the intended parents’ lives.
  • Legal Obligations: Adherence to the legal agreements made prior to the surrogacy arrangement ensures that the surrogate’s postpartum needs are met, safeguarding her health and well-being.

Surrogacy may help prevent genetic diseases by allowing intended parents to use preimplantation genetic diagnosis (PGD) or other genetic screening techniques to select embryos free from specific genetic disorders. 

Surrogacy combined with certain assisted reproductive technologies (ART) can help prevent genetic diseases from being passed on to the child. This prevention is particularly facilitated through the use of Preimplantation Genetic Diagnosis (PGD) and Preimplantation Genetic Screening (PGS), which are applied during the in vitro fertilization (IVF) process before the embryo is transferred to the surrogate. Here’s how it works:

Preimplantation Genetic Diagnosis (PGD)

  • Specific Genetic Conditions: PGD is used to test embryos for specific known genetic conditions that one or both of the intended parents may carry, such as cystic fibrosis, sickle cell anemia, or Huntington’s disease.
  • Embryo Selection: Only embryos that do not carry the genetic condition are selected for transfer to the surrogate’s uterus, significantly reducing the risk of the child inheriting the disease.

Preimplantation Genetic Screening (PGS) or Preimplantation Genetic Testing for Aneuploidies (PGT-A)

  • Chromosomal Normalcy: PGS/PGT-A screens embryos for chromosomal abnormalities that can lead to conditions like Down syndrome, Edwards syndrome, or Patau syndrome. While not targeting specific genetic diseases, this screening ensures the selection of embryos with the correct number of chromosomes, which can improve pregnancy outcomes and reduce the risk of miscarriage.
  • Embryo Selection: As with PGD, embryos deemed to have a normal chromosomal makeup are chosen for transfer.

Gestational Surrogacy

  • In cases where the intended mother can produce healthy eggs but has a medical condition that makes pregnancy risky for her or the baby, or if there are concerns about passing on a genetic condition from the mother, gestational surrogacy allows for the use of the intended mother’s or a donor’s egg with IVF. This way, the child can be biologically related to one or both parents without inheriting specific genetic conditions.

Traditional Surrogacy and Genetic Risks

  • In traditional surrogacy, where the surrogate’s egg is used, the genetic risk to the child is based on the surrogate’s genetic makeup. While less common today, traditional surrogacy doesn’t offer the same opportunities to prevent genetic diseases unless the surrogate herself undergoes genetic screening.


  • Ethical and Legal: The use of PGD, PGS, and surrogacy to prevent genetic diseases raises ethical and legal questions that vary by jurisdiction. Intended parents should seek counseling and legal advice to navigate these complexities.
  • Success Rates: While PGD and PGS can significantly reduce the risk of genetic diseases, no method is 100% foolproof. Discussions with fertility specialists about the limitations and risks are essential.