Risks and Side Effects of Being a Surrogate: What to Expect — A Doctor’s Perspective

Introduction

As a medical doctor who works closely with surrogates across the country, I want to provide clear, honest, and compassionate information to those considering this incredible journey. While surrogacy is deeply rewarding, it’s also important to understand the risks and side effects involved. This ensures you go into the process well-informed and emotionally prepared.

This guide will walk you through the physical, emotional, and psychological risks associated with surrogacy, grounded in the latest recommendations from the American Society for Reproductive Medicine (ASRM) and regulations from the U.S. Food and Drug Administration (FDA). Understanding these realities doesn’t diminish the beauty of surrogacy, it enhances it by honoring the full picture

1. Physical Risks of Surrogacy

Pregnancy itself comes with inherent risks, and surrogacy is no different. In fact, because assisted reproductive technology (ART) is involved, there are some additional factors to consider.

Common Physical Side Effects:

• Morning sickness (nausea, vomiting)
• Fatigue and sleep disturbances
• Swelling and weight gain
• Mood swings due to hormonal changes

Medical Risks Include:

• Gestational diabetes: Increased risk, especially if carrying multiples.
• Preeclampsia: A serious pregnancy complication marked by high blood pressure and potential organ damage.
• Placenta previa or placental abruption: Can lead to bleeding and require early delivery.
• Preterm labor: Surrogates are at slightly higher risk due to embryo transfer protocols.
• Cesarean delivery (C-section): Many surrogates require C-sections, especially if carrying twins or if there are complications.

Doctor’s Insight: These complications are rare but possible. That’s why surrogates undergo extensive screening to reduce risk and are closely monitored throughout the pregnancy.

2. Side Effects from Fertility Medications

Before embryo transfer, surrogates take hormones to prepare the uterine lining. These medications, while necessary, can have side effects.

Medications Typically Include:

• Estrogen (oral, patches, or injections)
• Progesterone (injections or vaginal forms)
• Lupron or GnRH agonists (to suppress ovulation before transfer)

Potential Side Effects:

• Headaches
• Bloating
• Irritability
• Breast tenderness
• Injection site pain or bruising

ASRM Guidelines: Surrogates must be fully briefed on all medications, and clinics should provide detailed information and 24/7 medical support during the cycle.

Pro Tip from a Surrogate Nurse Coordinator: Keep a journal of how your body responds to medications and communicate regularly with your IVF team.

3. Emotional and Psychological Risks

Even the most emotionally prepared surrogate may experience complex feelings during and after pregnancy.

Possible Emotional Reactions:

• Postpartum blues or depression
• Unexpected emotional attachment to the baby
• Anxiety about the hand-off after birth
• Relationship strain (with partner, family, or the intended parents)

Psychological Evaluation (Required):

• Assesses emotional readiness
• Reviews of past pregnancy and postpartum experiences
• Evaluates your support system

Doctor’s Note: Emotional support is critical. That’s why therapy and support groups are encouraged before, during, and after the surrogacy process.

Real Surrogate Story – Jenna, 34, Pennsylvania: *”I didn’t think I’d feel sad after the delivery, but I did. Not because I missed the baby, but because it was over. The therapy sessions my agency offered helped me find closure and focus on the joy I helped create.”

4. Legal and Social Challenges

Surrogacy is not just a medical journey; it’s also legal and social commitment. Understanding the risks in these areas is part of responsible preparation.

Legal Complexities:

• Surrogacy laws vary by state
• Contracts must address parental rights, medical decisions, termination clauses, and financial responsibilities

Social Dynamics:

• Opinions from family or community may not always be supportive
• The relationship with intended parents may require boundaries and open communication

Tip: Choose an agency with strong legal support and communication coaching to minimize misunderstandings.

5. Long-Term Health Considerations

Surrogacy is typically safe, but it still involves multiple medical interventions. It’s important to consider long-term reproductive health.

Potential Long-Term Effects:

• Uterine scarring (from C-sections or D&C procedures)
• Hormonal shifts
• Reduced fertility (rare, but possible after complications)

Monitoring Recommendations:

• Annual OB/GYN exams
• Monitor for signs of postpartum depression or hormonal imbalance
• Keep your primary care doctor informed

Doctor’s Guidance: Most surrogates return to full health within weeks or months of delivery, but staying proactive with your healthcare helps you recover fully.

6. Risks to Your Own Family and Responsibilities

Carrying a child for another family can impact on your own daily life in ways you might not expect.

Examples:

• Needing time off work for appointments or bed rest
• Managing childcare during late pregnancy
• Navigating your children’s questions or emotional reactions

Advice: Have honest conversations with your partner, children, and employer early in the process. A strong support network makes the experience smoother.

Real Surrogate Story – Maria, 38, California: *”My husband and I talked everything through. He came to all my appointments and took care of our kids when I was on bed rest. It became a family journey we were proud to be part of.”

7. Financial and Insurance Risks

Most reputable surrogacy agencies and legal teams ensure you are financially protected, but it’s still crucial to understand what is covered and what isn’t.

Covered by the Intended Parents:

• Medical expenses
• Travel and lodging (if needed)
• Maternity clothing
• Lost wages and childcare (if outlined in contract)

Potential Risks:

• Unexpected out-of-pocket costs
• Disputes about contract terms
• Gaps in insurance coverage (especially with pregnancy exclusions)

Doctor’s Advice: Only work with licensed, transparent agencies that provide legal guidance and connect you with experienced surrogacy insurance advisors.

Conclusion: Informed, Supported, and Ready

Being a surrogate is a selfless and transformative journey. Like any pregnancy, it comes with risks, but with the right medical care, emotional support, and legal guidance, it can be a deeply fulfilling experience.

As a doctor, I believe the best surrogates are those who ask questions, seek out information, and take care of themselves just as much as they care for others. If you’re considering surrogacy, know that you are not alone. You have a team here to walk with you every step of the way.