Gestational Surrogacy Explained

What is gestational surrogacy?

Gestational surrogacy is when a woman, called a gestational carrier or surrogate, carries a pregnancy for intended parents using an embryo created by IVF. The egg comes from the intended mother or a donor, so the surrogate is not genetically related to the baby. After birth, legal parentage passes to, or is confirmed for, the intended parents.

Gestational surrogacy is one stage of a longer journey that also involves lawyers, embassies and courts. Our step-by-step guide to the surrogacy process covers the whole journey. This page covers the medical side: what gestational surrogacy is, who it helps, how the IVF works, and what the research says about risks and long-term outcomes for surrogates, babies and families.

A few terms you will see:

• Intended parent(s): the person or couple who will raise the child.
• Gestational carrier or surrogate: the woman who carries the pregnancy. We use both terms respectfully. She is a person making a significant contribution, not a service.
• Egg donor: a woman who provides eggs when the intended mother cannot, or when there is no intended mother.
• Embryo transfer: placing an embryo in the surrogate's uterus through a thin catheter.

Gestational vs traditional surrogacy

The difference is genetics. In traditional (genetic) surrogacy, the surrogate's own egg is used, usually by insemination, so she is the baby's genetic mother. In gestational surrogacy she carries an IVF embryo with no genetic link to her. Professional bodies and almost all international programmes now offer only gestational surrogacy.

Why international programmes avoid traditional surrogacy

There are three main reasons. First, ethics and wellbeing. In its 2025 position statement, the International Federation of Gynecology and Obstetrics (FIGO) (opens in new tab) discourages arrangements in which a woman agrees in advance to give up a child to whom she is genetically related, and it supports gestational arrangements that follow core ethical principles. Second, law. Many destination laws and court processes are written only for gestational arrangements. A genetic link between the surrogate and the child can make it harder to transfer parentage. Third, recognition at home. Courts and embassies may treat a surrogate who is also the genetic mother very differently, which adds legal risk when the child is born abroad.

Who gestational surrogacy is for: medical and social indications

Gestational surrogacy is used when a woman cannot carry a pregnancy, or should not because it would be dangerous, and by intended parents with no uterus, such as gay male couples and single men. ESHRE's 2025 ethics paper accepts surrogacy for an absent uterus, serious health risks, repeated failure to achieve pregnancy, and male couples or single men.

Common reasons include:

• Absent uterus from birth. Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome affects women who are born without a uterus but usually have working ovaries, so they can often have genetically related children through gestational surrogacy.
• Hysterectomy. Removal of the uterus after cancer, severe bleeding at birth (postpartum haemorrhage) or other conditions.
• Severe uterine scarring. Asherman's syndrome, where scar tissue inside the uterus prevents implantation or causes repeated loss, can be an indication when surgery has not helped.
• Recurrent implantation failure or recurrent pregnancy loss. In selected cases, after thorough investigation, where a uterine cause is likely or other treatment has failed.
• A medical condition that makes pregnancy dangerous. Examples include serious heart disease, some kidney conditions, or a previous life-threatening pregnancy complication.
• Gay male couples and single men. These intended parents need both an egg donor and a gestational carrier. See our guides for gay couples and single men.

Destination laws do not always match these medical indications. Some countries only allow surrogacy where a woman has a documented medical reason, which excludes male couples and single men. Check the eligibility on each destination page.

How gestational surrogacy works: the IVF steps

Gestational surrogacy uses standard IVF in two parallel tracks. The egg provider has ovarian stimulation and egg retrieval, and the eggs are fertilised with sperm to create embryos, which are usually frozen. Separately, the surrogate's uterus is prepared with hormones, and a single thawed embryo is transferred. A pregnancy test follows about two weeks later.

1. Screening of everyone involved. Intended parents, any donors and the surrogate have medical and infectious disease testing. The surrogate and her partner also have a psychological assessment and implications counselling. ASRM's 2022 recommendations (opens in new tab) set out this process in detail.
2. Ovarian stimulation. The intended mother or egg donor injects hormones for about 10 to 14 days so that several eggs mature. Ultrasound scans and blood tests monitor her response.
3. Egg retrieval. Under sedation, eggs are collected with a needle guided by ultrasound.
4. Fertilisation. Eggs are fertilised by conventional IVF or by ICSI (injecting one sperm into each egg).
5. Embryo culture and freezing. Embryos are grown to the blastocyst stage (day 5 to 7) and frozen by vitrification. Some parents choose genetic testing (PGT-A) at this stage. The evidence on its benefit is mixed, as our surrogacy process guide explains.
6. Preparing the surrogate's uterus. She usually takes oestrogen and then progesterone, so the uterine lining is ready on the day of transfer.
7. Single embryo transfer. One embryo is thawed and transferred. This is a quick procedure that usually does not need anaesthesia.
8. Pregnancy test and early monitoring. A blood test comes about 9 to 12 days after transfer, then early ultrasound scans. Hormone support usually continues until around 10 to 12 weeks, after which she moves to routine obstetric care.

Why single embryo transfer is the standard

ASRM states that "single embryo transfer is strongly recommended in all GC cycles", and ESHRE's 2025 paper says only one embryo should be transferred. The reason is twins. In a Utah study of gestational carrier pregnancies, 21.3% were multiple pregnancies. Multiple pregnancy was linked to much higher odds of newborn complications (odds ratio 9.49), of preterm birth before 37 weeks, and of caesarean birth (Swanson et al., 2021 (opens in new tab)). A higher chance of a birth per transfer is not worth that cost to the surrogate or the babies.

Risks for surrogates

Gestational carriers face higher risks than women who conceive naturally, including high blood pressure in pregnancy, bleeding after birth and preterm delivery. In a large 2024 Ontario study, severe maternal complications affected 7.8% of gestational carrier births, compared with 2.3% after unassisted conception and 4.3% after IVF. Serious outcomes remain uncommon, and careful screening reduces risk.

The evidence is not completely consistent, and it is worth knowing why:

• Ontario, Canada, 2012 to 2021. This study covered 806 singleton births to gestational carriers. The risk of severe maternal morbidity was about 3.3 times that after unassisted conception, and 1.9 times that after IVF without a carrier. Hypertensive disorders, postpartum haemorrhage and preterm birth were also more common (Velez et al., Ann Intern Med 2024 (opens in new tab)). The authors note they lacked data on donor eggs, which may explain part of the difference.
• Utah, US, 2009 to 2018. In 361 gestational carrier pregnancies, severe morbidity occurred in 1.7%. This was lower than other IVF pregnancies (5.5%) and not significantly different from matched controls (Swanson et al., 2021 (opens in new tab)).
• A 2024 meta-analysis of six studies found carrier pregnancies had outcomes similar to, or slightly better than, other IVF pregnancies. However, they had higher odds of hypertensive disorders than pregnancies in general (adjusted odds ratio 1.44). Severe maternal morbidity and death were rare (Matsuzaki et al., JAMA Netw Open 2024 (opens in new tab)).
• The same women, compared with themselves. In 124 surrogates, pregnancies from IVF embryos had more preterm births (10.7% vs 3.1%), more low birth weight, and more gestational diabetes, high blood pressure and placenta previa than the same women's own spontaneous pregnancies (Woo et al., 2017 (opens in new tab)). A third of the surrogate pregnancies in that study were twins.

Extra risk with donor eggs

Pregnancies from donor eggs carry a clearly higher risk of pre-eclampsia, whoever carries them. A 2022 meta-analysis estimated pre-eclampsia in about 10.7% of singleton donor-egg pregnancies, compared with 4.1% after standard IVF and 2.0% after natural conception (Keukens et al., Hum Reprod 2022 (opens in new tab)). Another meta-analysis found donor-egg pregnancies had higher odds of pre-eclampsia (odds ratio 2.64) and preterm birth than IVF with the woman's own eggs (Moreno-Sepulveda and Checa, 2019 (opens in new tab)). Because many international journeys use donor eggs, surrogates should be told about this risk and monitored for it. Their obstetrician will decide whether preventive measures, such as low-dose aspirin, are appropriate.

Risks for babies

Babies born through gestational surrogacy generally do as well as other IVF babies. The main risks are preterm birth and low birth weight, and these rise sharply with twins. A systematic review found outcomes comparable to standard IVF and egg donation. A large Ontario study did not find clear evidence of increased severe newborn complications in singleton births.

The 2016 systematic review by Söderström-Anttila and colleagues (opens in new tab) found preterm birth in 0 to 11.5% of singleton surrogacy births across studies, with medical outcomes for children "satisfactory" and comparable to IVF and egg donation. In the Ontario cohort, severe neonatal morbidity was 6.6% for carrier births, compared with 5.9% after unassisted conception and 8.9% after IVF, a difference that was not statistically clear. Transferring one embryo makes the biggest difference. In one US programme, preterm birth after carrier transfers was 13.4% with one embryo and 40% with two (Namath et al., 2021 (opens in new tab)).

Psychological outcomes for surrogates and children

Long-term UK research, much of it led by Cambridge's Centre for Family Research, has found that most surrogates do well psychologically for up to 20 years, and children born through surrogacy are as well adjusted as their peers. The studies are small and mostly involve domestic UK arrangements, so they may not apply to every international programme.

Surrogates

• Ten years on. Twenty surrogates scored within normal ranges for self-esteem and showed no signs of depression, and none said they regretted taking part (Jadva et al., 2015 (opens in new tab)).
• Twenty years on. In a follow-up of 21 surrogates, published in 2026, none of the 17 who completed the questionnaires showed signs of depression. Four scored above a screening cut-off for possible psychological difficulties. Most reported good wellbeing, and 62% were still in contact with the child (Jadva et al., 2026 (opens in new tab)).
• Surrogates' own children. Most of the surrogates' own children viewed their mother's surrogacy positively, and their wellbeing was in the normal range (Jadva et al., 2014 (opens in new tab)). Most surrogates studied around seven years after the birth reported positive relationships with the families (Imrie and Jadva, 2014 (opens in new tab)).

The weeks after birth can be emotionally hard for some surrogates. Good programmes offer counselling before and after birth, and agree on contact in advance.

Children and families

• At age 14. In the UK longitudinal study, adolescents born through surrogacy showed no differences in adjustment, wellbeing or self-esteem compared with naturally conceived peers. Surrogacy mothers showed less negative parenting than mothers in gamete donation families (Golombok et al., 2017 (opens in new tab)).
• How adolescents feel. Most of the 14-year-olds interviewed felt indifferent or positive about how they were conceived (Zadeh et al., 2018 (opens in new tab)).
• Telling children early. Adolescents who learned about their biological origins before age 7 had more positive family relationships and wellbeing than those told later (Ilioi et al., 2017 (opens in new tab)).
• Gay father families. Children aged 3 to 9 born to gay fathers through surrogacy showed high levels of adjustment. Stigma experienced from outside the family, not family type, was linked to problems (Golombok et al., 2018 (opens in new tab)).

Next steps

If gestational surrogacy fits your situation, start with two conversations: a fertility specialist, about eggs, embryos and realistic chances, and a family lawyer in your home country, about parentage and citizenship. Then compare destinations that are legally open to your profile and that follow professional standards for screening and supporting surrogates.

• Follow the full journey in our surrogacy process guide, including timelines and success rates.
• Compare countries on the destination comparison hub.
• Understand how your baby will get citizenship and a passport in our parentage and citizenship guide.