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Surrogate pregnancy

Raymond M Anchan, MD, PhD
Elizabeth S Ginsburg, MD
Section Editor
Robert L Barbieri, MD
Deputy Editor
Kristen Eckler, MD, FACOG


Medical science allows motherhood to be divided into three categories: the genetic, the gestational, and the social mother. These "mothers" may be represented by as many as three different individuals.

A “gestational” surrogate is a woman who agrees to carry a pregnancy for another woman (intended mother). The intended mother provides the egg and the intended father provides the sperm; rarely, egg donors or sperm donors are involved. In vitro fertilization (IVF) is used to create an embryo, which is transferred into the uterus of the gestational surrogate [1]. The gestational surrogate has no genetic connection to the embryo.

By comparison, a “traditional” surrogate typically has a genetic connection to the embryo. The surrogate's own egg is fertilized by intrauterine insemination (IUI) of sperm from the intended father (or a sperm donor) [2]. Therefore, the surrogate has a genetic, as well as a gestational, connection to the embryo.

The role of surrogates is usually limited to carrying the pregnancy and delivery of the infant; it does not extend to the raising of the child (social mother). However, gestational and traditional surrogates may be family members, and thus may maintain familial contact with the child [3].

This topic will review issues related to gestational surrogate pregnancy. Many of these issues also apply to traditional surrogacy.


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Literature review current through: Sep 2016. | This topic last updated: Mar 15, 2016.
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  1. Utian WH, Sheean L, Goldfarb JM, Kiwi R. Successful pregnancy after in vitro fertilization and embryo transfer from an infertile woman to a surrogate. N Engl J Med 1985; 313:1351.
  2. Utian WH, Goldfarb JM, Kiwi R, et al. Preliminary experience with in vitro fertilization-surrogate gestational pregnancy. Fertil Steril 1989; 52:633.
  3. Ethics Committee of the American Society for Reproductive Medicine. Using family members as gamete donors or surrogates. Fertil Steril 2012; 98:797.
  4. Centers for Disease Control and Prevention, American Society for Reproductive Medicine, Society for Assisted Reproductive Technology. 2009 Assisted Reproductive Technology Success Rates: National Summary and Fertility Clinic Reports. Atlanta: U.S. Department of Health and Human Services; 2011.
  5. Practice Committee of the American Society for Reproductive Medicine, Practice Committee of the Society for Assisted Reproductive Technology. Recommendations for practices utilizing gestational carriers: a committee opinion. Fertil Steril 2015; 103:e1.
  6. Steigrad S, Hacker NF, Kolb B. In vitro fertilization surrogate pregnancy in a patient who underwent radical hysterectomy followed by ovarian transposition, lower abdominal wall radiotherapy, and chemotherapy. Fertil Steril 2005; 83:1547.
  7. Meniru GI, Craft I. Assisted conception options for patients with good-prognosis cervical cancer. Lancet 1997; 349:542.
  8. Siddle N, Sarrel P, Whitehead M. The effect of hysterectomy on the age at ovarian failure: identification of a subgroup of women with premature loss of ovarian function and literature review. Fertil Steril 1987; 47:94.
  9. Esfandiari N, Claessens EA, O'Brien A, et al. Gestational carrier is an optimal method for pregnancy in patients with vaginal agenesis (Rokitansky syndrome). Int J Fertil Womens Med 2004; 49:79.
  10. Beski S, Gorgy A, Venkat G, et al. Gestational surrogacy: a feasible option for patients with Rokitansky syndrome. Hum Reprod 2000; 15:2326.
  11. Brinsden PR. Gestational surrogacy. Hum Reprod Update 2003; 9:483.
  12. Stafford-Bell MA, Copeland CM. Surrogacy in Australia: implantation rates have implications for embryo quality and uterine receptivity. Reprod Fertil Dev 2001; 13:99.
  13. Farley DM, Grainger DA, Tjaden BL, et al. Use of a gestational carrier for a patient with recurrent adverse pregnancy outcomes from early onset severe pre-eclampsia. Fertil Steril 2007; 87:189.e1.
  14. Braverman AM, Corson SL. Characteristics of participants in a gestational carrier program. J Assist Reprod Genet 1992; 9:353.
  15. Marrs RP, Ringler GE, Stein AL, et al. The use of surrogate gestational carriers for assisted reproductive technologies. Am J Obstet Gynecol 1993; 168:1858.
  16. Pirhonen J, Bergersen TK, Abdlenoor M, et al. Effect of maternal age on uterine flow impedance. J Clin Ultrasound 2005; 33:14.
  17. Ubaldi F, Rienzi L, Baroni E, et al. Implantation in patients over 40 and raising FSH levels--a review. Placenta 2003; 24 Suppl B:S34.
  18. Pellicer A, Simón C, Remohí J. Effects of aging on the female reproductive system. Hum Reprod 1995; 10 Suppl 2:77.
  19. Cano F, Simón C, Remohí J, Pellicer A. Effect of aging on the female reproductive system: evidence for a role of uterine senescence in the decline in female fecundity. Fertil Steril 1995; 64:584.
  20. Abdalla HI, Wren ME, Thomas A, Korea L. Age of the uterus does not affect pregnancy or implantation rates; a study of egg donation in women of different ages sharing oocytes from the same donor. Hum Reprod 1997; 12:827.
  21. Navot D, Drews MR, Bergh PA, et al. Age-related decline in female fertility is not due to diminished capacity of the uterus to sustain embryo implantation. Fertil Steril 1994; 61:97.
  22. Cherry AL. Nurturing in the service of white culture: racial subordination, gestational surrogacy, and the ideology of motherhood. Tex J Women Law 2001; 10:83.
  23. Pretorius, D. Surrogate motherhood: A worldwide view of the issues. New Eng J Med 1994; 331:685.
  24. Golombok S, MacCallum F, Murray C, et al. Surrogacy families: parental functioning, parent-child relationships and children's psychological development at age 2. J Child Psychol Psychiatry 2006; 47:213.
  25. Van Zyl L. Intentional parenthood: responsibilities in surrogate motherhood. Health Care Anal 2002; 10:165.
  26. Fuscaldo G. Genetic ties: are they morally binding? Bioethics 2006; 20:64.
  27. Bravennan AM, Corson SL. A comparison of oocyte donors' and gestational carriers/surrogates' attitudes towards third party reproduction. J Assist Reprod Genet 2002; 19:462.
  28. Gunn, W. Bioethics and Law: Standard of Care: The Law of American Bioethics. JAMA 1994; 271:795.
  29. Yamamoto K, Moore SA. A trust analysis of a gestational carrier's right to abortion. Fordham Law Rev 2001; 70:93.
  30. Rosen A. Third-party reproduction and adoption in cancer patients. J Natl Cancer Inst Monogr 2005; :91.
  31. Brinsden PR. Surrogacy. In: A textbook of in vitro fertilization and assisted reproduction, Brinsden PR (Ed), The Parthenon Publishing Group, New York 1999.
  32. MacCallum F, Lycett E, Murray C, et al. Surrogacy: the experience of commissioning couples. Hum Reprod 2003; 18:1334.
  33. Massachusetts. Supreme Judicial Court. Culliton v. Beth Israel Deaconess Medical Center. Wests North East Rep 2001; 756:1133.
  34. American College of Obstetricians and Gynecologists’ Committee on Ethics, Ryan GL. ACOG Committee Opinion No. 660: Family Building Through Gestational Surrogacy. Obstet Gynecol 2016; 127:e97.
  35. Guichon J. The body, emotions and intentions: challenges of preconception arrangements for health care providers. CMAJ 2007; 176:479.
  36. Reilly DR. Surrogate pregnancy: a guide for Canadian prenatal health care providers. CMAJ 2007; 176:483.
  37. Adams KE. Gestational surrogacy for a human immunodeficiency virus seropositive sperm donor: what are the ethics? J Am Med Womens Assoc 2003; 58:138.
  38. Ethics Committee of the American Society for Reproductive Medicine. Consideration of the gestational carrier: a committee opinion. Fertil Steril 2013; 99:1838.
  39. Duffy DA, Nulsen JC, Maier DB, et al. Obstetrical complications in gestational carrier pregnancies. Fertil Steril 2005; 83:749.
  40. Parkinson J, Tran C, Tan T, et al. Perinatal outcome after in-vitro fertilization-surrogacy. Hum Reprod 1999; 14:671.
  41. Brinsden PR, Appleton TC, Murray E, et al. Treatment by in vitro fertilisation with surrogacy: experience of one British centre. BMJ 2000; 320:924.
  42. Meniru GI, Craft IL. Experience with gestational surrogacy as a treatment for sterility resulting from hysterectomy. Hum Reprod 1997; 12:51.
  43. Batzofin, J, Nelson, J, Wilcox, J, et al. Gestational surrogacy: is it time to include it as part of ART? Fertil Steril ASRM Annual Meeting Programme Supplement 1999.
  44. Goldfarb JM, Austin C, Peskin B, et al. Fifteen years experience with an in-vitro fertilization surrogate gestational pregnancy programme. Hum Reprod 2000; 15:1075.
  45. Raziel A, Schachter M, Strassburger D, et al. Eight years' experience with an IVF surrogate gestational pregnancy programme. Reprod Biomed Online 2005; 11:254.
  46. Corson SL, Kelly M, Braverman AM, English ME. Gestational carrier pregnancy. Fertil Steril 1998; 69:670.
  47. Anchan, RM, Ginsburg, ES. Gestational carriers: A viable alternative in assisted reproductive medicine. American Society for Reproductive Medicine 62nd Annual Meeting Abstract P-133. New Orleans, Louisiana.
  48. Gibbons WE, Cedars M, Ness RB, Society for Assisted Reproductive Technologies Writing Group. Toward understanding obstetrical outcome in advanced assisted reproduction: varying sperm, oocyte, and uterine source and diagnosis. Fertil Steril 2011; 95:1645.
  49. Jadva V, Murray C, Lycett E, et al. Surrogacy: the experiences of surrogate mothers. Hum Reprod 2003; 18:2196.
  50. Jadva V, Imrie S, Golombok S. Surrogate mothers 10 years on: a longitudinal study of psychological well-being and relationships with the parents and child. Hum Reprod 2015; 30:373.
  51. Jadva V, Imrie S. Children of surrogate mothers: psychological well-being, family relationships and experiences of surrogacy. Hum Reprod 2014; 29:90.