The Real Risks of Being a Surrogate: Medical and Emotional Realities
Every woman considering surrogacy deserves an honest picture of what it actually involves — including what can go wrong, what usually doesn’t, and what separates a well-managed journey from an unprotected one.
The risks of being a surrogate are real. Some match what comes with any pregnancy. Others are specific to carrying a genetically unrelated embryo or to the hormonal protocol involved in IVF. None of them are reasons to walk away without thinking — but all are worth understanding clearly before you commit.
At Physician’s Surrogacy, we believe that informed surrogates make better decisions and have safer journeys. This article covers what the research actually shows, what we do differently, and how to use this information to ask the right questions.
Key Takeaways
What the Research Actually Says About Surrogate Pregnancy Risk
Most articles about surrogacy risks are vague. The research is more specific — and worth knowing.
A 2024 large-scale study published in the Annals of Internal Medicine analyzed over 860,000 singleton births in Ontario, Canada between 2012 and 2021. Researchers from ICES and Queen’s University compared outcomes across three groups: unassisted pregnancies, IVF pregnancies, and gestational carrier pregnancies. The findings were striking.
The rate of severe maternal morbidity was 2% for naturally conceived pregnancies, 4% for IVF pregnancies, and 8% for gestational carrier pregnancies.
Surrogates also showed higher rates of hypertensive disorders, postpartum hemorrhage, and preterm birth compared to women who conceived naturally — and these risks persisted even after accounting for factors like prior birth history and pre-existing health conditions.
This doesn’t mean surrogacy is unsafe. It means surrogacy carries a specific risk profile — and the quality of your screening and monitoring matters far more than most people realize.
Quick Answer
Yes, surrogate pregnancies carry elevated medical risks compared to naturally conceived pregnancies. The most documented are preeclampsia, preterm birth, and postpartum hemorrhage. These risks are real — and they’re also manageable when you have rigorous physician-designed screening and ongoing clinical oversight throughout your journey.
Medical Risks of Being a Surrogate
The risks below aren’t equally severe. Some are common and manageable; others are rarer but more serious. All are worth understanding before you commit.
Not every surrogate candidate will face every risk listed here. Your individual health history changes your specific profile. At Physician’s Surrogacy, our OB/GYN team reviews each candidate’s full medical history individually — not against a checklist — to understand what your journey would actually look like. Review our surrogate requirements to see where you stand.
Emotional Risks of Being a Surrogate
The emotional side of surrogacy is frequently underestimated — both by women going in and by agencies that don’t adequately prepare surrogates for what they’ll feel. These aren’t rare outlier experiences. They’re part of what a surrogate journey involves.
Post-Birth Adjustment
The most common emotional challenge surrogates describe isn’t grief over the baby — it’s adjustment. After nine months of physical changes, a major life commitment, and a close relationship with the intended family, the sudden end of that chapter can feel disorienting.
Some surrogates describe it as similar to finishing a major project or leaving a job they valued. Others feel relief. A smaller number experience genuine grief or sadness.
All of these responses are normal. What makes them manageable is having realistic expectations going in, a strong personal support system, and ongoing counseling access — not just a pre-journey psychological evaluation that ends at matching.
Anxiety During Pregnancy
Carrying someone else’s child adds a layer of responsibility to normal pregnancy worry. Some surrogates experience real anxiety, particularly around the baby’s health.
Clear communication channels with your care team and intended parents help. So does working with an agency where a physician is directly accessible for real medical questions — not just routing everything through a coordinator.
Attachment and the Post-Delivery Period
Most women ask at some point whether they’ll feel attached to the baby. The honest answer is layered. Gestational surrogates carry no genetic connection to the child, and most report that the emotional experience is genuinely different from carrying their own child.
Caring for a pregnancy for nine months does produce emotional involvement — just not the same kind as parenting.
Most surrogates describe the post-delivery period as manageable when they’re well-prepared. Psychological screening before the journey exists specifically to identify women who have realistic expectations and the emotional tools for this phase. Read a fuller treatment of this topic in our post on surrogate attachment to the baby.
Relationship Strain
Surrogacy affects your entire household. Your partner takes on more during the pregnancy. Your children notice changes. Medical appointments, physical demands, and the emotional weight of the process all have spillover effects on your family.
Having those conversations honestly before you apply is one of the most protective things you can do. Our post on emotional readiness for surrogacy walks through the questions worth asking yourself first.
Quick Weigh-Up
Thinking through the emotional side before you apply.
What helps
What to think about
The surrogates who fare best emotionally are the ones who treated preparation as seriously as the application itself.
How Agency Choice Shapes Your Risk Profile
Here’s the part most surrogacy articles skip: the risks described above aren’t equally distributed across all surrogacy arrangements. The quality of your screening, the caliber of your ongoing medical oversight, and the responsiveness of your support system all affect your specific risk profile.
Most surrogacy agencies are coordination businesses run by non-medical staff. When a clinical concern arises, they relay information between you and outside physicians — but no one at the agency has the authority or training to step in directly.
Physician’s Surrogacy is the only surrogacy agency in the United States managed by practicing OB/GYNs. That structural difference translates into four concrete protections for surrogates:
Risk Doesn’t Have to Be Left to Chance
Most agencies rely on outside physicians and coordinator chains. At Physician’s Surrogacy, practicing OB/GYNs lead the screening, monitor your pregnancy directly, and maintain a peer-to-peer consultation channel with your delivering doctor.
Our preterm delivery rate is 50% below the national average.
That outcome comes directly from physician involvement at every stage — not from luck. Learn about our clinical model.
What to Do With This Information
The risks covered in this article aren’t reasons to stop thinking about surrogacy. They’re reasons to think carefully about which agency you work with, what questions to ask about your own health profile, and what supports you’ll need in place before, during, and after the journey.
Women who have the best surrogate experiences are the ones who went in with clear information and the right team — not the ones who assumed everything would be uncomplicated.
Read through our complete surrogate guide to understand the full process, or check the surrogate requirements page to see if you qualify. If you have questions about your health history and surrogacy safety, our physician team is the right place to start.
Surrogacy sits at the intersection of modern medicine and profound human generosity. Getting it right — for your health and for the family you’re helping build — starts with choosing a team that treats your safety as the non-negotiable it is.
Become a SurrogateFrequently Asked Questions
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Julianna Nikolic
Chief Strategy Officer Julianna Nikolic leads strategic initiatives, focusing on growth, innovation, and patient-centered solutions in the reproductive sciences sector. With 26+ years of management experience and a strong entrepreneurial background, she brings deep expertise to advancing reproductive healthcare.
