Surrogacy and Medical Decision-Making: What You Need to Know
Thoughtful planning in surrogacy helps protect everyone involved.
Posted May 6, 2025 | Reviewed by Kaja Perina
According to the Society for Assisted Reproductive Technology (SART), embryo transfers to gestational carriers increased by 146% between 2014 and 2017. This surge reflects several social changes: the federal legalization of same-sex marriage in 2015, increased utilization of the internet to share information and experiences, and the diminishing stigma surrounding infertility treatment.
As a result, more people — including those in same- sex relationships, those facing medical diagnoses like cancer, individuals with structural uterine issues or unexplained infertility, and those who could not discontinue critical medications — sought out surrogacy as a path to parenthood .
As the only therapist invited to testify before the State Senate Judiciary Committee to legalize compensated surrogacy in New York, I have witnessed firsthand that surrogacy remains misunderstood and, to some, controversial. Some still believe surrogacy harms women and should not be legal. However, this perception does not reflect the reality. The American Society for Reproductive Medicine (ASRM) has developed strong ethical guidelines that create a safe and supportive framework for both intended parents and gestational carriers, ensuring appropriate medical and mental health safeguards are in place.
Even with these protections, many intended parents feel overwhelmed when navigating the process — from selecting an agency to building a relationship with their gestational carrier and understanding how to approach critical medical decisions. At a 2021 American Society for Reproductive Medicine symposium, I shared key insights from my decades of experience, including the importance of preparing for medical testing and pregnancy termination decisions in advance.
Medical Decision-Making: Why It Matters
Your surrogacy contract will likely include many difficult "what if" scenarios — situations that feel uncomfortable to think about. Like a warning label on medication , most problems outlined will never occur. Yet, if an unexpected situation does arise, careful preparation can make all the difference.
When complicated medical situations arise — such as considering termination or a potentially risky medical procedure — intended parents often seek second and third opinions. Meanwhile, the pregnancy continues, and the longer decisions are delayed, the more emotionally charged and complicated they become.
Rather than avoiding discussing these possibilities, it is critical to use a thoughtful framework to prepare:
Two Key Challenges with Contracts:
You may be advised to group issues into "medical" versus "cosmetic" or "life-threatening" versus "non-life-threatening" categories. Unfortunately, this rarely captures the full complexity. Many issues involve varying degrees of emotional strain, financial burden, physical discomfort, and long-term consequences for both the child and the family.
A More Helpful Framework
A more productive approach is to think about medical testing and termination decisions in two broad categories:
This framework helps uncover true expectations early in the process. If a surrogate feels that, for emotional or religious reasons, she must participate in decisions concerning the fetus — even when her own health is not at risk — intended parents must know this before moving forward and must carefully consider whether they are willing to accept this plan.
How Often Do These Issues Arise?
Thankfully, such conflicts are rare. The guidelines and screening processes are designed to set surrogacy journeys up for success. However, rare does not mean impossible. And if you are one of the few facing an unexpected and difficult situation, statistics offer little comfort.
Taking the time to have these conversations in advance — even when they are uncomfortable — protects everyone involved and helps ensure your path to parenthood remains as joyful and smooth as possible.
Share this post Facebook Bluesky Linkedin Email
There was a problem adding your email address. Please try again.
By submitting your information you agree to the Psychology Today Terms & Conditions and Privacy Policy
Lisa Schuman, LCSW , is a psychotherapist, author, researcher, podcast host, and expert in helping people navigate fertility treatment, donor conception, and surrogacy to have the families they desire.
Get the help you need from a therapist near you–a FREE service from Psychology Today.
This article is part of the Bringwise Psychology Journal — daily insights on human behavior, mental health, and personal growth.