For most healthy women who become gestational carriers, pregnancy goes the way it did before - but "most" is not "all," and the honest answer starts with the numbers. A large 2024 population study found that gestational carriers had a 7.8% rate of severe maternal complications, compared with 2.3% for women who conceived without assistance and 4.3% for women who conceived through IVF (Annals of Internal Medicine, 2024). That is roughly three times the risk of an unassisted pregnancy. Surrogacy is not a risk-free way to be pregnant, and any agency that tells you it is has already lost your trust.
The reason surrogacy is still safe enough to be done responsibly, tens of thousands of times, is not that the risk isn't real. It is that the risk is screened for before it starts and watched for the whole way through. This page explains what the risks actually are, why they are higher for a gestational carrier, and how careful medical and psychological screening - the kind built into a real agency's process - is designed to catch problems early rather than pretend they don't exist.
Is being a gestational surrogate safe?
Being a gestational surrogate is safe for the great majority of carriers, but it carries a measurably higher risk of serious pregnancy complications than an ordinary pregnancy, and you deserve to know that before you decide.
In the largest study of its kind to date - a cohort of every singleton birth in Ontario, Canada from 2012 to 2021, covering more than 860,000 pregnancies including 806 carried by gestational carriers - researchers found severe maternal complications in 7.8% of gestational-carrier pregnancies, versus 2.3% of unassisted pregnancies and 4.3% of IVF pregnancies (Annals of Internal Medicine, 2024; ICES summary). After adjusting for other factors, carrying as a gestational carrier was associated with about 3.3 times the risk of severe complications compared with an unassisted pregnancy (weighted relative risk 3.30; 95% CI, 2.59 to 4.20), and about 1.9 times the risk compared with IVF (1.86; 95% CI, 1.36 to 2.55).
Two things are true at once, and honest safety content holds both. Serious complications are uncommon in absolute terms - the large majority of carriers have a healthy pregnancy and recovery. And the elevated relative risk is real, it is documented, and it is the reason screening and monitoring are not optional.
What are the real health risks of a surrogate pregnancy?
The complications that showed up more often in gestational carriers are the same serious complications any pregnancy can carry - they simply appeared at higher rates. In the 2024 cohort, the excess risk was driven mainly by hypertensive disorders including pre-eclampsia (dangerously high blood pressure in pregnancy), postpartum hemorrhage (heavy bleeding after birth), serious postpartum infection, and preterm birth before 37 weeks (Annals of Internal Medicine, 2024). Cesarean delivery and gestational diabetes are also part of the broader risk picture reported across studies of carrier pregnancies.
It is worth being precise about the newborn, because the honest picture is more reassuring there. In the same study, severe *neonatal* morbidity was 6.6% for babies of gestational carriers, compared with 5.9% for unassisted and 8.9% for IVF pregnancies - the evidence for higher risk to the baby was much less clear than the evidence for higher risk to the carrier. The elevated risk this page is about is a risk carried by *you*, the surrogate, which is exactly why your health is the thing being protected.
One correction to a claim you may see on older pages, including some of our own earlier writing: ovarian hyperstimulation syndrome (OHSS) is generally not a risk for a gestational carrier. OHSS is a complication of the ovarian stimulation used to retrieve eggs - a process the egg provider or IVF patient goes through, not the carrier. A gestational carrier's body is prepared for an embryo transfer with hormones such as estrogen and progesterone, not with the ovarian stimulation that causes OHSS.
Why is the risk higher for gestational carriers?
The most important and least comfortable finding is that the higher risk is not fully explained by IVF alone, and not erased by having had an easy pregnancy before. Gestational carriers in the 2024 study had more severe complications than IVF patients, not just more than unassisted pregnancies - so the embryo-transfer procedure is only part of the story. And separate research following the *same women across their own pregnancies* found more adverse outcomes when they carried as a surrogate than in their earlier, spontaneously conceived pregnancies (Annals of Internal Medicine, 2024; see also the researchers' plain-language explanation in The Conversation, 2024). Always know that you can and should ask your medical providers including the IVF physician directly about these risks. Always know that you can and should ask your medical providers, including the IVF physician, directly about these risks.
Researchers point to several likely contributors: the frozen-embryo-transfer and hormonal-preparation process itself, the biology of carrying a pregnancy that is not genetically the carrier's own, and the reality that carriers may differ from the general pregnant population in ways the data couldn't fully capture. The study's authors were candid that they lacked information on why each carrier was chosen and how each was screened - which is the honest limit of the evidence, and also the opening for the part you can actually control.
How does screening actually make surrogacy safer?
Screening does not remove the elevated risk - no one can promise that - but it lowers the part of the risk that is modifiable, and it makes sure a carrier starts pregnancy as healthy as possible and is watched closely enough to catch trouble early. That is the real mechanism by which a rigorous agency process protects you.
Here is the part that shows why screening is not a formality. When researchers checked how often real-world gestational carriers actually met the medical eligibility criteria set by the American Society for Reproductive Medicine (ASRM), a meaningful share did not. In one single-center study of 194 carrier pregnancies, about one in four carriers did not meet ASRM criteria - most often because of a body-mass index over 35 or an age outside the recommended range - and carriers who fell outside the guidelines had higher rates of some adverse outcomes, including a markedly higher rate of early pregnancy loss (23.7% versus 6.7%) (study reported in Fertility and Sterility; neutral trade summary, MDedge). ⚑ *Medical reviewer: please confirm this study's exact citation and the calibrated way it's stated - it is presented as an association, not proof of cause.*
The takeaway is not that carriers who fall outside the guidelines are doomed; it is that who is approved to carry, and how carefully, genuinely affects outcomes. Screening to a recognized medical standard is how an agency makes sure the woman it approves is one for whom the odds are as good as they can be.
What medical screening does a surrogate go through?
A responsible surrogate screening follows the medical eligibility standards published by ASRM, whose current guidance (a 2022 committee opinion) is the reference most U.S. programs use. Those standards include:
- A prior pregnancy history that predicts a healthy one. ASRM recommends that a carrier have had at least one term, uncomplicated pregnancy before carrying for someone else, and ideally no more than five previous deliveries or three prior cesarean deliveries (ASRM, 2022). A track record of carrying a pregnancy safely is the single strongest signal that you can do it again.
- An age range associated with lower risk. ASRM recommends carriers be of legal age and preferably between 21 and 45. In practice, most fertility clinics limit the carrier's age to 41 or 42, which is tighter than the ASRM guidance.
- A full medical evaluation and clearance for pregnancy, including a review of your own past pregnancy and delivery records, and a letter of medical clearance from your treating obstetrician.
- Infectious-disease and laboratory screening - testing for HIV, hepatitis B and C, syphilis, and other infections, for the protection of you, the baby, and the intended parents (ASRM, 2022).
- An evaluation of the uterus, commonly by a saline-infusion sonogram, to confirm the uterine cavity is ready to carry a pregnancy.
This is also why a surrogate's own health is protected before anyone talks about a match: a carrier who has already had a healthy pregnancy, is within the recommended age range, and is medically cleared is starting from the safest possible baseline. Worldwide Surrogacy Specialists screens to all of ASRM's medical and psychological standards, and the process begins with a personal consultation with one of our experienced team members who was a surrogate herself.
What does the psychological evaluation and background check involve?
Carrying a child for someone else asks something of you emotionally as well as physically, so a complete screening looks at readiness, support, and history - not only physical health. ASRM's guidance calls for a psychological evaluation and implication counseling by a qualified mental health professional for every potential carrier, and for her partner or primary support person (ASRM, 2022).
A thorough psychological screening typically includes:
- A clinical interview covering your motivation for carrying, your support system, your history, and how you would approach sensitive decisions that any pregnancy can raise.
- A standardized, validated personality assessment. ASRM names instruments such as the Personality Assessment Inventory (PAI) and the Minnesota Multiphasic Personality Inventory (MMPI) - the same objective tools clinicians use across mental-health settings, so the evaluation rests on evidence rather than a first impression.
- Implication counseling, a structured conversation to make sure you understand - and feel genuinely prepared for - what the journey involves before any contract is signed.
- A background check and a review of relevant history, which is standard for the protection of everyone involved.
A point that matters to your autonomy, from ASRM's 2023 ethics guidance: a gestational carrier is the sole decision-maker about her own medical care, from the embryo transfer through prenatal care, labor, delivery, and recovery (ASRM Ethics Committee, 2023). Screening is about making sure you enter this fully informed and supported - not about signing your choices away. Alongside the records review, medical clearance requires a letter of medical clearance from your own treating obstetrician. And your autonomy does not end at screening: you always have complete bodily autonomy and the right to make medical decisions for yourself, and those decisions are memorialized in the Gestational Surrogacy Agreement.
What prenatal care and monitoring can a surrogate expect?
Close, scheduled prenatal care is how the elevated risks on this page get caught early - most of them, including pre-eclampsia and growth problems, are far more manageable when they are found in time. A typical schedule of care becomes more frequent as the pregnancy progresses:
- The first visit is usually the longest, and often includes a urine test, bloodwork, and an early ultrasound to confirm the pregnancy and locate the heartbeat.
- Monthly visits through roughly the first two trimesters check your weight, blood pressure, and urine, measure the baby's growth, and watch for early warning signs - swelling in the hands or feet, for example, can be an early sign of pre-eclampsia.
- Every-two-week visits from about week 28 to 36 track your vitals, weight, and any swelling more closely.
- Weekly visits from about week 36 to delivery monitor blood pressure, the baby's heartbeat and growth, and position for birth.
- Ultrasounds are typically scheduled at the start and across the pregnancy, with more added if your provider wants a closer look.
The medical care itself is delivered by your own obstetrician, not the agency. What a good agency adds is continuity around that care - someone who knows your journey, helps coordinate, and makes sure nothing falls through a handoff.
How WSS supports a surrogate's health and safety
At Worldwide Surrogacy Specialists, a surrogate is screened and approved before she is ever matched, so the pregnancy begins from the safest medically appropriate starting point. WSS screening meets all ASRM medical and psychological standards, and begins with a personal consultation with one of WSS's experienced team members who was also a surrogate.
Two things about how WSS is built are directly relevant to your safety, and both are confirmed parts of how the agency works. First, the same case manager stays with you from your first conversation through delivery and beyond - one person who knows your history and your journey, so the details of your care don't get lost in a handoff between departments. Second, WSS was founded and is led by a practicing reproductive attorney, Victoria T. Ferrara, which means the legal protections around your medical decisions - your right to make your own care decisions, your independent legal counsel, the terms that protect you - are built into the journey from the start rather than added at the end.
None of this makes a surrogate pregnancy risk-free, and we won't tell you it does. What it does is put a screened, medically cleared start, close prenatal monitoring, continuous personal support, and real legal protection around a decision that deserves all four.
If you're considering becoming a surrogate and want to understand whether it's right for you, you can learn what's involved in becoming a surrogate, read about the surrogacy process step by step, or review what clears surrogate screening and what our requirements are.
Talk with our surrogate services team
Frequently asked questions
Is being a surrogate safe?
For most healthy carriers, yes - but it carries a higher risk of serious complications than an ordinary pregnancy. A 2024 study found severe maternal complications in 7.8% of gestational-carrier pregnancies, compared with 2.3% of unassisted pregnancies. Screening and close prenatal monitoring are how that risk is managed, not eliminated.
Can you die from being a surrogate?
Severe complications are not the same as death, and maternal death is rare in the United States - about 17.9 deaths per 100,000 live births in 2024, or under 0.02% (CDC / NCHS, 2024 data). The 7.8% figure above refers to *serious complications*, most of which are treatable when caught early - which is the entire purpose of the screening and monitoring described on this page.
Do I have to have been pregnant before to be a surrogate?
Yes. ASRM recommends that a gestational carrier have had at least one term, uncomplicated pregnancy before carrying for someone else, because a prior healthy pregnancy is the strongest predictor of another one (ASRM, 2022).
Will being a surrogate affect my own future fertility?
Any pregnancy may impact future fertility. This is why, although not required, it may be a good idea to complete your own family before deciding to become a surrogate.
What happens if a complication develops during the pregnancy?
Your obstetrician manages your medical care, and the frequent prenatal schedule is designed to catch complications like pre-eclampsia or growth restriction early, when they are most manageable. As the gestational carrier, you remain the decision-maker about your own medical care throughout (ASRM Ethics Committee, 2023).
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