The Psychosocial Effects of Surrogacy

iStock_000002245637Large2An increasing number of couples are turning to the option of surrogacy to achieve their dream of having a family. Although this method continues to be controversial, there are many happy families that have expressed unqualified support for the use of surrogacy. Yet while many happy outcomes have resulted, there are psychosocial effects of surrogacy on both the biological and surrogate parents.

The Psychological Effects of Deciding to Use a Surrogate

Many couples struggle with infertility, finding that the associated distress eventually affects all aspects of their lives. Yet the decision of how to pursue the goal of parenthood is profoundly personal. Thus, many physicians have a counselor who specializes in reproductive issues available for couples who want to take advantage of this resource.

With some exceptions, couples generally attempt alternate methods to surrogacy first. This is often due to strong negative emotional responses when thinking about including another individual in the birth process. In addition, fears regarding whether the surrogate will change her mind about giving up the child can create anxiety leading to hesitancy similar to that found in couples considering adoption.

Couples may choose surrogacy due to opposition to some assisted reproduction methods especially those that greatly increases the chance of a multiple pregnancy. Often couples are required to sign a document stating they will agree to undergo selective fetal reduction, eliminating a certain number of fetuses at 11-12 weeks of gestation. Couples may find this practice unacceptable for religious or personal reasons or change their minds after becoming pregnant, which can interfere with a positive patient/physician relationship.

Couples may also choose surrogacy after learning they will not be able to adopt due to either not meeting required age limitations or reluctance to place a child with a single parent or a homosexual couple. In addition, when using an agency, the waiting time can be extremely lengthy. Some of these families initially lose hope and go through a grieving process but eventually begin to consider other options and feel the return of optimism about the potential of establishing a family.

Medical reasons may also create a situation where surrogacy is recommended. When the probability of successful implantation or gestation is low, physicians often suggest the possibility of surrogacy. This is often an option couples never thought of using and they frequently experience a sense of shock when learning this process is their only option. They may also feel confusion over the desire to have a child and initial reluctance to use a surrogate.

Psychological Reactions to the Type of Surrogacy Utilized

There are two types of surrogacy. In traditional surrogacy, the birth mother is inseminated with the sperm of the father, such that the surrogates egg is used. This method may be chosen due to the mother lacking viable eggs or the couple being unable to afford IVF, as intrauterine insemination is considerably less expensive. This type of surrogacy may require the couple to adopt the child after birth.

This can result in emotional difficulties especially for the adoptive mother given that her husband will be the biological father and another woman will be the biological mother creating resentment. These future mothers then feel guilty since they agreed to the process and feel they should be grateful to the surrogate. They may then enter a stage of self- blame since the reason they aren’t the biological mothers is because of a perceived defect within their bodies and this can lead to depression and negative self –concept. Ideally, when the pre-procedure evaluation identifies possible emotional problems before, during and after implantation occurs it is recommended that supportive counseling be started prior to the beginning of the medical process and continue during the pregnancy and after the birth.

It’s not only the mother who experiences these emotions. Fathers often feel guilty that they are the only biological parent, knowing that this is negatively affecting their wives or partners. They also may experience guilt over feeling happy that they are the biological father. Couples often find it impossible to discuss these types of issues, underscoring the need for appropriate intervention to help the couple talk about their feelings and learn how to better support each other.

In gestational surrogacy, the couples sperm and egg are fertilized and transferred into the surrogate through IVF. In most states, the intended mother is allowed to put her name on the birth certificate after birth. There are far fewer negative psychological effects when using this type of surrogacy though the anxiety, jealousy and resentment related to another woman carrying their child can surface.

Effects on the Surrogate

There has also been concerns raised over the impact of the process on the surrogate. Many surrogates report experiencing negative reactions from those around them and some report negative effects on their relationship with their spouse and children. However, research suggests that surrogate mothers feel positively about their decision to act as a surrogate. Although some experience problems giving up the baby, these difficulties were not severe and dissipated quickly.

In one study, after giving up the baby, 35 percent of the surrogates experienced mild to moderate problems within the following two weeks, 15 percent reported problems three months afterwards, while only 6 percent reported problems one year afterward. Prior to the birth 9 percent of the surrogates experienced psychological problems, 6 percent consulted a general practitioner for help, and 3% had regular appointments at an outpatient clinic.

Research also demonstrated that there was a significantly higher number of known surrogates (e.g. mothers, sisters, friends), who experienced problems after giving up the baby when compared to unknown surrogates.

Few surrogates experienced conflicts with the commissioning couples and there was no difference in the reactions of known surrogates to unknown surrogates. All surrogates reported either positive or neutral reactions in their children. However, there was a mixed reaction from partners. At the time the women decided to become surrogate mothers, 57 percent of partners responded positively, 24 percent responded neutrally/ambivalently and 19 responded negatively. 12 percent of the surrogates reported the arrangement had resulted in a poorer relationship with their partners, while 3% reported very severe relationship problems.


While surrogacy arrangements can result in psychological difficulties for the both members of the commissioning couple, overall most parents report that while the decision to use a surrogate had been difficult that they had experienced little anxiety or other psychological difficulties during or after the pregnancy.

Similarly, while some surrogates and their partners experienced difficulties during the pregnancy and after handing over the child, for most the experience appears to be positive and most difficulties dissipate within a year after giving up the baby.

Commissioning couples and surrogates generally report positive relationships with each other during and after the birth and transfer of the baby. They also report maintaining contact and the intention to maintain contact throughout the child’s life.

Yet it’s important to keep in mind that there are those who do have psychological difficulties and it is important that there is a method in place during evaluations conducted throughout the process to assess such factors. If problems are discovered, encouraging supportive counseling is a crucial step in helping all participants perceive the surrogacy process as a positive experience.

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