Pregnancy Complications and Surrogacy: What Gestational Carriers Need to Know

A surrogate pregnancy can face the same complications as any pregnancy, including preeclampsia, gestational diabetes and preterm labor. A few risks are more relevant because the pregnancy starts through IVF, such as twins and a higher chance of cesarean birth. Clinics screen your history before any match, and your contract sets out how complications are handled. Exact standards vary by program and physician.

Why Pregnancy Complications Come Up Early in Surrogacy Research

You are thinking about carrying a pregnancy for someone else, and one of the first things you want to understand is what could go wrong with your own body. That is a practical question. It is not a fearful one. It is the question a careful person asks before giving a year or more of her life to a process.

It is also a question everyone in surrogacy treats as standard. Agencies ask about your pregnancy history on the first form. Fertility clinics review your obstetric records before anything else happens. Attorneys spend real time on the contract clauses that deal with medical events. Medical risk is not a niche concern on the edges of surrogacy. It sits at the center of how the process is built.

Surrogate Compass is an independent platform for women considering becoming a gestational surrogate in the United States. We help you understand eligibility, compensation, the process and how to compare programs, and we connect you with agencies. We do not screen, match, contract with or pay surrogates. Agencies and clinics do that.

This article covers three things: what complications can arise, how screening tries to reduce risk before a match, and how legal agreements handle medical decisions. It is general information, not medical or legal advice. Your own physician and an independent surrogacy attorney advise on your situation.

What Gestational Surrogacy Actually Involves Medically

As a gestational carrier, you have no genetic connection to the baby. The embryo is created through IVF using eggs and sperm from the intended parents or from donors. The ovarian stimulation and egg retrieval happen to the egg provider, not to you.

Your part starts with preparing your uterus. The clinic usually prescribes hormonal medications, typically estrogen and then progesterone, to build up the uterine lining so it is ready to receive an embryo. Some of this is given as injections, and the schedule runs for several weeks.

Then comes the embryo transfer. A fresh or frozen embryo is placed in your uterus through a thin catheter, a procedure that does not usually need anesthesia. The number of embryos transferred matters a great deal. The American Society for Reproductive Medicine publishes guidance on embryo transfer practice that clinics use as their clinical standard, and that guidance favors single embryo transfer (SET) for many patients to reduce the chance of a multiple pregnancy. Many clinics now transfer one embryo as their default, but policies differ, so it is worth asking.

After transfer, monitoring is frequent. Expect regular bloodwork to check hormone levels and confirm pregnancy, followed by early ultrasounds to confirm the heartbeat and where the pregnancy has implanted. Once the pregnancy is established, you usually move to an OB for standard prenatal care. For how this fits into the full timeline, see the overview of the surrogacy process.

Pregnancy Complications That Can Affect Any Pregnancy

These conditions are known, studied and closely monitored. Prenatal care is designed largely around catching them early. Baseline information on how common they are is published by the CDC, and the Office on Women's Health offers plain-language explanations of each.

Gestational hypertension and preeclampsia. Gestational hypertension is high blood pressure that develops during pregnancy. Preeclampsia is high blood pressure with signs that other organs are affected, such as protein in the urine. It usually appears in the second half of pregnancy. It is monitored through blood pressure checks and urine tests at prenatal visits. It becomes serious when blood pressure climbs sharply or symptoms like severe headache, vision changes or upper abdominal pain appear, and severe cases can require early delivery.

Gestational diabetes. This is high blood sugar that develops during pregnancy. It is usually screened for with a glucose test in the second trimester. Management ranges from diet changes to medication, and it typically resolves after delivery.

Preterm labor and premature birth. Birth before 37 weeks is considered preterm. Risk factors include carrying multiples, certain infections, high blood pressure and some uterine or cervical conditions.

Placenta previa and placental abruption. Placenta previa means the placenta covers part or all of the cervix, which usually leads to a planned cesarean. Placental abruption means the placenta separates from the uterine wall before birth, which is an emergency.

Hyperemesis gravidarum. This is nausea and vomiting far beyond typical morning sickness, severe enough to cause dehydration or weight loss. Some people need IV fluids or medication.

Postpartum hemorrhage. Heavy bleeding after delivery is a delivery-phase risk that hospital teams prepare for and treat quickly.

Risks That Are Elevated or Specific to Gestational Surrogacy

A surrogate pregnancy begins in a fertility clinic, and that changes the risk picture in a few specific ways. Research on IVF pregnancy outcomes is indexed on PubMed, and the NICHD funds and summarizes research on assisted reproduction.

Multiple gestation. Twins were historically much more common in IVF because clinics often transferred more than one embryo. Single embryo transfer has greatly reduced this. Twins are still possible, though, because a single embryo can split into identical twins. A multiple pregnancy carries higher chances of preterm birth, low birth weight, NICU admission for the babies and cesarean delivery.

Medication side effects. The preparation phase can bring bloating, breast tenderness, mood changes and headaches. Progesterone injections, which some clinics use for weeks into early pregnancy, commonly cause soreness or lumps at the injection site.

Ovarian hyperstimulation syndrome (OHSS). You may see this risk named in IVF material. OHSS affects the egg donor or intended mother whose ovaries are stimulated. It is not a risk to you as the carrier. It is useful to understand only because it can affect the cycle's timing on the other side.

Cesarean delivery. IVF pregnancies are associated with somewhat higher cesarean rates than spontaneous pregnancies, and the reasons are mixed. A cesarean means a longer recovery than a vaginal birth, usually several weeks with lifting restrictions. Each cesarean can also affect how a clinic views any future pregnancy, which matters if you hope to carry again.

Ectopic pregnancy. Rarely, a pregnancy after embryo transfer implants outside the uterus. Early ultrasounds are partly designed to rule this out.

For a wider look at the physical, emotional and financial side, see the guide to the risks of being a surrogate.

How Medical Screening Reduces Risk Before a Match

Screening exists to identify, before any transfer, whether a pregnancy is likely to be safe for you. It happens in layers.

Physical health criteria. Programs commonly look at age, BMI and prior pregnancy history. A common age range is roughly 21 to 40, but clinics and agencies set their own limits, and BMI ranges differ too. Many programs also look for at least one prior uncomplicated pregnancy. None of these is a single national rule. The common surrogate qualifications page explains how ranges differ between programs.

Obstetric history review. The clinic reviews your records: how many pregnancies, how you delivered, and any complications. A past complication is not automatically a disqualifier. The physician weighs what it was, how severe it was, whether it recurred and how long ago it happened.

Uterine evaluation. A hysteroscopy or saline sonogram checks the uterine cavity for polyps, fibroids, scarring or other issues that could affect implantation or pregnancy.

Lab work. This includes infectious disease screening and often genetic carrier screening, along with standard bloodwork.

Psychological evaluation. A licensed mental health professional usually meets with you, and sometimes your partner, to talk through readiness, support and expectations.

The roles matter here. An agency typically does a preliminary review of your application. The fertility clinic's medical team, working from ASRM guidance on gestational carrier evaluation, makes the medical determination. Passing an agency's preliminary review is not medical clearance. For the step-by-step version, see surrogate medical screening.

How the Gestational Surrogacy Contract Addresses Medical Complications

The gestational surrogacy agreement (GSA) is a legally binding contract signed before the medical transfer cycle begins. Surrogacy law varies significantly by state, and some states restrict compensated surrogacy, so the way these clauses work depends on where you live and deliver. The provisions below are common topics, not universal terms, and each one is negotiated.

Medical decision-making. Surrogacy practice in the US generally treats the carrier as keeping the right to make decisions about her own body and medical care. A contract cannot force you to undergo a medical procedure. Your attorney can explain exactly how this principle applies under your state's law.

Selective reduction and termination. These are among the most sensitive clauses. The contract records what the parties agree they intend if certain situations arise. It does not take away your bodily autonomy, but disagreements can have financial or legal consequences under some contracts. This section is among the most sensitive in any surrogacy contract. An independent attorney can explain what the clause means and how it interacts with the carrier's own values and the intended parents' expectations.

Medical costs. The contract sets out who pays for pregnancy-related care, including complications, and how it interacts with your health insurance. Some health plans exclude surrogacy, so an insurance review before matching is common. Ask who conducts it and what happens if your plan does not cover the pregnancy.

Life insurance and disability coverage. Common questions in this area include whether the arrangement includes a life insurance policy on the carrier, who pays for it, the coverage amount, and the duration, as well as whether disability coverage is included.

Lost wages and bed rest. If a complication means bed rest or early delivery, the contract may address lost income. Confirm whether it does, how lost wages are documented and whether there is a cap.

Cesarean delivery. Many contracts include an additional payment if a cesarean is needed. Whether yours does, and on what terms, is part of the negotiation. The highest-paying surrogacy agencies page explains how to read itemized compensation schedules.

You have your own independent attorney, separate from the intended parents' attorney. Ask the agency who pays for that attorney.

Questions to Ask Before You Commit

These are questions a thoughtful person might bring to each conversation. They are not a checklist to complete before moving forward.

For the fertility clinic: - What is your single embryo transfer policy, and when would you consider transferring more than one? - What is your protocol if I develop preeclampsia or need bed rest? - How do you weigh my specific prior complications?

For the agency: - How does your matching process account for my obstetric history? - What insurance review do you run before matching, and what happens if my plan excludes surrogacy?

For your attorney: - What does the contract say about my medical decision-making authority? - What provisions apply if I need a cesarean or a longer recovery? - How does my state's law affect these clauses?

For yourself: - Have you completed your own family? A complication, or an additional cesarean, can affect future pregnancies. - Who would help with your children, your job and your home if you needed bed rest or a longer recovery? - How do you feel about the possibility of a cesarean?

Not everyone who wants to be a carrier will be medically cleared. That is the screening process doing its job, and it protects you as much as anyone else. If you are comparing programs, the guide to comparing surrogacy agencies covers what to look for from your side.

If you want a clearer read on your own situation, Surrogate Compass offers a free eligibility review with no obligation. A Surrogate Compass intake coordinator will walk through your health history with you in a conversation that typically takes 20 to 30 minutes. It is not a sales call. The review looks at your age, your pregnancy and delivery history, any prior complications, and the other criteria programs commonly use, and it shows whether your situation looks likely to meet those common criteria. It is not approval. Agencies and clinics run their own screening, and a physician decides on medical clearance.

When you are ready, contact Surrogate Compass to request your free eligibility review. There is no deadline, and you can come back whenever it suits you.