People enter gestational surrogacy hoping for a healthy pregnancy, a healthy baby, and a positive experience for everyone involved. Still, they need to prepare for difficult situations that can arise during a pregnancy.
What happens if prenatal testing identifies a serious medical condition? How does everyone feel about pregnancy termination? What happens if the gestational surrogate and intended parents discover that they see an important decision very differently once there is an actual pregnancy?
These conversations are and should be part of the psychological preparation for gestational surrogacy.
As a reproductive psychologist who conducts third-party reproduction evaluations and intended parent consultations, I am interested in how people think through these possibilities and what informs the decisions they believe they would make. What shapes their values? How do they make difficult decisions? How do they handle disagreement? What happens when circumstances change?
These conversations can also help us understand whether a particular gestational carrier and intended parents are a good match.
Why Do People Become Gestational Surrogates?
When a difficult surrogacy case makes the news, it can shape how people view gestational carriers more broadly. One common assumption is that people become surrogates primarily for financial reasons.
Research on gestational carrier motivation remains limited and does not fully represent the racial, cultural, socioeconomic, or gender diversity of people who may become carriers. Across the available research, however, helping others and contributing to another person’s family-building have repeatedly appeared as important motivations.
A 2024 study of 231 U.S. surrogates, for example, found that altruistic and prosocial reasons were the primary motivations reported by most participants. The study did not collect race or ethnicity data, which limits what we can conclude about how well the sample reflects the broader population of gestational carriers.
People may choose to become gestational surrogates for several reasons, including compensation, positive experiences with previous pregnancies, personal or family experiences, and a desire to help someone become a parent.
These motivations can coexist. Someone can genuinely want to help another family while also valuing compensation for the significant physical, emotional, and practical commitment involved in pregnancy.
During the psychological evaluation, we explore a person’s motivation for becoming a gestational carrier and the experiences and considerations that have shaped that decision. We also explore compatibility and potential concerns between the gestational carrier and intended parents.
A Gestational Carrier and Intended Parents Still Need to Be the Right Match
A gestational carrier and intended parents may each be psychologically prepared for surrogacy while still being a poor match for one another. Differences in their expectations, values, communication, boundaries, or approaches to medical decisions can become especially important during a pregnancy.
Consider pregnancy termination, for example. A gestational surrogate may have clear beliefs about circumstances in which they would consider terminating a pregnancy. Intended parents may have equally clear beliefs about what they would want following a serious prenatal diagnosis.
We want to identify significant differences between those positions before pregnancy begins.
The same principle applies to prenatal testing, communication, boundaries, medical decisions, and expectations about the relationship between the surrogate and intended parents.
During psychological preparation, we can explore those differences while everyone has time to think, ask questions, and decide whether they feel comfortable moving forward together.
The American Society for Reproductive Medicine (ASRM) recommends psychological evaluation and counseling for gestational carriers, psychoeducational counseling for intended parents, and a joint session to discuss expectations and potential areas of concern.
Exploring these differences before pregnancy helps everyone determine whether they can navigate them together or whether another match would be more appropriate.
When a Hypothetical Decision Becomes Real
Another layer matters just as much: people do not always know exactly how they will feel until they are living through something.
Imagine discussing pregnancy termination months before an embryo transfer.
You have thought carefully about your values. You understand the question. You feel confident about how you would respond if prenatal testing identified a serious medical condition.
Now imagine receiving that diagnosis during an actual pregnancy.
There may be fear, grief, attachment, uncertainty about the prognosis, religious or cultural considerations, family opinions, and medical information that leaves room for difficult choices.
The decision feels different because the circumstances are different.
Someone can sincerely describe how they believe they would respond during a psychological evaluation and later experience the situation differently.
This is why I pay attention to the process behind someone’s answer.
How does this person make difficult decisions? What happens when they feel overwhelmed? How have they handled conflict in other important relationships? How do they communicate when someone disagrees with them? How comfortable are they with uncertainty?
Understanding how someone arrives at an answer can offer insight into their values, decision-making, and approach to uncertainty.
Psychological preparation also helps us understand what the gestational surrogate and intended parents bring into the relationship and identify differences that could become especially important during a pregnancy.
We cannot prepare people for every circumstance they may encounter, but we can help them understand whether they are prepared to face those circumstances together.
Dr. Wiyatta Fahnbulleh is a reproductive psychologist licensed in California and Maryland who provides intended parent consultations, donor and gestational carrier evaluations, and reproductive mental health services.
If you would like to learn more about working together, click here to schedule a complimentary 15-minute consultation. click here.