Surrogacy goes more mainstream
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More Americans are turning to surrogacy to build their families, as the practice becomes more common and more publicly discussed.
Why it matters: As surrogacy becomes more visible and accessible, ethical, legal and cultural tensions become harder to ignore.
How it works: A surrogate carries a pregnancy for intended parents — typically via IVF with an embryo that uses a donor or the intended mother's egg.
- That's called gestational surrogacy, and the surrogate can be referred to as the gestational carrier. (When a surrogate uses her own egg, that's called traditional or genetic surrogacy.)
It's an option for people who want biological kids but can't — or can't safely — carry a pregnancy.
- It's "not something I would recommend for somebody who doesn't have a medical indication or a reason to do it," says Laura Meyer, reproductive endocrinologist at Illume Fertility.
By the numbers: U.S. clinics reported more than 11,500 gestational carrier cycles in 2023 — nearly seven times as many as were done in 2004, when the American Society for Reproductive Medicine (ASRM) began tracking the data.
- And pregnancies via gestational carrier increased by 55% from 2017 to 2020, according to a national analysis cited by ASRM.
- Yes, but: Births from gestational carriers account for only 13.7 per 100,000 deliveries nationwide between 2017-2020, and less than 2% of fertility treatment cycles.
State of play: Surrogacy has undergone a quiet cultural transformation.
- What once seemed like an inaccessible or poorly understood method of family-building has become something more people actually picture for themselves, because there are more public figures talking about pregnancy challenges and surrogacy, Meyer says.
- The topic has also migrated into pop culture, appearing on social media and as a central plot line on Apple TV+'s "Shrinking."
The latest: Olympic gold medal figure skater Alysa Liu was born via surrogacy. And singer Meghan Trainor recently shared that medical complications from her first two pregnancies led her family to surrogacy for their third child.
- But the headlines on surrogacy aren't all celebratory: Reaction to Trainor's baby news was mixed, and a recent criminal investigation involves the surrogate births of more than 20 children.
The big picture: The topic of surrogacy remains fraught, because it involves complex health and rights implications for everyone involved — surrogates, intended parents, donors, and the children born.
- Figures from the late Pope Francis to prominent feminist Gloria Steinem have opposed surrogacy because they saw it as exploitative of women and/or babies.
What they're saying: Because for-profit surrogacy agencies and fertility clinics measure success by the birth of a "healthy" child, that can skew incentives and create power imbalances, says Emily Galpern, a consultant for the Center for Genetics and Society.
- She notes that intended parents pay far more than surrogates receive.
The other side: Meyer says agencies build in "a lot of care," including counseling with social workers and psychologists to align expectations.
What we're watching: Whether legislation can evolve to ensure surrogacy arrangements are safe across the country. See the current patchwork of state regulations.
