Medical risks of surrogacy: for the carrier, the baby and the parents
Surrogacy is a medical process as well as a legal one. This guide explains the main risks in plain words, what experts recommend and what to ask a clinic. It is general information, not medical advice.
Short answer. Pregnancy through surrogacy carries the risks of any pregnancy plus those linked to IVF and twins. A 2024 review found a higher chance of high blood pressure disorders than in general pregnancies. Experts strongly recommend transferring one embryo. Ask about screening, insurance, complications and what happens if a transfer fails.
Not legal or medical advice. This guide is written by an independent publisher, not by a lawyer or doctor. Surrogacy law abroad is unsettled and changes. Talk to an attorney in the country where the surrogacy will happen and to an attorney in your home state before making any decision.
What are the medical risks of surrogacy?
A carrier faces the usual risks of pregnancy and birth. Because the pregnancy starts with IVF (in vitro fertilization, where eggs and sperm meet in a lab), it also carries the risks seen after IVF. A 2024 systematic review in JAMA Network Open looked at six studies. It found that gestational carrier pregnancies had higher odds of hypertensive disorders (high blood pressure problems such as preeclampsia) than general pregnancies, by about 44 percent in the adjusted analysis. Compared with other IVF pregnancies, the risks were similar for hypertension, preterm birth and low birth weight, and the odds of cesarean delivery were lower (Matsuzaki and others, 2024). The authors list real limits: the studies were looking back at past records, important data were missing and causes could not be proved.
The American Society for Reproductive Medicine (ASRM) says carrier counseling should cover the possible complications of pregnancy and the possible loss of her own fertility (ASRM practice committee, 2022). In short, a healthy carrier can have a healthy pregnancy, and a careful program still cannot remove risk. We could not find Colombian data on carrier outcomes.
Why do experts recommend transferring only one embryo?
Twins and other multiple pregnancies raise the risk of complications for the woman who is pregnant and for the babies. ASRM says multiple pregnancy leads to "an increased risk of complications" for both and that single embryo transfer should be strongly recommended in all gestational carrier cycles (ASRM 2021 guidance). The JAMA review authors also call elective single embryo transfer crucial. Ask the clinic what its policy is and whether you can ask for one embryo. If the clinic transfers two without a medical reason, ask why.
How should a carrier be screened?
ASRM recommends that carriers be of legal age and preferably between 21 and 45, that they have had at least one term and uncomplicated pregnancy, and ideally no more than five deliveries or three cesarean deliveries. It also recommends a psychosocial evaluation, counseling for her and her partner, testing for infections and a stable home with support (ASRM 2022). Colombia has no statute on this. Press accounts attribute a similar list to case law, and in T-968 the Court quoted a list proposed by legal scholars, not a rule in force (T-968). So the standard in Colombia is the clinic's own protocol. Ask to see it, in writing.
What should you know about embryo testing (PGT)?
PGT-A is a test that counts the chromosomes of an embryo before transfer. ASRM says its 2024 review of the evidence does not support using it for all IVF patients. It calls the benefit mixed and limited, says false results are possible and notes that tests can label an embryo "mosaic" in a way that is hard to interpret (ASRM 2024). It may be useful in some cases, such as when an egg provider is older, and ASRM's carrier guidance suggests considering it when the egg provider is 38 or older. Ask your doctor whether it fits your case and what the clinic will do with embryos that are not transferred. Do not choose a program because it promises that testing will "guarantee" a healthy baby. No test can.
What changes with donor eggs or donor sperm?
Donors are screened for health and infections. The age of the person who provides the eggs matters for the number of embryos that doctors advise transferring (ASRM). Ask how donors are chosen, what medical history you receive and whether the clinic keeps records for the child. For Colombia we found no specific statute on gamete donation. A news report says donors receive money to compensate their time and discomfort, and an expert quoted there questions that as disguised payment (RCN, 2022). For citizenship, a donor generally cannot pass on U.S. citizenship (USCIS). See the guide for different families.
Does the age or health of the intended parents matter?
We found no Colombian rule on the age or health of intended parents. It matters in two ways. The age of whoever provides the eggs affects the chance and the embryo choices. Your own health may affect your ability to travel and care for a newborn. Clinics and agencies may set age limits. Ask for the policy in writing, and discuss your case with your own doctor before you pay.
What happens if the embryo transfer fails or there is a pregnancy loss?
A transfer may not lead to a pregnancy, and a pregnancy may end. This is common enough that every contract should address it. Check: how many transfers are included, who pays for another, how long the carrier must rest, what is refunded if she cannot continue and what happens to the remaining embryos. In ASRM's view the carrier keeps ultimate authority over her own medical care, including prenatal testing, pregnancy termination and multifetal reduction, and a contract cannot compel a procedure (ASRM 2023 ethics opinion). In T-968 the Court quoted a scholars' proposal that she could end a pregnancy only on medical advice, so sources disagree. Ask a Colombian attorney how your contract treats this, and read it with the carrier's attorney.
Who pays for medical complications, insurance and the newborn?
ASRM says carriers should have adequate health coverage for pregnancy care, and that contracts should say who pays for counseling and for extra costs of a multiple pregnancy (ASRM). We could not verify how a carrier's care is covered in Colombia in each program. Ask: Which hospital will she deliver at? Who pays for complications, a long stay or a cesarean? Who pays if the baby needs intensive care? Does your own policy cover a newborn born abroad? What is covered if you need to be evacuated? Get the answers in the contract, not in a chat.
What about mental health?
ASRM recommends counseling for the carrier, her partner and the intended parents before treatment, and access to counseling during and after the pregnancy (ASRM). Hand-over of a baby can be emotionally hard for everyone, and so can waiting through failed attempts. Ask who provides counseling, who pays and for how long after birth. A 2026 bill would require 24 months of psychological support for carriers, but it is only a draft (bill guide).
How do medical risks connect to the legal plan?
A medical complication can change the legal picture. A premature birth can keep the baby in hospital and you in Colombia longer (timeline). A loss or a termination raises contract questions about money and consent (legal disputes). A baby with a health condition raises questions about who decides and who pays. Ask your attorneys to read the medical clauses of the contract with these cases in mind, and ask the carrier's attorney to confirm that she understands them.
Key takeaways
- Surrogacy is a medical process with real risks for the carrier and the baby. Single embryo transfer lowers some of them.
- Carrier screening standards in Colombia are set by each clinic. Ask to see them.
- PGT-A is not proven to help everyone. No test guarantees a healthy baby.
- Put insurance, complications, failed transfers and counseling in the contract.
What to ask the clinic
- What is your screening protocol for carriers, and can I read it?
- Do you recommend single embryo transfer? Under what conditions do you transfer two?
- Which hospital will she deliver in, and who pays for complications and intensive care?
- What is covered if a transfer fails or a pregnancy ends?
- What counseling does she get, and for how long after birth?
- Are you enabled for these services in the national health registry?
Common mistakes
- Asking about success rates and not about the carrier's safety.
- Accepting two embryos for a higher chance without discussing twin risks.
- Assuming insurance will cover everything.
Next step
Read what a carrier should have in surrogate protections, then what you pay for.
Frequently asked questions
Is surrogacy safe for the surrogate?
No pregnancy is risk free. A 2024 review found higher odds of high blood pressure disorders in carrier pregnancies than in general pregnancies, with other outcomes similar to other IVF pregnancies, but the evidence has limits. Careful screening, single embryo transfer, insurance and counseling help. Ask the clinic for its written protocol and speak with a doctor.
How many embryos should be transferred to a surrogate?
The American Society for Reproductive Medicine strongly recommends single embryo transfer in all gestational carrier cycles, because twins raise risks for the carrier and the babies. The decision is made with the doctor. Ask the clinic for its policy and why it would transfer two.
How are Colombian surrogates screened?
Colombia has no statute that sets the screening standard. Clinics use their own protocols. ASRM suggests a carrier aged 21 to 45, at least one uncomplicated term pregnancy, psychological evaluation and infection testing. Ask the clinic to show you its written rules and whether the carrier's own doctor has seen them.
Should I test my embryos with PGT-A?
ASRM says the benefit of PGT-A is mixed and limited and does not recommend it for all IVF patients. It may help in specific cases, and it can give results that are hard to read. Talk to your doctor about whether it fits your case, and distrust promises of a guaranteed healthy baby.
What if the embryo transfer fails?
A transfer may not result in pregnancy. Your contract should state how many transfers are included, who pays for another, what happens to the remaining embryos and what is refunded. We do not quote success rates because none that we could verify applies to your case.
Who pays if the surrogate has complications?
It depends on the contract and insurance. ASRM says the carrier should have adequate health coverage and that contracts should address extra costs such as a multiple pregnancy. Ask who pays for her care, a cesarean, a long hospital stay and your newborn's intensive care, and get it in writing.
Can the surrogate end the pregnancy?
ASRM says the carrier keeps ultimate authority over her own medical decisions, including termination, and a contract cannot compel a procedure. A scholars' list quoted in Colombia's T-968 said she could end it only on medical advice, so sources disagree. Ask a Colombian attorney and the carrier's attorney how your contract treats this.
Do the intended parents' age and health matter?
We found no Colombian rule. The age of the person providing the eggs affects medical choices, and your health affects travel and newborn care. Providers may set their own age limits. Ask for the written policy and discuss your own case with your doctor before you pay.