Navigating the Surrogacy Journey: Common Challenges for Intended Parents

Cultural attitudes and laws around surrogacy vary widely across the world, making international surrogacy journeys complex. 

But, does it have to be?

Surrogacy offers a path to parenthood for those who cannot carry a pregnancy, but it also presents an era of challenges. Intended parents, the individuals or couples who commission a surrogate to carry their child, often encounter legal, medical, emotional, and financial hurdles at different stages of the journey. 

These challenges can vary significantly depending on the type of surrogacy (gestational, traditional, or hybrid) and the countries involved. 

So, today we wanted to talk to you about the most common issues faced by intended parents in gestational surrogacy (using a surrogate who has no genetic link to the baby), traditional surrogacy (where the surrogate’s own egg is used, making her the genetic mother), and emerging hybrid surrogacy arrangements (which strategically combine multiple countries in the process). 

Hope you will find some information that will help you in your journey!

Understanding Types of Surrogacy (Gestational, Traditional, and Hybrid)

Gestational surrogacy is the most common form today. In gestational arrangements, the surrogate carries an embryo created from the egg and sperm of the intended parents or donors, meaning the surrogate has no biological relation to the child. This arrangement is generally favored by professionals due to legal safeguards: since the gestational carrier isn’t genetically related, it avoids many of the parentage disputes that can plague traditional surrogacy. 

Traditional surrogacy, by contrast, involves the surrogate’s own egg fertilized by the intended father’s (or donor’s) sperm, making the surrogate the child’s biological mother. Traditional surrogacy is available in some countries, although it is less common because it raises additional legal and emotional complexities. 

Finally, hybrid surrogacy refers to a multi-country approach to family building: intended parents might perform different phases of the process in different jurisdictions to leverage each country’s advantages. 

For example, a couple might create embryos in one country with an IVF clinic and then work with a surrogate in another country with more favorable surrogacy laws. Hybrid programs allow flexibility but also introduce extra layers of complexity in terms of logistics and legal coordination, especially if not carefully managed. 

Each type of surrogacy comes with distinct challenges that influence the legal, medical, emotional, and financial journey for intended parents.

Legal Challenges for Intended Parents

Variable Laws and Parental Rights

Surrogacy laws vary enormously across the globe, creating a legal maze for intended parents. 

Some countries have well-established surrogacy statutes, while others ban surrogacy outright or lack any clear laws. This patchwork means intended parents often must travel abroad to find a surrogacy-friendly country, especially if their home country prohibits surrogacy. 

For instance, countries like France, Germany, and Spain outlaw all forms of surrogacy; intended parents there frequently look overseas despite the legal and social stigma they already have in their countries. In 2024, Italy went further: not only is surrogacy illegal there, but a new law was passed that criminalises Italian citizens who travel abroad to use a surrogacy service, even in countries where it is legal and regulated.  

By contrast, countries such as the United States (in many states), Ukraine, or Georgia have legal frameworks that recognize intended parents as the baby’s legal parents at birth, streamlining the transfer of parentage. 

Navigating these disparities between countries is a major challenge. 

Also, before the baby is born, intended parents must ensure that their own country will recognize their parental status when they return home. In some cases, they may need to undergo additional legal steps such as adoption or court orders after the birth to secure their parental rights in their home jurisdiction.

In the end, all families forget about their struggles once the baby is born, but most of them also feel like they haven’t been prepared for everything that happened to them in the legal process. This can be less stressful for the intended parents if they have an independent surrogacy consultant. From the outset, intended parents benefit from a clear understanding of the process, get access to specialized legal advice from a third party lawyer, and understand their overall budget with all the necessary components.

Parentage and Traditional Surrogacy Risks

Legal issues are especially thorny in traditional surrogacy. Because the surrogate is also the genetic mother of the child in traditional arrangements, she is legally considered the mother at birth in many countries. This means intended parents must obtain her consent and often complete a post-birth adoption or parental order to transfer maternity to the intended parent. 

There is an inherent risk that the surrogate could change her mind. Traditional surrogacy “leaves the door wide open” for a surrogate who has given birth (and is biologically connected) to assert parental rights and keep the baby. Even if such cases are rare, the mere possibility is a serious concern for intended parents. 

Some countries have responded by outlawing traditional surrogacy or refusing to enforce those agreements. Moreover, because of her initial legal status as the mother, a traditional surrogate often has greater say in medical decisions during pregnancy without needing the intended parents’ approval. This can complicate matters if disputes arise (for example, over prenatal care or whether to continue a risky pregnancy). 

By contrast, gestational surrogacy avoids many of these pitfalls since the surrogate has no genetic ties or presumptive parental rights, which is why it’s “the preferred surrogacy option of nearly all professionals today”.

Cross-Border Surrogacy and Citizenship

For international surrogacy, cross-border legal complications are a top concern. When the surrogate delivers the baby in a foreign country, the child’s citizenship and parentage documentation must be sorted out so the intended parents can bring the baby home. 

Problems can occur if there is not clear understanding about the “exit” plan or the legal steps in getting the birth certificate and applying for a passport for the child post birth. 

For example, a child was born through surrogacy in Georgia, using a donor egg and sperm from the intended father. Both intended parents were from the UK. Upon the child’s birth in Georgia, the Georgian authorities issued a birth certificate listing both intended parents as the legal parents. However, under UK law, the surrogate is automatically considered the legal mother, regardless of the birth certificate issued abroad. Consequently, the intended parents had to undergo a legal process in the UK to obtain a parental order, officially recognizing them as the child’s legal parents.

Legal hurdles upon returning home are frequently reported; intended parents often face bureaucratic delays or court processes to register the child.Such processes can be lengthy and stressful, requiring lawyers in multiple countries.

Hybrid Surrogacy Complexities

Those pursuing hybrid surrogacy (splitting the process across countries) must contend with multiple legal systems. Each border crossing adds complexity: moving embryos and gametes between jurisdictions requires careful planning to avoid violating any country’s laws. On our Hybrid surrogacy page, we talked about what happens if an embryo transfer happens in one country, but the birth occurs in another, and how this can be very complicated for some intended parents, legally. 

This scenario can trigger additional legal hurdles, immigration concerns, and unclear parental recognition if, say, the birth ends up taking place where surrogacy is restricted or illegal. Intended parents must therefore obtain comprehensive legal counsel in all jurisdictions involved to ensure that parental rights will be recognized and that they can safely bring the newborn home.

Evolving Laws and Contracts

Another legal challenge is the dynamic nature of surrogacy laws. Several countries have tightened or changed their surrogacy regulations in recent years. 

India, once a major hub for international surrogacy, banned commercial surrogacy for foreigners in 2015 and later outlawed most commercial arrangements entirely.

Thailand similarly shut down foreign surrogacy after high-profile incidents, and countries like Cambodia and Nepal went from permissive to prohibitive virtually overnight. 

Argentina, once a growing hub for international intended parents seeking surrogacy, has experienced significant legal shifts in recent years. In 2024, the Argentine Supreme Court issued a landmark judgment declaring surrogacy contracts legally invalid, reaffirming that under the Civil Code, the woman who gives birth is the legal mother, regardless of any prior agreements. 

Intended parents who are mid-process when laws change can be left in very complicated situations - unable to obtain birth certificates for babies or forced to relocate embryo transfers to a new country. 

The unenforceability of contracts in certain jurisdictions is another issue: in places with no surrogacy law or bans, the agreement between intended parents and surrogate may not be legally binding at all. This means if a dispute arises (over compensation, or if either party has a change of heart), there may be little legal recourse. Intended parents have to place tremendous trust in the surrogate under these conditions (or indeed the agency they choose to facilitate the arrangement), or else work only in countries with enforceable surrogacy contracts. 

So, ensuring surrogate’s rights and autonomy are respected is part of the legal balance. The surrogate’s bodily autonomy, her right to make health decisions and be free from coercion, must be upheld even as the intended parents seek to protect their future child. Crafting clear, ethical contracts that cover scenarios like pregnancy complications, selective reduction, or miscarriage is essential (e.g. outlining what happens if multiple embryos implant or if severe fetal abnormalities are detected). 

Legal challenges range from big-picture issues like finding a favorable jurisdiction and securing parentage, to fine-grained issues like contract details and cross-border paperwork. Consulting experienced surrogacy attorneys in all relevant countries is crucial to navigate this legal labyrinth.

Medical and Health Challenges

Complex Medical Processes

The surrogacy journey is built on complex medical procedures that can pose challenges for all involved. 

In gestational surrogacy, in vitro fertilization (IVF) is typically required to create embryos, which are then transferred to the surrogate’s uterus. IVF can be a tiring process for intended parents (especially if the intended mother undergoes egg retrieval) and it does not always succeed on the first try. Multiple IVF cycles may be needed, adding physical and emotional strain when embryos fail to implant or pregnancies miscarry. 

Intended parents must be prepared for the possibility of failed embryo transfers or early miscarriages, which are not uncommon. Even with a healthy surrogate, IVF success rates can vary, and each attempt is a roller-coaster of hope and anxiety. 

Traditional surrogacy, on the other hand, often uses intrauterine insemination (IUI) or artificial insemination with the surrogate’s own egg. While that process is simpler and less expensive medically (no IVF lab required), it can have lower success rates per cycle and still carries the usual risks of pregnancy.

Pregnancy Risks and Complications

Once pregnancy is achieved, the surrogate faces all the usual health risks of pregnancy and childbirth, and intended parents often share in the worry for her well-being and the baby’s. 

Surrogates are generally medically screened women with proven fertility, but complications can still arise. These include gestational diabetes, hypertension (pre-eclampsia), hemorrhage, premature labor, or in rare cases, life-threatening conditions for the surrogate. 

Regular prenatal monitoring is essential, yet even with excellent care, nature can be unpredictable. A heartbreaking scenario is a miscarriage or stillbirth after months of pregnancy – a deeply painful outcome for both the surrogate and the intended parents, who must emotionally recover and decide whether to attempt another cycle. 

Another medical challenge is the possibility of multiple pregnancy. In IVF-based surrogacy, transferring more than one embryo can increase the chance of success, but it also raises the risk of twins or triplets. A multiple gestation adds medical risks (premature birth, C-sections, greater strain on the surrogate’s health) and can lead to difficult decisions about selective reduction (reducing the number of fetuses) to protect overall outcomes. Such decisions are ethically and emotionally complicated for intended parents and surrogates alike. 

Clear agreements beforehand and alignment on these issues is critical, but if local law prohibits abortion or reduction, the parties might have limited options in practice.

Quality of Healthcare and International Differences

In international surrogacy arrangements, medical standards and access to care may vary by country. 

Intended parents may find themselves navigating unfamiliar healthcare systems. 

For example, some developing countries that offer more affordable surrogacy programs, might have different approaches to prenatal care or less stringent regulations on fertility treatments. 

Neonatal intensive care is another concern: if a baby is born premature or with health issues in a foreign country, intended parents must arrange and often pay for specialized hospital care until the infant is stable. This can be incredibly stressful as they may be far from home and navigating a foreign hospital bureaucracy. Moreover, not all insurance plans cover the surrogate’s pregnancy or a newborn’s care abroad, so intended parents often foot these bills out-of-pocket (bleeding into the financial challenges category).

Ethical and Decision-Making Challenges

Medical ethics questions can also arise. One such issue is decision-making authority during the pregnancy. While the surrogate is the patient under medical care (and has the ultimate say about her body), intended parents understandably wish to have input on matters affecting their future child. Tensions may surface if, for example, a serious fetal anomaly is detected. The intended parents might feel that terminating the pregnancy is the more humane choice, whereas the laws in that country might not permit abortion beyond a certain gestation. 

Conversely, a surrogate might want to abort for her own health reasons or if the fetus has a condition, while the intended parents desperately hope to continue, but a surrogate cannot be forced. 

Generally, contracts try to address these possibilities in advance (specifying under what conditions an abortion or reduction would be considered), but in practice these clauses may not be enforceable due to the surrogate’s rights. 

Intended parents must be in piece with the uncertainty that, ultimately, some critical medical decisions might be out of their hands. They also may face the emotional fallout of medical complications: if a baby is born with disabilities, for instance, the ethical duty is to care for the child. Such extreme outcomes are rare, but cast a shadow over surrogacy, reinforcing the need for responsible screening and counseling. 

For intended parents, worries about the baby’s health, the surrogate’s health, and the countless medical what-ifs can make the pregnancy term an anxious time, even though they are not the ones physically carrying the baby. It’s often recommended that intended parents maintain close communication with the agency and the medical team to stay informed and feel involved despite the distance.

Emotional and Psychological Challenges

Anxiety, Stress, and Loss of Control

The surrogacy journey is often an emotional rollercoaster for intended parents. After possibly enduring infertility or other obstacles to pregnancy, they may approach surrogacy with hope tinged with fear that something could go wrong. It’s very common for intended parents to experience anxiety, uncertainty, and a sense of reduced control throughout the process. 

Unlike a traditional pregnancy where the parents can directly experience and manage the pregnancy, here they must rely on another person’s body and health. This inherent lack of direct control can cause constant worry: Is the surrogate taking care of herself? What if she has an accident or falls ill? Will we find out immediately if complications arise? These thoughts often swirl in the intended mother’s or father’s mind. 

Stress peaks at certain milestones: waiting for IVF results, the two-week wait after embryo transfer, prenatal test results, pregnancy screenings,  and of course the delivery. Emotional and psychological stress can be very weighty for both the intended parents and the surrogate. Intended parents may ride waves of excitement followed by crashes of anxiety with each update. Managing this stress requires patience and often support from counselors or support groups. 

Trust and Communication with the Surrogate

Building a trusting relationship with the surrogate is another emotional challenge. A surrogacy arrangement isn’t merely transactional; it’s a highly intimate partnership requiring good communication and mutual understanding. Intended parents must place enormous trust in the surrogate to care for their unborn child for nine months. 

This can be emotionally challenging, especially if the intended parents and surrogate live far apart or come from different cultures. 

Working with a reputable agency or facilitator can help set clear expectations on how and how often updates will be shared, but even then, intended parents sometimes yearn to be more involved in the day-to-day pregnancy experience. 

On the other hand, surrogates also desire a positive relationship; they may worry about pleasing the intended parents or feel stress if the relationship is strained. Effective communication and managing expectations are a key but can be challenging to achieve consistently. 

For intended parents, learning to let go of some control while maintaining supportive communication is a delicate balance. Many describe the period of the surrogate’s pregnancy as emotionally intense - they need to be supportive for the surrogate’s well-being, while handling their own hopes and fears alone.

Jealousy, Bonding, and Parental Identity

Surrogacy can also evoke more complex emotions like jealousy or feelings of inadequacy, particularly for intended mothers. 

In traditional surrogacy, it’s noted that intended mothers sometimes struggle with jealousy knowing the surrogate is the biological mother of the child - a feeling that can “sour the intended-parent–surrogate relationship” if not addressed. Even in gestational surrogacy, an intended mother might feel an envy or sadness that another woman is able to carry her child when she could not.

These emotions are natural and not uncommon, but they can be difficult to admit openly. Without proper support, such feelings could lead to guilt or tension between the intended parents and surrogate. 

On the surrogate’s side, especially in traditional arrangements, emotional attachment is a known risk. Carrying a baby that is biologically hers may lead a traditional surrogate to feel a stronger maternal bond, making the relinquishment emotionally painful. 

Intended parents might worry throughout the pregnancy about how the surrogate will cope with giving up the baby, and whether she might not want to let go. While most surrogates enter the process fully intent on helping the intended parents, hormonal and emotional dynamics can be unpredictable, so this remains a source of concern until a successful handover happens. 

Gestational surrogacy greatly reduces this attachment risk (surrogates consistently report that they do not see the baby as “theirs” genetically), which in turn reduces intended parents’ fears on this front. Still, some emotional complexity is always present: surrogates may form a bond with the baby in a nurturing sense and then experience grief or mixed emotions after birth, and intended parents often empathize with that and feel responsible for ensuring the surrogate is emotionally supported too.

Patience and Emotional Endurance

The surrogacy journey requires immense patience and emotional resilience. It is often a long process: finding a match, legal and medical preparations, the pregnancy itself. Intended parents must endure months or even years of waiting. Hope and uncertainty coexist for extended periods. 

A lot of patience is required to go through the process successfully. Intended parents can benefit from seeking support from friends, family, or others who have been through it. So sometimes, online communities can be a great help, more like a “digital village” ready to go through this journey with you.

The waiting and powerlessness to speed things up can be frustrating and emotionally draining. Many intended parents also fear “jinxing” the outcome, so they may keep the pregnancy a secret from their wider social circle, which can feel isolating. 

Meanwhile, they are preparing mentally for parenthood without the usual physical cues of pregnancy. This can lead to a surreal disconnect. Some intended mothers describe feeling like it’s not “real” until the baby is in their arms, since they didn’t experience carrying the child. That in itself can cause anxiety about bonding: Will I bond with the baby instantly? 

Also, there’s the emotional challenge of involving one’s extended family or community. In some cultures or communities, surrogacy might be misunderstood or frowned upon. Intended parents might grapple with whether to be open about it or keep it private to avoid intrusive questions or judgment. Those who do share may need to educate family and friends and deal with insensitive comments, which is another emotional burden.

Post-Birth Emotions

Agencies and intended parents don’t talk about this often or in public, but it’s real!After the baby is born, intended parents often feel enormous joy and relief – but there can be lingering emotional challenges. 

Some intended mothers experience a form of “postpartum” emotional low or delayed grieving for not having carried the pregnancy. They are over the moon to have a child yet may mourn the loss of the experience of pregnancy and birth. 

At the same time, they might worry about the surrogate’s feelings and well-being after parting with the baby, wanting to ensure she feels appreciated and not abandoned. Deciding the level of ongoing contact with the surrogate is an emotional consideration too: many surrogates and intended families remain in touch, but expectations on both sides need to be managed.

All in all, the emotional landscape of surrogacy is complex and requires open communication and support. Intended parents who proactively seek counseling or peer support often cope better with the emotional ups and downs. 

The good news is that with support and understanding, most surrogacy journeys result in positive relationships and emotional fulfillment, but getting to that happy outcome can test one’s emotional fortitude.

Financial Challenges and Costs

High Cost of Surrogacy

Surrogacy can be very expensive, and the financial burden is one of the most common challenges intended parents face. Between medical procedures, agency or clinic fees, legal fees, and surrogate compensation, the costs can reach staggering levels. 

In the United States, where commercial surrogacy is well-established, the typical cost ranges from about $150,000 to $250,000. This is roughly equivalent to the price of a small home in many countries, illustrating how surrogacy can strain or exceed the average family’s finances. 

Intended parents are often required to show proof of funds or place the entire estimated cost in ESCROW up front, to ensure that all expenses can be paid when due. Coming up with this funding can cause huge stress. Unlike buying a home or car, there are limited financing options for surrogacy. Traditional bank loans or insurance typically do not cover the surrogacy. As a result, intended parents may deplete savings, take out second mortgages, borrow from family, or even turn to crowdfunding in order to afford the process. This financial stress adds another layer of anxiety to an already emotional journey: the stakes are incredibly high when you’ve poured your life savings into the hope of having a child.

Global Cost Variations

The cost of surrogacy, however, varies widely by country, which is a major reason international surrogacy has become common. Many intended parents look abroad for more affordable options when domestic surrogacy prices are out of reach. 

For example, countries like Ukraine or Georgia offer surrogacy programs in the range of roughly $50,000 to $85,000. Similarly, programs in parts of Latin America, such as Colombia, are about $50,000–$70,000. 

In summary, “the average cost of surrogacy can be as little as $45,000 in some developing countries, to over $200,000 in the USA. These global cost differences drive “fertility tourism,” but they come with trade-offs. 

Generally, lower-cost countries have cheaper medical fees and lower surrogate compensation. For instance, surrogate carriers in Mexico or Georgia historically received significantly lower compensation than American surrogates, and overall living and clinical costs are lower, hence programs are cheaper. However, the flip side can be that those countries may have less comprehensive support services. 

Intended parents must weigh cost vs. risk. In developed countries, surrogacy process can be very expensive, but it also offers strong legal protections (pre-birth orders, established contract law) and often includes surrogate health insurance in the cost. In contrast, an unregulated environment may save money but at the risk of unforeseen complications not being covered by law (for example, if a surrogate has a medical emergency, who pays? If a baby is born with disabilities and needs prolonged care, are there safety nets?). Thus, budget constraints often force intended parents into tough choices about where and how to pursue surrogacy.

The surrogacy journey is not that simple.It’s essential to understand the associated risks from the outset. Consulting with an independent surrogacy consultant can provide clarity and guidance, ensuring that intended parents are well-informed and prepared. Such consultants can connect clients with experienced legal professionals and reputable agencies, creating a cohesive team dedicated to navigating the surrogacy process seamlessly. This collaborative approach minimizes the risk of oversights and enhances the overall experience for all parties involved.

Unexpected Expenses

Even with a detailed budget, surrogacy is full of unpredictable expenses. Intended parents are advised to plan for contingencies, but surprises still occur. 

• A miscarriage might mean paying some surrogate fees and medical costs without having a baby, and then paying again for a new attempt. 

• If complications arise, such as a high-risk pregnancy requiring extra medical procedures or a longer hospital stay, costs can spike. 

• Twins or multiples can dramatically increase medical and neonatal costs (as well as requiring additional compensation to the surrogate per the contract). 

• International surrogacy adds travel expenses: intended parents may need to fly to the surrogate’s country multiple times (to leave samples for IVF, for the birth involving a prolonged stay to complete legal processes and obtain the baby’s passport). 

• Travel and accommodations for weeks and months can amount to thousands of dollars more. 

• There are also legal costs on both ends: lawyers in the country where the surrogacy process takes place and lawyers to handle paperwork back home, which can mount up. 

Currency exchange rates are another often overlooked factor: paying program fees in a foreign currency can lead to fluctuation in actual costs if exchange rates change over time. For example, if an intended parent’s home currency weakens against the U.S. dollar during a U.S. surrogacy journey, their costs effectively increase. Many intended parents buffer an extra 10-20% of the budget for such volatility and surprises.

Insurance and Liability

Insurance is a significant financial concern. In some jurisdictions, the surrogate’s medical insurance may not cover a surrogate pregnancy (some policies explicitly exclude surrogacy-related care). Intended parents might have to purchase a specialized insurance plan for the surrogate or pay medical bills out-of-pocket. These insurance plans can be costly and still have deductibles and limits.

If no insurance is in place, a single complicated delivery or NICU stay could result in bills of tens of thousands of dollars on top of other surrogacy costs. 

Life insurance for the surrogate (in case, tragically, something happens to her) is often recommended. Intended parents usually pay for this policy to provide for the surrogate’s family in a worst-case scenario. While rare, these possibilities must be planned for financially. All of this means that intended parents need a robust financial plan and often a willingness to spend more than initially expected. Scrimping on critical services or legal protections to save money can backfire badly, leading to greater costs later if things go wrong.

Financial Strain and Ethical Concerns

The enormous sums involved in surrogacy also raise ethical and emotional questions for intended parents. Some struggle with the idea of “paying for a baby” and need to reconcile the transactional aspects with the personal, human nature of the journey. 

It can feel uncomfortable to negotiate fees and payments in a process that is also deeply emotional and altruistic on the surrogate’s part. There’s also the ethical aspect of disparities: intended parents from wealthier nations can afford to hire surrogates in poorer countries for relatively “low” compensation by Western standards. This sometimes leads to guilt or concern about exploiting women in economic need. 

Indeed, international surrogacy has been criticized by some human rights groups as potentially exploitative, saying that the commercial surrogacy industry commodifies women and children for profit. Intended parents might face social criticism along these lines or might themselves worry about the fairness of the arrangement. Reputable agencies can mitigate this by ensuring surrogates are adequately compensated and willingly participate, but the moral scrutiny is something intended parents often have to weather. 

Moreover, the financial commitment can put strain on marriages or partnerships. Disagreements may arise if one partner is more comfortable spending or taking loans than the other, or if repeated failures occur and they must decide how much more to invest. It’s not unheard of for couples to face intense financial stress and even debt due to surrogacy, which can impact their relationship.

The financial challenges of surrogacy encompass not just the high upfront cost, but also the planning for uncertainties and the psychological weight of investing so much capital into an unpredictable outcome. 

Intended parents must be financially and emotionally prepared for the possibility that they could spend a great deal with no guarantee of success. Many manage these challenges by thorough financial planning: creating detailed budgets, setting aside emergency funds, and consulting with financial advisors experienced in fertility matters. But even with the best planning, the financial aspect remains one of the most daunting parts of the surrogacy journey.

Concluding Thoughts

Starting on a surrogacy journey requires navigating a complex game of legal, medical, emotional, and financial challenges. Intended parents must act as project managers of a sort - coordinating lawyers, doctors, agencies, and the surrogate herself, all while coping with profound emotional stakes and significant expenses. 

Each type of surrogacy brings its own nuances: traditional surrogacy may save money but heightens legal/emotional risks; gestational surrogacy offers clearer legal parentage but involves intensive medical procedures; hybrid or international surrogacy can open doors to global resources yet introduces cross-border complications. 

Also, let’s not forget that every country’s stance on surrogacy imposes different hurdles, from strict legal barriers to practical difficulties like finding a surrogate or obtaining citizenship for the newborn.

The common thread across all these scenarios is that surrogacy is a journey - often a long and challenging one, that tests the resilience of intended parents. Those who pursue it learn to expect the unexpected: a sudden legal twist, an unforeseen medical issue, an emotional curveball or an unplanned expense. 

Preparation helps, but flexibility and support are equally essential. 

Despite the many challenges outlined above, surrogacy continues to grow globally as a family-building option. For most intended parents, the arrival of a baby at the end of the journey makes all the hardships worthwhile. By being aware of the potential pitfalls, legal complexities, medical risks, emotional stresses, and financial costs, intended parents can better prepare themselves for the road ahead. In doing so, they increase their chances of navigating the surrogacy process successfully and ethically, ultimately achieving the goal that inspired their journey: the birth of their long-awaited child, and the start of a new family story.

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Frequently Asked Questions

What are the main types of surrogacy and how do they differ in terms of challenges?

There are three main types of surrogacy, each presenting distinct challenges for intended parents. Gestational surrogacy is the most common form today, where the surrogate carries an embryo created from the egg and sperm of the intended parents or donors, meaning the surrogate has no biological relation to the child. This arrangement is generally favored by professionals due to legal safeguards—since the gestational carrier isn't genetically related, it avoids many parentage disputes that can plague other arrangements. Traditional surrogacy involves the surrogate's own egg fertilized by the intended father's (or donor's) sperm, making the surrogate the child's biological mother. Traditional surrogacy is available in some countries but less common because it raises additional legal and emotional complexities, particularly the inherent risk that the surrogate could change her mind since she's legally considered the mother at birth in many jurisdictions. The mere possibility of the surrogate asserting parental rights and keeping the baby is a serious concern for intended parents, even though such cases are rare when proper legal steps are followed. Hybrid surrogacy refers to a multi-country approach where intended parents might perform different phases of the process in different jurisdictions to leverage each country's advantages—for example, creating embryos in one country with an IVF clinic and then working with a surrogate in another country with more favorable surrogacy laws. Hybrid programs allow flexibility but introduce extra layers of complexity in logistics and legal coordination, requiring careful management to ensure embryo transfers happening in one country but births occurring in another don't trigger legal hurdles, immigration concerns, or unclear parental recognition. Each type of surrogacy comes with distinct legal, medical, emotional, and financial challenges that influence the entire journey, with gestational surrogacy representing the preferred option of nearly all professionals today due to clearer legal frameworks and reduced emotional complications.

What are the biggest legal challenges in international surrogacy?

Legal challenges represent some of the most complex obstacles in surrogacy journeys because surrogacy laws vary enormously across the globe, creating a legal maze for intended parents. Some countries have well-established surrogacy statutes while others ban surrogacy outright or lack any clear laws, meaning intended parents often must travel abroad to find surrogacy-friendly countries, especially if their home country prohibits surrogacy. Countries like France, Germany, and Spain outlaw all forms of surrogacy, forcing intended parents to look overseas despite legal and social stigma. In 2024, Italy went further by criminalizing Italian citizens who travel abroad to use surrogacy services, even in countries where it's legal and regulated. By contrast, countries like the United States (in many states), Ukraine, and Georgia have legal frameworks recognizing intended parents as the baby's legal parents at birth, streamlining parentage transfer. Before babies are born, intended parents must ensure their own countries will recognize their parental status when they return home—in some cases requiring additional legal steps like adoption or court orders after birth to secure parental rights in home jurisdictions. Cross-border legal complications are particularly concerning because when surrogates deliver babies in foreign countries, the child's citizenship and parentage documentation must be sorted out so intended parents can bring babies home. For example, a child born through surrogacy in Georgia to UK parents receives a Georgian birth certificate listing both intended parents as legal parents, but under UK law, the surrogate is automatically considered the legal mother regardless of birth certificates issued abroad, requiring intended parents to undergo legal processes in the UK to obtain parental orders officially recognizing them as legal parents. Legal hurdles upon returning home are frequently reported, with intended parents facing bureaucratic delays or court processes requiring lawyers in multiple countries. Another challenge is the dynamic nature of surrogacy laws—several countries have tightened or changed regulations recently, like India banning commercial surrogacy for foreigners in 2015, Thailand shutting down foreign surrogacy, and Argentina's 2024 Supreme Court ruling declaring surrogacy contracts legally invalid. Intended parents mid-process when laws change can be left in very complicated situations, unable to obtain birth certificates or forced to relocate embryo transfers to new countries, making comprehensive legal counsel in all jurisdictions involved absolutely essential.

What medical and health challenges should I expect during surrogacy?

Medical challenges in surrogacy encompass complex procedures, pregnancy risks, and international healthcare variations. The surrogacy journey is built on complex medical processes—in gestational surrogacy, in vitro fertilization (IVF) is typically required to create embryos then transferred to the surrogate's uterus. IVF can be tiring, especially if the intended mother undergoes egg retrieval, and doesn't always succeed on first attempts. Multiple IVF cycles may be needed, adding physical and emotional strain when embryos fail to implant or pregnancies miscarry. Even with healthy surrogates, IVF success rates vary, and each attempt is a roller-coaster of hope and anxiety. Traditional surrogacy often uses intrauterine insemination (IUI) with the surrogate's own egg—simpler and less expensive medically but with lower success rates per cycle. Once pregnancy is achieved, surrogates face all usual health risks of pregnancy and childbirth, and intended parents share worry for her well-being and the baby's. Surrogates are generally medically screened women with proven fertility, but complications can still arise including gestational diabetes, hypertension (pre-eclampsia), hemorrhage, premature labor, or rarely, life-threatening conditions. Regular prenatal monitoring is essential, yet even with excellent care, nature can be unpredictable. Heartbreaking scenarios like miscarriage or stillbirth after months of pregnancy represent deeply painful outcomes requiring emotional recovery and decisions about attempting another cycle. Another medical challenge is multiple pregnancy—transferring more than one embryo in IVF-based surrogacy increases success chances but also raises risk of twins or triplets. Multiple gestations add medical risks (premature birth, C-sections, greater strain on surrogate health) and can lead to difficult decisions about selective reduction to protect overall outcomes. In international surrogacy, medical standards and access to care vary by country—developing countries offering more affordable programs might have different prenatal care approaches or less stringent fertility treatment regulations. Neonatal intensive care represents another concern: if babies are born premature or with health issues in foreign countries, intended parents must arrange and often pay for specialized hospital care until infants are stable, which can be incredibly stressful when far from home and navigating foreign hospital bureaucracies. Medical decision-making authority during pregnancy can also create tensions—while surrogates are patients under medical care with ultimate say about their bodies, intended parents understandably wish input on matters affecting their future children, potentially creating conflicts if serious fetal anomalies are detected or if local laws restrict certain medical options.

What emotional and psychological challenges do intended parents face during surrogacy?

The surrogacy journey is an emotional rollercoaster for intended parents who often approach it with hope tinged with fear after possibly enduring infertility or other obstacles to pregnancy. It's very common for intended parents to experience anxiety, uncertainty, and a sense of reduced control throughout the process. Unlike traditional pregnancy where parents directly experience and manage pregnancy, here they must rely on another person's body and health, creating inherent lack of direct control that causes constant worry: Is the surrogate taking care of herself? What if she has an accident or falls ill? Will we find out immediately if complications arise? Stress peaks at certain milestones—waiting for IVF results, the two-week wait after embryo transfer, prenatal test results, pregnancy screenings, and delivery. Managing this stress requires patience and often support from counselors or support groups. Building a trusting relationship with the surrogate represents another emotional challenge—surrogacy arrangements aren't merely transactional but highly intimate partnerships requiring good communication and mutual understanding. Intended parents must place enormous trust in surrogates to care for unborn children for nine months, which can be emotionally challenging especially if they live far apart or come from different cultures. For intended parents, learning to let go of some control while maintaining supportive communication is a delicate balance, with the period of surrogate pregnancy described as emotionally intense—needing to be supportive for the surrogate's well-being while handling their own hopes and fears. Surrogacy can also evoke complex emotions like jealousy or feelings of inadequacy, particularly for intended mothers. In traditional surrogacy, intended mothers sometimes struggle with jealousy knowing surrogates are biological mothers of children—feelings that can sour relationships if not addressed. Even in gestational surrogacy, intended mothers might feel envy or sadness that another woman carries their child when they couldn't. On the surrogate's side, especially in traditional arrangements, emotional attachment is a known risk—carrying babies that are biologically theirs may lead traditional surrogates to feel stronger maternal bonds, making relinquishment emotionally painful. Intended parents might worry throughout pregnancy about how surrogates will cope with giving up babies and whether they might not want to let go. The surrogacy journey requires immense patience and emotional resilience as a long process spanning months or even years. After babies are born, intended parents often feel enormous joy and relief but there can be lingering emotional challenges—some intended mothers experience forms of "postpartum" emotional lows or delayed grieving for not having carried pregnancies, simultaneously worrying about surrogates' feelings and well-being after parting with babies.

What are the financial challenges and costs associated with surrogacy?

Surrogacy can be very expensive, with the financial burden representing one of the most common challenges intended parents face. In the United States where commercial surrogacy is well-established, typical costs range from about $150,000 to $250,000—roughly equivalent to the price of a small home in many countries, illustrating how surrogacy can strain or exceed average family finances. Between medical procedures, agency or clinic fees, legal fees, and surrogate compensation, costs can reach staggering levels. Intended parents are often required to show proof of funds or place entire estimated costs in escrow upfront to ensure all expenses can be paid when due. Coming up with this funding causes huge stress since unlike buying homes or cars, there are limited financing options for surrogacy—traditional bank loans or insurance typically don't cover surrogacy. Intended parents may deplete savings, take out second mortgages, borrow from family, or turn to crowdfunding to afford the process. The cost of surrogacy varies widely by country, which is why international surrogacy has become common—many intended parents look abroad for more affordable options when domestic prices are out of reach. Countries like Ukraine or Georgia offer programs in the range of roughly $50,000-$85,000, while programs in parts of Latin America like Colombia cost about $50,000-$70,000. The average cost of surrogacy can be as little as $45,000 in some developing countries to over $200,000 in the USA, with these global cost differences driving "fertility tourism," though they come with trade-offs. Lower-cost countries have cheaper medical fees and lower surrogate compensation, but may offer less comprehensive support services. Even with detailed budgets, surrogacy is full of unpredictable expenses—miscarriages might mean paying surrogate fees and medical costs without having babies then paying again for new attempts; complications like high-risk pregnancies requiring extra procedures or longer hospital stays can spike costs; twins or multiples dramatically increase medical and neonatal costs; international surrogacy adds travel expenses for multiple trips; legal costs mount up on both ends; and currency exchange rate fluctuations can lead to actual cost changes over time. Insurance represents a significant financial concern—in some jurisdictions, surrogates' medical insurance may not cover surrogate pregnancies, requiring intended parents to purchase specialized insurance plans or pay medical bills out-of-pocket. If no insurance is in place, a single complicated delivery or NICU stay could result in bills of tens of thousands of dollars on top of other surrogacy costs. Many intended parents buffer an extra 10-20% of budget for volatility and surprises, but the financial commitment can put strain on marriages or partnerships, with disagreements arising about spending comfort levels or how much more to invest after repeated failures.

How do hybrid surrogacy programs work and what unique challenges do they present?

Hybrid surrogacy refers to multi-country approaches to family building where intended parents perform different phases of the process in different jurisdictions to leverage each country's advantages. For example, a couple might create embryos in one country with an IVF clinic and egg donor, then work with a surrogate in another country with more favorable surrogacy laws and lower costs. This strategic approach allows flexibility and can optimize both cost and legal protections—intended parents might create embryos in Albania or Czech Republic with access to European egg donors at competitive prices, then ship embryos to surrogacy destinations like Colombia, Mexico, or the United States for the actual surrogacy. However, hybrid programs introduce extra layers of complexity requiring careful management. Those pursuing hybrid surrogacy must contend with multiple legal systems—each border crossing adds complexity as moving embryos and gametes between jurisdictions requires careful planning to avoid violating any country's laws. The scenario where embryo transfer happens in one country but birth occurs in another can be very complicated legally. If an embryo transfer takes place in one jurisdiction but the birth happens elsewhere, this can trigger additional legal hurdles, immigration concerns, and unclear parental recognition, particularly if births end up taking place where surrogacy is restricted or illegal. For example, a program involving embryo transfer in North Cyprus with delivery in Georgia might sound convenient on the surface, but Georgian law doesn't allow surrogates to be listed on birth certificates—births must list only intended parents. If agencies promise surrogates can be listed on birth certificates, this would violate Georgian laws, suggesting agencies might try something unofficial that could jeopardize babies' exit documents. Intended parents must obtain comprehensive legal counsel in all jurisdictions involved to ensure parental rights will be recognized and they can safely bring newborns home. Hybrid programs require coordination of multiple service providers across different countries, each with their own regulations about embryo import/export, fertility treatments, and surrogacy arrangements. Documentation requirements multiply—proper permits, medical clearances, and legal authorizations must be obtained in each jurisdiction. The logistics of shipping embryos internationally require specialized medical courier services maintaining cryogenic temperatures throughout transport, adding costs and complexity. Despite these challenges, hybrid surrogacy has become increasingly popular because it allows intended parents to optimize their journeys by selecting the best locations for different phases—creating embryos where it's most cost-effective or where desired donor characteristics are available, then completing surrogacy where legal protections are strongest and costs are manageable.

What happens if laws change in my surrogacy destination during my journey?

The dynamic nature of surrogacy laws represents one of the most frightening challenges for intended parents because several countries have tightened or changed surrogacy regulations in recent years, sometimes mid-process for families already committed. India, once a major hub for international surrogacy, banned commercial surrogacy for foreigners in 2015 and later outlawed most commercial arrangements entirely. Thailand similarly shut down foreign surrogacy after high-profile incidents, while countries like Cambodia and Nepal went from permissive to prohibitive virtually overnight. Argentina, once a growing hub for international intended parents, experienced significant legal shifts—in 2024, the Argentine Supreme Court issued a landmark judgment declaring surrogacy contracts legally invalid, reaffirming that under Civil Code, women who give birth are legal mothers regardless of any prior agreements. Intended parents mid-process when laws change can be left in very complicated situations—unable to obtain birth certificates for babies, forced to relocate embryo transfers to new countries, or stuck in legal limbo without clear pathways to establish parental rights. The unenforceability of contracts in certain jurisdictions is another issue: in places with no surrogacy law or bans, agreements between intended parents and surrogates may not be legally binding at all, meaning if disputes arise over compensation or if either party has changes of heart, there may be little legal recourse. To protect against these risks, intended parents should work only in countries with established, stable surrogacy frameworks and enforceable surrogacy contracts. Choose destinations with long track records of supporting international surrogacy rather than newly opened markets where regulations might be unstable. Work with experienced legal counsel who monitors proposed legislative changes in your surrogacy destination and can provide early warnings if risks are emerging. Have contingency plans including identifying alternative destinations if your primary location becomes untenable mid-journey. Consider purchasing insurance or working with agencies offering guarantees that include relocation assistance if legal changes force program moves. Stay informed about political and social attitudes toward surrogacy in your destination—if there's growing public controversy or government scrutiny, these can be warning signs that restrictions may be coming. Document everything meticulously so if you must relocate or navigate unexpected legal processes, you have comprehensive records. The reality is that surrogacy operates in a global patchwork of constantly evolving laws, making flexibility and expert guidance essential for navigating potential regulatory changes successfully.

How can I prepare emotionally for the challenges of surrogacy?

Preparing emotionally for surrogacy requires acknowledging that it will be an emotional rollercoaster requiring immense patience and emotional resilience, with hope and uncertainty coexisting for extended periods. Start by seeking support from the beginning rather than waiting until you're struggling—this includes working with therapists or counselors experienced in fertility and surrogacy issues who can help you process complex emotions like anxiety, jealousy, grief over not carrying your own pregnancy, and fear of things going wrong. Many intended parents benefit from joining support groups of other intended parents who understand the unique emotional challenges of surrogacy, providing both practical advice and emotional solidarity. Online communities can be particularly helpful, functioning as a "digital village" ready to go through the journey with you. Proactively address communication and relationship building with your surrogate—establish clear expectations early about how often you'll communicate, what milestones you want to be involved in, and what boundaries feel comfortable for both parties. Good communication with surrogates built on trust and mutual respect dramatically reduces anxiety and helps you feel more connected to the pregnancy process despite physical distance. Learn to let go of some control while maintaining supportive communication—this delicate balance is one of the hardest emotional aspects of surrogacy since you must rely on another person's body and health decisions, but finding peace with this uncertainty is essential for your mental health. Manage expectations realistically by understanding that setbacks like failed embryo transfers, miscarriages, or delays are common and not the end of your journey—planning emotionally (not just financially) for the possibility of multiple attempts helps cushion the blow if first attempts don't succeed. Prepare for complex emotions that may surprise you, like jealousy toward your surrogate or feelings of inadequacy, and know these are normal reactions that don't make you a bad person—acknowledging these feelings openly with therapists or support groups prevents them from festering into guilt or relationship damage. Consider how you'll handle the waiting periods—the months of surrogate pregnancy when you're preparing mentally for parenthood without usual physical cues of pregnancy can feel surreal, so finding ways to feel involved (attending ultrasound appointments when possible, preparing nurseries, connecting with surrogate regularly) helps make it feel "real." Prepare for potential post-birth emotions including possible "postpartum" emotional lows or delayed grieving for not having carried the pregnancy even while feeling joy about your baby—knowing these mixed emotions are normal helps you navigate them without guilt. Most importantly, be kind to yourself throughout the process and recognize that emotional ups and downs are inevitable and valid.

What should I know about unexpected expenses and financial contingencies?

Even with detailed budgets, surrogacy is full of unpredictable expenses that can significantly increase costs beyond initial quotes, making contingency planning absolutely essential. Intended parents are strongly advised to buffer an extra 10-20% of their budget for volatility and surprises, though even this may not cover all possibilities. Common unexpected expenses include failed attempts requiring repeat procedures—if miscarriage occurs, you might pay surrogate fees and medical costs without having a baby, then pay again for new attempts including additional IVF cycles, embryo transfers, and potentially new surrogate matching fees if original surrogates cannot continue. Medical complications during pregnancy can dramatically spike costs—high-risk pregnancies requiring extra procedures, medications, or monitoring; extended hospital stays; emergency C-sections; or premature births requiring weeks or months of neonatal intensive care can add tens of thousands of dollars beyond base program costs. Multiple pregnancy outcomes (twins or triplets) from transferring multiple embryos dramatically increase both medical costs and surrogate compensation per contractual terms for carrying multiples. International surrogacy adds substantial travel expenses beyond initial expectations—you may need to fly to surrogate's country multiple times (for sperm deposits/egg retrievals, potentially during pregnancy for important milestones, and definitely for birth), with each trip including airfare, accommodations, meals, and local transportation. Post-birth stays can extend weeks or even months while completing legal processes, obtaining birth certificates, and securing baby's passport from your embassy, with accommodation and living expenses mounting daily. Legal costs often exceed estimates because you need lawyers in multiple jurisdictions—the country where surrogacy takes place AND your home country to handle parentage recognition, plus potential additional legal fees if complications arise requiring court proceedings or dispute resolution. Currency exchange rate fluctuations represent often overlooked factors—if your home currency weakens against the currency you're paying program fees in during your multi-month or multi-year journey, your costs effectively increase through no fault of your own. Insurance gaps can create massive expenses—if surrogate's medical insurance doesn't cover surrogate pregnancies (some policies explicitly exclude this) and you haven't purchased specialized insurance, you may pay all medical bills out-of-pocket, with a single complicated delivery potentially costing $20,000-$50,000+ depending on location. If babies are born with health issues or disabilities requiring ongoing medical care, intended parents are ethically and often legally obligated to provide this care regardless of cost, which can be financially devastating if unexpected. To manage these risks, work only with agencies providing detailed, itemized cost breakdowns that clearly specify what's included and what's not; maintain robust contingency funds of at least 20% beyond quoted prices; verify what insurance coverage exists and purchase supplemental coverage if needed; ask explicitly about policies for scenarios like failed transfers, surrogate changes, medical complications, and multiple pregnancies; and consider guarantee programs offered by some agencies that include multiple attempts and medical contingencies for higher upfront costs but greater financial predictability.

Despite all these challenges, why do intended parents say surrogacy is worth it?

Despite the complex legal maze, medical uncertainties, emotional rollercoaster, and staggering financial costs, surrogacy continues to grow globally as a family-building option because for most intended parents, the arrival of a baby at the end of the journey makes all hardships worthwhile. Intended parents consistently report that holding their long-awaited child erases the memory of challenges endured along the way—the months or years of waiting, anxiety, financial stress, and bureaucratic hurdles fade in significance compared to the joy of finally becoming parents. For many intended parents, surrogacy represents their only viable path to biological children after exhausting other options like IVF, adoption attempts, or facing medical conditions making pregnancy impossible or dangerous. The knowledge that surrogacy is their best or only hope motivates them to navigate whatever challenges arise with determination and resilience. The surrogacy journey, while challenging, often results in beautiful relationships—many intended parents describe their surrogates as angels or heroes, people who restored their faith in humanity through incredible acts of generosity. These connections, built through the intimate experience of creating life together, often continue long after babies are born, enriching families with extended relationships. The preparation and navigation of challenges actually strengthens intended parents as individuals and couples—learning to advocate for themselves, manage complex logistics, handle emotional uncertainty, and work as teams through adversity prepares them well for the challenges of parenthood itself. Many intended parents report that the difficult journey makes them appreciate parenthood even more deeply than if children had come easily, with every doctor's appointment, pregnancy milestone, and legal step feeling like precious victories. The global surrogacy community provides invaluable support—connecting with others who understand the unique challenges creates bonds and provides both practical advice and emotional solidarity that helps families persist through difficulties. Advances in medical technology, legal frameworks, and international cooperation continue to make surrogacy safer, more accessible, and more successful—success rates keep improving, legal protections strengthen in many jurisdictions, and professional standards evolve to better serve intended parents and surrogates. Ultimately, surrogacy works because it brings together people with complementary needs and capabilities—intended parents who desperately want children but cannot carry pregnancies, and surrogates who can and want to help, all supported by medical professionals, lawyers, and agencies dedicated to facilitating safe, ethical, successful journeys. By being aware of potential pitfalls through comprehensive education, surrounding themselves with experienced professionals, preparing financially and emotionally for realistic scenarios, and maintaining flexibility and patience, intended parents increase their chances of navigating the surrogacy process successfully and ethically, ultimately achieving the goal that inspired their journey: the birth of their long-awaited child and the start of their new family story.