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Committee Opinion No. 660 Summary

Family Building Through Gestational Surrogacy

doi: 10.1097/AOG.0000000000001350
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ABSTRACT: Gestational surrogacy is an increasingly common form of family building that can allow individuals or a couple to become parents despite circumstances in which carrying a pregnancy is biologically impossible or medically contraindicated. The practice of gestational surrogacy involves a woman known as a gestational carrier who agrees to bear a genetically unrelated child with the help of assisted reproductive technologies for an individual or couple who intend(s) to be the legal and rearing parent(s), referred to as the intended parent(s). Obstetrician–gynecologists may become involved in gestational surrogacy through caring for the gestational carrier or by caring for the intended parent(s). Although gestational surrogacy increases options for family building, this treatment also involves ethical, medical, psychosocial, and legal complexities that must be taken into account to minimize risks of adverse outcomes for the gestational carrier, intended parent(s), and resulting children. The purpose of this document is to provide an overview of gestational surrogacy and to describe the ethical responsibilities for obstetrician–gynecologists who take part in the care of women who participate in these arrangements.

For a comprehensive overview of these recommendations, the fulltext version of this Committee Opinion is available at

Committee on Ethics:This Committee Opinion was developed by the American College of Obstetricians and Gynecologists’ Committee on Ethics. Member contributors included Ginny L. Ryan, MD. While this document reflects the current viewpoint of the College, it is not intended to dictate an exclusive course of action in all cases. This Committee Opinion was approved by the Committee on Ethics and the Executive Board of the American College of Obstetricians and Gynecologists.

Copyright March 2016 by the American College of Obstetricians and Gynecologists. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, posted on the Internet, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without prior written permission from the publisher.

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The American College of Obstetricians and Gynecologists 409 12th Street, SW, PO Box 96920, Washington, DC 20090-6920

Official Citation: Family building through gestational surrogacy. Committee Opinion No. 660. American College of Obstetricians and Gynecologists. Obstet Gynecol 2016;127:e97–103.

Received January 20, 2016

Accepted January 20, 2016

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On the basis of the considerations and principles outlined in this Committee Opinion, the American College of Obstetricians and Gynecologists (the College) makes the following recommendations:

  • Because of the ethical, legal, and psychosocial complexities and potential medical risks to the gestational carrier, it is recommended that the use of gestational surrogacy be restricted to situations in which carrying a pregnancy is biologically impossible or medically contraindicated for the intended parent(s).
  • Because the legal status of gestational surrogacy varies from state to state, obstetrician–gynecologists who assist in gestational surrogacy arrangements should encourage their patients, whether they are the gestational carriers or intended parents, to seek guidance from appropriately qualified legal counsel (ie, experienced in third-party reproduction arrangements and licensed to practice in the relevant state or states). To avoid potential conflicts of interest, it is recommended that the gestational carrier and intended parent(s) are represented by separate and independent legal counsel.
  • Obstetrician–gynecologists should remain informed regarding the medical, ethical, and psychosocial complexities of gestational surrogacy because they may play one of several roles in gestational surrogacy arrangements, including counseling potential gestational carriers, caring for pregnant gestational carriers, and advising and referring infertile patients considering this treatment. Obstetrician– gynecologists participating in these arrangements may benefit from consultation with appropriately qualified legal counsel and colleagues with experience in reproductive endocrinology and infertility
  • Pertinent medical risks, benefits, and alternatives should be discussed by the physicians treating the gestational carrier and intended parent(s), and these physicians should be separate and independent, whenever possible, to optimize patient advocacy and avoid conflicts of interest.
  • Separate and independent mental health counseling should be strongly encouraged for all parties involved. Mental health counselors can assist the intended parent(s) in anticipating issues surrounding disclosure of the pregnancy and the child’s genetic lineage. For gestational carriers, mental health counselors can assist in anticipating issues surrounding questions and concerns from family and community as well as potential attachment issues for the gestational carrier during pregnancy and after delivery.
  • In an attempt to decrease potential conflict during pregnancy, obstetrician–gynecologists who counsel women who are considering gestational surrogacy should encourage them to discuss with the intended parent(s) as many foreseeable decision-making scenarios in pregnancy as possible, and the plans for addressing these situations should be formally documented in the gestational surrogacy contract.
  • Cross-border reproductive care refers to the rapidly growing practice of individuals seeking assisted reproductive technology treatment outside of their country of domicile. This practice includes Americans seeking gestational carrier arrangements abroad and foreign nationals seeking gestational carrier arrangements in the United States. Obstetrician– gynecologists should be aware of the existence of these types of gestational surrogacy arrangements, and those who counsel and care for these patients should encourage patients to seek legal advice from appropriately qualified legal counsel experienced in cross-border gestational carrier arrangements.
  • Obstetrician–gynecologists are not obligated to participate in nonemergent medical care related to either domestic or cross-border gestational surrogacy arrangements. However, physicians who choose to care for gestational carriers should provide the same level of medical care as they would to any patient, regardless of the complexities of gestational surrogacy and their personal beliefs regarding a particular parenting arrangement.
© 2016 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.