Navigating Surrogacy Relationships: How Mental Health Professionals Support Intended Parents and Carriers
Surrogacy can be a life-changing path to parenthood, offering hope and opportunity when carrying a pregnancy isn’t possible. But beyond the medical and legal aspects, surrogacy involves a deeply human element: the relationship between intended parents and their gestational carrier.
Establishing and maintaining a healthy connection is essential to ensure the process is ethical, supported, and emotionally sustainable.
Reproductive mental health professionals play a vital role in guiding intended parents and surrogates through this journey, helping both sides navigate expectations, boundaries, and emotions. This article explores what we know about these relationships and how mental health professionals support positive outcomes.
Understanding the Gestational Carrier Relationship
There are many reasons someone might choose to use a gestational carrier. Failed fertility treatments, medical conditions that prevent pregnancy, or the family-building journey of same-sex couples all shape how individuals or couples approach surrogacy.
Because the gestational carrier is carrying a much-wanted child, the relationship can feel intensely personal and, at times, overwhelming. For some intended parents, opening themselves to closeness with a gestational carrier may feel difficult, especially after infertility or loss. For others, like same-sex couples pursuing genetic parenthood, the relationship may be met with joy and gratitude.
What’s important to recognize is that surrogacy doesn’t just involve embryos and contracts. It involves real people (intended parents, surrogates, and often their families) interacting through a uniquely intimate process. These social dynamics are critical to consider from the very beginning.
Who Becomes a Surrogate?
Research has shed light on the motivations of women who choose to become surrogates:
Love of pregnancy. Many surrogates express deep contentment and fulfillment during pregnancy (Blyth, 1994; Ciccarelli & Beckman, 2005; Jadva et al., 2003).
Sense of achievement. Some surrogates report that surrogacy increases their self-worth and provides a sense of purpose (Blyth, 1993; van den Akker, 2003).
Attachment to intended parents. Contrary to the concern that surrogates may become too attached to the baby, research shows surrogates more often form strong bonds with the intended parents themselves (Berend, 2012).
This closeness can also create vulnerability. For example, a surrogate may hope for a close relationship that doesn’t develop as she imagined, or she may feel a loss of connection once the pregnancy ends and the baby is placed with the intended parents.
Intended Parents and Their Surrogates: What We Know
The relationship is not one-sided. Intended parents also play a powerful role in shaping the surrogate’s experience.
Contact and involvement – Surrogates benefit when intended parents are engaged in the pregnancy and attentive to their wellbeing (Yee et al., 2024).
Shared joy at birth – Surrogates’ sense of reward and emotional wellbeing often increase when they see the happiness they’ve helped create (Shaw et al., 2024).
Positive outcomes for male same-sex couples – Research shows that male same-sex fathers often maintain strong, lasting relationships with surrogates, who may even help facilitate bonding with the newborn (Yee & Librach, 2019).
Long-term relationships – Even when frequency of contact decreases, quality of relationships often remains high, lasting up to a decade or more (Jadva et al., 2012; Soderstrom-Antilla et al., 2016).
These findings reinforce that surrogacy can foster enduring, positive relationships when approached thoughtfully.
How to Foster Positive Outcomes
A key to success is engaging a reproductive mental health professional throughout the process. Their expertise ensures that the emotional, psychological, and interpersonal aspects of surrogacy are supported.
Psychological Evaluations
Assess whether a gestational carrier is psychologically appropriate for surrogacy.
Identify areas where the gestational carrier may need support before, during, and after pregnancy.
Highlight potential interpersonal issues that may influence matching.
(ASRM, 2021)
Counseling and Joint Sessions
Psychoeducational counseling for intended parents is strongly recommended (ASRM, 2022).
Joint sessions with all parties allow for open discussion of expectations, boundaries, and communication styles.
These sessions promote transparency, reducing the risk of mismatched expectations.
Reflecting on Relationship Needs
Before matching with a gestational carrier, intended parents should consider:
Proximity: Is it important to live close for visits or the birth?
Communication: What frequency and method of contact feels right?
Post-birth expectations: Will the relationship continue, and in what form?
There are no universal “right” answers. What matters most is alignment between intended parents and their gestational carrier, supported by clear communication and professional guidance.
The Role of Reproductive Mental Health Professionals
Reproductive mental health professionals are more than evaluators. They are educators, mediators, and supporters throughout surrogacy. They help:
Clarify expectations and foster open communication.
Prepare all parties for the emotional complexities of surrogacy.
Promote ethical practices to safeguard everyone involved.
By guiding both intended parents and surrogates, these professionals help ensure the surrogacy journey is not only medically successful but also emotionally healthy.
Finding a Qualified Professional
For individuals or couples beginning a surrogacy journey, seeking a qualified reproductive mental health provider is essential. Helpful resources include:
Conclusion
Surrogacy is more than a medical or legal arrangement. It’s a deeply human journey that thrives on trust, respect, and communication. Healthy relationships between intended parents and surrogates not only ease the process but can create bonds that last well beyond the birth.
Reproductive mental health professionals provide the expertise needed to navigate this complex relational landscape, ensuring that everyone involved feels supported, respected, and prepared. Their role is indispensable in making third-party reproduction an experience rooted in both science and compassion.
Your Next Step: Build Your Expertise in Fertility Mental Health
At the Seleni Institute, we offer specialized fertility coursework designed for mental health professionals who want to expand their practice and better support clients utilizing and navigating third-party reproduction.
Our evidence-based CE courses will help you:
Understand the psychosocial dimensions of fertility care.
Gain confidence in conducting evaluations and consultations.
Apply ASRM guidelines in clinical practice.
Support clients with empathy, clarity, and competence through one of the most complex experiences of their lives.
Explore our coursework and join the growing community of mental health professionals advancing reproductive care.
