Gestational carrier (GC) care is a long-established, medically indicated specialized modality of assisted reproductive technology (ART). It is governed by state law, subject to FDA requirements, and guided by evidence-based clinical and ethical standards developed by the American Society for Reproductive Medicine (ASRM) and the Society for Assisted Reproductive Technology (SART). GC care is not experimental, unregulated, or elective for the patients who rely on it.
A GC is an individual who carries a pregnancy created through in vitro fertilization (IVF) using an embryo with which the carrier has no genetic relationship. This model differs from traditional surrogacy, which is rare in modern clinical practice and presents distinct ethical and legal issues. Contemporary medical and statutory frameworks overwhelmingly address gestational carrier arrangements.
Consistent with ASRM Practice Committee guidance, gestational carrier care is appropriate when a documented medical or psychological condition makes pregnancy impossible or poses a serious risk to the intended parent or fetus. Examples include:
Myth: GC care is largely unregulated or a “wild west.”
Fact: GC care operates within state legal frameworks, FDA oversight, and long-standing ASRM and SART clinical and ethical guidance.
Myth: GC arrangements are common and rapidly expanding.
Fact: GC care represents a very small faction of pregnancies and ART cycles and has increased gradually, not explosively.
Myth: Systemic issues and anomalies justify restricting access to GC care.
Fact: Patients and providers are also harmed by bad actors. Targeted oversight that addresses misconduct —rather than restricting medically indicated care—is more effective and protective.
Despite increased media attention, GC care remains rare:
ASRM Practice and Ethics Committee opinions establish clear safeguards, including:
Risks arise when laws are silent, fragmented, or misaligned with medical evidence. Overbroad ideologically driven restrictions can limit access to medically indicated care, undermine informed consent and bodily autonomy, increase legal and medical uncertainty for patients and providers, and exacerbate health risks by interfering with clinical judgement.
Jurisdictions with clear, regulated GC frameworks demonstrate:
Gestational carrier care is rare, regulated, and medically necessary for a defined group of patients. ASRM supports evidence-based oversight that closes gaps exploited by bad actors while preserving patient access, provider judgement, and ethical medical practice.
What is a Gestational Carrier?
A GC is an individual who carries a pregnancy created through in vitro fertilization (IVF) using an embryo with which the carrier has no genetic relationship. This model differs from traditional surrogacy, which is rare in modern clinical practice and presents distinct ethical and legal issues. Contemporary medical and statutory frameworks overwhelmingly address gestational carrier arrangements.
Who Needs Gestational Carrier Care?
Consistent with ASRM Practice Committee guidance, gestational carrier care is appropriate when a documented medical or psychological condition makes pregnancy impossible or poses a serious risk to the intended parent or fetus. Examples include:- Cardiovascular conditions e.g., severe pulmonary hypertension; advanced cardiomyopathy or heart failure.
- Autoimmune & inflammatory disorders e.g., systemic lupus erythematosus with renal or cardiac involvement; antiphospholipid antibody syndrome with prior thrombosis.
- Renal disease e.g., advanced chronic kidney disease – stage IV-V; kidney transplant with impaired graft function.
- Metabolic and endocrine disorders e.g., poorly controlled diabetes with end-organ damage (e.g., nephropathy, retinopathy).
- Pulmonary disease e.g., severe cystic fibrosis; advanced interstitial lung disease or severe COPD.
- Hematologic conditions e.g., sickle cell disease with recurrent crisis or organ damage; severe inherited or acquired thrombophilia with prior thromboembolism.
- Oncological considerations e.g., active cancer requiring chemotherapy, radiation, or targeted therapy; recent cancer with high-risk recurrence
- where pregnancy is contraindicated.
- Uterine/obstetric factors posing serious maternal risk e.g., absence of a uterus (congenital or surgical); prior life-threatening complications (e.g., uterine rupture).
Gestational Carrier Myths vs. Facts
Myth: GC care is largely unregulated or a “wild west.”Fact: GC care operates within state legal frameworks, FDA oversight, and long-standing ASRM and SART clinical and ethical guidance.
Myth: GC arrangements are common and rapidly expanding.
Fact: GC care represents a very small faction of pregnancies and ART cycles and has increased gradually, not explosively.
Myth: Systemic issues and anomalies justify restricting access to GC care.
Fact: Patients and providers are also harmed by bad actors. Targeted oversight that addresses misconduct —rather than restricting medically indicated care—is more effective and protective.
How Common is Gestational Carrier Care?
Despite increased media attention, GC care remains rare:- Approximately 13.7 per 100,000 US deliveries (2017-2020)
- Roughly 1-2% of all ART cycles nationwide
- Growth has been gradual from a historically low baseline
Clinical and Ethical Safeguards
ASRM Practice and Ethics Committee opinions establish clear safeguards, including:- Comprehensive medical and psychological screening
- Robust informed consent requirements
- Independent legal counsel for GCs
- Recognition of the carrier’s bodily autonomy and medical decision-making authority throughout pregnancy
- Strong preference for single-embryo transfer (SET) to reduce obstetric risk
Where Policy Gaps Exist and What Works: Evidence-Based Policy
Risks arise when laws are silent, fragmented, or misaligned with medical evidence. Overbroad ideologically driven restrictions can limit access to medically indicated care, undermine informed consent and bodily autonomy, increase legal and medical uncertainty for patients and providers, and exacerbate health risks by interfering with clinical judgement.Jurisdictions with clear, regulated GC frameworks demonstrate:
- Stronger protections for GCs and providers who work with them
- Predictable parentage outcomes for children
- Reduced risk of exploitation and abuse
- Increased transparency and accountability
Conclusion
Gestational carrier care is rare, regulated, and medically necessary for a defined group of patients. ASRM supports evidence-based oversight that closes gaps exploited by bad actors while preserving patient access, provider judgement, and ethical medical practice.
Learn More:
- American Society for Reproductive Medicine (ASRM) Center for Policy & Leadership (CPL) Report. Gestational Carrier Policy in the United States: Regulatory Overview and Key Considerations for Policy Development, 2026.
- American Society for Reproductive Medicine (ASRM) Ethics Committee. Consideration of the Gestational Carrier: an Ethics Committee Opinion. Fertil Steril. 2023;120(6):e63–e71.
- American Society for Reproductive Medicine (ASRM) Ethics Committee. Family Members as Gamete Donors or Gestational Carriers. Fertil Steril. 2024;121:946–53
- American Society for Reproductive Medicine (ASRM) Practice Committee. Recommendations for Practices Using Gestational Carriers: a Committee Opinion. FertilSteril. 2022;118(1):65–74.
- American Society for Reproductive Medicine (ASRM) Legal Professional Group. Surrogacy Laws by State. 2024.
Resources For You
The American Society for Reproductive Medicine (ASRM) is committed to providing patients with the highest quality information about reproductive care.
Advocacy Resources
ASRM has prepared resources to help you explain and advocate for reproductive rights and the continuation of in vitro fertilization and other fertility treatments.
Frequently Asked Questions
ASRM's Frequently Asked Questions (FAQ) provides answers to common questions about reproductive health.
Patient Journeys
ASRM has resources and publications to help you through each stage of your journey.
State and Territory Infertility Insurance Laws
One way that ASRM works to improve access to fertility care is by advocating for insurance coverage for reproductive medicine care. All patients should have access to the care they need.
Fact Sheets and Infographics
ASRM produces a series of fact sheets and booklets on various topics related to infertility, reproductive health, and family planning. The fact sheets and booklets are available in English, Spanish, and Chinese.
Reproductive Rights and You
The Dobbs decision has sparked a litany of changes in state laws across the nation, and more are expected. We need your help!
Reproductive Topics
Find all the resources on a specific topic compiled onto a single page.
SART Fertility Experts Podcast
An educational project of ASRM's affiliated society, the Society for Assisted Reproductive Technology (SART), this series is designed to provide up to date information about a variety of topics related to fertility testing and treatment such as IVF.
Patient Education Videos
ASRM and its affiliated society SART have made several videos to explain the sometimes difficult topics related to reproductive medicine.
Terms and Definitions
Find explanations for the meaning behind the doctor-speak you hear when trying to research reproductive medicine topics. ASRM has defined the most popular terms in easy to understand language.
Patient Stories
Read real-life stories from patients who have faced reproductive medicine challenges and come out stronger on the other side.
Fertility in the News
ASRM Press Releases and Bulletins are published by ASRM's Office of Public Affairs to inform the world about important happenings in reproductive medicine and at ASRM.
More Reproductive RIghts Resources
Find a Health Professional
Connect with reproductive medicine experts who will guide you through your unique journey. Our search tool allows personalized matches based on location, specialization, and expertise. Take control of your reproductive health with compassionate providers, innovative treatments, and unwavering support.
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Gestational Carrier or Surrogacy
Just the Facts: Gestational Carrier Care in the United States
Gestational carrier (GC) care is a long-established, medically indicated specialized modality of assisted reproductive technology (ART). View the Advocacy Resource
SART Fertility Experts - The Legal Side of IVF: What Patients and Providers Should Know
Explore IVF legal issues including surrogacy, egg donation contracts, and parentage laws. Attorney Amani Hanson explains guidance for intended parents. Listen to the Episode
ASRM Center for Policy and Leadership Releases Policy Report on Gestational Carrier Pregnancies
ASRM Center for Policy and Leadership released a report discussing gestational carrier policy in the U.S. discussing it's impact and how lawmakers should proceed going forward. View the Press Release
Gestational Carrier Policy in the United States
Third-party reproduction using a gestational carrier (GC) is a family-buildingoption carried out in accordance with existing legal frameworks. View the Advocacy Resource
Lis Regula's Story
My name is Lis (pronounced like “Lease”) and this is the fertility story of a trans man and two time surrogate. Read the story
SART Fertility Experts - Gestational Carrier and Intended Parents
Some fertility patients are unable to carry a pregnancy to term.
Listen to the Episode
What do I need to know about Turner syndrome and having children?
Turner syndrome (TS) is an infrequent genetic disorder in females. View the fact sheet
SART Fertility Experts - Gestational Carriers
What’s the difference between a surrogate and a gestational carrier? Listen to the Episode
What Is A Gestational Carrier & Who Needs One?
This SART micro-video will explain the aspects of using a gestational carrier including selection, screening, and indications. Watch Video
Gestational Carrier or Surrogacy Infographics
ASRM has prepared infographics to illustrate the subject of Gestational Carriers or Surrogacy better. View the infographicsIn Vitro Fertilization (IVF)
Just the Facts: Gestational Carrier Care in the United States
Gestational carrier (GC) care is a long-established, medically indicated specialized modality of assisted reproductive technology (ART). View the Advocacy Resource
ASRM President-Elect Dr. Amy Sparks Receives Michigan State University Outstanding Alumni Award
ASRM has proudly announced President-Elect Dr. Amy Sparks, Ph.D., as the winner of the 2026 Outstanding Alumni Award from the Michigan State University College of Agriculture and Natural Resources (CANR). View the Press Release
SART Fertility Experts: Complimentary and Integrative Medicine in Reproductive Care and Infertility Treatment
Explore how acupuncture and naturopathic care support IVF, endometriosis, and fertility in this ASRM expert talk on integrative reproductive medicine. Listen to the Episode
A Social Media Campaign Fighting IVF Disinformation and Sharing Gratitude
ASRM's Office of Public Affairs is running an Instagram campaign highlighting positive IVF stories featuring patients and providers. View the Press Release
American Society for Reproductive Medicine Responds to TrumpRx Announcement, Says IVF Access Requires More Than Lower Drug Prices
ASRM has responded to the latest announcement about TrumpRx and its impact on IVF treatments. View the Press Release
SART Fertility Experts: Can IVF make people happy?
SART Fertility Experts podcast: Dr. Mark Trolice, Dr. Sousa-Leite, and Dr. Lawson discuss IVF’s psychological effects and meaning beyond conception. Listen to the Episode
ASRM PRIMED scholar Dr. Caiyun Liao Publishes Article on RRM in JAMA
A new Viewpoint warns about the growing politicization and promotion of “restorative reproductive medicine." View the Press Release
ASRM Reacts to First-Ever, Bipartisan, Standalone TRICARE Mandate Introduced in House
ASRM applauds the Bipartisan IVF for Military Families Act advancing TRICARE fertility coverage, backing military families’ access to IVF and related care. View the Press Release
American Society for Reproductive Medicine Responds to Speaker Johnson’s Stripping of Fertility Coverage for America’s Military Personnel
We are profoundly disappointed that TRICARE coverage of fertility care for servicemembers has once again been dropped. View the Press Release
ASRM Center for Policy and Leadership Publishes New Research Analyzing the Trump Administration’s IVF Initiative
ASRM CPL’s new report analyzes the Trump administration’s IVF initiative—examining drug‑pricing, employer fertility benefits, access, equity, and policy implications.
Evaluating the Trump Administration’s Initiative on IVF
Analysis of Trump’s IVF initiative by ASRM with key policy insights, cost implications, and equity concerns in fertility care access. View the advocacy resource
Key Abstracts Presented at the ASRM 2025 Scientific Congress & Expo
ASRM 2025 reveals support for IVF access, wildfire smoke's fertility risks, and how insurance mandates improve outcomes in reproductive health care.
Fertility and Sterility Publishes Editorial Exploring the Origins of “Restorative Reproductive Medicine” and Why Modern Fertility Care Must Remain Comprehensive
Restorative reproductive medicine overlooks IVF, male-factor care, and the need for full-spectrum fertility treatment using modern technologies.
Key Details & Emerging Questions from the White House's IVF Announcement
White House IVF initiative offers deep discounts on fertility drugs and new employer‑benefit pathways, though full coverage and equity gaps remain. View the advocacy resource
Fertility and Sterility Publishes New Research Underscoring Importance of IVF, Fertility Preservation Access for Cancer Patients During Breast Cancer Awareness Month
New ASRM‑supported research highlights key IVF and fertility preservation access needs for cancer patients — particularly during Breast Cancer Awareness Month.
American Society for Reproductive Medicine Reacts to White House Announcement on IVF Coverage
ASRM applauds the White House’s first steps toward IVF access but underscores that true equity demands mandatory insurance coverage.
SART Fertility Experts - IVF & Religion with Dr. Kelly Lynch and Dr. Bill Petok
Explore how major religions view IVF with Kelly Lynch, MD, and insights from Bill Petok, PhD, on balancing faith, fertility, and family building. Listen to the Episode
ASRM PRIMED Cohort Members—Including Physicians, Providers, and Experts—Meet with Congressional Offices to Advocate for IVF Access & Educate About Realities of Restorative Reproductive Medicine
ASRM PRIMED cohort meets Congress to push for IVF access, clarify risks of restorative reproductive medicine, and defend science‑based fertility care.
ASRM Hosts Capitol Hill Briefing for Policymakers & Congressional Staff to Hear From Providers & Patients About Importance of IVF Access, Realities and Limitations of Restorative Reproductive Medicine
ASRM briefing united lawmakers, physicians & patients on IVF access, exposing RRM limits and urging policies to expand fertility care options.
SART Fertility Experts - Technology in ART & IVF
Explore the latest IVF technologies, from AI for embryo selection to vitrification, balancing innovation with compassionate patient care in fertility treatment. Listen to the Episode
Fertility & Sterility Publishes New Study Validating IVF Data Accuracy of a National Commercial Claims Database, Comparable with National IVF Registries
New study validates IVF data from commercial claims database, supporting its use by policymakers, employers, and researchers in expanding IVF coverage.
ASRM Statement on Palm Springs Bombing
ASRM condemns the Palm Springs bombing, stands with victims, and urges action to protect healthcare providers from violence and harassment.
Just the Facts: “Restorative Reproductive Medicine” and “Ethical IVF” are Misleading Terms That Threaten Access
Terms like “restorative reproductive medicine” and “ethical IVF” mislead and restrict access to proven fertility care like IVF. Evidence must guide policy. View the advocacy resource
US IVF usage increases in 2023, leads to over 95,000 babies born
SART releases 2023 IVF data during National Infertility Awareness Week, showing record births and rising demand for ART to support growing families.
SART Fertility Experts - Surgery Before IVF Egg Retrieval and/or Embryo Transfer
Expert insights on surgery before IVF, egg retrieval, and embryo transfer. Learn how procedures like fibroid removal and tubal surgery impact fertility success. Listen to the Episode
SART Fertility Experts - Egg Retrieval: What is it REALLY like?
Learn about egg retrieval, preparation, procedure, recovery, and risks with fertility experts Dr. Susan Nasab and Dr. Dan Williams on the SART Fertility Experts Podcast. Listen to the Episode
SART Fertility Experts - PGT-A and Mosaicism
Explore PGT-A, a genetic screening test for embryos, discussing its role in IVF, accuracy, candidates, mosaicism, and the future of fertility treatments. Listen to the Episode
SART Fertility Experts - Vanquishing Multiples
Learn how a variety of factors such as geography, race, and the availability of comprehensive infertility mandates affect access to effective infertility treatment. Listen to the Episode
Advocacy in Action
Join the ASRM Advocacy in Action campaign by making a tax-deductible charitable gift Be part of Advocacy in Action
SART Fertility Experts - Global Access to IVF and the Status of Women
Around the world, there are vast differences in the number of IVF cycles performed per capita. Learn why these differences exist. Listen to the Episode
SART Fertility Experts - Recurrent Pregnancy Loss and Implantation Failure
"I can get pregnant, but I can't stay pregnant," is echoed by patients with recurrent pregnancy loss. Listen to the Episode
SART Fertility Experts - Navigating IVF as a Couple
Mary Casey Jacob, PhD is interviewed by Dr. Daniel Grow, and together they explore the emotional and practical support that couples need. Listen to the Episode
Fertility Rights and Responsibilities
Can a fertility program or clinic deny treatment to patient(s) if there is concern about the ability to care for the child(ren)? Yes. Fertility programs can withhold services if there are signs that patients will not be able to care for child(ren). View this Fact Sheet
Progesterone supplementation during IVF
Progesterone is a hormone produced by the ovary. View the fact sheet
Side effects of injectable fertility drugs (gonadotropins)
Gonadotropins are fertility medications given by injection that contain follicle-stimulating hormone (FSH) alone or combined with luteinizing hormone (LH). View the fact sheet
What do I need to know about conceiving after surgery on my Fallopian tubes?
Fallopian tubes connect the ovary (where the eggs are stored and grow) to the uterus (womb), where the fertilized egg develops into a baby (fetus). View the fact sheet
Hydrosalpinx
The fallopian tubes are attached to the uterus (womb) on the left and right sides. View the Fact Sheet
In vitro fertilization (IVF): what are the risks?
IVF is a method of assisted reproduction in which a man’s sperm and a woman’s eggs are combined outside of the body in a laboratory dish. View the fact sheet
What is In Vitro Maturation (IVM)?
In vitro maturation (IVM) is when a woman’s eggs are collected and matured outside the body. This is done as part of an in vitro fertilization (IVF) procedure. View the fact sheet
Destekli Çatlatma (Assisted Hatching)
Destekli çatlatma, bazen in vitro fertilizasyon (IVF) tedavisi ile birlikte insan erken embriyolarına uygulanan bir laboratuvar prosedürüdür. View the fact sheet
In vitro fertilizasyon (IVF)
IVF, bir erkeğin spermi ve bir kadının yumurtalarının vücut dışında bir laboratuvar kabında birleştirildiği yardımcı üreme yöntemidir. View the fact sheet
İn Vitro Maturasyon (IVM)
İn vitro maturasyon (IVM), yumurtaların vücut dışında toplanıp olgunlaştırılması işlemidi. View the fact sheet
SART Fertility Experts - Recurrent Pregnancy Loss
Candace discusses her experience with infertility, IVF, multiple pregnancy losses and ultimately a successful delivery with Dr. Julia Woodward.Listen to the Episode
SART Fertility Experts - Infertility Advocacy and Government Affairs
In today's episode, Dr. Mark Trolice interviews Sean Tipton about the fact that many infertility patients do not have insurance coverage for treatment. Listen to the Episode
SART Fertility Experts - Behind the Scenes in the IVF Lab
Dr. Sangita Jindal, helps patients understand the importance of the IVF lab when choosing an IVF program. Listen to the Episode
SART Fertility Experts - Your Infertility Nurse: Partner in Your Care
Infertility nurse practitioner and health coach Monica Moore explains the essential role of the infertility nurse in the IVF process. Listen to the Episode
SART Fertility Experts - Genetics and IVF
Genetics is a significant part of advanced reproductive technology screening. Listen to the Episode
Intracytoplasmic sperm injection (ICSI)
A procedure called intracytoplasmic sperm injection (ICSI) can be done along with in vitro fertilization (IVF) if a sperm cannot penetrate the outer layer of an egg. Read the Fact Sheet
SART Fertility Experts - Fertility and LGBTQ
In this episode, Dr. Daniel Grow interviews Dr. Mark Leondires, the founder of Gay Parents To Be. Listen to the Episode
SART Fertility Experts - What is IVF?
In this episode, we discuss the ins-and-outs of in vitro fertilization (IVF). Listen to the Episode
Start with SART
The very first thing you should do when evaluating a clinic is verify that it is a member of SART. Watch Video
Preparing for In Vitro Fertilization (IVF): Lifestyle Factors
This SART micro-video discusses lifestyle factors that may affect in vitro fertilization, or IVF, outcomes. Watch Video
Assisted Reproductive Technologies (booklet)
This booklet will help you understand in vitro fertilization (IVF) and other assisted reproductive technology (ART) that have become accepted medical treatments for infertility. View the Booklet
The Difference Between IUI and IVF
It is important to know Intrauterine insemination (IUI) or In vitro fertilization (IVF) can both be successful at helping grow your family. Watch Video
Understanding the SART Clinic Report
During this video we will discuss the SART Clinic Report concepts and demonstrate some of the report features. Watch Video
Infertility: an Overview (booklet)
Infertility is typically defined as the inability to achieve pregnancy after one year of unprotected intercourse. View the booklet
Kristen Ritchie's Story
I spent seven years navigating infertility, which was tumultuous but also a period of tremendous personal growth in hindsight. Read the story
In Vitro Fertilization Infographics
ASRM has prepared infographics to illustrate the subject of in vitro fertilization (IVF) better. View the infographics
SART FAQ About IVF
Created by the Society for Assisted Reproductive Technology (SART) the following are answers to frequently asked questions concerning in vitro fertilization (IVF). Learn the facts
It takes more than one
Why IVF patients often need multiple embryos to have a baby View the advocacy resource
What support for IVF looks like
Bipartisan support for IVF, that is responsible for the birth of over 2% of all babies born in the USA each year, will ensure that families continue to grow. View the advocacy resource
Oversight of IVF in the US
In the US, medical care is regulated by a complex and comprehensive network of federal and state regulations and professional oversight. View the advocacy resource
Just the Facts: IVF Policy Priorities
ASRM advocates for expanded IVF access, urging policy solutions that prioritize patient care, inclusivity, and medical decision-making free from political interference. View the advocacy resource
Just the Facts: The Safety of In Vitro Fertilization (IVF)
IVF is a safe, proven medical procedure with extensive research backing. Though risks exist, advancements and strict monitoring ensure most IVF babies are healthy. View the advocacy resource
IVF Treatment Journey
In vitro fertilization (IVF) is a process in which an egg and sperm are combined in a laboratory dish to facilitate fertilization.
View the Patient Journey
