Deciding how you feel about surrogacy termination and reduction is one of the most sensitive parts of becoming a surrogate. It means considering situations where the intended parents may need to make medical decisions—such as ending or reducing a pregnancy in cases of serious fetal complications, disabilities, or high-order multiple pregnancies (for example, triplets).
Living in the U.S. after the overturning of Roe v. Wade has made this topic more sensitive.
To help both parties navigate these difficult conversations, we’ve outlined the key considerations, legal and emotional factors, and frequently asked questions surrounding termination and reduction in surrogacy.
Termination refers to the medical procedure of ending a pregnancy, often due to health risks to the surrogate or fetus, or due to unforeseen complications.
On the other hand, reduction involves the selective reduction of multiple fetuses in a high-order pregnancy, typically to improve the chances of a healthy outcome for the remaining fetuses and the surrogate.
Both procedures are deeply personal and complex. In surrogacy, their implications go beyond medical considerations, introducing unique legal and emotional factors that set them apart from similar situations in traditional pregnancies. Understanding these nuances helps intended parents, surrogates, and medical professionals make informed and compassionate decisions throughout the process.
In surrogate pregnancies, termination and reduction are only considered in specific—and often critical—circumstances.
Comprehensive genetic testing and medical screenings play a key role in preventing complications. These evaluations, conducted early in the process by the surrogacy agency and fertility clinic, help identify potential health risks before pregnancy.
Medical reasons are the most common circumstances under which surrogacy termination or reduction may be considered. These situations arise when continuing the pregnancy poses serious health risks to the surrogate or when significant fetal abnormalities are detected.
For example, termination may be discussed if the surrogate develops severe pregnancy complications such as placental abruption or other conditions that endanger her life or long-term health.
High-order multiple pregnancies, where carrying several fetuses to term could pose significant health risks, might also lead to the consideration of selective reduction to improve the chances of a successful and healthy pregnancy.
One of the most effective prevention methods is limiting the number of embryos transferred during the initial IVF/embryo transfer stage — for instance, choosing a single-embryo transfer (eSET) when conditions allow.
Conversations about termination and reduction should happen before a surrogate is matched with intended parents. These early discussions ensure that everyone shares similar values and expectations, building trust and preventing emotional conflict later in the journey.
The surrogacy agency plays a key role in facilitating these conversations in a neutral, supportive setting where both parties can openly express their views.
At Hatch, we aim to match surrogates and IPs with aligned views, ensuring that everyone involved is comfortable and prepared for any decisions that may arise.
Understanding the rights of both surrogates and intended parents is fundamental to a successful surrogacy arrangement.
In most cases, intended parents hold the legal right to make medical decisions for their unborn child, including those related to termination or reduction. A surrogate’s agreement to this is outlined in the surrogacy contract before any medical procedures begin.
At the same time, surrogates retain key legal protections. They have the right to comprehensive medical care, full transparency about all procedures, and a say in any decisions affecting their own health.
These rights are balanced through a carefully drafted legal contract that defines responsibilities, decision-making authority, and safeguards for everyone involved.
At Hatch, we work with some of the best attorneys in reproductive and family law that we can refer you to.
The laws surrounding termination and reduction in surrogacy vary widely across the United States.
The impact of landmark cases, such as Roe v. Wade, continues to affect the permissibility and processes of termination and reduction.
Within the surrogacy contract, specific clauses related to these procedures must be carefully reviewed and understood.
The contract should clearly outline:
Hatch works closely with trusted reproductive and family law attorneys to ensure every surrogacy agreement is transparent, fair, and compliant with state regulations.
To help potential surrogates understand this better, we wanted to take a moment to cover some key frequently asked questions:
A: We have the utmost respect for your beliefs, and it is important that you and your Intended Parents are in step for critical decisions like this. Unfortunately, we do not have any Intended Parents on our wait list who would be comfortable waiving their ability to make such an important medical decision for a child they will be raising.
A: Terminations and reductions are extremely rare, with more parents choosing to do single embryo transfers, and more parents using genetically-tested embryos, both of which help to reduce risks (but do not eliminate them). The reasons we have seen included:
A: They are very rare due to increased embryo testing prior to transfer, many parents utilizing young, healthy egg donors, and because transferring more than one embryo at a time is less common. A surrogate can absolutely choose whether she is willing to transfer more than one embryo at a time or not, and the IVF doctor she is working with will also decide if a surrogate who is open to doing a double embryo transfer is a suitable candidate for carrying twins before approving this.
A: Most issues take time to diagnose with the first non-invasive prenatal testing, and then more invasive prenatal testing, like an amniocentesis or CVS, as well as consultations with a maternal/fetal medicine specialist or possibly a geneticist, depending on the issues, before a decision can be made. Most commonly, issues are identified in the early to mid-2nd trimester. Intended Parents want to have all the information before making these difficult decisions.
A: At Hatch, we have been making families possible since 1991. In the history of our agency, we have never had a client opt to terminate or reduce for a non-medical reason, such as a split in their marriage, the baby’s sex not being what they hoped for, or for no reason at all. Our Intended Parents have often struggled for many years before turning to surrogacy to build their families. They want a healthy baby more than anything. These difficult decisions are not made lightly.
A: No, in a situation where a surrogate opted to not comply with her agreement with the Intended Parents and follow through with allowing their decision to terminate or reduce a pregnancy, she would still not have a claim to custody of the child and would also be in breach of the contract with the parents. It is very important to feel confident knowing you can uphold what you have agreed to before signing your surrogacy contract with the Intended Parents.
A: We absolutely respect your stance on this personal subject and would happily refer you to another reputable program that has Intended Parents who are firm in their own stance to not terminate or reduce, or to only do so in limited situations. It is important that you and your Intended Parents are on the same page.
A: Surrogates are not responsible for any medical expenses for their surrogate pregnancy, or their travel costs for any procedures for their surrogacy. Our surrogates also have the option of receiving counseling by a licensed mental health professional if needed, plus the emotional support from their Case Manager, our private online support group, and monthly support zooms.
A: Typically, this will not impact your ability to be a surrogate again, but any D&C or D&E procedure carries a small risk of impacting your ability to build an adequate uterine lining. If the reason for the termination was due to severe intrauterine growth restriction or complications related to the surrogate, rather than baby’s genetics or a fluke, this would preclude you from being cleared for another surrogacy because of the risk of recurrence.
A: These occurrences are exceedingly rare. The health and safety of a surrogate is always the top priority because a surrogate is already a mother to her own children. When a pregnancy cannot be continued safely for a surrogate, then the contracts absolutely permit a termination of pregnancy or induction to delivery early (for example, in the case of eclampsia). Typically, someone cannot proceed with future surrogate pregnancies if they have needed a termination or induction to preserve their health. However, selective reduction of multiples does not usually disqualify a candidate from future surrogacies.
At Hatch, we pride ourselves on guiding our families through the complex journey of surrogacy with expertise and compassion. Understanding the intricacies of termination and reduction in surrogate pregnancies is just one of the many areas where we offer support. From defining these procedures and when they might be considered, to facilitating open discussions before matching, and ensuring a clear understanding of legal rights and considerations, we are dedicated to supporting all parties involved.
Our team is made up of previous surrogates, intended parents, and donors, and your case is near and dear to our hearts. Though refining our meticulous approach over the past 30 years, we work with all parties to ensure that the rights and responsibilities of both surrogates and intended parents are balanced and protected. We are here to help you navigate this journey with confidence and peace of mind.