Gestational Carrier Policy in the United States

Introduction

Third-party reproduction using a gestational carrier (GC), which for purposes of this paper will be used broadly to refer to utilization of a gestational carrier, is a family building option carried out in accordance with existing legal frameworks, subject to applicable Food and Drug Administration (FDA) requirements, and informed by professional clinical guidance issued by the American Society for Reproductive Medicine (ASRM) and the Society or Assisted Reproductive Technology (SART).(6)

GC pregnancies make up a small percentage of overall births, representing 13.7 per 100,000 deliveries nationwide between 2017-2020. Although it remains a specialized medical intervention, GC use may be the best option for family-building for patients with certain medical indications.(15)

Laws on third-party reproduction vary by state and are apt to evolve as policymakers consider GC-related legislative and regulatory proposals amidst intensifying political attention toward assisted reproduction. Policy stakeholders should evaluate proposed restrictions on GC treatment cycles tactfully to avoid limiting access to medically indicated care, misaligning with clinical best practice, and exacerbating practical and legal uncertainty for intended parent(s), GCs, and medical providers.(7)

This paper provides policy guidance on GC arrangements to encourage patient and provider protective lawmaking and regulation.

Gestational Carrier Arrangements

In a GC arrangement, an embryo created through in vitro fertilization (IVF), using the gametes of intended parent(s), donors, or both, is transferred to the uterus of the GC who agrees to carry the pregnancy and has no genetic relationship to the child.(4)

Traditional, or genetic, surrogacy differs from GC arrangements in that it does not involve IVF and instead relies on the carrier’s own oocyte.(4) This model involves a genetic link between the carrier and child, presenting unique legal and ethical questions. Today, it is uncommon in clinical practice.(4) Contemporary statutory frameworks primarily address GC arrangements, not traditional surrogacy.(3) (5)

In the U.S., GC arrangements are governed under state-specific statutes, court opinions, and regulatory policies. Many states statutorily permit GC arrangements; others have no statutes or case law specifically permitting or prohibiting GC usage, and some prohibit GC arrangements, making surrogacy contracts void and unenforceable.(7) To date, there exists no overarching federal statute governing the use of GCs.

Clinical Guidance

ASRM Practice Committee guidance emphasizes that GCs may be used when a clearly documented medical indication makes pregnancy impossible or poses a serious risk to the intended parent or fetus.(6)

The ASRM Practice Committee identifies several examples of such medical indications, including:

• Congenital or acquired absence of the uterus;
• Significant uterine anomalies, such as extensive intrauterine scarring associated with
• Asherman syndrome or a unicornuate uterus linked to recurrent pregnancy loss;
• Absolute psychological of medical contraindication to pregnancy;
• Serious psychological or medical condition that could be exacerbated by pregnancy
• or pose significant risk to the intended parent or fetus;
• Familial structures in which gestation by an intended parent is biologically infeasible,
• including single men and male same-sex couples.(6)

These examples demonstrate that GC usage functions as essential family-building health care for a specific subset of patients with medical indications.

In addition to defining appropriate medical use, ASRM Practice and Ethics Committee opinions recommend procedural safeguards to protect GCs and the intended parent(s).

These include independent legal counsel for the GC, comprehensive informed consent practices, and recognition of the carrier’s medical decision-making authority from embryo transfer through the postpartum period.(4) ASRM and SART guidance also strongly recommends single-embryo transfer (SET) as the preferred approach in GC cycles, considering the obstetric risk associated with multiple gestation.(6) (16)

National Trends

As previously noted, GC pregnancies occur at low rates nationally, measured at 13.7 per100,000 deliveries in the U.S. from 2017-2020.(15) Though, the prevalence of GC pregnancies steadily increased by 55% over that period, from 11.8 to 18.2 per 100,000 deliveries, according to an inpatient sample analysis published in 2023.(15)

This incremental growth from a low initial usage rate demonstrates that GC utilization is expanding, but remains a specialized modality within assisted reproductive technology (ART).

The Centers for Disease Control and Prevention (CDC)’s Division of Reproductive Healthhighlights the National ART Surveillance System (NASS) as the official system for monitoring ART procedures and outcomes nationwide. NASS provides the infrastructurefor tracking cycle-level activity and longer-term trends in assisted reproduction,including GC cycles, across U.S. clinics. CDC ART Summary data, viewable in Table 1, tracks the total number of ART cycles inthe United States from 2013-2022.

CDC ART Summary data, viewable in Table 1, tracks the total number of ART cycles inthe United States from 2013-2022.

Year ART Cycles
2013 190840
2014 208630
2015 231937
2016 263577
2017 284385
2018 306197
2019 330773
2020 326468
2021 413776
2022 435426

Table 1: Data attributable to the CDC, which collects data from all reporting clinics to create national summary figures describing ART utilization from 2013 to 2022.(8)

In 2016, NASS data indicated that of 2,071,984 ART cycles reported between 1999-2013, only 30,927, or less than two percent, used a gestational carrier.(15) Further data from the CDC’s 2022 ART summary indicates that, of the ART cycles performed in 2022, only 1.5 percent were utilized with the reason for usage being a gestational carrier.(8)

Additional data from the Society for Assisted Reproductive Technology (SART),viewable in Table 2, tracks the number of GC cycles from reporting clinics from 2004 to 2023.

Year GC Cycles Reported by Clinics
2004 1539
2005 1901
2006 2076
2007 1893
2008 2539
2009 2616
2010 2723
2011 3100
2012 3423
2013 3530
2014 4112
2015 5401
2016 5940
2017 6628
2018 7746
2019 9535
2020 8039
2021 9238
2022 9225
2023 11515

Table 2: Data attributable to the Society for Assisted Reproductive Technology (SART), which tracks the number of gestational carrier cycles reported by clinics each year from 2004-2023.(17)

Taken together, this data illustrates that GC utilization is growing at a steady rate but remains a small fraction of overall AR usage and pregnancies within the U.S.

Public Misconceptions

Despite heightened media attention, data indicates that GC usage has increased gradually from a historically low baseline, rather than a dramatic surge in usage.(15)

Individual outstanding cases of misconduct and misperceptions about the prevalence of GC arrangements can cause confusion regarding their regulation, frequency, and prevalence. Legislative drafting and statutory evaluation should rely on data and peer‑reviewed analyses, not anecdote, recognizing GC as relatively uncommon but critical for patients with documented medical indications.

Obstetric Outcomes & Risk Profiles

The medical profile of GC pregnancies differs meaningfully from non‑GC pregnancies. A national inpatient sample analysis found higher adjusted risks among GC pregnancies of multiple gestation, placental abruption, low‑lying placenta, late‑preterm and peri viable delivery, and postpartum hemorrhage, but lower cesarean rates in singleton deliveries compared to non‑GC pregnancies.(12)
 
These findings underscore that oversight by qualified fertility specialists on GCarrangements is critical. The data also highlights the importance of avoiding statutorymandates that contradict established, proven clinical practices.

Legal Landscape in the United States

In the U.S., many states have statutes recognizing and regulating GC arrangements. These legal frameworks vary, but may authorize GC arrangements that meet specified screening, consent, and counseling requirements; provide a parentage order pathway so intended parents are listed on the original birth certificate; and clarify definitions and protections for GCs, intended parents, donors, and children.(7)

Recent examples of state statutory regulation include the Massachusetts Parentage Act, enacted in 2024, which explicitly addressed assisted reproduction and GC arrangements and introduced pre‑birth parentage pathways and procedural safeguards,(13) and the Michigan Family Protection Act, also enacted in 2024, which repealed the prior criminal ban and enacted a regulated GC framework.(14)

To be sure, a fractured legal landscape persists. Some jurisdictions still void or restrict compensated GC contracts or require additional adoption steps for non‑genetic parents, and county‑level practice can vary even within states where GC arrangements are permitted.(7)

Moreover, ideologically driven policy proposals, such as personhood initiatives seeking to confer legal rights and status under the law to zygotes, embryos, or fetuses, have influenced state debates, creating downstream impacts on IVF and access to GC arrangements (e.g., clinical decision‑making and potential liability), underscoring the need for GC statutes that explicitly protect ART care and parentage pathways.(18)

American Bar Association (ABA) Family Law resources highlight that jurisdictions which authorize and regulate GC arrangements by specifying procedural safeguards like medical evaluation, independent counsel for GCs, and parentage order pathways, are the ones where arrangement agreements are enforceable, yielding more predictable legal outcomes for intended parents, gestational carriers, and children.(1) (2)

Key Questions for Policy Development

As policy stakeholders work to craft legislation and regulatory guidance, ASRM recommends the following key questions and design principles for consideration:

(1) Is the proposed bill narrowly constructed to address a specific issue (e.g., parentage clarity, consent, coverage)? Is it based on data rather than anecdote? Consult national prevalence, outcomes, and state-by-state data to avoid over‑regulation of a low‑volume service.

(2) Does this legislation protect access to medically indicated care for patients with documented conditions precluding them from pregnancy while upholding comprehensive GC consent and bodily autonomy?

(3) Are statutory requirements consistent with ASRM and SART guidance (screening, testing, counseling, SET)? Does policy align with best clinical practices?

(4) How will informed consent be safeguarded without creating unnecessary barriers for intended parent(s) with medical indications?

(5) Are there any potential unintended consequences of this proposed legislation for patients, providers, and clinics? These may include insurance coverage denials for GC pregnancies if nondiscrimination or a pregnancy special‑enrollment pathway is not explicit (12), ambiguous parentage at delivery without clear parentage orders (11), and increased obstetric risk if statutes undercut clinician discretion and SET given GC risk profiles.(16)

Considerations for Policy Stakeholders

• Recognize that providers and patients also suffer from bad actors. GC regulation should target misconduct, not restrict access to family-building for those withdocumented medical indications.
• Carefully assess both intended and unintended consequences of any proposed legislation, including financial and operational impacts on taxpayers, healthcare providers, and patients, and ensure that any resulting costs are clearly justified by demonstrable public benefit.
• Promote independent legal counsel, informed consent, and transparency regarding legal rights and responsibilities for both GCs and intended parent(s).
• Support evidence-based clinical standards from ASRM and SART for screening, testing, and psychological evaluation, so GC agreements respect the health and eligibility of GCs and assist intended parent(s) in building healthy families.

Conclusion

As policymakers and regulators evaluate proposals concerning GCs, intended parent(s), and the professionals who support family-building, careful consideration of patient and provider autonomy, informed consent, and evidence‑aligned clinical safeguards, as articulated in ASRM Practice and ASRM Ethics guidance, is critical. Well-crafted statutes help ensure that GC arrangements remain safe, legal, and accessible for patients with clearly documented medical indications. Clear parentage procedures, insurance nondiscrimination protections, and explicit alignment with clinical and ethical standards, such as informed consent, retention of GC bodily autonomy, independent legal counsel, and the SET guideline endorsed by ASRM and SART practice committees, should be taken into consideration. 

References

1. American Bar Association (ABA) Family Law Section. Parentage Statutes in 2024. 2024.
2. American Bar Association (ABA) Health Law Section. Creating Families: Surrogacy and theEvolution of Assisted Reproductive Technology. 2024.
3. American College of Obstetricians and Gynecologists (ACOG). Family Building Through Gestational Surrogacy. Committee Opinion No. 660. 2016.
4. American Society for Reproductive Medicine (ASRM) Ethics Committee. Consideration of the Gestational Carrier: an Ethics Committee Opinion. Fertil Steril. 2023;120(6):e63–e71.
5. American Society for Reproductive Medicine (ASRM) Ethics Committee. Family Members as Gamete Donors or Gestational Carriers. Fertil Steril. 2024;121:946–53
6. American Society for Reproductive Medicine (ASRM) Practice Committee. Recommendations for Practices Using Gestational Carriers: a Committee Opinion. FertilSteril. 2022;118(1):65–74.
7. American Society for Reproductive Medicine (ASRM) Legal Professional Group. Surrogacy Laws by State. 2024.
8. The Center for Disease, Control, and Prevention (CDC). National Assisted Reproductive Technology (ART) Summary. 2024. 
9. Dobbs v. Jackson Women’s Health Organization, 597 U.S. ___ (2022).
10. LePage v. Center for Reproductive Medicine, P.C., 403 So. 3d 747 (Ala. 2024).
11. Levine B, Cirel AL, Schoyer KD, Derse AR, Rydze RT, Feinberg EC. Should Physicians be Facilitating Gestational Carrier Arrangements in the Absence of Medical Indication? FertilSteril. 2025;123(2):201–207.
12. Masjedi AD, Mandelbaum RS, Erickson KV, et al. National-level Assessment of Gestational Carrier Pregnancies in the United States. Journal of Assisted Reproduction and Genetics.2025;42(1):201–211.
13. Massachusetts Governor’s Office. Governor Healey Signs Parentage Act, Ensuring Equality for All Families in Massachusetts. 2024.
14. Michigan Governor’s Office. Whitmer Signs Bills Decriminalizing Surrogacy and Protecting IVF. 2024.
15. Perkins KM, Boulet SL, Jamieson DJ, Kissin DM; National ART Surveillance System Group.Trends, Characteristics, and Outcomes of Gestational Carrier Pregnancies in the United States. Fertil Steril. 2016;106(2):435–442.e2. 
16. American Society for Reproductive Medicine (ASRM) Practice Committee, Society for Assisted Reproductive Technology (SART). Guidance on the Limits to the Number of Embryos to Transfer: A Committee Opinion. Fertil Steril. 2021;116:651-54. 17.Society for Assisted Reproductive Technology (SART). SART Member Clinics Reported Gestational Carrier Cycles 2004-2023. 2026.
18. Ziegler, M. IVF Users Face Uncertain Legal Landscape, State Court Report, 2025.

Acknowledgements

This research was led by ASRM Center for Policy and Leadership Associate, Amelia Letson, with support from ASRM Center for Policy and Leadership Director, Rebecca W. O’Connor, JD, ASRM Chief Policy and Advocacy Officer, Sean Tipton, MA, ASRM Director of Government Affairs, Jessie Losch, MPH, and ASRM Chief Executive Officer, Jared Robbins, MD, MBA.

About the ASRM Center for Policy & Leadership

The American Society for Reproductive Medicine (ASRM) is the global leader in multidisciplinary reproductive medicine research, ethical practice, and education. ASRM impacts reproductive care and science worldwide by creating funding opportunities for advancing reproduction research and discovery, by providing evidence-based education and public health information, and by advocating for reproductive health care professionals and the patients they serve.

The ASRM Center for Policy and Leadership (CPL) is a nonpartisan think tank that advances reproductive health, medicine, and science by delivering fact-driven and scientifically based legal and policy analysis to inform the public and decision-makers as they navigate the landscape of reproductive health lawmaking and policy implementation.

Please contact opa@asrm.org for inquiries about this report.