Ten Emotional Challenges Intended Parents face During the Surrogacy Process & How to Cope

10 minutes

If you are reading this, you’re likely in one of two places: either contemplating the idea of embarking on a journey with a gestational carrier (GC), or you’re already deep in the process, eagerly soaking up all the information you can find. While much has been written about the logistics of surrogacy, there’s a notable gap when it comes to addressing the emotional journey intended parents (IPs) may face.

Choosing to use a GC is not simply a clinical or practical decision; it’s a deeply emotional one. It brings a wide range of feelings—some expected and some that may catch you by surprise. Below are ten of the most common emotional challenges I’ve encountered in working with IPs, along with ways to navigate these feelings so that, hopefully, your experience can be one filled with more moments of peace and hope rather than frustration and overwhelm. I feel it’s important to recognize that everyone’s journey to get here and throughout the process is incredibly unique; some of these may not apply to you, or be relevant, and some that are relevant may be missing.

1. Grief and Loss

By the time many IPs reach the surrogacy stage, they’ve often endured significant grief and loss. Yet, it can still be surprising when new layers of grief emerge during this process. Even for those who have always known surrogacy would likely be their path—whether due to medical reasons or being in a same-sex relationship—the feelings of loss can show up unexpectedly. This might happen if their chosen GC doesn’t pass medical screening, if an embryo doesn’t take, or if there is a miscarriage.

For those who rushed into surrogacy after the heartbreak of being unable to carry a pregnancy, they may not have had the chance to properly grieve. Once things settle and their GC is pregnant, the emotional weight of it all can suddenly feel overwhelming. It can lead to being obsessive over everything they can control or distancing from the process altogether; such as skipping appointments or avoiding communication with their GC. On the outside, it may look like someone being overbearing or disinterested, but often it’s a protective response to the pain and fear based on what they have endured or because they are not the one physically experiencing the pregnancy.

For those who have taken the time and space to grieve, it might seem that reaching a place of acceptance means the grieving process is over. However, grief tends to resurface, especially as the journey unfolds with its many key moments—attending the transfer, watching the ultrasounds, and hearing the heartbeat. These are often a complex mix of emotions. One intended mother shared, “It was so beautiful to see the heartbeat, and I’m so happy everything is going smoothly, but it also made me sad that I wasn’t the one on the table and having my partner by my side smiling with me. Then I felt guilty for not being just excited.”

It’s important to remember that it’s okay to feel both joy and loss at the same time. Surrogacy, like so many parts of the parenthood journey, is full of contradictory emotions. Acknowledging this emotional complexity, instead of trying to push it aside, can help you navigate the process with more compassion for yourself.

2. Anxiety and Uncertainty

This is likely the most intense emotion that will come up for IPs. The surrogacy process is filled with long waits and uncertainty at every turn. If you’ve already been through your own infertility journey, you’re likely no stranger to inconceivable levels of worry. Unfortunately, surrogacy often brings a new wave of anxiety to manage.

First, there’s the anxiety about the beginning process—choosing the right agency if you are going that route, matching—what if your GC isn’t as amazing as you thought she would be? There is the anticipation of meeting her for the first time, and getting through each step including psych clearance, legal, and medical clearance, sometimes a mock cycle. At any one of these steps, something could set you back to square one.

And of course, there is the actual pregnancy—waiting for blood test results, anxiously anticipating each scan, and scares along the way, such as the GC spotting. You may have had miscarriages at a certain week, and the anticipation leading up to that week can be completely terrifying.

And then there is the anxiety with regard to communication and the relationship with your GC. Even if you’ve agreed on the frequency and type of communication, now that it's happening, doubts may arise. “Am I reaching out too much? Does she think I don’t care because I’ve backed off? Is she taking care of herself—and the baby?” It’s not uncommon to spiral into overthinking. You may wonder, “Why did her Instagram story show her out on a Friday night? Should she be driving at night? What if she leaves the country? It’s been three hours since she texted me back, is something wrong?”

The truth is, this anxiety can feel all-consuming at times. For some, it can lead to complete disconnection, causing them to miss out on the pregnancy experience. Your fears are valid—this is a monumental moment in your life, and you might already have trauma in this realm. What matters is acknowledging how terrifying this process is, not feeling embarrassed or ashamed about it, and finding ways to cope.

3. Loss of Control

This one is pretty straightforward, but it’s also one of the hardest realities to face. You’re placing the most precious thing—the baby you’ve dreamed of for so long, invested a lot of time and money in, and possibly endured so much heartache for—into the hands of someone else, often a stranger. It’s a monumental leap of faith. Take a big, deep breath.

4. Guilt and Envy

Guilt and envy are other common emotions that surface during the surrogacy journey. You may feel guilty for not experiencing the physical discomforts of pregnancy—nausea, swollen ankles, sleepless nights. There may be guilt that your body won’t bear the visible signs of carrying life, or envy that you’re not the one providing the nurturing environment for your baby to grow. For those who have carried a child before, there’s often guilt about having carried one baby but not another.

Then there’s the less obvious guilt: the guilt that comes with feeling relieved. After years of struggle—infertility treatments, surgeries, miscarriages—the decision to work with a GC can bring an unexpected sense of hope and relief. The pressure lifts, fueling another guilt: that you’re relieved to pass the baton, that you won’t have to endure another devastation at the hands of your body.

It’s important to remember that it’s okay and even expected that you may feel these things. Relief, envy, guilt—they can all coexist.

5. Bonding Concerns

This is one of the most, if not the most, common concerns I hear, especially from intended mothers. There’s often a deep fear that because your baby spent nine months hearing someone else’s voice and being nurtured in someone else’s body, holding your baby in your arms might not feel natural—that something might feel missing between the two of you.

First, it’s important to know that even mothers who carry their own babies don’t always bond right away. That immediate connection isn’t a given for everyone. Second, whether you feel an intense bond the moment you hold your baby or not, trust that it will absolutely develop. From the moment your baby enters the world, you become their constant. Your voice, your scent, your touch—these will be the things your baby learns to rely on and feel comforted by.

Bonds, like any relationship, grow with time, consistency, and care. Your baby will know you as their parent from day one, and that bond will only strengthen with time. As a reassuring note, one intended mother shared a sentiment I hear often: “I rarely even think about my child not coming from my body; it’s usually only if I’m explaining something or surrogacy comes up in the media. Of all the things I stressed over, this was one that never felt relevant once my baby was born.”

I assure you, when your baby is screaming at 3:00 a.m. after you’ve finally just fallen back asleep, they are screaming for you, not the GC.

6. Relationship Strain

If you’ve been through infertility or other hardships, you probably already know that you and your partner won’t always see eye to eye. You likely cope in different ways, which can sometimes lead to misunderstanding and even resentment. Once the decision is made to move forward with a GC, it might feel like things will get better—and often they do—but other conflicts can arise.

One of the most common challenges is that one partner ends up making the bulk of the decisions. It’s not unusual for one partner to take a step back, either because they don’t believe they will be as involved in building the relationship with the GC or because they are disconnected due to issues we discussed above. While this makes sense, it can also feel isolating for the person left to make the tough decisions, leading to decision fatigue.

Once the process is underway, it’s often the same person managing the relationship with the carrier, coordinating appointments, or reaching out to the agency if issues arise. This can be exhausting, and over time, it may stir fears about whether their partner will be equally involved when the baby arrives.

7. Financial Stress

The financial strain of surrogacy is tremendous. For many IPs, this comes after already spending tens of thousands of dollars on infertility treatments. Now, to move forward with surrogacy, you’ll need to fund an escrow account unless you are pursuing an independent journey with other arrangements, and this often runs into the hundreds of thousands of dollars. This might mean asking for or borrowing money from family and friends, taking out loans, staying in unsatisfying jobs, as well as putting off or changing many parts of your life to be able to afford it. This strain can impact every aspect of your current and future life, including relationships.

8. Social and Family Annoyances/Pressures

Whether it’s cultural expectations or simply a lack of understanding, there’s often no shortage of inappropriate or insensitive comments throughout the surrogacy process. Some IPs face pressure from family members who may not fully accept the decision due to stigma; though, thankfully, as surrogacy becomes more publicly recognized, there’s growing acceptance.

Still, you may find yourself fielding frustrating and sometimes hurtful remarks, such as, “Lucky you, I hated being pregnant,” “Why don’t you just adopt?” or “Oh, like in The Handmaid's Tale?” Even when the comments come from well-meaning people, they can sting, especially when they come from those closest to you.

Constantly having to explain your choice or educate others can be exhausting and emotionally draining, especially when you're already navigating a complex journey. It’s important to protect your energy and know that you don’t owe anyone an explanation for your path to parenthood.

9. Attachment to the Surrogate

Navigating the relationship with your GC can be challenging, given that it blends elements of friendship, partnership, and a shared goal, but it also involves deeply personal and emotional stakes. Sometimes, everything clicks right away—you hit it off, and the connection feels natural and seamless. But even with the best intentions on both sides, there can still be moments of conflict or misunderstanding. Finding the balance between being friendly and maintaining appropriate boundaries, while also having expectations, can be difficult and highlights why a joint meeting with a mental health provider is so important prior to beginning. Unfortunately, sometimes all communication gets cut off and is done solely through the agency or a third party. When this happens, it’s incredibly sad for all parties.

There is also sometimes a feeling of sadness once the baby is born due to missing the connection with your GC. If you felt incredibly close and communicated daily about the pregnancy, then it can feel as if you had a very active partner focused on the well-being of your baby. Once that connection is gone, it can suddenly feel as if parenting without that constant support leaves a void—hopefully one that will be filled by your partner, if you have one, but it can often feel different.

10. Postpartum Adjustment

Bringing a baby home is a challenging transition for anyone, but it can be especially complex for those who didn’t carry the baby. Many IPs express feelings of disbelief, saying things like, “It just doesn’t feel real. One day I was living my normal life—enjoying cocktails and feeling like myself—and now there’s a baby.” Without the physical reminders of pregnancy, such as feeling the baby move or being able to talk to them during gestation, the shift can feel more abrupt.

Additionally, new parents often find themselves fielding a lot of questions, especially from people who may not have been aware of their journey or who are misinformed. Meeting new people can lead to comments like, “Wow, you look amazing for just having had a baby!” or inquiries about their birth experience. Remarks such as, “Your surrogate was fine just giving the baby to you?” can be particularly offensive. While these comments may not come from malintent they can easily trigger negative emotions. As a result, some new parents may start to isolate themselves to avoid these hurtful encounters or feel they “don’t fit in” with new parent groups.

Strategies for an emotionally positive journey

Although it's impossible to eliminate all the emotions that may arise, there are strategies that can help minimize potential issues or lessen some of the feelings that often surface.

1. Grieve any losses that come with moving forward. You don’t need to take a year off to grieve; you’re in a hurry—it’s understandable. However, don’t wait to process your emotions until your GC is well into her pregnancy or after the baby arrives. Actively work on understanding what this step means for you, your identity, and the experiences you may never have.

2. Educate yourself about the process before jumping ahead. Naturally, after taking this leap, you want it done yesterday, but rushing into the process can lead to poor decision-making, a complicated journey, or even longer timelines if matches are broken due to impulsive decision-making.

3. Work with experienced professionals. Partnering with reputable surrogacy agencies, fertility clinics, a mental health provider, and an attorney well-informed in this particular area can provide much-needed guidance and support throughout the journey (Check out ASRM and SEEDS).

4. Set realistic expectations. Setbacks and complications will unfortunately likely occur. Whatever your timeline is, add several weeks or months to it. It’s incredibly frustrating to deal with these setbacks, but ensuring a smooth journey and a happy ending involves many players in the game and numerous checkmarks in place.

5. Develop coping strategies. Have a list of things that help you relax or clear your mind when things get rough. Techniques like journaling, exercise, talking to a close friend, listening to music, asking for a hug, or petting a dog can be quick ways to help manage anxiety and stress when you are in a panicky moment and need a minute to think straight.

6. Get a therapist who specializes in third-party reproduction. You may have a wonderful therapist, or you may have trouble finding one who takes your insurance, but a therapist not well-versed in this area won’t be able to hold space for what you are going through and offer the education, resources, and understanding you need. If you have to explain every step while venting or crying about it, you will likely leave the session feeling even more frustrated.

7. Build a strong support system. Connect with other IPs, join support groups, and lean on family and friends who have demonstrated support for your journey. Distance yourself from those that are not understanding or leave you feeling judged.

8. Clarify your expectations regarding communication and the relationship you want with your GC. I know it’s difficult to know exactly what you want until the process is underway, but try your best to envision how you want it to look. If you leave it too open and flexible, a mismatch in communication can lead to an incredibly disconnected and disheartening journey.

9. Focus on what you can control. While much is uncertain, you can control your own health, preparations for parenthood, and fostering the relationship with your GC.

10. Celebrate milestones. This can be very challenging when your experience has been fraught with devastation. However, as best you can, acknowledging each successful step can lead to moments of joy and memories you can one day share with your child that aren’t overshadowed by stories of terror and disconnect.

Check out my guest appearance on The Surrogacy Scoop discussing mental health from the GC and IP perspective.