Surrogacy & IVF
How to create equitable agreements around decision making during pregnancy between surrogate and intended parents.
This guide outlines practical, compassionate strategies for building fair, clear decision-making processes during pregnancy when surrogacy connects intended parents and a surrogate, emphasizing mutual respect, legal clarity, open communication, and shared goals to support a healthy journey.
July 15, 2025 - 3 min Read
In any surrogacy arrangement, the moment-to-moment choices during pregnancy can become emotionally charged. Establishing a framework for decision making that feels fair to everyone begins with early conversations about core values, boundaries, and expectations. It helps to identify which decisions are strictly medical (like procedures or tests), which are logistical (such as scheduling and travel), and which are emotional or relational (for instance, how to handle information sharing with family and friends). The goal is to prevent miscommunication before it arises by documenting agreements in a neutral, accessible document, reviewed by both parties and their legal counsel. A shared language reduces the risk of conflict escalating as pregnancy progresses.
Early in the process, consider appointing a nonpartisan mediator or reproductive law attorney to translate expectations into concrete guidelines. Clarify who has decision-making authority in the event of disagreement, and specify steps for escalation—such as a structured discussion, followed by a cooling-off period, then mediation or arbitration if needed. Emphasize that decisions should prioritize the wellbeing of the fetus while honoring the surrogate’s health and autonomy. Wording these provisions carefully helps ensure there is room for flexible adjustments when medical realities require changes. The resulting protocol should feel balanced, practical, and adaptable.
Balancing medical guidance with personal autonomy and care.
A fair framework begins with transparent disclosure about medical recommendations, potential risks, and the implications for both parties. Each side should have access to the same information, ideally through shared digital records or joint meetings with the medical team present. When medical teams propose a course of action that could affect the surrogate’s health, time should be allowed for thoughtful consideration rather than rushed consent. Likewise, intended parents should have the opportunity to voice concerns and ask questions about how a recommended path might influence family goals after birth. Documenting these deliberations helps prevent misunderstandings and fosters trust.
Beyond medical decisions, practical arrangements warrant careful consideration. For instance, consent around travel for appointments, the use of fertility or prenatal services, and the sequencing of ultrasounds should be described in plain language. Also, address privacy expectations—how much information the surrogate wishes to share with others and how much the intended family will know about day-to-day experiences. Establishing shared routines, such as regular check-ins, can create continuity and reduce anxiety on both sides. This proactive approach demonstrates respect for diverse comfort levels and reinforces a collaborative spirit throughout the pregnancy.
Creating space for ongoing dialogue and mutual respect.
Balancing medical guidance with personal autonomy requires ongoing dialogue about risk, comfort, and consent. When a medical team recommends a course of action that might be burdensome or uncomfortable, both parties should have opportunities to reflect and respond. The surrogate’s wellbeing remains a priority, but the intended parents also bear emotional and financial responsibilities that can influence expectations. Build in explicit provisions for consent to tests or procedures, with alternatives when possible. If a request is made that feels ethically uncomfortable for the surrogate, discuss acceptable compromises and seek to align medical necessity with personal agency. A well-crafted agreement can accommodate complex feelings without compromising safety.
To sustain fairness over time, incorporate regular review points into the agreement. Schedule periodic check-ins that revisit consent for ongoing procedures, daily routines, and the evolving needs of the pregnancy. Use neutral language in updates to avoid implying fault or blame. Consider including a facilitator who can help navigate sensitive topics without taking sides. The goal is continuous collaboration rather than confrontation. When changes arise due to new medical information or personal circumstances, document them, confirm mutual understanding, and adjust the written agreement accordingly to preserve equity and trust.
Practical, compassionate steps for ongoing collaboration.
An equitable agreement also accounts for emotional labor and psychological impact. Pregnancy can stir anxiety, fear, or joy in unexpected ways, affecting communication. Establish a protocol for expressing concerns respectfully, with a focus on listening. Encourage both parties to articulate their emotional needs, such as desires for reassurance, boundaries around social media updates, or preferences for who accompanies the surrogate to medical appointments. The agreement should acknowledge the vulnerability inherent in surrogacy and include resources for counseling or support groups. When people feel heard and valued, conversations about difficult choices tend to unfold more smoothly.
Clear boundaries around information sharing help prevent conflicts with extended families and friends. Decide in advance what details may be shared publicly and what should remain private. Determine who, if anyone, is confidant to receive updates and with what frequency. This transparency minimizes unsolicited input and preserves the dignity of everyone involved. It also provides a framework for responding to comments or pressure from outsiders. A well-managed information plan reinforces autonomy while maintaining the shared goal of a healthy, successful pregnancy.
Ensuring lasting fairness through shared responsibility and clarity.
A practical tool is the decision log—a neutral, dated record of choices made and the rationale behind them. Keeping such a log ensures accountability and helps new clinical teams understand the history of decisions if medical circumstances change. The log should capture who was involved, the options discussed, the final choice, and any dissenting views. It also serves as a reference if future disputes arise. Importantly, the log should be accessible to both parties and their legal representatives, reinforcing a sense of joint stewardship over the pregnancy and its outcomes.
Incorporate contingency planning for unexpected events. For example, if a diagnosed condition requires alternative treatments or procedures, it is essential to revisit consent with both sides present. Creating a set of “what if” scenarios enables proactive problem solving and reduces anxiety. Agree on how resource allocation, such as time off work and financial contributions, will be handled under various possibilities. This foresight demonstrates commitment to shared responsibility and helps keep decisions aligned with the family’s broader values.
In the final analysis, equitable decision making hinges on trust, clarity, and adaptability. The best agreements recognize that circumstances will evolve, and rigid rules can hinder compassionate responses. A collaborative process should invite ongoing input from both the surrogate and the intended parents, with mechanisms to adjust the plan as circumstances shift. Celebrating milestones together—ultrasounds, birth planning, and eventual transitions into parenthood—can reinforce teamwork. By prioritizing open communication, fair processes, and mutual respect, all parties can navigate pregnancy with dignity and confidence, reducing the likelihood of conflict while maximizing the chance for a healthy outcome.
To translate these principles into everyday practice, commit to a living agreement that remains flexible yet clear. Provide for regular revisits, inclusive dialogue, and access to neutral counsel. Establish shared goals that center safety and wellbeing for the fetus and the surrogate’s health, while acknowledging the intended parents’ longing to participate in meaningful ways. The resulting framework should feel participatory rather than prescriptive, empowering both sides to contribute their perspectives. With intentional design and thoughtful facilitation, decision making during pregnancy can unfold as a cooperative journey rather than a battleground, yielding harmony and trust that endure beyond birth.
