Why People Choose Surrogacy: Medical, Social, and Cultural Perspectives

Surrogacy is one of those topics that sits at the intersection of biology, emotion, culture, and social identity. For the people who pursue it, the decision is rarely simple – it’s the result of deeply personal circumstances, long-considered values, and sometimes years of heartbreak. So why do people choose surrogacy? The answer spans medical realities, social structures, a profound desire for genetic connection, and even ancient human history. Understanding these reasons is essential to grasping surrogacy not just as a reproductive technology, but as a human experience.

Medical infertility and surrogacy 🔗

For a significant proportion of intended parents, surrogacy begins with a medical diagnosis. Medical infertility refers to physical or biological conditions that prevent conception or the ability to carry a pregnancy to term. According to the National Infertility Association (RESOLVE), conditions such as an absent or impaired uterus, chronic illness, or a history of cancer are among the most common medical reasons people turn to a surrogate.

Some women are born without a uterus (a condition called Mayer-Rokitansky-Küster-Hauser syndrome), while others have it surgically removed due to cancer or life-threatening complications. Conditions like severe endometriosis, uterine scarring, repeated IVF failure, or dangerous pregnancy complications such as preeclampsia can also make carrying a child medically inadvisable or physically impossible. UPMC, one of the leading medical centers in the U.S., notes that fertility problems and medical conditions that make pregnancy high-risk are among the primary circumstances in which a surrogacy arrangement becomes necessary.

Male infertility is another factor. For single men or male same-sex couples who want a biological child, surrogacy – typically paired with egg donation – is the only available path to genetic parenthood. A peer-reviewed study published in PMC identifies infertility, medical conditions, same-sex parenting, and sexual identity diversity as the primary drivers behind surrogacy decisions globally.

Social infertility: when the barriers aren’t biological 🔗

Not everyone who chooses surrogacy is medically unable to carry a child. Social infertility is a term used to describe the situation of individuals or groups who face structural or social barriers to having children through conventional means – not because of a physical condition, but because of who they are or the circumstances of their lives.

Same-sex male couples, for example, cannot carry a pregnancy and must rely on a surrogate and egg donor to have a child. Single men who wish to become fathers face the same situation. A study on single fathers and surrogacy found that the majority of these men pursue surrogacy specifically because they value a genetic connection to their child and view it as a more legally predictable path than adoption. Lesbian couples may choose surrogacy so that one partner can contribute eggs, creating a biological tie even when the other partner cannot carry the pregnancy.

Age is another social factor. Older individuals or couples – people who delayed family-building due to career, relationships, or health concerns – may find that pregnancy is no longer safe or viable for them, even if no specific medical diagnosis exists. The Hatch surrogacy agency notes that in some cases, mental health considerations, such as severe anxiety around pregnancy, can also constitute a genuine barrier that leads people toward surrogacy. These motivations are not about convenience – they reflect the full range of human lives and the structures within which reproduction takes place.

LGBTQ+ families and surrogacy 🔗

For LGBTQ+ individuals and couples, surrogacy is often not a last resort but one of the few viable paths to biological parenthood from the outset. Research on gay fathers found that most chose surrogacy over adoption largely because of a desire for genetic connection, and also because adoption systems in many regions continue to present legal and institutional barriers for same-sex couples. In gestational surrogacy, one partner’s sperm can be used with a donor egg, allowing at least one parent to have a biological link to the child. Some couples even alternate genetic contribution across multiple pregnancies, ensuring both partners have a biological child.

The preference for a genetic link: surrogacy over adoption 🔗

One of the most significant reasons people choose surrogacy rather than adoption is the desire for a genetic connection to their child. This is not a superficial preference – it is rooted in deep emotional, psychological, and cultural needs that researchers and clinicians have documented across multiple populations.

A review published in the journal Psychosocial Intervention found that the primary motivation for choosing gestational surrogacy over adoption is the desire to have a genetic link with the child, alongside the wish to be involved in the pregnancy from the start. Intended parents often describe wanting to know their child’s full genetic history, to pass on family traits, and to feel a biological continuity between themselves and the next generation.

There are also practical considerations that reinforce this preference. SurrogateFirst highlights that surrogacy generally offers greater legal clarity for intended parents – a pre-birth parentage order can often be obtained, meaning the intended parents are recognized as the legal parents from the moment of birth. Adoption, by contrast, involves court processes that begin after birth, a waiting period during which a birth parent can change their mind, and in many regions, significant barriers for single individuals or same-sex couples. These legal realities make surrogacy a more predictable and secure route for many families, quite apart from the question of genetics.

It is also worth noting that genetic preference is not universal. Research on gay fathers found that roughly half of participants cited genetic connection as a primary factor, while others chose surrogacy primarily for legal or practical reasons. The decision is always multifaceted.

Surrogacy vs. adoption: a nuanced comparison 🔗

Adoption and surrogacy both lead to parenthood, but they serve different needs. Adoption provides a home for children who already exist and need families. Surrogacy creates a child specifically for a family that intends to raise them. The ethical dimensions of both paths are worth taking seriously. Critics of surrogacy sometimes argue that it prioritizes the desires of adults over the well-being of children already in need of homes. Proponents counter that the desire to have a biological child is a legitimate human aspiration, and that surrogacy and adoption are not mutually exclusive – different families have different needs, values, and circumstances.

Adoption costs in the U.S. typically range from $10,000 to $50,000 depending on the type, while surrogacy can cost between $100,000 and $150,000 or more. This financial gap means that surrogacy, despite being a preferred option for many, remains inaccessible to a large portion of people who might otherwise choose it.

Historical roots of surrogacy 🔗

Surrogacy is not a product of the modern fertility industry. The human desire to have biological children – and the arrangements people made to fulfill that desire when nature did not cooperate – can be traced back thousands of years.

One of the earliest recorded accounts of surrogacy comes from the Book of Genesis in the Hebrew Bible. Sarah, unable to conceive a child with her husband Abraham, offered her handmaid Hagar to carry a child on her behalf. Later in Genesis, Rachel similarly gave her maid Bilhah to Jacob when Rachel herself could not conceive. These accounts describe what we would today call traditional surrogacy, where the woman carrying the child also contributes her own eggs and is therefore genetically related to the baby.

Beyond biblical texts, ancient Mesopotamian and Babylonian records reveal that surrogacy-like arrangements were legally recognized. The Code of Hammurabi, a Babylonian law code dating to approximately 1754 BCE, contains provisions related to surrogacy. Notably, according to Wikipedia’s extensively sourced entry on surrogacy, Babylonian law allowed infertile women to use surrogacy specifically to avoid divorce, which was otherwise considered inevitable if a wife could not produce an heir. A cuneiform marriage contract discovered in Kültepe-Kanesh, Turkey, and dated to around 2000 BCE, even stipulated that if a couple could not produce a child within two years, a slave woman would be brought in as a surrogate – one of the earliest written surrogacy contracts in existence.

Ancient Hindu mythology also contains surrogacy-like narratives. The story of Kunti in the Mahabharata, who bore children through divine intervention on behalf of the Pandava family, reflects a cultural recognition that biological parenthood could be mediated through other women. Historical surrogacy records also reference ancient Greece, where surrogacy themes appear in mythological narratives alongside the practical use of wet nurses and proxies in aristocratic family lines.

What ancient surrogacy tells us 🔗

A consistent thread runs through all of these ancient examples: the overwhelming social and cultural pressure to produce biological heirs. In most ancient societies, surrogacy was considered a last resort for continuing a family line – something resorted to only when all other options had failed. The preservation of lineage, the inheritance of property, and the fulfillment of religious and cultural obligations all depended on a man having a biological heir. This meant that infertile women faced not just personal grief, but social stigma, legal vulnerability, and the threat of divorce or displacement.

It is significant that even in these ancient contexts, the arrangement involved a woman carrying a child on behalf of the intended family – the child would then be claimed and raised by the commissioning couple. The social logic of surrogacy, in other words, has been remarkably consistent across millennia: where biological parenthood was impossible, communities found ways to approximate it.

Modern surrogacy, enabled by in vitro fertilization (IVF) since the 1970s and the birth of the first IVF baby Louise Brown in 1978, has transformed this ancient practice entirely. Today’s gestational surrogacy – in which the surrogate carries an embryo to which she has no genetic relationship – separates biological and gestational motherhood in a way that ancient cultures could never have imagined. Yet the underlying motivation remains unchanged: the deep human desire to have a child one can call one’s own.

What do you think? Does the historical continuity of surrogacy – from ancient Babylon to modern IVF clinics – change how you perceive it as a practice? And how should societies weigh the rights and wellbeing of surrogates against the reproductive aspirations of intended parents?

References

1. https://resolve.org/learn/family-building-options/surrogacy/
2. https://www.upmc.com/services/womens-health/services/obgyn/obstetrics/fertility/surrogacy
3. https://pmc.ncbi.nlm.nih.gov/articles/PMC6077588/
4. https://pmc.ncbi.nlm.nih.gov/articles/PMC9688871/
5. https://www.hatch.us/en/blog/social-surrogacy
6. https://pmc.ncbi.nlm.nih.gov/articles/PMC5400050/
7. https://www.elsevier.es/es-revista-psychosocial-intervention-362-articulo-gestational-surrogacy-psychosocial-aspects-S1132055916300230
8. https://surrogatefirst.com/surroblog/surrogacy-vs-adoption/
9. https://surrogate.com/about-surrogacy/surrogacy-101/history-of-surrogacy/
10. https://www.numberanalytics.com/blog/surrogacy-history-motherhood-context
11. https://en.wikipedia.org/wiki/Surrogacy
12. https://www.tammuz.com/the-history-of-surrogacy/
13. https://surrogatefirst.com/surroblog/history-of-surrogacy-when-did-surrogacy-start/