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Abstract

STUDY QUESTION
What were the psychological health outcomes for surrogates 20 years after the surrogacy pregnancy?

SUMMARY ANSWER
Most surrogates did not experience psychological problems 20 years after the pregnancy with many showing positive psychological wellbeing.

WHAT IS KNOWN ALREADY
Studies of surrogates from the global north have found that although some surrogates may experience psychological difficulties in the weeks following the birth of the child, this decreases over time, with most surrogates not experiencing psychological problems at 6 months, 1 year or 10 years following the birth.

STUDY DESIGN, SIZE, DURATION
Cross-sectional follow-up study of 21 surrogates who had conducted surrogacy ∼20 years previously (M = 20.33 years, SD = 3.31, range 13–26 years). Data are presented from phase 3 of the study. All participants were interviewed and 17 completed psychometric scales. Data were collected between December 2021 and September 2022.

PARTICIPANTS/MATERIALS, SETTING, METHODS
Twenty-one surrogates participated in the study. Ten surrogates (48%) had completed only gestational surrogacy arrangements, five (24%) had completed only traditional surrogacy arrangements, and six (29%) had completed both traditional and gestational surrogacy arrangements. All were domestic arrangements for heterosexual couples. Data were collected using semi-structured interviews and standardized psychometric questionnaires to assess experiences of surrogacy and psychological health of surrogates. Data on frequency of contact and relationship with the surrogacy family were also obtained.

MAIN RESULTS AND THE ROLE OF CHANCE
Seventeen of the 21 surrogates completed the questionnaires assessing mental health and psychological wellbeing. None of the 17 surrogates who completed the assessments of psychological health showed signs of depression. Four surrogates scored above the cutoff of 5 on the General Health Questionnaire-30 indicating a 50% likelihood of having a psychiatric condition. Two of the four were in contact with a medical professional about their mental health. The mean score for self-esteem as measured by the Rosenberg Self-esteem Scale was within the normal range. The scores on the Scale of Positive and Negative Experience questionnaire showed moderately positive emotional balance for the majority of participants. Most surrogates scored within the normal range for satisfaction with life and flourishing. Thirteen (62%) surrogates had stayed in contact with the child with 11 describing their relationship as positive.

LIMITATIONS, REASONS FOR CAUTION
Sample size for this study was relatively small and some participants from previous phases were unable to be contacted or declined. Five surrogates had completed 11 surrogacy arrangements between them since Phase 2. Seven of these were gestational arrangements, however, whether donor gametes were used was not recorded.

WIDER IMPLICATIONS OF THE FINDINGS
This is the first study to assess psychological health of surrogates 20 years after the birth of the child. Findings show that the majority of surrogates did not experience psychological problems in the longer term. Future research should focus on understanding what individual and contextual factors contribute to both negative and positive psychological health of surrogates in the longer term.

STUDY FUNDING/COMPETING INTEREST(S)
This research was funded by the Wellcome Trust (grant number 208013/Z/17/Z) and by the University of Cambridge’s Returning Carers Scheme. The authors have no conflicts of interest to declare.

TRIAL REGISTRATION NUMBER
N/A.

Publication Type:	Article
Additional Information:	© The Author(s) 2025. Published by Oxford University Press on behalf of European Society of Human Reproduction and Embryology. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
Publisher Keywords:	surrogacy, gestational, traditional, surrogate, follow-up, psychological health, mental health
Subjects:	B Philosophy. Psychology. Religion > BF Psychology R Medicine > RC Internal medicine > RC0321 Neuroscience. Biological psychiatry. Neuropsychiatry R Medicine > RG Gynecology and obstetrics R Medicine > RJ Pediatrics
Departments:	School of Health & Medical Sciences School of Health & Medical Sciences > Department of Psychology & Neuroscience
SWORD Depositor:	Symplectic Administrator

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