Miscarriage During a Surrogate Pregnancy

Surrogacy can be a beautiful journey, filled with hope, purpose, and deep human connection. But sometimes, this path takes an unexpected and painful turn: a miscarriage. When this happens during a surrogate pregnancy, the emotional, physical, and logistical challenges can be even more complex—for both the surrogate and the intended parents.

Let’s talk honestly about what happens, what it means, and how everyone involved can begin to process and move forward.

Miscarriage is more common than most people think. According to data from the American College of Obstetricians and Gynecologists (ACOG), roughly 10–20% of known pregnancies end in miscarriage. In the context of surrogacy, the causes are largely the same as in any pregnancy, but there are some additional layers worth considering.

Physically, a miscarriage may involve cramping, bleeding, and passing tissue. This can occur naturally or require medical management like a D&C (dilation and curettage) or medication such as misoprostol.

Medically, clinics or OBs will usually confirm the miscarriage via ultrasound and bloodwork. Depending on how far along the pregnancy was, the approach to treatment may differ.

Possible Causes of Miscarriage

Common Biological Causes

1. Chromosomal abnormalities: These account for the majority of miscarriages in the first trimester and are usually random.
2. Hormonal imbalances: Issues like low progesterone or thyroid disorders can interfere with a pregnancy’s development.
3. Uterine abnormalities: Conditions like fibroids or uterine septum can increase miscarriage risk.
4. Infections: Some untreated infections (like listeria, cytomegalovirus, or toxoplasmosis) can pose risks.
5. Lifestyle factors: Smoking, alcohol use, or unmanaged chronic conditions can all be contributors.

Surrogacy-Specific Considerations

6. Embryo quality: Since many surrogacies involve IVF, embryo quality is a major factor. Even when embryos are tested, there’s always a risk.
7. Immune system response: In rare cases, a surrogate’s body may react to the pregnancy as a foreign presence.
8. Medication protocols: Surrogates typically take hormone support medications. Mistimed or discontinued use (rare, but possible) can lead to complications.

Psychological Effects of Miscarriage

What You May Feel

1. Grief – Even if you weren't genetically connected to the baby, your body was still nurturing it.
2. Guilt – Many surrogates wonder, “Did I do something wrong?” (Answer: very likely, no.)
3. Fear – Concerns about whether you’ll be able to carry again or what this means for future matches.
4. Disconnection – A sudden loss after months of medical protocols and bonding can leave you feeling empty or alone.
5. Responsibility – Feeling you’ve let down the intended parents, even if no one is blaming you.

How to Cope with Your Emotions

1. Seek Professional Support: A licensed therapist—ideally one experienced in fertility or perinatal grief—can help untangle your emotions in a safe space.
2. Talk to Other Surrogates: You're not alone. Surrogacy forums, online groups, and peer networks can offer understanding that family and friends might not be able to.
3. Give Yourself Grace: This wasn’t your fault. Allow yourself time to heal, both physically and emotionally.

Navigating the Relationship with Your Intended Parents

Open, Honest Communication

Both sides are grieving. It's important to talk about what happened in an open but respectful way. Ask how they’re doing. Share how you’re feeling. If you’re not ready to talk, a heartfelt message or email is also okay.

Agency Support Can Help

Agencies can act as mediators, especially when emotions are raw. If you're unsure how to proceed, ask your coordinator for help setting up a conversation.

Give Each Other Time

Some intended parents may pull back temporarily to process their own grief. Don’t take this personally. Everyone heals at their own pace.

Determining Your Next Steps after Miscarriage

Medical Evaluation

You’ll likely undergo a full post-miscarriage workup, especially if the pregnancy was beyond the first trimester or if this wasn't your first loss. This may involve blood tests, ultrasounds, or a uterine evaluation.

Re-Matching or Trying Again

If you and the intended parents wish to try again, you’ll need medical clearance. Most clinics recommend waiting at least one full cycle before a new embryo transfer.

Legal and Financial Considerations

Contracts usually address miscarriage scenarios, including reimbursements for time, travel, and medical costs. Review your agreement and speak with your agency or attorney if needed.

Useful Resources

For more information on miscarriage, pregnancy health, and mental wellness, you can visit:
womenshealth.gov
nimh.nih.gov
cdc.gov
nih.gov

Conclusion

Miscarriage during a surrogate pregnancy is devastating—and uniquely complex. But with the right support, honest communication, and time, healing is possible. Whether you’re a surrogate, an intended parent, or part of the agency support team, the most important thing is compassion—for each other and for yourself.

Your journey isn’t over. It may just be taking a different path.