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Life insurance is important for gestational carriers (surrogates) because it provides financial protection for their families in the event of a worst-case scenario. 

Although serious complications are rare, pregnancy and childbirth do carry medical risks, and surrogates take on those risks on behalf of intended parents.

Surrogates often have children or dependents of their own. If a life-threatening complication occurred, the policy ensures their family wouldn’t face financial hardship.

Most ethical agencies or legal agreements require a policy:

• usually at least $250,000 to $500,000
• paid for by the intended parents
  This safeguards everyone in the arrangement.

Knowing coverage is in place allows the surrogate and her family to feel secure throughout the process.

Modern Fertility Law has made this content available to the general public for informational purposes only. The information on this site is not intended to convey legal opinions or legal advice.

Surrogacy contracts sit at one of the most sensitive crossroads in law and human emotion. They are not just documents to sign; they are frameworks of shared responsibility, trust, and moral clarity. A surrogacy contract should never be treated as a checklist of signatures and clauses. It must represent a true meeting of the minds—a genuine, mutual understanding of what each party values, expects, and agrees to do when things go smoothly and when they don’t.

The Meaning of a “True Meeting of the Minds”

In law, a contract requires “offer,” “acceptance,” and “consideration.” But in surrogacy, it requires something deeper: alignment of intent. A meeting of the minds means both the intended parents and the surrogate fully grasp—not just the words, but the spirit—of what they are agreeing to. For example: A surrogate may say, “I agree to carry your embryo,” believing she retains some influence over medical choices. The intended parents may think, “She has agreed to follow every medical instruction we approve. Both believe they are agreeing to the same thing—but perhaps they are not. Without clear conversation, there is no true meeting of the minds. The contract must therefore go beyond legal language and ensure that each participant cognitively understands what they’re agreeing to.

Simplifying Legal Language for Laypersons

Most parties are not lawyers, and the language of “hereinafter,” “indemnify,” and “severability” can alienate them. The goal is to translate legalese into human sense without losing accuracy. Even if the parties have a legal background or experience with documents, a more “user-friendly” contract is more appropriate for surrogacy arrangements. After all, this is not an impersonal transaction for the sale of goods. Example:  Legalese: “Material breach”. Plain language: “A serious violation that changes the purpose of the agreement—for example, refusing to undergo embryo transfer without medical reason.“

A contract isn’t just a signature—it’s a shared understanding. If any part feels unclear or uncomfortable, let’s talk about it.

Modern Fertility Law has made this content available to the general public for informational purposes only. The information on this site is not intended to convey legal opinions or legal advice.

It is recommended that Intended Parents disclose working with multiple surrogates to ensure everyone is informed, to maintain transparency, and to build a solid foundation of trust with each surrogate and the agency. This disclosure is crucial for managing expectations, preventing misunderstandings, and ensuring that both the surrogates and the Intended Parents are making decisions with complete information, which is a key component of the surrogacy process. It also avoids potential complications and ensures that the agency can properly support all parties involved.

Key reasons for disclosure:

• Transparency and trust: Open communication is essential for building a strong relationship between Intended Parents and surrogates. Hiding the fact that multiple surrogates are involved can erode trust if discovered later.
• Informed consent: Surrogates must be fully informed about all aspects of the arrangement, including the number of surrogates involved and the reasons behind it, to provide free and informed consent.
• Agency support: Agencies need full information to ensure they are supporting the needs of both the Intended Parents and the surrogates effectively, especially in managing the complexities of a multi-surrogate arrangement.
• Preventing complications: Disclosure prevents potential medical, legal, and emotional complications that could arise if the information is kept secret.

Modern Fertility Law has made this content available to the general public for informational purposes only. The information on this site is not intended to convey legal opinions or legal advice.

Advances in assisted reproductive technologies (ART) have made it possible for many more people to have children than a generation ago. Clinics and policymakers, however, do not treat ART as purely a medical service divorced from the future child’s welfare. Assessments of prospective parents’ ability to raise a child—sometimes called “welfare of the child” or “parenting capacity” considerations—have both ethical and practical effects on who receives treatment, how services are funded, and where people seek care. Here we will examine how judgments about the ability to provide parental care influence access to fertility services, with attention to regional legal frameworks, income and socioeconomic status, age, health and medical history, and the practical tensions clinics face when balancing reproductive autonomy with child welfare.

Clinical and ethical foundations

Professional bodies and national regulators generally accept that welfare considerations are part of responsible fertility practice, though they frame and apply that principle differently. In the United States the American Society for Reproductive Medicine (ASRM) has advised clinicians that the ability to provide parental care is a legitimate ethical concern that can, in limited and well-reasoned circumstances, justify withholding treatment. The guidance stresses careful, individualized assessment rather than broad moralizing or discrimination.

In the UK the Human Fertilisation and Embryology Authority (HFEA) requires clinics to consider the welfare of any child who might be born as a result of treatment; welfare assessments are embedded in clinic practice and, when there are clear risks of significant harm to a child, clinics are expected to refuse treatment. That regulatory duty creates a formal gatekeeping role for clinics which is uncommon elsewhere.

These high-level statements leave much room for interpretation. In practice clinics must translate ethical standards into workable policies: what counts as an unacceptable risk; how to weigh poverty against parental love and support networks; whether older parenthood is a disqualifier; and how to respond to histories of substance misuse, severe mental illness, or criminal behaviour. The answers vary widely and drive the patterns of access explored below.

Regional factors: law, regulation and public funding

Where you live strongly determines whether and how parenting capacity is considered.

United Kingdom: The HFEA requirement to assess welfare of the child makes parenting assessments routine in fertility clinics. Local NHS commissioning policies also add eligibility conditions for funded IVF—age caps, requirement that at least one partner has no living children, BMI and smoking rules—and those criteria differ by commissioning area. The combined effect is both a legal basis for welfare screening and a patchwork of local eligibility that shapes access.

United States: Regulation is mostly at the clinic and medical-association level rather than centralized statutory rules. ASRM guidance influences practice but does not create hard regulatory thresholds. Public funding for ART is minimal in most U.S. states, so access is strongly market-driven and clinics adopt varied screening approaches—some formalize psychosocial assessments; others limit evaluations to medical suitability.

Europe and elsewhere: Countries range from very permissive (Denmark, where donor systems and clinic policies are liberal, attracting cross-border patients) to restrictive (nations that limit access to married heterosexual couples or impose strict age limits). Public funding frameworks (e.g., Denmark, parts of Scandinavia vs. France’s evolving policies or private-heavy systems) create different incentives: where public programs exist, regulators are more likely to impose welfare and eligibility rules; where services are privately purchased, socioeconomic barriers dominate.

Regulatory differences also create fertility tourism: patients denied access or facing restrictive eligibility at home may travel to jurisdictions with fewer welfare screens or different eligibility rules. That movement redistributes ethical questions—who bears responsibility for ongoing child welfare when treatment occurs abroad?—and can exacerbate inequities between those who can travel and those who cannot.

Income and socioeconomic status

Socioeconomic factors are among the strongest predictors of who obtains ART and how clinics treat welfare concerns.

Affordability and funding: Where ART is expensive and largely private, income becomes the primary access barrier. People with higher incomes can not only pay for procedures but also choose clinics with more permissive psychosocial screening or opt for treatment abroad. In contrast, in public systems where ART is funded, means-testing and eligibility criteria (e.g., no prior children, residency requirements) often shape access in complex ways. Studies consistently show socioeconomic disparities in ART usage even where some public funding exists.

Poverty and welfare considerations: Poverty itself is not a reliable indicator of child maltreatment risk, but clinics and funders sometimes treat low income as a marker of instability. In some jurisdictions, scarcity of public resources leads policymakers to prioritize applicants who appear most likely to achieve positive outcomes (e.g., stable household, employment). This introduces moral tension: denying treatment because of poverty risks punishing social inequality rather than protecting children—and may disproportionately affect racialized or marginalized groups. Evidence suggests that welfare-based gatekeeping can perpetuate social inequities unless coupled with social supports and clear, narrowly tailored criteria.

Age factors: parental age, fertility potential and welfare concerns

Age affects both medical suitability for ART and concerns about future caregiving.

Medical and outcome considerations: Female reproductive aging reduces success rates and raises pregnancy risks; paternal age introduces genetic considerations. Clinically, age has an objective role in counseling and in some publicly funded programs where age cutoffs determine eligibility. These clinical realities justify some age-sensitive policies, but they do not automatically translate into blanket disqualification.

Parental care horizon: Regulators and clinicians sometimes justify age limits on the basis that prospective parents may die or become incapacitated while children are young. The ethical counterargument stresses reproductive autonomy: chronological age predicts variability across individuals, and age alone is a blunt instrument for assessing parenting capacity. Best practice recommends individualized risk assessment (medical, social support, estate planning) rather than rigid age exclusion. Professional guidance increasingly emphasizes balancing outcome probabilities with fair access.

Health and medical history

Physical health, mental health, substance use, and past social history are central to welfare assessments.

Physical health and pregnancy risk: Chronic medical conditions (cardiac disease, uncontrolled diabetes, severe pulmonary disease) can make pregnancy dangerous. Clinics are ethically and medically obligated to counsel about risks and may decline treatment when pregnancy would pose serious maternal risk. Reproductive autonomy interacts with non-maleficence: when treatment is likely to cause significant harm to the patient, many programs will decline. ASRM and other bodies provide frameworks for these judgments.

Mental health and substance use: A history of severe, untreated mental illness or active substance misuse raises concerns about capacity to parent safely. However, clinicians are typically advised to distinguish between treatable or remitted conditions and active, uncontrolled risk. Offering support and treatment (e.g., addiction services, psychiatric stabilization) and reassessing can be more just than outright refusal. Blanket exclusions based on diagnosis are discouraged; the focus should be on current functioning and supports.

Criminal history and child protection records: Serious histories—e.g., convictions for violence against children—are legitimate grounds for concern. Regulatory frameworks like the HFEA permit refusal when there is reasonable belief that a child would be at risk of significant harm. Clinics must balance privacy, evidence standards, and fairness when investigating such histories. Clear thresholds, pathways for review, and opportunities to provide mitigating evidence (rehabilitation, changed circumstances) help make these decisions less arbitrary.

Practical clinic responses and variability

Because the criteria are complex and locally variable, clinics deploy a range of operational responses:

Routine psychosocial screening: Many clinics include baseline psychosocial questionnaires and brief assessments to flag potential concerns; these can be triaged to social workers or psychologists for fuller evaluation. Clear, transparent forms reduce the sense of hidden gatekeeping.

Referral to social supports: Where social determinants (housing instability, poverty, lack of parenting skills) are the main concerns, some programs link prospective parents with social services rather than refuse treatment outright. This cooperative model recognizes that improving parental capacity can be a route to safe childbearing.

Hard refusal with appeal mechanisms: In jurisdictions with legal mandates (e.g., HFEA), clinics may refuse and document reasons; good practice includes an appeal or review mechanism and clear communication about the reasons and any remedial steps a patient might take.

Policy implications and recommendations

The intersection of child welfare and reproductive services raises difficult moral questions. Several practical recommendations can reduce arbitrariness and inequity:

Explicit, evidence-based criteria: Regulators and clinics should publish clear, narrowly tailored standards that specify what constitutes an unacceptable risk to a child and how assessments are carried out. This reduces discretion and perceived bias.

Individualized assessments with pathways to remedy: Rather than blanket exclusions (e.g., by age or poverty), clinics should offer individualized evaluation and, where appropriate, link patients to services (mental health care, addiction treatment, housing supports) that address modifiable risks.

Equity safeguards: Because socioeconomic status is a major determinant of access, public funding and program design should seek to reduce disparities—either by expanding funding or by ensuring that welfare assessments do not become proxies for social disadvantage.

Transparency and appeal: Patients should receive written reasons for refusals and have access to timely review. Transparency builds trust and allows patients to remedy specific concerns.

Cross-border coordination: For patients who travel for treatment to avoid restrictive regimes, better international cooperation on follow-up care and child protection standards would reduce ethical and practical harms.

Conclusion

The ability to provide parental care legitimately factors into the responsible provision of fertility services, but how it is assessed and applied varies widely by jurisdiction, clinic practices, and the availability of public funding. Age, health, medical history, and socioeconomic context all influence both the clinical suitability for treatment and ethical judgments about future child welfare. The dominant ethical challenge is to protect children without entrenching social inequities or arrogating moral judgments that exclude deserving parents. Clear, evidence-based policies, individualized assessments, support pathways for modifiable risks, and transparency are the practical tools that can reconcile reproductive autonomy with child protection in a fairer and more humane way.

Modern Fertility Law has made this content available to the general public for informational purposes only. The information on this site is not intended to convey legal opinions or legal advice.

The use of donor gametes and embryos has enabled millions of people worldwide to experience parenthood despite infertility, medical challenges, or lack of a reproductive partner. While the medical aspects of assisted reproduction have evolved rapidly, the psychosocial and ethical question of whether—and when—to inform children about their conception through gamete or embryo donation remains one of the most enduring and sensitive debates in reproductive ethics.

Parents must navigate a complex landscape of emotional, psychological, legal, and privacy issues when deciding whether to disclose this information. Furthermore, advances in genetic testing and information sharing make it increasingly difficult to ensure secrecy. The decision to tell or not tell—along with how and when to tell—carries profound implications for family relationships, identity formation, and the privacy of all parties involved.

I. The Case for Disclosure: Honesty, Identity, and Trust

1. Promoting Psychological Well-being and Identity Formation

Children who learn about their donor conception early, in an open and supportive environment, often integrate this information into their sense of identity in a healthy way. Research suggests that children told before adolescence tend to experience less confusion and distress than those who learn later or by accident.

Knowing one’s genetic background can help an individual understand aspects of their health, personality, or appearance. It can also prevent a sense of betrayal that may arise if the truth is discovered through other means, such as genetic testing or accidental disclosure by a relative.

Disclosure, when handled sensitively, strengthens the parent-child bond by demonstrating trust and openness. Many psychologists argue that withholding this information can create an atmosphere of secrecy, which may undermine familial trust if the truth emerges later.

2. Medical and Genetic Awareness

Knowing one’s genetic origins can have practical health benefits. Access to accurate medical histories is essential for assessing genetic risks and guiding health decisions. Even when donor anonymity limits the information available, knowing that a donor was involved allows offspring to seek updates if genetic health issues arise or if new information about hereditary conditions becomes relevant.

3. The Ethical Imperative of Truth

From an ethical standpoint, many argue that donor-conceived individuals have a right to know the truth about their origins. This view aligns with broader principles of autonomy and informed identity. Several professional organizations, such as the American Society for Reproductive Medicine (ASRM) and the European Society of Human Reproduction and Embryology (ESHRE), recommend openness with donor-conceived children as best practice.

These recommendations emphasize that knowledge about one’s conception is a matter of personal dignity and respect for the individual’s right to self-understanding.

4. Anticipating Future Discoveries

With the proliferation of direct-to-consumer genetic testing services like 23andMe, AncestryDNA, and others, the possibility of maintaining secrecy has drastically diminished. Even if parents do not disclose, the child—or their extended relatives—may discover the truth unintentionally through genetic matching databases.

When discovery occurs later in life without prior discussion, it often leads to feelings of shock, anger, or betrayal. In contrast, planned and age-appropriate disclosure allows parents to frame the narrative positively and helps the child understand their story in context.

II. The Case Against Disclosure: Privacy, Family Dynamics, and Emotional Risks

1. Protecting Family Unity and Emotional Stability

Many parents fear that revealing donor conception could destabilize the family’s sense of unity. For example, non-genetic parents—such as the father in donor sperm conception or the mother in cases of embryo donation—may fear being perceived as less of a “real” parent.

Parents may also worry that the child’s reaction could be one of confusion, rejection, or anger. For some, the decision to keep the conception private stems from a desire to protect the family’s emotional equilibrium and avoid unnecessary conflict.

2. Respecting Donor Privacy

Disclosure has implications not just for the parents and child, but also for the donor. Some donors, particularly those who contributed under anonymity agreements, did so with the expectation that their identities would remain confidential.

Revealing donor involvement—especially if the offspring later seeks identifying information—can infringe upon the donor’s privacy and autonomy. In regions that still allow anonymous donation, disclosing the existence of a donor can lead to emotional tension if the child’s curiosity cannot be satisfied due to legal or contractual barriers.

3. Cultural and Social Considerations

In some cultural or religious contexts, gamete or embryo donation remains stigmatized or even prohibited. Parents may fear social judgment or ostracization if the child—or the wider community—learns the truth.

Similarly, in small communities or among families with traditional views about genetics and inheritance, disclosing donor conception can raise uncomfortable questions about legitimacy, belonging, and parental roles.

For single parents or same-sex couples, disclosure may be perceived as redundant, since the use of donor gametes is often self-evident. Yet even in these cases, deciding how to explain the donor’s role requires care to preserve privacy while ensuring the child’s understanding.

4. The Risk of Overemphasizing Genetic Ties

Another argument against disclosure is that it may inadvertently reinforce the notion that genetic connections are more important than social or emotional ones. Parents who raise donor-conceived children often emphasize that love, commitment, and caregiving define parenthood—not biology.

In this view, focusing too heavily on donor identity could risk undermining the intended parents’ role or confuse the child’s perception of family structure.

III. Privacy Implications for All Parties Involved

1. The Donor’s Privacy

Donors have historically relied on anonymity, believing their identity would remain private. However, legal and technological changes are eroding this expectation. Several countries—such as the United Kingdom, Australia, and parts of Canada—have abolished anonymous donation, requiring that donor information be made available to offspring upon reaching adulthood.

For donors who contributed before such laws took effect, retroactive disclosure can be unsettling. Balancing a donor’s right to privacy with an offspring’s right to know remains a legally and ethically complex issue.

2. The Parents’ Privacy

Parents may also face privacy challenges if disclosure leads to broader social or familial awareness of their infertility or reproductive history. For some, the decision not to disclose is rooted in deeply personal experiences of grief or stigma associated with infertility.

Additionally, the more individuals who know the story, the greater the risk of unwanted dissemination of private reproductive information—especially in the age of social media and digital recordkeeping.

3. The Surrogate’s Privacy (if applicable)

In cases involving surrogacy alongside gamete or embryo donation, another layer of privacy emerges. The surrogate may wish to maintain confidentiality about her role, particularly if she is a gestational carrier with no genetic link to the child.

Conversely, the child may express interest in understanding all contributors to their conception—the donor(s) and the surrogate—raising complex questions about whose privacy takes precedence.

IV. The Inevitability of Disclosure in the Modern Age

Genetic testing, online databases, and the growth of social networks have made it nearly impossible to guarantee secrecy about biological origins. Even if parents choose nondisclosure, the truth may surface years later through a casual DNA test, a distant relative’s genetic match, or digital records.

In such circumstances, the context of discovery matters greatly. Learning the truth from an impersonal source, rather than from parents, can be emotionally devastating. Many adults who discovered their donor conception late in life describe feelings of betrayal—not because they were donor-conceived, but because the information was withheld.

Given these realities, many experts advocate a proactive approach: parents should aim to manage disclosure on their own terms, ensuring that the story is told with love, honesty, and sensitivity rather than being revealed accidentally or through third parties.

V. How to Conduct the Conversation

1. Timing and Developmental Stages

Professionals generally recommend beginning the disclosure process early—ideally before the child reaches adolescence. For young children, simple explanations can be given, evolving in complexity as the child matures.

For example:

Preschool years: Introduce the concept simply: “It took a special helper to make our family.”

Elementary school: Explain the role of the donor in more detail, emphasizing love and intentionality.

Teenage years: Discuss biological and ethical dimensions more fully, allowing space for questions and emotional processing.

Early disclosure allows the child to grow up with the knowledge as part of their normal life story, rather than as a shocking revelation later on.

2. Tone and Framing

The tone should always affirm the child’s place in the family and the love that surrounded their conception. Emphasizing intentionality—how deeply the parents wanted the child and the effort they took to bring them into the world—helps frame the story positively.

Avoid framing the donor or surrogate as a “parent.” Instead, describe them as someone who provided a gift that helped create the family. This approach reinforces emotional security while acknowledging the truth.

3. Resources and Support

Parents can benefit from counseling or guidance from professionals experienced in reproductive psychology. Storybooks for donor-conceived children, support groups, and online communities can provide language and reassurance for both parents and offspring.

Engaging in family therapy during adolescence or young adulthood may also help address questions of identity, especially if the child seeks to know more about their genetic background.

VI. Finding the Balance: Between Secrecy and Openness

Ultimately, the question of disclosure is not a binary choice between total secrecy and full transparency. It is a continuum shaped by family dynamics, cultural context, and personal comfort.

Some parents choose “partial openness,” sharing basic facts about donor involvement without providing identifying details. Others may wait until the child asks questions or reaches a certain level of maturity. What matters most is that decisions are made thoughtfully, with an understanding of how today’s choices may affect the child’s future sense of trust and belonging.

VII. Conclusion

The decision to inform offspring of their conception through gamete or embryo donation touches the deepest aspects of family, identity, and privacy. The benefits of disclosure—trust, openness, psychological well-being, and preparation for future discoveries—are increasingly recognized as outweighing the short-term comfort of secrecy.

Yet the process must be handled with great sensitivity to the privacy and emotions of all parties involved: the child, the parents, the donor, and, where applicable, the surrogate.

As technology continues to make genetic truth accessible, the emphasis should shift from whether to tell to how to tell—ensuring that children grow up understanding that their conception, however unique, was rooted in love, intention, and the deep desire to bring them into the world.

Modern Fertility Law has made this content available to the general public for informational purposes only. The information on this site is not intended to convey legal opinions or legal advice.