Determinants of gestational surrogates' satisfaction in relation to the characteristics of surrogacy cases

Research question: The study undertook an evaluation of the retrospective experiences of gestational surrogates within a Canadian context. Design: Data were collected using an anonymous online survey from June 2016 to February 2017 with participants recruited from the Canadian surrogacy community and the internet. The characteristics of surrogacy arrangements carried out by the participants, factors influencing their surrogacy satisfaction, the impact of surrogacy on their family functioning, and their attitudes towards carrying a pregnancy for different types of intended parents were analysed. Results: A total of 184 gestational surrogates (mean age at surrogacy 32 years, range 21-48 years) who were involved in 287 arrangements completed a study-specific survey. More than three-quarters of these cases involved an agency (225 cases, 78.4%). Most of the intended parents were heterosexual couples (158, 55.1%), followed by same-sex male couples (113, 39.4%). More than one-third of these cases were for non-residents from 15 different countries (n = 108, 37.6%). The two main determinants of surrogates' satisfaction were being a surrogate for domestic intended parents (P < 0.05) and having a viable pregnancy outcome (P < 0.005). Nine out of ten participants were comfortable with carrying a pregnancy for same-sex male couples (93.4%) and cancer survivors (89.6%), yet less than one-third (30.7%) were comfortable with being a surrogate for heterosexual couples at advanced ages of over 50 years. Conclusions: The findings suggest that many intended parents, including same-sex male couples and non-residents, used Canadian surrogacy services to build their families. A better understanding of the fundamentals contributing to positive experiences would help clinicians develop better practice models to care for the well-being of surrogates.