Is concurrent gestational surrogacy an ethical practice?

Gestational carrier use has gained significant attention over the last three decades as an important family-building option for individuals and couples unable to carry a pregnancy. It is used by women with uterine factor infertility or medical contraindications to pregnancy, as well as by single men and same-sex male couples. Although gestational surrogacy represents a relatively small proportion of assisted reproductive technology (ART) cycles in the United States, it is one of the fastest-growing groups. In 2022, the Centers for Disease Control and Prevention reported that 1.5% of all ART cycles involved gestational carriers—a four-fold increase from 1999. As the practice expands, so too does the surrounding conversation about its social, ethical, and legal complexity. Ethical concerns have been raised regarding medical risks to gestational carriers, the psychological implications for intended parents and future offspring, and broader societal issues such as commodification, power dynamics, and the potential exploitation of carriers. Nevertheless, professional societies, including the American Society for Reproductive Medicine, the Society for Assisted Reproductive Technology, and the American College of Obstetricians and Gynecologists, continue to support gestational carrier use as a reasonable and ethically acceptable option for individuals who cannot conceive or carry a pregnancy.

Conclusions: The concurrent use of two gestational carriers highlights the tension between reproductive autonomy and professional responsibility. Ethical practice in assisted reproduction demands that the clinician carefully weighs the fulfillment of patient preference against their broader implications. Balancing autonomy with beneficence, nonmaleficence, justice is essential to protect the best interests and safety of GCs. This approach minimizes unnecessary risk to the GCs and promotes equitable access to a limited avenue of reproductive care. As reproductive medicine continues to evolve, we must continue to remain grounded in ethical integrity.