Medical Risks and Comprehensive Management of Miscarriage in Surrogate Mothers

Introduction: the specificity and complexity of surrogate mother abortion

Miscarriage by surrogate mothers not only involves medical risks, but also becomes a focus issue in the global reproductive health field due to the hidden nature of the surrogacy industry chain, legal gray areas and ethical controversies. According to statistics, the miscarriage rate of surrogate pregnancy is 15%-30% higher than that of natural pregnancy, which is related to multiple factors such as embryo quality, maternal health management, medical technology and psychological pressure. This article combines medical guidelines, legal cases and industry practice to analyze the causes of surrogate mother’s miscarriage, prevention strategies and subsequent rights and interests protection, providing systematic references for commissioning families, surrogacy agencies and medical teams.

Main types and medical causes of surrogate mother’s miscarriage

1. Early miscarriage (before 12 weeks of pregnancy)
   Embryo chromosome abnormality: about 60% of early miscarriages are caused by chromosome number or structure abnormality of the embryo, especially when the commissioning party uses advanced age eggs (>35 years old) or poor sperm quality, the risk surges.
   Maternal luteal insufficiency: surrogate mothers with hormonal imbalances (e.g., low progesterone levels) may not be able to maintain endometrial tolerance, leading to failure of embryo implantation or early miscarriage.
   Infection and immune rejection: Frequent medical operations during surrogacy (e.g. embryo transfer) may trigger endometritis, while maternal immune rejection of the embryo (e.g. antiphospholipid antibody syndrome) is also an important trigger.
2. Late miscarriage (13-28 weeks of gestation)
   Cervical insufficiency: surrogate mothers with congenital cervical laxity or a history of previous cervical surgery may experience premature rupture of membranes in the absence of contractions, leading to irreversible miscarriage.
   Complications of pregnancy: poorly controlled hypertension, pre-eclampsia and diabetes during pregnancy can directly threaten placental function, resulting in inadequate blood supply to the fetus and miscarriage.
   Risks of multiple pregnancies: In order to increase the success rate, some institutions implant multiple embryos in violation of the law, leading to uterine overdistension and increased risk of preterm delivery.
   Case Alert: In 2025, a surrogacy agency in Zhongshan, Guangdong Province implanted three embryos in violation of the law, resulting in cervical tear hemorrhage at 20 weeks of gestation of the surrogate mother, and ultimately, both fetuses were miscarried and triggered medical disputes.

The prevention strategy and medical intervention of surrogate mother’s miscarriage

1. Scientific control of embryo quality
   Three-generation IVF technology (PGT): screening for chromosomal abnormalities and single-gene disorders through pre-implantation genetic testing (PGT-A/PGT-M) of embryos, reducing the miscarriage rate from 40% to less than 10%.
   Sperm and egg source standardization: preferred healthy egg donors aged 25-35 years old, and DFI (DNA Fragmentation Index) testing of the commissioning party’s sperm, requiring DFI <15% to reduce the risk of embryo sterilizations.
2. Health management of surrogate mother
   Comprehensive preconception screening:
   Control of underlying diseases: hypothyroidism, diabetes mellitus and coagulation abnormalities require treatment to be completed 3 months prior to embryo transfer.
   Reproductive system assessment: uterine malformations, submucous fibroids and other impediments to implantation are ruled out through hysteroscopy.
   Pregnancy monitoring is standardized:
   Hormonal support: progesterone vaginal gel (90 mg/day) was continued after transfer until 12 weeks of gestation to maintain endometrial stability.
   Infection prevention and control: regular vaginal microecology testing, avoiding the use of invasive examination instruments, and the use of azithromycin to prevent upstream infections when necessary.
3. Lifestyle and psychological intervention
   Behavioral contraindications: prohibit smoking, drinking and exposure to environmental toxins such as formaldehyde; avoid lifting heavy objects (>5kg) and long-distance flights in early pregnancy.
   Nutritional fortification program:
   Folic Acid & Vitamin D: Daily supplementation with active folic acid (0.8mg) and vitamin D3 (2000IU) can reduce the risk of neural tube defects and pre-eclampsia.
   Omega-3 fatty acids: Improve placental blood flow through deep-sea fish or algae DHA supplementation (300mg/day).
   Psychological support system: Establish an exclusive psychological counseling group for surrogate mothers, and reduce the frequency of anxiety-induced contractions through positive thinking meditation (20 minutes 3 times a week).

Legal Disputes and Ethical Dilemmas after Surrogate Abortion

1. Contract validity and attribution of responsibility
   Contract Invalidity: According to the Measures for the Administration of Human Assisted Reproductive Technology, the surrogacy agreement is void ab initio for violating public order and morals, and the commissioning party is unable to recover the paid expenses through litigation.
   Determination of medical fault: If the miscarriage is caused by the operation error of the organization (e.g., the temperature of embryo culture is out of control), the surrogate mother can claim compensation for medical damages according to Article 1218 of the Civil Code.
2. Ethical Disputes and Damage to Rights and Interests
   Maternal Health Sacrifice: Surrogate mothers may face complications such as uterine perforation, hemorrhage, and even permanent loss of fertility in abortions, and the existing compensation mechanism is generally less than 100,000 RMB, which is difficult to cover the long-term treatment costs.
   Dispute over the right to dispose of the fetus: the attribution of the remains of the aborted fetus is unclear, and some institutions use them for stem cell extraction without authorization, which constitutes a trampling on the dignity of life.
   Typical case: in 2025, a surrogacy agency in Guangzhou illegally sold a 12-week aborted fetus to a biological company, and the personnel involved were criminally prosecuted for the crime of “illegally dealing in human organs”.

The urgent need for industry standardization

1. Standardization of medical technology
   Laboratory certification: mandatory requirement for surrogacy agencies to be equipped with ISO-5 air purification systems and time-lapse photography incubators (Time-lapse) to ensure that the embryo culture environment is up to standard.
   Physician qualification audit: implement the record-keeping system for attending physicians, who must have more than 10 years of experience in reproductive medicine and pass the examination of the International Society for Reproductive Surgery (ASRM).
2. Improvement of legal and insurance mechanisms
   Specialized liability insurance: launch “surrogacy pregnancy complication insurance” to cover abortion-related medical expenses (insured amount ≥500,000 RMB) and psychological rehabilitation expenses.
   Cross-border judicial cooperation: establish a joint regulatory mechanism between the country of nationality of the surrogate mother and the place where the surrogacy takes place, and crack down on the cross-border evasion of responsibility by black intermediaries.
3. Ethical review and social support
   Independent Ethics Committee: Composed of medical, legal and sociological experts, the committee evaluates the “necessity” and “risk-benefit ratio” of each surrogacy application.
   Fund for surrogate mothers’ rights and interests: a special fund is set up by withdrawing the profits (≥5%) of the organization, which is used for post-abortion vocational training and mental health reconstruction.

Conclusion: Building a balance between bioethics and technological rationality

The problem of surrogate mothers‘ miscarriages reflects the double-edged sword effect of human assisted reproduction technology – bringing hope to the infertile group, but also triggering a humanitarian crisis due to the lack of regulation. Three major changes need to be promoted in the future:

Technological innovation: accelerate the research and development of artificial uterus to reduce the physiological dependence on surrogate mothers;
Legal breakthrough: while strictly prohibiting commercial surrogacy, explore the limited legalization of altruistic surrogacy;
Social co-governance: reversing the perception of “infant commoditization” through public education, and rebuilding the reverence for the dignity of life.
Only by combining medical advances, legal constraints and ethical awakening can surrogacy truly become a bridge for transmitting life, rather than a hotbed of exploitation and harm.