JBRA Assist. Reprod. 2026 2026;00(0):00-00
SBRA PAGES
doi: 10.5935/1518-0557.20260098
Gestational Surrogacy in Brazil: A Position Statement of the Brazilian Association of Assisted Reproduction (SBRA)
1Genesis - Center for Assistance in Human Reproduction. Brasilia - DF - Brazil
2Red Latinoamericana de Reproducción Asistida (REDLARA)-Vice President
3Department of Obstetrics and Gynecology, School of Medicine, University of São Paulo (FMUSP). São Paulo - SP - Brazil
4Fertilizare- Reproductive Medicine. Volta Redonda - RJ - Brazil
5Mater Prime Human Reproduction Clinic. São Paulo - SP - Brazil
6Department of Gynecology and Obstetrics, School of Medicine, Federal University of Minas Gerais (UFMG). Belo Horizonte - MG - Brazil
7Department of Gynecology and Obstetrics, School of Medicine, University of São Paulo (FMUSP). São Paulo - SP - Brazil
8Monteleone Center for Human Reproduction - One Fertility. São Paulo - SP - Brazil
9Health Law Commission of the Brazilian Bar Association, Federal District Chapter (OAB/DF) - President
10Maia & Munhoz Law Firm -Health Law and Bioethics. Brasília- DF - Brazil
11Brazilian Association of Assisted Reproduction (SBRA) -Vice President
12Ideia Fértil Institute of Reproductive Health. Santo André -SP, Brazil
13Brazilian Association of Assisted Reproduction (SBRA) - President
14Fertipraxis Center for Human Reproduction - Huntington/Eugin Group. Rio de Janeiro - RJ - Brazil
15Department of Gynecology, Federal University of Rio de Janeiro (UFRJ) - Rio de Janeiro - RJ - Brazil
CONFLICTS OF INTEREST
All the authors declared that they have no conflicts of interest.
ABSTRACT
Surrogacy includes traditional surrogacy, in which the carrier contributes her own oocyte, and gestational surro-gacy, in which the embryo is derived exclusively from the gametes of the intended parents or donors. In Brazil, only gestational surrogacy is legally recognized. It is governed by resolutions of the Federal Council of Medicine and the national health surveillance agency in the absence of spe-cific federal legislation, and it requires altruistic, unpaid participation and compliance with carrier eligibility crite-ria. This Position Statement, developed by the Strategic Committee on Gestational Surrogacy of the Brazilian As-sociation of Assisted Reproduction, addresses the clinical, bioethical, legal, and psychological dimensions of the prac-tice and is intended to guide specialists throughout Brazil. Clinical indications include uterine absence or anomalies, contraindications to pregnancy, medical conditions that may be aggravated by pregnancy, and biological inability to conceive or carry a pregnancy. No universally validated protocol for carrier selection exists; current requirements include a maximum age of 50 years, at least one previous live birth, and satisfactory physical and mental health. Peri-natal outcomes are comparable to those of conventional in vitro fertilization, although long-term data on cross-border arrangements remain scarce. The bioethical framework is based on autonomy, beneficence, non-maleficence, and justice. SBRA opposes simultaneous surrogacy arrange-ments because they are incompatible with the altruistic na-ture of the practice and supports gradual, age-appropriate disclosure of the child’s gestational origin. Legal challenges include the absence of statutory regulation, cross-border reproductive tourism, and the child’s right to know their origins. Continuous psychological support for all parties is mandatory and central to favorable long-term outcomes. Gestational surrogacy is a valid reproductive option for se-lected patients but requires rigorous oversight and must prioritize the best interests of the child within the Brazilian regulatory framework.
Keywords: gestational surrogacy, assisted reproductive tech-nology, bioethics, gestational carrier, reproductive law, SBRA
INTRODUCTION
Surrogacy, also referred to in Brazil as temporary uterine transfer (TUT), is broadly defined as an arrangement in which a woman-the gestational carrier-carries a pregnancy and, after delivery, relinquishes the child to another individual or couple-the intended parent or parents, who may include the biological mother, father, or both (Brandão & Garrido, 2022). It encompasses two distinct modalities: traditional surrogacy, in which the carrier contributes her own oocyte and is therefore the genetic mother of the child, and gestational surrogacy, in which the embryo is formed exclusively from the gametes of the intended parents or donors, with no genetic link between the carrier and the child. In Brazil, only gestational surrogacy is legally recognized. Participation must be voluntary and unpaid, and the procedure must be performed exclusively through IVF (CFM, 2022).
With respect to gamete origin, surrogacy is further classified as homologous-when the gametes belong to the intended parents themselves-or heterologous-when one or both gametes are obtained from donors. Brazilian regulations prohibit a gestational carrier from simultaneously donating her own oocytes to the intended parents and serving as their gestational carrier (CFM, 2022).
Brazil has no specific federal legislation governing ART. Federal Council of Medicine (CFM) Resolution No. 2,320/2022 and Brazilian Health Surveillance Agency (ANVISA) Resolution RDC No. 771/2022 constitute the primary regulatory framework. These regulations establish ethical guidelines intended to balance the reproductive goals of the intended parents with the protection of all parties involved-ART centers, the intended parents, the gestational carrier, and, above all, the child to be born (CFM, 2022; ANVISA, 2022).
This Position Statement, developed by the SBRA Strategic Committee on Gestational Surrogacy, addresses four core dimensions-clinical, ethical, legal, and psychological-with the aim of guiding ART professionals and centers, encouraging critical reflection on the challenges associated with this practice, and safeguarding the best interests of all parties, with particular emphasis on the child.
CLINICAL ASPECTS
Classification
Gestational surrogacy is classified according to two main criteria, as summarized in Table 1.
Table 1. Gestational surrogacy is classified according to two main criteria.
Indications
Gestational surrogacy may be indicated in conjunction with ART in the following clinical circumstances (Kim, 2020):
• Absence of the uterus, whether congenital (Mayer-Rokitansky-Küster-Hauser syndrome) or acquired (hysterectomy);
• A significant uterine anomaly-such as extensive intrauterine adhesions or a unicornuate uterus-associated with recurrent pregnancy loss;
• Absolute medical contraindication to pregnancy, such as severe pulmonary arterial hypertension;
• A serious medical condition-including active malignancy or its sequelae-that may be aggravated by pregnancy or pose a significant risk to the pregnant woman or fetus;
• Biological inability to conceive or carry a pregnancy, as in the case of single men or male same-sex couples.
Carrier Screening and Preparation
No universally accepted clinical protocol currently exists for selecting a gestational carrier. Ideally, the carrier should be physically and mentally healthy, free of conditions that could compromise pregnancy outcomes-including diabetes mellitus, hypertension, thrombophilias, or mood disorders-and fully committed to following prenatal care recommendations (Kim, 2020). CFM Resolution No. 2,320/2022 establishes the following minimum requirements: a maximum age of 50 years, satisfactory physical and mental health, and at least one previous live birth (CFM, 2022).
Required Workup
1. Gestational Carrier:• Mandatory serological screening, valid for 90 days: HIV-1 and HIV-2, hepatitis B (HBsAg and anti-HBc), hepatitis C (anti-HCV), syphilis (VDRL), HTLV-I and HTLV-II, toxoplasmosis (IgG/IgM), rubella, and cytomegalovirus (ANVISA, 2022);
• Clinical and gynecological evaluation;
• Psychological fitness assessment issued by a qualified mental health professional.
2. Intended Parents:• Serological screening for HIV, hepatitis B, hepatitis C, syphilis, and HTLV-I and HTLV-II (the latter applicable to semen only) (ANVISA, 2022);
• Karyotyping, when clinically indicated;
• Screening for sexually transmitted infections.
IVF Protocol
The IVF cycle follows standard protocols and includes the following steps:
• Controlled ovarian stimulation with transvaginal ultrasound monitoring;
• Oocyte retrieval and identification;
• Insemination of mature oocytes (MII) by conventional IVF or intracytoplasmic sperm injection (ICSI);
• Fertilization assessment and embryo culture;
• Embryo transfer at the cleavage stage (Day 2 or 3) or blastocyst stage, according to the number and quality of embryos and in compliance with the limits established by CFM Resolution No. 2,320/2022 (CFM, 2022);
• Cryopreservation of supernumerary embryos, including embryos remaining after preimplantation genetic testing for aneuploidy or monogenic disorders.
Risks and Outcomes
Although IVF is considered a safe procedure, complications may occur. Severe ovarian hyperstimulation syndrome (OHSS) affects up to 1% of stimulated cycles. The use of antagonist protocols combined with progesterone-based suppression of the LH surge, GnRH agonist triggering, and freeze-all strategies has substantially reduced its incidence (Massin, 2017). Risks associated with oocyte retrieval include complications related to anesthesia, abdominal discomfort, bleeding, and rare infections. In addition, the gestational carrier is exposed to all obstetric and puerperal risks inherent to pregnancy, which must be fully documented during the informed consent process (Murugappan et al., 2018).Most studies of gestational surrogacy have substantial methodological limitations, and large-scale Brazilian data remain unavailable (Torres et al., 2019). International evidence suggests that most surrogacy arrangements are completed successfully and that gestational carriers report little difficulty separating from the child after delivery (Söderström-Anttila et al., 2016).Data from REDLARA 2022 confirm the association between multiple pregnancy and preterm birth in IVF pregnancies (Zegers-Hochschild et al., 2026). Perinatal outcomes among children born through gestational surrogacy are comparable to those reported after conventional IVF and oocyte donation, with no evidence of additional psychological risks through 10 years of age (Jadva et al., 2015). Available studies, although limited in sample size and duration of follow-up, have not demonstrated psychological or behavioral harm in children raised by male same-sex couples. Nevertheless, robust long-term prospective studies and large case series remain scarce (Söderström-Anttila et al., 2016).
ETHICAL FRAMEWORK
Bioethical Principles Governing Gestational Sur-rogacy
The ethical framework for gestational surrogacy is structured around the four classical principles of bioethics: autonomy, beneficence, non-maleficence, and justice (Pessini & Barchifontaine, 2014; Beauchamp & Childress, 2019).
Autonomy and Altruism
Respect for the gestational carrier’s autonomy is the primary ethical foundation of the procedure. The carrier must make her decision freely, with complete information and without physical, psychological, or financial coercion. This principle underlies the prohibition of commercial surrogacy in Brazil (CFM, 2022). The term “altruistic surrogacy,” commonly used in patient communication as an alternative to “commercial surrogacy,” reflects this ethical orientation, in which solidarity must prevail over economic interests (Brazil, 1997).The requirement that the carrier be related to one of the intended parents-established to minimize external pressure and future conflict (CFM, 2022)-does not eliminate the risk of intrafamilial coercion, even in apparently altruistic arrangements. Individual consultations and independent psychological follow-up are essential to confirm that the carrier’s decision is genuinely autonomous.
Non-Maleficence and Beneficence
The principles of non-maleficence and beneficence require that the procedure be performed only when clinically indicated and with the utmost care to minimize physical and emotional risks for all participants (Pessini & Barchifontaine, 2014). Requirements for medical and psychological clearance, together with the requirement that the carrier have had at least one previous live birth, directly reflect these principles by ensuring that she has firsthand knowledge of the physical and emotional demands of pregnancy and childbirth (CFM, 2022).
Primacy of the Child’s Best Interests
The welfare of the child to be born is of paramount importance in contemporary bioethical debate and encompasses the child’s right to legal certainty and a healthy family environment (Gama, 2003). SBRA recommends that children be given access, in a manner appropriate to their cognitive development, to information about their gestational origin. Absolute secrecy is discouraged because it may undermine identity formation and erode trust within the family.
Requirements Under CFM Resolution No.2,320/2022
The gestational carrier must be related to one of the intended parents within the fourth degree of consanguinity. Cases in which this familial relationship is absent require authorization from the competent Regional Medical Council (CRM) (CFM, 2022). This requirement is intended to reduce the risk of future conflicts and safeguard the legal integrity of the arrangement.Commercial compensation of the gestational carrier is expressly prohibited to prevent the exploitation of economically vulnerable women and the commodification of the human body (Brazil, 1997). Reimbursement of expenses directly attributable to the pregnancy-such as transportation for prenatal care or dietary expenses related to gestational diabetes-is permitted and must be specified in the Commitment Agreement (CFM, 2022).All parties must sign an informed consent document addressing the medical, legal, and psychological aspects of the procedure. In accordance with CFM Recommendation No. 1/2016 (CFM, 2016), informed consent is not merely a bureaucratic formality but an ongoing communication process with three distinct functions: respecting the autonomy and freedom of choice of those involved, strengthening the therapeutic relationship, and defining the ethical and legal parameters of professional conduct (Maia & Munhoz, 2025).
Simultaneous Gestational Arrangements
The possibility that intended parents may simultaneously engage more than one gestational carrier has emerged as one of the most ethically contested issues in contemporary ART practice. Based on the bioethical principles underlying this Position Statement, SBRA considers such arrangements incompatible with the altruistic nature of surrogacy because they instrumentalize women’s bodies and exacerbate social inequalities by making access a privilege reserved for those with substantial financial resources (Pessini & Barchifontaine, 2014). ART professionals are expected to communicate this position clearly when counseling patients.
Professional Autonomy and Ethical Obligations
The ART specialist is not merely a technical provider but also an ethical guardian of medical practice. Accordingly, physicians have both the right and the duty to decline procedures that violate established bioethical principles or endanger the well-being of any party involved (Pessini & Barchifontaine, 2014). Such decisions must be based on objective, documented criteria rather than personal values or individual moral convictions. Patient autonomy is not absolute; it is limited by the ethical principles governing medicine and the regulatory requirements established by the CFM (2022).
Cultural, Social, and Religious Dimensions
Gestational surrogacy is not merely a medical procedure; it is a phenomenon shaped by cultural, social, and religious forces. The separation of motherhood into genetic, gestational, and socio-affective dimensions challenges traditional conceptions of family and parenthood. Religious traditions and cultural perspectives differ in their views of ART, and Brazilian regulations reflect some of these tensions, particularly through the prohibition of commercial compensation and the kinship requirement. ART professionals must be prepared to address these dimensions without imposing their own values on patients.
LEGAL ASPECTS
Regulatory Framework
Gestational surrogacy in Brazil is governed exclusively by administrative regulations-CFM Resolution No. 2,320/2022 and Anvisa RDC No. 771/2022-in the absence of specific federal legislation on ART (CFM, 2022; ANVISA, 2022). This regulatory gap may be viewed in two ways: on the one hand, it leaves professionals and patients without formal statutory protection; on the other, it allows specialized organizations such as SBRA to update standards promptly in response to scientific and technological advances, without the delays inherent in the legislative process.When reviewing requests for authorization of gestational surrogacy, Regional Medical Councils (CRMs) must adhere to CFM standards, seek consistency in their assessments, and provide timely decisions, particularly because many patients are already of advanced reproductive age.
Required Documentation
CFM Resolution No. 2,320/2022 requires surrogacy to occur within a family context, with the carrier related to one of the intended parents within the fourth degree of consanguinity, and requires the carrier to have had at least one previous live birth. Authorization from the competent CRM is required when the kinship criterion cannot be met (CFM, 2022). The following documents are mandatory:
• Informed consent signed by all intended parents and the gestational carrier, addressing biopsychosocial considerations, the risks of pregnancy, childbirth, and the puerperium, and the legal aspects of parentage;The gestational carrier is not entitled to register the child or to breastfeed. When the procedure is conducted in accordance with the applicable regulations, the intended parents-who initiated and assumed responsibility for the IVF treatment-are entitled to full parental registration and custody from birth, regardless of whether donor gametes were used (CFM, 2022).
• A medical report confirming the physical and mental fitness of all parties;
• A Commitment Agreement between the intended parents and the gestational carrier explicitly establishing the child’s parentage;
• A commitment by the intended parents to provide medical follow-up-including multidisciplinary support when indicated-for the carrier throughout the postpartum period;
• A commitment to register the child in the names of the intended parents, with the necessary documentation to be arranged during pregnancy;
• Written consent from the carrier’s spouse or partner, if applicable.
Carrier Autonomy and Informed Consent
Respect for the carrier’s autonomy must be actively and continuously promoted throughout the process. As emphasized by Maia & Munhoz (2025), informed consent is not a mere bureaucratic act but an ongoing communication process that serves three functions: respecting freedom of choice, strengthening the relationship of trust, and defining the ethical and legal parameters of professional conduct. Individual consultations and independent psychological follow-up are strongly recommended to ensure that the carrier’s decision is free from external or intrafamilial pressure.
Cross-Border Surrogacy and Medical Tourism
Because of the restrictions imposed by Brazilian regulations, some patients pursue surrogacy arrangements in countries that permit compensation of gestational carriers, such as the United States, Ukraine, Colombia, and Albania (Torres et al., 2019). This practice raises substantial concerns about the social vulnerability of the women involved and the risk of exploitation, particularly in settings marked by pronounced socioeconomic inequality.Brazilian patients pursuing cross-border surrogacy must be counseled regarding: (i) the obligation to comply with Brazilian regulations in all procedures performed domestically; (ii) the steps required to ensure the legal registration of a child born abroad and the child’s entry into Brazil; and (iii) the importance of using reputable services that comply with applicable international standards.
Emerging Challenges and Future Directions
Two challenges require particular attention in the future: ensuring equitable access to surrogacy for individuals who do not have eligible or willing family members, and addressing the child’s right to know their genetic and gestational origins-an issue that remains inadequately addressed by current regulations (Gama, 2003). SBRA considers both matters priorities for the ethical and legal agenda of the ART community in the coming years.
PSYCHOLOGICAL DIMENSION
Gestational surrogacy is emotionally complex and requires rigorous clinical assessment. Intended parents frequently experience anxiety related to grief over infertility and a perceived loss of control over the reproductive process (Levy, 2014; Maldonado, 2017). At the same time, the carrier may be motivated by reparative or altruistic psychological dynamics, which require careful clinical evaluation to identify external pressure or unacknowledged guilt.
As required by CFM Resolution No. 2,320/2022, psychological evaluation and ongoing support are not merely therapeutic recommendations but mandatory components of the clinical protocol (CFM, 2022). Their purpose is to assess the cognitive and volitional autonomy of all parties, reduce biopsychosocial risks, and prevent iatrogenic psychological harm, with particular attention to the welfare of the future child.
Discrepancies between idealized expectations and clinical reality may strain relationships between the parties and compromise individual autonomy throughout pregnancy and the puerperium. Continuous psychological support can mediate between the biological experience of carrying a pregnancy and the social role of motherhood, thereby helping to prevent traumatic outcomes for all parties involved.
Gradual, age-appropriate disclosure of the child’s gestational origin is essential for healthy identity development and the preservation of family trust (Söderström-Anttila et al., 2016). Absolute secrecy regarding gestational origin is discouraged because it may create gaps in the child’s personal narrative and stigma associated with family secrets, potentially affecting psycho-affective development.
Ultimately, the success of gestational surrogacy extends beyond the outcome of the pregnancy. An interdisciplinary approach-in which physicians, psychologists, and legal professionals work in an integrated and sustained manner-is essential to protecting the mental health of all parties and supporting the development of stable family relationships grounded in honesty and ethical care.
CONCLUSION
Gestational surrogacy, regulated in Brazil by CFM Resolution No. 2,320/2022, represents an important reproductive option for patients with diverse family configurations or clinical barriers to pregnancy (CFM, 2022). At the same time, it raises complex ethical, legal, and psychosocial issues that require sustained attention from all stakeholders across the continuum of care.
The principles of autonomy, beneficence, non-maleficence, and justice guide a practice that seeks to prevent the exploitation of women’s bodies and preserve the altruistic nature of gestational surrogacy (Beauchamp & Childress, 2019; Pessini & Barchifontaine, 2014). The prohibition of commercial compensation, the kinship requirement, and the documentary obligations are concrete expressions of these principles within the Brazilian regulatory framework.
Ongoing debates concerning simultaneous gestational arrangements, cross-border reproductive tourism, physicians’ ethical autonomy, children’s right to disclosure of their origins, and cultural and religious influences illustrate the continuing complexity of this field and the need for ongoing ethical and legal reflection (Torres et al., 2019). SBRA reaffirms its commitment to providing qualified guidance to ART professionals and centers, promoting responsible scientific debate, and protecting all parties, with the best interests of the child as the primary consideration, in accordance with Brazilian law.
Acknowledgements:
During the preparation of this manuscript, the authors used an AI-based language assistant to help organize and refine the English text. The authors subsequently reviewed, verified, and edited all content and take full responsibility for the accuracy and integrity of the publication.
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