Surrogacy 'unicorn' is pregnant with 11th baby: Experts question lack of US oversight

By Elizabeth Pratt | Fact-checked by Davi Sherman
Published May 7, 2024

Key Takeaways

  • A 37-year-old woman who describes herself as a surrogacy "unicorn" is pregnant with baby number 11. 

  • She has given birth to three of her own biological children and seven for other families as a surrogate. 

  • Experts say that giving birth this many times goes against guidelines for gestational carriers and comes with risks.

Physicians are calling for closer adherence to surrogacy guidelines after a surrogate in Ohio fell pregnant with her 11th baby.

Emily Westerfield, 37, has given birth to 10 babies in the past 13 years, describing herself as a surrogacy “unicorn.”[]

Westerfield has carried twins twice and gave birth in 2011, 2013, 2014, 2015, 2017, 2018, 2021, and 2022. She is due to deliver her 11th baby in July 2024. Experts say that having so many babies goes against medical guidelines.

Against medical guidelines

“I think it's appalling. I think it is medically extraordinarily high-risk for everybody," Wendy Chavkin, MD, MPH, a special lecturer in the Department of Population and Family Health at Columbia University’s Mailman School of Public Health, tells MDLinx. "Apparently she's done well, but it contravenes all medical guidance.”

"Eleven babies for anybody is high-risk. After five babies, you're considered very high-risk."

Wendy Chavkin, MD, MPH

Westerfield has given birth to three biological children and seven children for other families as a gestational carrier. She has even expressed interest in having a 12th baby.[]

Lusine Aghajanova, MD, an OB/GYN at Stanford Medicine Children's Health and Director of the Third Party Reproduction Program at Stanford Medicine Reproductive Endocrinology and Infertility, says that acting as a gestational carrier this many times goes against guidelines. “The ASRM (American Society for Reproductive Medicine), [which] is our governing body, provides quite comprehensive recommendations in that respect,” Dr. Aghajanova tells MDLinx.

“The recommendation is that the gestational carrier has at least one term pregnancy before, and, ideally, the gestational carrier should not have had more than a total of five previous deliveries or three deliveries via cesarean section," she adds.

"We should be following these recommendations, for the sake of the health of gestational carriers and the fetuses/babies they carry."

Lusine Aghajanova, MD

What physicians can do

Dr. Aghajanova argues that reproductive endocrinology and infertility (REI) physicians have an important role to play in protecting all parties involved. “Surrogates are taking on risks of pregnancy and delivery for someone else, and the place of REIs is to protect the health of surrogates and the babies while helping our patients, the intended parents,” she says.

Gestational surrogacy is legal in the US, but laws regarding the practice vary significantly among states.[] “It’s completely lacking oversight and is basically in the hands of people who are trying to make a lot of money off of it,” Dr. Chavkin says.

The ASRM provides recommendations for the use of gestational carriers.[] The organization recommends that, preferably, gestational carriers be between the ages of 21 and 45 and have at least one previous uncomplicated pregnancy prior to becoming a surrogate.

The gestational carrier should ideally not have had more than five previous deliveries or three deliveries via cesarean section. The ASRM also advises that gestational carriers have a stable family environment that has necessary support to help them cope with the stress that can accompany pregnancy.

"There are guidelines that are out there for us to follow and to prevent situations," Dr. Aghajanova says. "Ideally, surrogate agencies follow the same ASRM recommendations and do not accept women who don’t fit safety criteria."

She notes the significant health impacts of pregnancy—it's a "huge stress" for the entire body, with risks at every step, including during pregnancy, delivery, and the postpartum period.

"Some patients have exacerbations of prior conditions [and] some patients develop new conditions that may or may not resolve after pregnancy," she explains. "So, if during gestational carrier evaluation we disqualify the gestational carrier for any health-related reason, it’s usually for her own benefit."

Both Dr. Chavkin and Dr. Aghajanova say that it’s important for physicians to do their part in adhering to appropriate guidelines when working with gestational carriers, ensuring they are followed while counseling both surrogate candidates and intended parents about the potential risks.

“If a surrogate doesn’t meet criteria based on [the] number of prior pregnancies, complications, cesarean deliveries, comorbidities, high BMI, [or] anything that increases risk of complications, she is recommended to stop,” Dr. Aghajanova says. “There will always be another good candidate for surrogacy. Our job is to make sure everyone is healthy and patients get a healthy baby.”

What this means for you

Physicians are stressing the importance of adhering to surrogacy guidelines following Emily Westerfield's 11th surrogacy pregnancy in Ohio. Despite her good health, experts warn of high medical risks for both surrogates and babies, in general. Guidelines recommend limits on prior deliveries and emphasize a stable support system for gestational carriers. Physicians must prioritize safety, ensuring thorough evaluation of surrogate candidates to protect all involved. This highlights the need for tighter regulation in the surrogacy industry.

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