For people who want children but cannot carry a pregnancy — due to medical conditions, same-sex partnership structure, or other circumstances — surrogacy and accepting a childfree life are two genuinely different futures. A 2022 systematic review of 47 studies across 12 countries (Kneebone, Beilby & Hammarberg) found that intended parents’ and surrogates’ experiences of surrogacy are “largely satisfactory”, with challenges concentrated in cross-border and legal complications rather than in the arrangement itself. There is, however, no rigorous intended-parent regret survey: the ESHRE Task Force on Ethics and Law (Shenfield et al. 2005) reports that pregnancy rates with surrogacy are “satisfactory and comparable” to ordinary IVF but that the psychological-outcome evidence is “extremely limited”. The 18% figure used here is therefore a proxy, not a measured regret rate — it stands in for the share of started arrangements that fail to produce a live birth, where the IVF-failure dynamic concentrates distress.
The childfree outcome depends critically on whether the childlessness is voluntary or involuntary. Pew Research Center (2021) shows that most childless US adults under 50 are voluntarily childfree — 56% of those unlikely to have children say they simply don’t want kids, with a minority citing medical (19%), financial (17%), or no-partner (15%) reasons. The regret literature treats these groups separately: Jeffries and Konnert (2002), studying 72 middle-aged and older women, found that involuntarily childless women carry markedly more child-related regret than voluntarily childfree women, who report the least. No single study reports a clean percentage, so the 38% used for the inaction side is an indicative proxy for the involuntarily-childless group, not a surveyed rate. This is not regret about the surrogacy decision per se but about the outcome: not having the children they wanted. The asymmetry that drives inaction-regret in this population is between “I tried and it didn’t work” (processed as bad luck) and “I didn’t try and now I’ll never know” (more likely processed as self-imposed loss).
Cost and legal context impose real constraints. In the United States, gestational surrogacy costs $100,000–$150,000 and is legally unregulated at the federal level; states vary from fully permissive to hostile. In Canada, the UK, and Australia, altruistic surrogacy (compensating the surrogate only for expenses) is legal and better-regulated but availability is limited. In many jurisdictions, commercial surrogacy is banned. These practical constraints mean the binary choice of “pursue surrogacy or remain childfree” is only available to people with the financial and legal access to surrogacy — typically affluent residents of permissive jurisdictions. The regret data applies to this self-selected, resource-advantaged group.