Not having a uterus, either for congenital or acquired causes, it one of the most common medical reasons for surrogacy. Uterine diseases and Müllerian duct anomalies, certain diseases considered contraindications to pregnancy, and repeated IVF failure are some causes leading straight couples, lesbian couples, and single women to have no alternative but to use a surrogate to have a child.

In the case of gay couples and single males, the reason is a biologic inability to get pregnant and bear a pregnancy, since they lack the female reproductive organs necessary for a pregnancy to occur.

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