Loss at a Distance, Fatherhood Rewritten: Perinatal Bereavement and Subsequent Cross-Border Surrogacy Arrangements in Gay Couples and Single Fathers

Surrogacy is an increasingly used—yet unevenly accessible—pathway to parenthood for gay couples and single men. This qualitative study examined how fathers experience and navigate perinatal loss in cross-border surrogacy, and how they reenter surrogacy arrangements and parent following a subsequent live birth. Forty-seven Italian fathers (36 from 18 gay couples, 7 single gay fathers, and 4 single heterosexual fathers) took part in in-depth semi-structured interviews. Reflexive thematic analysis yielded six themes: perinatal loss as a rupture in the fatherhood journey; coping with grief: couple dynamics versus solitary struggles; fear and vigilance in subsequent surrogacy attempts; reframing fatherhood identity through resilience and meaning-making; relationships with the surrogate after loss; and disclosure of perinatal loss to children, families of origin, and friends. Integrating lenses of ambiguous/disenfranchized grief, minority stress, reproductive governance, and continuing bonds, grief emerged as both hyper-real (data, scans) and unreal (thin ritual), making recognition work central after loss in cross-border surrogacy. Fathers framed information cadence and pacing agreements as “trust prosthetics” that enabled progress amid uncertainty. Family psychologists can normalize asynchronous coping, offer father-inclusive loss groups, validate softer masculinities, scaffold single-father supports, and design post-loss pathways with triadic debriefs and time-zone-aware care.