"This is about medical risks," said Dr. Richard Paulson, director of the USC Fertility in Los Angeles. "What that story is describing is a train wreck."
Age isn't that big a factor, although most American surrogates are in their early 40s or younger, according to Paulson. "Late 40s is a little unusual."
A woman is considered an obstetrical risk if she has delivered more than five children, putting her at risk for losing her uterus -- and perhaps the baby.
"Some have implantation problems, and are at increased risk for post-partum hemorrhage and bleeding," he said. "The uterus doesn't contract, and there is a potential for hysterectomy in that setting.
"I cannot imagine someone in the U.S. wanting a gestational surrogate who had nine prior deliveries," said Paulson.
Reproductive experts also look for gestational carriers who have already had their own children, "so there is a sense of parenthood," he said. Pregnancy is always a risk, and a woman could potentially lose her ability to have her own children.
Paulson said he had advised a couple in his practice not to use a gestational surrogate who had had three previous Caesareans.
"It can be done," said Paulson. "Most of the time, things go fine, but we expect in this day and age to have the best possible outcome. We don't want to tip the scales in the direction to make it more risky."
When a married couple decides to have a child, they take their own risks, but surrogacy is "an elective process," he said.
Synesiou agrees, citing television's Michelle Duggar, a 45-year-old with 19 children who lost a 20th child to miscarriage last year.
"No one is saying that to her," she said. "It's her own body, and a family can take all the risks it wants. But you can't take risks when you are helping someone else. You have a duty to your own children."
Synesiou said she is "personally disgusted" that a doctor would agree to perform IVF on a woman like Hawkins.
And she said her agency would have asked more questions.
"When a surrogate mom does this for the first time, we ask, 'Why are you doing this? What motivates you?'" she said. Most say they enjoy being pregnant and want to help others.
When second-time surrogates offer to have a child, they often say they want to help a couple "complete their family," said Synesiou.
"When they come back a third time, now we ask significant questions: 'What does your husband think about this? What do your children think about this? They see their mommy pregnant again and again, giving away babies each time,'" she said.
"We all know the rules. … We are very cautious," said Synesiou.
"It's not healthy," she said of Hawkins' multiple surrogacies. "It's like a drug she needs more and more."