This section addresses frequently asked questions about international commercial surrogacy and other types of surrogacy. It will be updated as new questions are raised and as answers continue to evolve. Please contact us if you have comments or questions of your own that might be helpful to other readers.

Q: What is surrogacy?

Surrogacy is a social arrangement, usually bound by a contract, in which a woman –- known as a gestational mother or surrogate –- agrees to carry and birth a child for another person or family with the help of assisted reproductive technologies (ARTs). In international commercial surrogacy arrangements, gestational mothers usually receive payment.

Q: Are there different types of surrogacy?

Yes. The type of surrogacy depends on specific elements of each arrangement and the location of the intended parents and the gestational mother. Here are the terms used to describe each one:

Traditional: A gestational mother’s eggs are fertilized with sperm from an intended father or provider.

Gestational: A gestational mother carries an embryo created from sperm and eggs from intended parents or providers.

In-country (often called domestic): A gestational mother and intended parent(s) live in the same country.

International (often called transnational or cross-border): A gestational mother and intended parent(s) live in different countries.

Altruistic: A gestational mother does not receive payment (beyond pregnancy-related expenses).

Commercial: A gestational mother receives payment.

Q: Does Surrogacy360 focus on a particular type of surrogacy? 

Yes. Surrogacy360 focuses on arrangements that are international and commercial, which are also almost always gestational. These arrangements are referred to on the site as “international commercial surrogacy” and involve the following: intended parents, egg providers, and gestational mothers, as well as go-betweens that facilitate the relationship and the children that are born as a result of it.

Visit the Surrogacy Relationship section for more information, and the Resources section for related articles and research.

Q: Is international commercial surrogacy legal?

Laws vary depending on the country. Visit the Current Law section to learn more.

Q: Is there an easy way to distinguish between the types of surrogacy?

It can take a little time to become familiar with all the possible surrogacy arrangements. It might help -– as a start and to make the concepts more real -– to consider two vastly different hypothetical situations commonly represented in the media.

Altruistic Surrogacy
Example: A gay couple in the United States (the intended parents) asks a close friend or family member to carry and birth a child for them. In this arrangement, let’s now suppose:

  • No payment is exchanged beyond pregnancy-related expenses.
  • The gestational mother willingly helps a friend or family member. She and the intended parents are of similar socio-economic background, and she feels no social or financial pressure.
  • Everyone participating in the arrangement is involved in the pregnancy. The intended parents are present at the birth and, as much as possible, they all agree to be in lifelong relationships with the child and one another.

In a broad social sense, this type of situation is breaking historic barriers to parenting for the LGBTQ community, people with infertility, and individuals who are not married. It is also expanding traditional ideas of what is meant by “family.” A recent film, “The Guys Next Door,” presents a sympathetic and compelling picture of altruistic surrogacy in the United States.

International Commercial Surrogacy
Example: The intended parents are in the United States and a woman in another country, such as Mexico, Vietnam, or Kenya, agrees to carry and birth a child for them. In this arrangement, let’s suppose:

  • There is a legally binding agreement between the intended parents, the gestational mother, and the many go-betweens (agencies, clinics, etc.), but the gestational mother may not speak the language in which the contract is written.
  • The gestational mother is a stranger to the intended parents; she has been selected for them from a large pool of women.
  • The gestational mother is likely drawn in by financial need or crisis, and she has little or no ability to negotiate contract terms or influence the arrangement as it proceeds.
  • The intended parents pay a large sum of money (upwards of $20,000) that is divided between the many go-betweens and the gestational mother.
  • The arrangement requires navigating borders and cultures, immigration and legal systems, and class and race – and all of these divides can operate in ways that give greater power to the intended parents than to the gestational mother.
  • The gestational mother and intended parents are allowed limited, if any, contact or relationship. Contact might be “chaperoned” and sharing personal information is discouraged.

This is an international commercial surrogacy arrangement, usually between intended parents and gestational mothers of different socio-economic, racial, and cultural backgrounds. This arrangement poses different benefits and risks to the people involved than the first scenario discussed. The film “Can We See The Baby Bump Please?” documents the nature and impact of these contractual agreements in some detail.

While other arrangements fall somewhere between or beyond the two scenarios described here, these illustrate the difficulty of a one-size-fits-all approach to defining surrogacy or addressing questions that arise.

Q: How does international commercial surrogacy actually work?

One word: Go-betweens.

International commercial surrogacy is characterized by limited contact between intended parents and gestational mothers. Go-betweens, who handle different aspects of the arrangement, include:

  • Local recruiters who are paid to find potential gestational mothers in their communities.
  • Agencies who match intended parents with pre-screened gestational mothers and coordinate every aspect of the arrangement.
  • Clinicians who provide medical services — from IVF and embryo transfers to labor and birth.
  • Lawyers who help intended parents with the legal issues of hiring gestational mothers and establishing parental rights.
  • Tourism and hospitality businesses that offer attractive hotel and sightseeing deals to intended parents visiting foreign countries.

International commercial surrogacy is part of multibillion dollar global industry. While there are well-meaning go-betweens who genuinely want to protect the interests of their clients -– the intended parents -– and help them form families, others mainly prioritize their own interests. Either way, the vast majority of gestational mothers are left to fend for themselves, with no one looking out for their needs.

Q: Is it possible to find answers to questions about the ethics of international commercial surrogacy?

While answers are complicated, many people are at least asking the hard questions. This is because surrogacy, in all its forms, is relatively new and quite complex.

Assisted reproductive technologies (ARTs) have only been available for about 40 years and arrangements developed around them — such as paid egg donation and commercial surrogacy — are still unfamiliar to most people. In addition, laws around these practices differ widely between and, in places like the United States and Mexico, within the same country.

Intended parents are part of a significant social shift in the way families are now formed. Many are concerned about the ethics of the practice and seek information that can reliably help them answer their questions and guide their decisions. The challenge is finding the right information and knowing the right questions to ask.

Surrogacy360’s Resources can help intended parents frame questions, identify red flags, and examine the benefits and risks to all the people involved in the arrangement they are considering. Along the way, answers on the ethics of that arrangement may begin to emerge.

Q: What are some ethical issues to consider?

Questions about ethics can range from whether human rights are being protected (including the right to reliable information for intended parents and the right to reliable medical care for gestational mothers), to whether there is an absence of safeguards for egg providers and children.

Visit the Surrogacy Relationship section for more information, and the Resources section for related articles and research.

Risks and ethical concerns for intended parents include:

  • Business practices that exploit the emotional vulnerability of people who face biological, social, and/or legal barriers to parenting.
  • Incomplete information about the legal differences between their own country and the country where the child is born.
  • Fraud, when go-betweens deceive intended parents by accepting payment with no intention of arranging the birth of a child in exchange.

Risks and ethical concerns for gestational mothers include:

  • Contracts in languages they do not speak or read — thus making it difficult to give informed consent.
  • Dormitory-style living arrangements with frequent surveillance and restricted access to the outside.
  • Medically unnecessary cesarean sections for the convenience of intended parents and to increase the speed and volume of births at fertility clinics.
  • Absence of independent medical or legal advice and lack of recourse when problems arise.
  • Insufficient medical and emotional support after the birth.

These and other risks affect children as well –- from health implications of multiple and pre-term births (linked to in vitro fertilization and cesarean sections) to challenges to legal parentage and citizenship, which can delay returning home and, in worst-case scenarios, leave children stateless.

Intended parents and gestational mothers have a right to know about all possible challenges and options available to them, as well as risks to future children, so they can participate in arrangements that minimize harm. One important example is highlighted below — the increasingly common assumption that gestational surrogacy is a better choice than traditional surrogacy.

Q: What is the difference between traditional and gestational surrogacy? Why is it important?

Most international commercial surrogacy arrangements now use gestational surrogacy rather than traditional surrogacy. Here are some basic differences between the two:

Traditional surrogacy uses the eggs of the gestational mother. She is artificially inseminated with sperm from the intended father or a donor and, because her own eggs are involved, the pregnancy can be timed to her reproductive cycle. This makes traditional surrogacy safer. It does not involve an egg provider and requires low medical intervention, thus avoiding many health risks for the gestational mother.

Gestational surrogacy uses the eggs of the intended mother or an egg provider, who go through extensive medical treatment to artificially increase and extract their eggs. These eggs are fertilized by sperm from the intended father or donor, with the resulting embryo transferred into the gestational mother. Preparing the gestational mother’s body for in vitro fertilization is complex. The process exposes her to risks arising from high doses of hormones (to artificially prepare a body to receive and carry an embryo) and multi-fetal pregnancies (due to the common practice of implanting multiple embryos to increase the rate of live births – a practice that also has implications on the children that are born).

The prevalence of gestational surrogacy is overlooked or underplayed in international commercial surrogacy. In fact, intended parents are often advised against using the gestational mother’s eggs – even if the intended mother is not using hers – and use donor eggs instead.

Q: If gestational surrogacy is riskier than traditional surrogacy, why is it on the rise?

Gestational surrogacy is on the rise for a few different reasons.

First, gestational surrogacy eliminates the genetic connection between a child and the gestational mother (since her eggs are not used), limiting her role to pregnancy and birth. If a gestational mother has a genetic connection to the child, it may be more difficult for her to give up the newborn.

On the flip side, if the eggs and/or sperm of the intended parent(s) are used, gestational surrogacy makes possible a genetic connection between them and the child that is born.

Second, in some cultures, it is unacceptable for a woman to be inseminated by someone other than her husband. The lack of genetic connection between the surrogate and the fetus with a gestational surrogacy arrangement circumvents this issue. There can also be a misunderstanding of the way traditional surrogacy is done — the belief that a woman must have sexual intercourse with an intended father or donor to become pregnant, which is not true.

Finally, when intended parents do not use their own eggs, they will often identify an egg provider who looks like them or who shares their ethnic background rather than use the eggs of a gestational mother who does not.

Top photo: Véronique Debord-Lazaro (cc)