What is surrogacy?

Surrogacy is an arrangement, usually bound by a contract, in which a woman agrees to carry and birth a child for another person or family with the help of assisted reproductive technologies (ART). In international commercial surrogacy arrangements, surrogates receive compensation; the amount varies by country and depends on a number of other circumstances.

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What are the different types of surrogacy?

This list defines the most common types of surrogacy:

Altruistic: A surrogate usually knows the intended parents in advance and does not receive payment (beyond pregnancy-related expenses).
Commercial: A surrogate does not know the intended parents in advance and does receive payment.
Gestational: A surrogate carries an embryo created from sperm and eggs from intended parents or providers (donors) or a combination; there is no genetic connection between the surrogate and the embryo.
Traditional: A surrogate’s own eggs are fertilized with sperm from an intended parent or provider (donor), typically through donor insemination.
Domestic: A surrogate and intended parents live in the same country.
International: A surrogate and intended parents live in different countries. (Also called transnational or cross-border.)

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Why does Surrogacy360 focus on international commercial surrogacy?

International commercial surrogacy arrangements almost always take place between intended parents in wealthier countries and surrogates with fewer economic resources, often in nations with few or no regulations. Because of the power imbalances and the challenges related to crossing national borders, and also because surrogacy contracts have historically given more decision-making power to intended parents, surrogates’ health and rights are often not protected or guaranteed. This site promotes an international standard whereby all parties’ rights are protected and the health of surrogates is paramount. This should also be the standard in domestic arrangements.

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Who is involved in international commercial surrogacy?

This type of surrogacy involves multiple parties: 1) intended parents; 2) egg and/or sperm providers (donors); 3) a surrogate; 4) intermediaries who facilitate the relationship and carry out the medical procedures (there are many types of intermediaries); and 5) the child or children born as a result of the arrangement. Visit the Surrogacy Relationships page for more information.

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Is international commercial surrogacy legal?

Laws vary widely depending on the country (and, in some cases, depending on the state or province within a country) and are subject to change. Visit the Current Laws page to learn more.

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How does international commercial surrogacy work?

This type of surrogacy is almost always facilitated by intermediaries who handle different aspects of the arrangement. In most cases, they limit contact between intended parents and gestational mothers, despite research that shows a desire on the part of most surrogates for contact and increased satisfaction when it is allowed. Intermediaries may include:

• • Local recruiters who are paid to find potential surrogates in their communities.
  • Agency employees who match intended parents with pre-screened surrogates and coordinate every aspect of the arrangement.
  • Brokers or fertility clinics that recruit egg and/or sperm providers and match them with intended parents.
  • Clinicians who provide medical services — from egg retrieval, IVF, and embryo transfers to labor and birth.
  • Lawyers who help intended parents with the legal issues related to hiring surrogates and establishing parental rights.
  • Representatives of tourism and hospitality businesses that offer hotel and sightseeing deals to intended parents visiting foreign countries.

International commercial surrogacy is part of a multibillion-dollar global industry. While some well-meaning intermediaries genuinely want to protect the interests of intended parents and help them grow their families, others prioritize their own commercial interests over the interests of intended parents and children. In the vast majority of cases, intermediaries do not prioritize the needs of surrogates.

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What are some of the ethical considerations related to international commercial surrogacy?

Intended parents seeking new modes of reproduction are part of a significant social shift in the way families are formed. Many intended parents are concerned about the ethics of international commercial surrogacy and seek reliable information that can answer their questions and guide their decisions.

It’s important to begin this inquiry with the knowledge that surrogacy in all its forms is complex, for a number of reasons:

• • The technologies upon which it is based are relatively new. Assisted reproductive technologies (ART) 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.
  • Laws governing these practices differ widely between countries and, in places like the United States and Mexico, within the same country.
  • There is usually an unequal power relationship between intended parents and surrogates due to disparities in economic position and in access to social and other resources.
  • Among surrogacy intermediaries and in society in general, surrogates are often described as being driven by a desire to help people who are otherwise unable to form genetically related families. While this may be the case for some, emphasizing altruism often serves to downplay the reality that surrogates in commercial arrangements are engaging in work and must be afforded just and fair conditions.

Within this context, Surrogacy360’s resources can help intended parents find the information they need to frame questions, identify red flags, and examine the benefits and risks to everyone involved in the arrangement they are considering. Along the way, answers about the ethics of that arrangement may begin to emerge.

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See Surrogacy360’s tool Principles and Standards for Engaging in International Surrogacy, which provides a foundation for investigating arrangements and shaping contracts that safeguard the health and rights of everyone involved.

What questions do intended parents need to ask when considering an international commercial surrogacy?

The process of setting up an international surrogacy arrangement involves uncertain legal outcomes and limited access to dependable, unbiased information. For example, it is particularly hard for intended parents to ascertain how potential surrogates will be informed, treated, and compensated. Surrogacy360 suggests that intended parents take time to investigate, ask questions, and fill in the details necessary to make a decision that fits their values and priorities. If intended parents decide to enter into an international surrogacy arrangement, they can be part of shaping a contract that safeguards all parties.

Here are some important questions to ask in discussions with surrogacy agencies, fertility clinics, medical personnel, and legal counsel:

• • What is the role of each intermediary (agents who arrange egg or sperm donation, the fertility clinic where embryo transfer will take place, the physicians conducting procedures, legal counsel, etc.)? What specific activities will each intermediary engage in?
  • Are there clear, established laws and precedents surrounding surrogacy between the countries in question, and within the country or countries where the surrogacy procedures will take place?
  • Will the intended parents have help navigating immigration systems, making legal decisions across borders, and establishing the child’s citizenship?
  • Are there any pending legal decisions regarding surrogacy practices in the countries in question that might affect the arrangement?
  • What legal, cultural, socio-economic, and linguistic dynamics are at play that would empower the intended parents over the surrogate? How can this imbalance be mitigated?
  • Will the child or children be assured access to information about their genetic background and heritage?
  • How comprehensive is the informed consent process for the surrogate?
  • To what degree can the surrogate realistically negotiate contract terms, influence the surrogacy contract, and shape the arrangement as it proceeds?
  • Will the surrogate be guaranteed decision-making ability over herself and her pregnancy?
  • What are the conditions in which the surrogate will be living during her pregnancy? Will there be restrictions on her daily activities and decisions?
  • Of the total sum paid by intended parents, what amount of compensation will the surrogate receive? At what points during the pregnancy will she receive payment?
  • Will the surrogate be guaranteed independent legal counsel before, during, and after her pregnancy at no cost to herself?
  • Will the surrogate be guaranteed medical care before, during, and after her pregnancy, at no cost to herself?
  • Will the intended parents and the surrogate have the opportunity to meet and maintain contact throughout her pregnancy and after the birth?
  • Will the surrogate be supported in forming an emotional connection to the fetus?
  • What protocols are in place to ensure the egg provider (donor) is given comprehensive information about the known health risks of the process and about the lack of long-term studies on hormonal stimulation?
  • What safeguards are in place for the egg provider to reduce the risk of ovarian hyperstimulation syndrome and ensure monitoring — during the process and follow-up — to address any complications and adverse health outcomes?

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See Surrogacy360’s tool Principles and Standards for Engaging in International Surrogacy, which provides a foundation for investigating arrangements and shaping contracts that safeguard the health and rights of everyone involved.

What risks do intended parents and surrogates face?

Risks for intended parents include:

• • Legal or personal discrimination based on their sex, gender identity, sexual orientation, marital status, disability, or religion.
  • Business practices that exploit the emotional vulnerability of intended parents who face biological, social, or legal barriers to parenting.
  • Legal entanglements caused by incomplete information about the legal differences between their own country and the country where the child will be born.
  • Fraud, when intermediaries deceive intended parents by accepting payment with no intention of arranging the birth of a child or when they engage in other illegal or unethical conduct that puts intended parents at risk.
  • Restrictions (imposed by intermediaries) on how much, if any, contact they may have with the surrogate during pregnancy and after the birth.

Learn more about intended parents here.

Risks for surrogates include:

• • Incomplete information regarding health risks and decisions that may need to be made during the pregnancy and contracts in languages they do not speak or read, thus making it impossible to give meaningful informed consent.
  • Limited ability to make decisions about herself and her pregnancy, with medical personnel and intended parents granted greater power or veto authority in these decisions.
  • Dormitory-style living arrangements with frequent surveillance and restricted access to the outdoors, family, and community.
  • Medically unnecessary cesarean sections for the convenience of intended parents and to increase the speed and volume of births at fertility clinics.
  • Transfer of multiple embryos to increase the chance of pregnancy, even though this greatly increases the health risks to the surrogate and child(ren).
  • Absence of independent no-cost medical advice or legal counsel and lack of recourse when problems arise.
  • Payment contingent on the birth of a child and loss of payment with termination, miscarriage, or stillbirth.
  • Unethical practices by intermediaries regarding payment or other provisions of the arrangement.
  • Being left with the child if the parents do not want to accept custody due to the child(ren)’s sex, genetic condition, or physical or mental disability.
  • Restrictions (imposed by intermediaries) on how much, if any, contact they may have with the intended parents during pregnancy and after the birth.
  • Insufficient medical and emotional support during pregnancy and after the birth.