For some intended parents, surrogacy feels like the last path to parenthood. In the United States, it is primarily governed by state law and can be complex in practice. This guide explains the main models, the U.S. legal landscape, typical medical risks and cost ranges, how overseas pathways differ, and safer alternatives that keep the child’s rights, documentation, and transparency at the center.
What surrogacy involves
Surrogacy is an arrangement where a woman carries a pregnancy for intended parent(s) and, after birth, the child is cared for by them. Depending on the model, the surrogate may or may not be genetically related to the child. Because the process spans medicine, law, and ethics, independent counseling for all parties is essential.
Types: traditional vs. gestational
Traditional surrogacy: The surrogate provides the egg and is genetically related to the child. This increases both legal and emotional complexity.
Gestational surrogacy: Embryos are created from the intended mother’s or a donor’s eggs and the intended father’s or a donor’s sperm. The surrogate has no genetic connection to the child. This is the more common model internationally.
Legal framework in the U.S.
The U.S. has no single federal surrogacy law. States set the rules on whether and how surrogacy is permitted, what types of compensation are legal, which court orders are available, and how legal parentage is established.
- States broadly supportive: Many allow compensated gestational surrogacy with detailed requirements (e.g., independent legal counsel, medical/psychological screening, clear contracts). Some offer pre-birth orders that confirm parentage before delivery.
- Restrictive or mixed states: Some limit compensation, require post-birth adoption or recognition steps, or have differing rules by county or judge.
- Prohibitive states: A few prohibit compensated surrogacy or enforce only altruistic models; enforcement can vary and penalties may apply to brokering or paid arrangements.
Because rules vary by state, secure early advice from an attorney experienced in assisted reproduction law where you live and where the birth will occur. Helpful overviews and patient-facing resources include:
Documents & returning after overseas birth
If you consider surrogacy abroad, plan documentation from day one: the local legal framework, how parentage is recognized, birth registration, travel documents for the child, and how U.S. citizenship/parentage will be established. Without a solid legal plan, passports and homecoming can be delayed.
Medical aspects & risks
Surrogacy typically involves IVF. Known risks include hormonal side effects (including ovarian hyperstimulation syndrome), multiple pregnancy, pregnancy complications, and psychological stress for both surrogate and intended parents. Independent medical and psychosocial counseling is recommended, along with a conservative embryo-transfer policy to reduce multiple gestation.
Patient-friendly overviews: HFEA: Surrogacy (UK regulator; neutral patient info) and ASRM: Patient Resources.
Cost ranges by country
Total costs vary by country, model (altruistic vs. commercial), number of IVF cycles, court processes, insurance, and travel. Globally, end-to-end totals often range from mid five figures to six figures (USD/EUR equivalent). The table below is a guide only and not a recommendation.
| Country/Region | Legal situation (short) | Typical payments | Approx. total range* |
|---|---|---|---|
| United States | By state; commercial often permitted | Compensation + agency/clinic/legal | high five- to six-figure range |
| USA (California) | Established practice; pre-birth orders common | Compensation + extensive contracts | upper five- to six-figure range |
| USA (other states) | Mixed; rules vary widely | Varies by state | broad range |
| Canada | Altruistic only (federal) | Documented expense reimbursement | mid five-figure range |
| United Kingdom | Altruistic; Parental Order post-birth | Expense reimbursement | mid five-figure range |
| Greece | Court-approved, regulated | Compensation permitted | upper five-figure range |
| Georgia | Rules in flux | Compensation possible | mid five-figure range |
| Ukraine | Previously commercial; situation volatile | Compensation common | upper four- to mid five-figure range |
| Mexico | Varies by state | Compensation sometimes allowed | broad range |
| Argentina | Mixed; court-driven practice | Mainly expense-based | mid five-figure range |
| South Africa | Pre-birth court approval required | Altruistic; documented expenses | mid five-figure range |
| Australia | By state; commercial prohibited | Expense reimbursement | mid five-figure range |
| New Zealand | Altruistic; ethics approval | Expense reimbursement | low to mid five-figure range |
| France/Spain/Portugal | Prohibited; recognition of overseas cases difficult | — | — |
| Italy | Prohibited; criminal penalties | — | — |
| Netherlands/Belgium/Denmark | Heavily restricted; commercial banned | Expense reimbursement where allowed | low to mid five-figure range |
| Poland/Czechia | Unclear/grey areas | Case-specific | broad range |
| Israel | Regulated; committee approval | Compensation/expenses | upper five-figure range |
*Indicative only; influenced by region, number of treatment cycles, insurance, legal steps, and length of stay. In altruistic systems (e.g., Canada, UK) typically only documented expenses are reimbursed.
Overseas: models & trends
Broadly, jurisdictions follow three models: prohibition, altruistic (expense-only), and commercial (compensation permitted). Regardless of destination, essentials include robust contracts, verified clinical standards, a plan for parentage recognition, and citizenship/travel documentation for the child. As a neutral process guide, the UK government provides an English-language overview of overseas processes and risks.
Alternatives to grow your family
- Adoption or foster-to-adopt: Government-regulated pathways with clear child-protection standards.
- Sperm donation: In the U.S., often clearer medically and legally than surrogacy; review your state’s parentage rules and clinic consent requirements early.
- Egg donation/other ART abroad: Highly country-specific; seek careful legal and medical review before proceeding.
Important note & the RattleStork alternative
RattleStork does not offer surrogacy and is not a platform for brokering or carrying out surrogacy arrangements. We expressly distance ourselves from such services.
As a safer alternative, we help people in the U.S. begin with sperm donation in an informed and secure way — with verified donor profiles, practical guides, and pointers to reputable counseling services — keeping clinical safety, documentation, and the child’s rights in focus.
Conclusion
Surrogacy in the U.S. is state-driven and procedurally complex; overseas models vary and can change quickly. Without a strong legal and clinical plan, parentage recognition, citizenship, and homecoming can become complicated. Consider lower-risk routes — sperm donation, adoption, or fostering — and seek independent legal and clinical advice early.