For couples and individuals who cannot achieve parenthood through natural conception or other assisted reproduction methods, surrogacy can feel like the final option. In the United States, however, laws vary dramatically by state—from full recognition and regulation to outright prohibition. This article outlines the different types of surrogacy, explains the current U.S. legal landscape, compares key international alternatives, reviews costs and medical risks, and explores other paths to building a family.
What Is Surrogacy?
Surrogacy is an arrangement in which a woman (the surrogate) carries and delivers a child on behalf of intended parents, then legally transfers parental rights after birth. It supports heterosexual couples, same-sex couples, and single intended parents who face infertility or other medical challenges.
Traditional vs. Gestational Surrogacy
Traditional surrogacy: The surrogate’s own egg is fertilized with the intended father’s or a donor’s sperm. Because she is genetically related to the child, legal and emotional complexities can arise.
Gestational surrogacy: Embryos created from the intended mother’s (or an egg donor’s) eggs and the intended father’s sperm are transferred into the surrogate’s uterus. The surrogate has no genetic link to the child, simplifying many legal arrangements.
Surrogacy Agencies: Facilitation and Support
Reputable agencies manage the process end-to-end, offering:
- Screening and matching surrogates with intended parents
- Legal consultation and contract drafting
- Coordination of medical procedures (IVF, monitoring)
- Psychological counseling and conflict mediation
Ethical providers present clear timelines, fees, and risk disclosures upfront to protect everyone involved.
Surrogacy in the United States: Legal Situation
U.S. surrogacy law is determined at the state level. States like California, Illinois, and New Hampshire fully recognize and enforce both gestational and compensated surrogacy agreements. Others, such as Michigan, Indiana, and Louisiana, prohibit commercial surrogacy or any compensated arrangement. The Uniform Parentage Act, adopted by several states, allows intended parents to be listed on the birth certificate before birth, clarifying parentage.
In restrictive states, intended parents may face complex post-birth adoption or second-parent adoption procedures. It’s essential to consult a specialist attorney in the state where the surrogate resides to understand enforceability and any potential penalties.
Costs and Financing of Surrogacy
Total expenses depend on the state, agency, and medical package. Typical line items include:
- IVF procedures and medical monitoring
- Attorney fees and court filings
- Surrogate compensation and health insurance
- Agency facilitation fees
- Travel, lodging, and related expenses
In the U.S., total costs generally range from $90,000 to $150,000. Financing options include personal loans, fertility grants, and peer-to-peer fundraising.
Medical Aspects and Risks
Surrogacy typically uses in vitro fertilization (IVF), where embryos created in the lab are transferred into the surrogate’s uterus (Moragianni et al. 2021; Zhang et al. 2020).
Potential risks:
- Ovarian hyperstimulation syndrome (OHSS), affecting up to 5% of IVF cycles (Patient.info OHSS).
- Hormonal side effects such as mood swings, nausea, and bloating (MedlinePlus 2023).
- Increased chance of multiple pregnancy (twins, triplets), with higher rates of preterm birth and preeclampsia (WHO 2021).
- Psychological stress from hormone treatments and social pressures (Burgio et al. 2022).
Close medical supervision—including regular ultrasounds, lab tests, and specialist consultations—is essential to manage complications early.
Criticism and Ethical Debate
Critics argue that surrogacy can commodify human life and exploit lower-income women. They also question the long-term psychological impact on children born through compensated arrangements.
Proponents insist that, with rigorous screening, fair compensation, and transparent contracts, ethical surrogacy offers a compassionate path to parenthood. Strong legal oversight and comprehensive support services help prevent abuses.
International Alternatives: Overview and Regulations
Some intended parents travel abroad to countries with clearer or more affordable surrogacy laws. Examples include:
- Canada: Only altruistic programs; surrogates receive expense reimbursement only.
- United Kingdom: Altruistic surrogacy permitted; commercial payments prohibited.
- Greece: Commercial surrogacy allowed under regulated contracts.
- Ukraine: Commercial surrogacy available under defined conditions; subject to political risks.
- Russia: Both altruistic and commercial surrogacy allowed, though legal gray areas exist.
- Poland: Surrogacy operates in a legal gray zone; careful legal review advised.
- India: Commercial surrogacy largely banned for foreigners; regulations frequently change.
- Mexico: Laws vary by state; some regions permit compensated arrangements.
- Australia: Commercial surrogacy prohibited; altruistic only in certain states.
- Brazil: Altruistic surrogacy allowed under court approval.
- South Africa: Contracts must be court-approved before embryo transfer.
- Germany: Surrogacy is effectively banned under the Embryo Protection Act.
- Switzerland: All forms of surrogacy are prohibited.
- France: Surrogacy is banned; intended parents must seek services abroad and navigate complex recognition procedures.
- Sweden: Surrogacy is not permitted; many travel to neighboring countries.
- Denmark: Both commercial and altruistic surrogacy are heavily restricted, creating high legal risks.
Alternative Paths to Building a Family
Other family-building options include:
- Adoption: A legally defined process that places a child into a permanent home.
- Foster care: Temporary or long-term care for children, coordinated by social services.
- Sperm or egg donation: Regulated by the FDA; donors are screened and recipients matched.
Sperm Donation as an Alternative: RattleStork
Many U.S. intended parents now choose sperm donation instead of surrogacy. On platforms like RattleStork, users can create a free account and select from a network of vetted donors.
Conclusion
Surrogacy raises intricate legal, medical, and ethical questions. In the U.S., state-by-state differences can significantly affect your options. Whether you pursue domestic arrangements, travel abroad, or explore alternatives such as adoption or sperm donation, expert legal counsel, realistic budgeting, and thorough medical care are vital to a successful outcome.