How to Have an Ethical Surrogacy Journey Outside the United States

Previously, I published an article about the ‘truth’ of surrogacy costs in the United States and that many - if not most - queer men are now pursuing IVF and surrogacy in countries like Mexico, Colombia, and Argentina (https://www.babymoonfamily.com/original-articles/ivf-and-surrogacy-abroad).

However, since publishing this, I have been struggling with my strong belief in ethical surrogacy.  What I mean by ethical surrogacy is essentially the process of undergoing IVF and surrogacy in a state like California, where there are guardrails and protections in place for all parties.  By doing this, California ensures that the intended parents (IPs), egg donors, and gestational carriers (GCs) are all involved for the right reasons.  There is no coercion, no desperation, no remorse or regrets.  It also helps to protect the process of assisted reproductive technology (ART) for future queer men, as it greatly minimizes the possibility for scandals and legislation that could result in it being made illegal.

With that in mind, I wanted to outline some minimum criteria that queer men should look for when engaging in IVF and surrogacy outside the U.S.  I believe that if a clinic or agency does not offer these services for your journey, then it is a red flag, and you should consider either supplementing the process to cover it or choosing a different provider.

Here are the minimum requirements for ethical surrogacy that I will expand upon in this article:

• Legal representation:  Everyone gets their own lawyer.

• Psychological evaluation:  Everyone talks at least once with a mental health provider.

• Financial clearance:  Compensation should not be needed to provide basic life necessities.

• GC Specific Criteria:

• Have had at least one child without complications.

• Have social support.

• Be able to communicate independently with the IPs.

Legal Representation

Even though I am a physician, I wanted to start with the legal aspect because it is so incredibly important to ensure an ethical journey.  In fact, it is so important that I have even thought about going back to law school to be able to provide this support to other queer intended fathers.  (Unfortunately, my crippling educational debt from medical school prevents me from embarking on any additional degrees).

The most important aspect to legal representation is that every party, at every stage, needs their own, independent lawyer.

This is a non-negotiable, and it ensures that everyone’s voice is heard, everyone’s needs can be addressed, and that no one is forced to do anything they don’t want to do.  The independent lawyers can ensure they are advocating without bias for their client, whether it be the IPs, egg donor, or GC.

Separate lawyers and detailed contracts.  These go together and need to be included in any ethical journey.  

Psychological Evaluation

The journey to parenthood through IVF and surrogacy is not easy, and neither is the process of egg donation or being a GC.

For this reason, every person in this process needs to be seen at least once by a mental health professional.

My husband and I had a great experience talking with a psychologist about what we were looking for in an egg donor and GC, how we felt about becoming parents, and discussing the overall process of ART.  This is called psychoeducation, and even for those with no mental health issues, it’s critical to have a professional talk you through what you are going to potentially experience on your journey to parenthood.

I strongly believe a similar evaluation should be done for egg donors and GCs in any country.  Aside from screening for significant mental health issues, mental health professionals can also help women understand the process they are embarking on and assess if they are mentally equipped and prepared to handle it.  Having this space to openly and without judgment talk about fears and uncertainties can help women realize that maybe this isn’t for them.  On the other hand, it can give some women increased confidence that this is something they want to pursue.  

This mental health experience is essential to helping screen and prevent someone from continuing with this process to only have issues or regrets, and so I believe it is crucial to any ethical journey.

Financial Clearance

This is one of the more ‘contentious’ aspects to ethical surrogacy.  I strongly believe that the women who donate eggs or who act as GCs absolutely deserve to be compensated for their physical, mental, and emotional journeys.  

However, to make this ethical, it means that these women cannot need the financial compensation in order to provide basic necessities. 

Egg donation and GC remuneration should not go to pay for food, clothing, housing, or healthcare that the person or family could not otherwise afford.  It should not pay for any necessity, or else then there is no way to ensure that the women are not being coerced into the practice.

In the United States, this can be done in a number of ways.  Background checks, credit checks, and other financial documentation can be obtained to ensure fiscal stability.  Social workers or agency representatives can do home visits to validate the current state of a person’s home life.

I am not sure how this can be carried out in other countries, but I would strongly advocate that anyone working in one of these countries have evidence that the women who are helping them start a family are not doing this because they absolutely need the money to survive.

GC Specific Criteria:  Family Planning, Social Support, and Communication

The GC is, understandably, the most expensive part of the journey to fatherhood for queer men.  Because of this, I believe that the GCs deserve to have extra guardrails in order to ensure that the journey is ethical.

Family Planning

No GC should go through a surrogate pregnancy without having experienced pregnancy before.  Pregnancy is a physical and emotional rollercoaster, and a woman needs to completely understand what she is signing up for if she is to carry a pregnancy for IPs.  There is no substitution for having this firsthand experience, and it also is necessary to know that medically she is capable of having an uncomplicated pregnancy and delivery.  This is important for her, the baby, and the IPs.

Ideally, although I am not including this as an essential item for ethical surrogacy, the GC should be finished with her own family building.  This is because there is a small but not zero chance that any pregnancy can result in complications where reproductive organs can be permanently damaged or removed, preventing her from any future childbearing.  

A woman who may still want to have more children of her own needs to be informed that this may not be possible after her gestational surrogacy.  Otherwise, the process is not ethically respecting her by allowing her to prioritize her body and family above someone else’s.  

Social Support 

Being a GC is not a process a woman should go through alone.  Of course the IPs should be supportive, but in the case of an international journey, the IPs will be in another country so their support is geographically very limited.  The GC needs the support of her partner, her children, and her close friends and family.  

In the United States, this is often demonstrated through the relationship building and interactions that IPs have with the GC.  The partner and her children should be involved in these meetings and in the relationship building that goes on throughout the pregnancy.  

There should be no judgment or secrecy for the GC, or else she will experience undue stress and potential complications for the pregnancy as a result.

Communication

While each relationship between IPs and a GC is different, there should always be the ability for the IPs and GC to communicate independently.

What I meant by this is that the IPs and GC should be able to speak a common language.  For example, I don’t speak Spanish, so to have a GC in Central or South America, they would need to speak fluent English, or else we would have to communicate through the agency or another third party.

Some GCs and IPs want this compartmentalization.  That is fine, but my point on the ethical aspect to this is that compartmentalization of communication has to be a choice.  It is not a choice if the two parties do not speak the same language.  

This is by no means an exhaustive list of components for an ethical surrogacy journey, but I do believe these would cover the minimum requirements for any journey outside the United States for queer men to pursue with a clear conscience.

Will this add cost to the process?  Absolutely.  

But think about what you are doing here.  You are creating a life and your family.  There should be no cutting corners or saving a buck here or there.  This process doesn’t have to be prohibitively expensive for everyone, but it should include these elements to help guarantee an ethical journey and the sustainability of international IVF and gestational surrogacy for future generations of queer men.