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Pros and Cons of Surrogacy Overseas
“Fertility tourism” refers to traveling abroad for fertility treatments. For Americans, it’s primarily to save money on surrogacy, which can run upwards of $100,000 in the U.S.
Q: What are the advantages of going overseas for surrogacy?
Dr. Feinman: The only true advantage of going overseas for surrogacy is cost. Depending on factors like whether or not an egg donor is required, the cost can be reduced by 50 percent or more. The second subtle advantage is the child is born an American citizen. Some states, including California, allow the names of the intended parents to immediately appear on the birth certificate. Going overseas requires getting visas to bring the baby home.
Q: What are the disadvantages of going overseas for surrogacy?
A: There are two main potential disadvantages.
The first is the nature of the countries that offer this choice. At the moment, they are primarily Thailand, and Mexico. While the clinics that perform surrogacy are quite upscale and focused on what is needed to do a good job, it is still not the United States. Moreover, if twins are born and require prolonged neonatal intensive care, this will occur in these countries, not at home. Again, these countries have made great strides in their medical systems, but American neonatal care is unparalleled in most of the world, including much of Europe.
The second disadvantage is the nature of the experience itself. American surrogacy is about relationships. The intended parents, the surrogate mother, and her family all know each other and often form lifelong friendships. Regardless of the nature of how these relationships persist, the children resulting from surrogacy know exactly what lead to their birth and know who gave them the gift of life.
For the most part, surrogacy performed outside the U.S. is done with a relative lack of transparency. The intended parents usually do not meet the surrogate ahead of time and in some countries, there is no contact until after the delivery. In India, two women are sometimes prepared for the embryo transfer, in case one of them does not show up! If the parents and surrogate eventually meet, this is usually a brief meeting and the patients and surrogate never hear from each other again.
One could argue that this approach is not consistent with Western values of openness and the rights of the children to know how they came into the world. Some of the agencies working in Mexico are trying to improve on this by allowing contact after the first trimester.
There are legitimate concerns about the level of coercion that may occur when indigent women act as surrogates for wealthier Western women. While the people promoting this practice say the amount of money these women receive, though small by our standards, can change their lives. We have heard that a significant number of women acting as surrogates in India are Moslem. The reason this is significant, is that surrogacy is not allowed by Islamic Law. Thus, one has to worry about the pressures being brought on these women to participate.
Dr. Feinman concluded by saying, "International surrogacy does offer patients who need a surrogate an affordable alternative. While most patients who choose this path have good experiences, it is still prone to logistical and ethical problems that are of concern. Hopefully, with continued patient pressure, the process will become more open, and thus, a mores satisfying experience."