The debate around surrogacy hit a boiling point over the summer following comments from the former tennis star, Martina Navratilova. 

“Surrogacy is just wrong. Sometimes you can’t have it all,” the 68-year-old, who recently adopted two boys with her wife, wrote in a since-deleted post shared via X. 

Ms. Navratilova later clarified, “I don’t agree with surrogacy, regardless of who is doing it,” indicating that she does not believe morally in the process. Last year, she also referred to surrogacy as something out of “The Handmaid’s Tale,” in which women — referred to as “handmaids” — forced to bear children for wealthy, elite families in a patriarchal society.

Ms. Navratilova’s blunt remarks unleashed a wave of public backlash, thrusting surrogacy into the limelight at a time when it has also played a role at the forefront of American politics. Earlier this year, the Trump administration expanded access to in vitro fertilization (IVF), promoting fertility treatments required for surrogacy as a priority for family building. 

At the same time, the influential blueprint from conservative think tank The Heritage Foundation, “Project 2025,” targets surrogacy and IVF with increased scrutiny and regulation, raising alarm in some circles that these options could become less accessible or more heavily restricted.

All this raises a pressing question: How ethical is surrogacy, and does the industry urgently need stronger legal safeguards?

Surrogacy in the United States has grown significantly, primarily due to advances in reproductive technology such as IVF and increasing societal acceptance. The number of embryo transfer cycles using a gestational carrier — each representing a single attempt or procedure — nearly tripled from 3,202 in 2012 to 8,862 in 2021. These now make up 4.4 percent of all Assisted Reproductive Technology cycles.

Gestational surrogacy, when a woman carries a baby for someone else using an embryo created from the intended parents’ or donors’ egg and sperm, expands family-building options but comes with ethical, medical, and legal risks for all involved, the American College of Obstetricians and Gynecologists warns. 

The Backstory 

Surrogacy has evolved over the decades from an obscure practice to a booming business. The first reported commercial surrogacy case dates back to the late 1970s. While many countries, including Australia, Germany, and France, ban commercial surrogacy and practices like gender selection of embryos, the United States remains far less regulated, with laws varying widely by state and few federal restrictions in place.

Financially, surrogacy is a costly and multifaceted process. The average costs in the United States range between $100,000 and $150,000, influenced by factors like agency fees, legal costs, medical expenses, and surrogate compensation. 

These figures vary widely depending on location, complexity, and the type of surrogacy, with gestational surrogacy (requiring IVF) being the most expensive due to extensive medical procedures and higher surrogate compensation, unlike altruistic or traditional surrogacy, which can be less costly but involve different complexities and legal considerations.

An estimated 2,500 to 3,000 surrogate births take place per year in the United States. So, why do so many use surrogacy? While there are cases of not wanting to go through the often-arduous process of carrying a pregnancy and having the financial means to outsource, most turn to the process out of medical necessity due to infertility, serious health risks during pregnancy, or because they’re part of a same-sex couple. 

For those who opt to be a surrogate, the reasons vary. 

One Oregon mother, who has three children of her own, tells the New York Sun that, as a stay-at-home parent, she “wanted others to experience the beauty of motherhood.” Another Colorado nurse with a toddler said it was her “best option” for getting through graduate school and paying the bills while also granting “someone else’s wish.”

Yet, while many surrogates describe the experience as deeply meaningful or financially practical, the broader practice continues to spark intense ethical debate.

In Arcadia, California, authorities have removed 21 children between the ages of two months and 13 years, all born via surrogacy to biological parents Silvia Zhang, 38, and Guojun Xuan, 65, triggering a sweeping investigation into possible fraud and child endangerment.

The case first came to light in May when their 2-year-old was admitted to hospital with severe head trauma. Police later revealed that video footage from the property showed a nanny violently shaking and hitting the toddler. Mr. Xuan and Ms. Zhang were arrested on felony child endangerment charges. They were released on bond as the investigation continues. 

The incident has sparked concern not only because of its disturbing details, but also for what it reveals about the murky, loosely regulated landscape of surrogacy in America.

Several surrogates hired by Ms. Zhang and Mr. Xuan allege they were misled by the couple, who told them that they had only one child and were unable to conceive again, and that they had no idea that multiple women were carrying embryos for the couple at the same time. Some surrogates also say they were underpaid or that Ms. Zhang and Mr. Xuan were absent during delivery.

The couple also operated Mark Surrogacy Investment LLC, and allegedly used this to procure surrogates. California, like many states, does not require licensing for surrogacy agencies; a gap now under intense scrutiny.

With the FBI now involved, the case raises urgent questions about oversight in the fast-growing surrogacy industry and the risks to children and surrogates when transparency and regulation fall short.

Ethical and Social Debates

Advocates for surrogacy emphasize its transformative power for families who would otherwise have no path to biological parenthood. It can provide a viable option for individuals facing infertility, LGBTQ+ couples, and those with medical conditions precluding pregnancy.

Assistant Professor of Pediatrics at Texas Children’s Hospital, Dr. Seema Jilani, pointed out to the Sun that medical literature shows surrogates typically have higher live birth rates compared with patients undergoing routine in vitro fertilization. Gestational carriers are usually younger than intended parents, have proven fertility, and often undergo single embryo transfers — all factors linked to healthier pregnancies and fewer complications.

She also noted that, although data is limited to observational studies, families formed through gestational surrogacy do as well as those formed through natural conception in terms of psychological health, parenting, and child development.

Ethically, proponents argue that surrogacy can be a mutually beneficial arrangement when conducted with informed consent and fair compensation, and one that empowers women to make choices about their bodies and helps intended parents fulfill their dreams of family. 

Take the case of Sarah, a TV producer in California, who endured years of the journey to motherhood, which was marked by loss, heartbreak, and hope. After years of trying to conceive, multiple rounds of fertility treatments, and two miscarriages, she turned to surrogacy as a last resort. 

“It almost broke the bank,” Sarah, who requested her full name not be used for privacy purposes, tells the Sun. “But eventually, we welcomed a daughter. That was two years ago. And it was worth every cent and every moment of uncertainty.”

Supporters also highlight regulatory advances that protect surrogates’ rights and ensure transparent, ethical practices. 

Critics, however, caution that surrogacy risks commodifying women’s bodies and children, reducing reproduction to a commercial transaction. They warn that paying women to be surrogates, treating women’s reproductive capabilities and children as marketable goods or services, can exploit those who are poor or struggling, especially in countries where there are few rules to protect them.

Religious groups, including the Vatican, oppose surrogacy outright, labeling it morally impermissible and calling for prohibitions. Many argue that surrogacy fractures traditional notions of motherhood and family, creating legal and emotional complications.

“A child’s right to be born of a father and mother known to him and bound to each other by marriage is a foundational right. Surrogacy clearly violates this tenet,” President of the Catholic League for Religious and Civil Rights, Bill Donohue, tells the Sun. “The intervention of a third party dissociates husband and wife, effectively neutering their biological status and their social responsibilities.”

From his purview, “Western nations are already highly materialistic, and that is why surrogacy only adds to this problem by commodifying sexual relationships.”

“To commercialize reproduction, that is what the phenomenon of rent-a-womb does, is to cheapen marriage, the family and sexuality,” Donohue said. 

Bioethicist and Senior Fellow of the National Catholic Bioethics Center, Joseph Meaney, also claimed that too often “surrogacy contracts exploit the financial need of poor women and withhold or reduce payment in the event of complications, miscarriage or other violations of the contract.”

“Most surrogacy contracts dictate the surrogate’s lifestyle choices during pregnancy, including clauses regarding diet, exercise, and sometimes confinement to surrogate homes,” he tells the Sun. “Although this is much more likely to happen internationally than in the U.S. In practical terms, altruistic surrogacy is exceedingly rare, so banning commercial surrogacy goes a long way towards ending the practice.”

Legal Patchwork 

Surrogacy offers a pathway to parenthood for people facing medical or structural barriers. However, concerns persist about exploitation, especially in cases involving financial need or lack of oversight.

While Americans can find surrogates outside the country, likely at a lower cost and with different legal frameworks, women who choose to become surrogates in the United States are generally required to demonstrate financial stability and are typically disqualified if they are receiving government assistance programs like WIC, SNAP (food stamps), Medicaid (for themselves, though coverage for their existing children may be separate), or living in government housing. 

As public attention grows, several experts and advocates across the spectrum illuminate the need for more straightforward guidelines that protect the rights and well-being of all parties involved, while acknowledging the reasons many turn to surrogacy in the first place.

From a legal standpoint, the United States government has not established a unified federal stance. 

Dr. Jilani emphasized that couples using a surrogate should speak with a lawyer beforehand. This is because the laws around surrogacy differ depending on where you live  — and they determine who is legally considered the baby’s parents when the child is born.

In California, for example, the intended parents are usually recognized as the legal parents right away if a valid surrogacy contract is in place. Yet Arizona explicitly states that “a surrogate is the legal mother of a child born as a result of a surrogate parentage contract and is entitled to custody of that child.”

While some states like California, Illinois, and Connecticut offer clear legal frameworks, others impose strict restrictions, particularly on commercial surrogacy. For instance, Louisiana prohibits commercial surrogacy and limits arrangements to married heterosexual couples using their gametes, while Nebraska makes compensated surrogacy contracts unenforceable. 

Notably, Michigan, which previously criminalized compensated surrogacy, has legalized and regulated it with a new law effective April 1, 2025, joining states like New York, which also recently legalized it after a prior ban. This lack of uniform federal regulation forces many intended parents and surrogates to navigate a challenging legal maze, often traveling to more surrogacy-friendly states.

Where Does Surrogacy Go From Here?

Beneath the contracts and court rulings lie far messier questions about bodies, boundaries, and belonging. Surrogacy offers hope and healing for some, yet poses profound ethical questions about commodification, exploitation, and the meaning of parenthood.  

Yet, for Sarah and many others, surrogacy is not a transaction — it’s an act of love and survival. Behind every contract is a family built from longing, sacrifice, and the hope of a future.

“Without this,” she added. “I would never have been able to bring a child into this world.”