The (U.S.) market for surrogate wombs

The NY Times has a great story on surrogacy, by Tamar Lewin:
Coming to U.S. for Baby, and Womb to Carry It--Foreign Couples Heading to America for Surrogate Pregnancies

"Other than the United States, only a few countries — among them India, Thailand, Ukraine and Mexico — allow paid surrogacy. As a result, there is an increasing flow in the opposite direction, with the United States drawing affluent couples from Europe, Asia and Australia. Indeed, many large surrogacy agencies in the United States say international clients — gay, straight, married or single — provide the bulk of their business.

The traffic highlights a divide between the United States and much of the world over fundamental questions about what constitutes a family, who is considered a legal parent, who is eligible for citizenship and whether paid childbirth is a service or exploitation.

In many nations, a situation that splits motherhood between the biological mother and a surrogate carrier is widely believed to be against the child’s best interests. And even more so when three women are involved: the genetic mother, whose egg is used; the mother who carries the baby; and the one who commissioned and will raise the child.

Many countries forbid advertising foreign or domestic surrogacy services and allow only what is known as altruistic surrogacy, in which the woman carrying the baby receives payment only for her expenses. Those countries abhor what they call the commercialization of baby making and view commercial surrogacy as inherently exploitive of poor women, noting that affluent women generally do not rent out their wombs.

But while many states, including New York, ban surrogacy, others, like California, welcome it as a legitimate business. Together, domestic and international couples will have more than 2,000 babies through gestational surrogacy in the United States this year, almost three times as many as a decade ago. Ads galore seek egg donors, would-be parents, would-be surrogates. Many surrogates and intended parents find each other on the Internet and make their arrangements independently, sometimes without a lawyer or a formal contract.

The agencies that match intended parents and surrogates are unregulated, creating a marketplace where vulnerable clients yearning for a baby can be preyed upon by the unscrupulous or incompetent. Some agencies pop up briefly, then disappear. Others have taken money that was supposed to be in escrow for the surrogate, or failed to pay the fees the money was to cover.

Surrogacy began in the United States more than 30 years ago, soon after the first baby was born through in vitro fertilization in England. At the time, most surrogates were also the genetic mothers, becoming pregnant through artificial insemination with the sperm of the intended father. But that changed after the Baby M case in 1986, in which the surrogate, Mary Beth Whitehead, refused to give the baby to the biological father and his wife. In the wake of the spectacle of two families fighting over a baby who belonged to both of them, traditional surrogacy gave way to gestational surrogacy, in which an embryo is created in the laboratory — sometimes using eggs and sperm from the parents, sometimes from donors — and transferred to a surrogate who has no genetic link to the baby.

But thorny questions remain: How much extra will the surrogate be paid for a cesarean section, multiple births — or loss of her uterus? What if the intended parents die during the pregnancy? How long will the surrogate abstain from sex? If she needs bed rest, how much will the intended parents pay to replace her paycheck, and cover child care and housekeeping?

“The gestational carrier has to agree to follow medical advice, but there has to be some level of trust,” said Andrew W. Vorzimer, a Los Angeles surrogacy lawyer who advises on many arrangements that have gone awry. “Once everyone goes home and the doors are closed, there’s no way to really monitor what’s going on.”

Since the Baby M case, the common wisdom has been that the main risk for parents is the surrogate’s changing her mind. But Mr. Vorzimer, who has tracked problem cases in the United States over the years, said it was the reverse: Trouble most often starts with the intended parents. One intended mother decided, well into the pregnancy, that she could not raise a child that was not genetically hers. Another couple, after a divorce, offered the surrogate mother money to have an abortion.

...

Critics sometimes draw an analogy to prostitution, another subject that raises debate over whether making money off a woman’s body represents empowerment or exploitation.

In Canada, as in Britain, payment for surrogacy is limited to expenses.

“Just like we don’t pay for blood or semen, we don’t pay for eggs or sperm or babies,” said Abby Lippman, an emeritus professor at McGill University in Montreal who studies reproductive technology. “There’s a very general consensus that paying surrogates would commodify women and their bodies. I think in the United States, it’s so consumer-oriented, so commercially oriented, so caught up in this ‘It’s my right to have a baby’ approach, that people gloss over some big issues.”

Germany flatly prohibits surrogacy, with an Embryo Protection Act that forbids implanting embryos in anyone but the woman who provided the egg. Ingrid Schneider of the University of Hamburg’s Research Center for Biotechnology, Society and the Environment said it is in children’s best interest to know that they have just one mother.

“We regard surrogacy as exploitation of women and their reproductive capacities,” Dr. Schneider said. “In our view, the bonding process between a mother and her child starts earlier than at the moment of giving birth. It is an ongoing process during pregnancy itself, in which an intense relationship is being built between a woman and her child-to-be. These bonds are essential for creating the grounds for a successful parenthood, and in our view, they protect both the mother and the child.”

With all that is known about adopted children’s seeking out their biological parents, other European experts say, it is wrongheaded to create children whose relationship with the woman who provided the egg or carried them will be severed.

...

The restrictions in many countries have been a boost for American surrogacy. For overseas couples, the big draw is the knowledge that many states have sophisticated fertility clinics, experienced lawyers, a large pool of egg donors and surrogates, and, especially, established legal precedent.

“We chose the United States because of the certainty of the legal process,” said Paulo, an engineer and scrub nurse. “Surrogacy is very secretive in Portugal. People don’t talk about surrogacy, and it’s hard to get any information. In the United States it is all clear.”

But it is not cheap. International would-be parents often pay $150,000 or more, an amount that rises rapidly for those who do not get a viable pregnancy on their first try. Prices vary by region, but surrogates usually receive $20,000 to $30,000, egg donors $5,000 to $10,000 (more for the Ivy League student-athlete, or model), the fertility clinic and doctor $30,000, the surrogacy agency $20,000 and the lawyers $10,000. In addition, the intended parents pay for insurance, fertility medication, and incidentals like the surrogate’s travel and maternity clothes.

Because surrogacy is so expensive in the United States, many couples travel to India, Thailand or Mexico, where the total process costs half or less. But complications have arisen — as in the case of a couple stuck in India for six years, trying to take home a baby boy, whom genetic testing had found not to be related to them, apparently because of a mix-up with the sperm donation.

Continue reading the main story

Four years ago, according to Stuart Bell, the chief executive of Growing Generations, a Los Angeles surrogacy agency, only about 20 percent of its clients came from overseas, but now international clients are more than half. Other agencies report the same trend.

“Anyone who can afford it chooses the United States,” said Lesa A. Slaughter, a fertility lawyer in Los Angeles."

Market for eggs and sperm

The Boston Globe reports Recession spurs egg and sperm donations
Giving provides extra income.

"Couples, and some single women, pay $20,000 to $30,000 for an egg donation, in vitro fertilization, and transfer to the recipient. Donors generally must be healthy nonsmokers between ages 21 and 32 with a good family health history, "reasonably educated and reasonably attractive," Benardo said. Screening involves physical, psychological, and genetic testing. If accepted, the woman undergoes hormone injections, then a surgical procedure to remove her eggs. Fees paid to the donor generally range from $5,000 to $10,000. Recipients choose prescreened donors."
...
"In Charlestown, NEEDS (National Exchange for Egg Donation and Surrogacy) also reports a 25 percent increase. "Very few of them will say just straight out it's for the money," said NEEDS manager Jan Lee. "They don't want to sound like a money-grabber. We ask them if they're applying because they need the money or out of the goodness of their heart, and they say both." "
...
"[Dr. Vito Cardone, founder of Cardone Reproductive Medicine & Infertility] cautions against women seeing this as a gold mine.
"The money that's given is limited; it's not going to be something to create a yearly revenue to get them through life," he said.
He believes in compensating women for their time and trouble but said there needs to be "some ethics to it" - both an altruistic motive and a monetary limit.
"When I see people who want to 'sell' their eggs for $20,000 or more it makes no sense, because then it becomes commercial, like selling any other thing," he said. "There has to be a little bit of kindness, because these couples have had a lot of hardship and desire a child very strongly." "
...
" Sperm donations are also on the increase, although they pay much less - an average of $85 to $100 per donation. Such "banks" generally require that the donor be at least 5-foot-8, a college student or graduate between the ages of 18 and 38, and in good health.
California Cryobank, which has offices in Cambridge, recruits largely on college campuses and asks each donor for a year's commitment, with the average donor contributing 2-3 times a week.
In the past six months, applications are up 20 percent, said Scott Brown, communications manager. "I think the recession has certainly opened up interest," he said. But less than 1 percent of applicants are chosen, based on family history, a physical exam, and analyses of blood, urine, and semen. "It's tougher to get into the Cryobank than into Harvard," Brown said."

Matching for platonic co-parenting: "like a divorce, without the wedding or the arguments."

The WSJ has the story, about two web sites that are trying to pioneer matching for people who want to conceive a child who will have two involved parents, who won't be married to each other:

Co-Parenting Sites Skip Love and Marriage, Go Right to the Baby Carriage
A new kind of online service matches people who want to have children, but not necessarily romance 
By Julie Jargon

"When Jenica Andersen felt the tug for a second child at age 37, the single mom weighed her options: wait until she meets Mr. Right or choose a sperm donor and go it alone.

"The first option didn’t look promising. The idea of a sperm donor wasn’t appealing, either, because she wanted her child to have an active father, just like her 4-year-old son has. After doing some research, Ms. Andersen discovered another option: subscription-based websites such as PollenTree.com and Modamily that match would-be parents who want to share custody of a child without any romantic expectations. It’s a lot like a divorce, without the wedding or the arguments."
...
"Given the prominence in today’s society of both single parenthood and online dating, this digital approach could be seen as a natural progression. It could also be considered shocking or even, as some have called it, an affront to marriage.
***********

Here's Pollentree.com: https://www.pollentree.com/, which also offers to match prospective moms with sperm donors.

And here's Modafamily: https://modamily.com/, which speaks of romantic, co-parenting, or known-donor relationships.

Law and economics of repugnant markets

Kimberly Krawiec at The Faculty Lounge, some time ago followed up on one of my posts with an interesting one of her own: Selecting for Sex: US entrepreneurship in the baby market

She is a professor at Duke Law, and a scholar of repugnant markets, often analysing them with respect to rent seeking behavior. See e.g.

Altruism and Intermediation in the Market for Babies, 66 WASH. & LEE L. REV. 203 (2009).
Abstract: Central to every legal system is the principle that certain items are off-limits to commercial exchange. In theory, babies are one such sacred object. This supposed ban on baby selling has been lamented by those who view commercial markets as the most efficient means of allocating resources, and defended by those who contend that commercial markets in parental rights commodify human beings, compromise individual dignity, or jeopardize fundamental values. However, the supposed and much-discussed baby selling ban does not, and is not intended to, eliminate commercial transactions in children. Instead, it is an asymmetric legal restriction that limits the ability of baby market suppliers to share in the full profits generated by their reproductive labor, insisting instead that they derive a large portion of their compensation from the utility associated with altruistic donation. Meanwhile, a wide range of baby market intermediaries profit handsomely in the baby market, without similar restrictions on their market activities. Baby selling "bans" thus have more in common with the rent-seeking by powerful marketplace actors seen in other commercial markets than with normative statements about the sanctity of human life. The author concludes with a call for the removal of the last vestiges of the "ban" against baby selling and other laws that diminish the capacity of baby market suppliers to access the marketplace.

Price and Pretense in the Baby Market, in BABY MARKETS: MONEY, MORALS, AND THE NEOPOLITICS OF CHOICE (Cambridge University Press, forthcoming 2009).

Show Me the Money: Making Markets in Forbidden Exchange, 72 LAW & CONTEMP. PROBS. (2009).

Sunny Samaritans and Egomaniacs: Price-Fixing in the Gamete Market, 72 LAW & CONTEMP. PROBS._ (2009).
Abstract: This Article considers the market structure of the human egg (or “oocyte”) donation business, particularly the presence of anti-competitive behavior by the fertility industry, including horizontal price-fixing of the type long considered per se illegal in other industries. The Article explores why this attempted collusion has failed to generate the same public and regulatory concern prompted by similar behavior in other industries, arguing that the persistent dialogue of gift-giving and altruistic donation obscures both the highly commercial nature of egg “donation” and the benefits to the fertility industry of controlling the price of a necessary input into many fertility services – namely, eggs. A comparison to the egg market’s closest cousin – the sperm market – does not reveal similar collusive attempts to depress the price of sperm. A further analysis of the industry explores potential reasons for this difference.

The last two articles appear in an edited online journal volume by Professor Krawiec, called Show Me the Money: Making Markets in Forbidden Exchange, which has articles on the sale of blood, organs, eggs and sperm, labor, and surrogate wombs: here's her blog post summarizing them.

Repugnant markets involving altruistic motivations

Kim Krawiec follows up on Kieran Healy's work on markets for organs, and how the distinction between gift giving and buying and selling isn't so clear.

Krawiec writes (I quote at length, but not the whole thing):

"...I agree with Kieran that financial incentives for human organs are more likely to win social acceptance if they resemble the gift-based allocation systems that have already gained social legitimacy. And the oocyte market – a clearly market-based system with the trappings of gift, including the language of donation -- is a good example of this phenomenon. 

In fact, as I’ve discussed before, this disconnect between market realities and gift narrative is an important feature of many taboo trades.  By normalizing otherwise jarring transactions, gift narratives may facilitate markets that otherwise would stagnate under the weight of social disapproval. For those, like me, who believe there is social value in enabling the infertile to reproduce or those dying from kidney failure to live – and, by corollary, allowing those who consider themselves better off by the receipt of compensation in exchange for an egg or kidney – to do so, this is a good thing. 

At the same time, though, the oocyte market example also illustrates the costs of denying market realities in favor of the pretense of gift exchange -- gifts in name only: 

(1) Legal misfit

Gift-based exchange regimes are typically governed by a different set of legal rules than are market-based exchange regimes.  We tend to recognize, for example, the possibilities for opposing interests and opportunistic behavior in a regime of market-based exchange.  And many legal rules governing market-based regimes are designed with these considerations in mind. In contrast, we often assume (incorrectly, especially when the gift is one in name only) an absence of opportunism and an alignment of interests in the case of gift-based exchange. 

(2) Social stereotypes

I do not know if, or how, this would play out in organ markets, but it has for some time concerned me with respect to reproductive markets, especially the oocyte and surrogacy markets.  Scholars have long noted the presumption that many services provided by women, including reproductive and domestic labor, should be provided altruistically, despite their high economic value.  Says Mary Anne Case, for example:

Much of what women have market power over, such as their sexual and reproductive services, they have long been expected not to commodify at all. Even when monetary compensation is allowed, it is often kept low and female providers are expected to be interested in rewards other than money.

The continued insistence that egg donors are, and should be, motivated primarily by altruism and the desire to help others, rather than by the desire for monetary compensation, threatens to reinforce gendered notions that the market activities of women are driven in large part by altruism and that women as a group are uninterested in reaping the full gains of trade from the provision of their goods and services. 

The comparison to sperm markets is especially telling. The insistence on the altruistic motivations of egg donors is in stark contrast to the presumed motivations of sperm donors, who are recruited through materials that ask, “Why not get paid for it?” and advertise, “your sperm can earn!” 

...

In the end, gifts in name only represent a trade-off.  On the one hand, the language of donation coupled with the realities of market-based exchange has the capacity to legitimate otherwise troubling exchanges, facilitating life-saving operations and parenthood for the infertile.  At the same time, gift-in-name-only exchange has consequences for the social, legal, and market structure of these industries, and for the consumers, producers, and others, including the public-at-large, affected by them."

Gamete exchange

 Here's a cheerful story of peer to peer assisted reproduction, from the Washington Post:

Two couples couldn’t have babies, so they helped each other  By Kyle Melnick

"Neva and her wife, Kelsey, were considering using a surrogate or an in vitro method to have a child. John and his wife, Amy, couldn’t carry a pregnancy because of a hysterectomy Amy underwent to treat endometriosis.

“Just give us your sperm,” Neva recalled telling John. “We’ll have a baby, and then we’ll just give you an egg. It’s not a big deal.”

...

"In 2020, John donated sperm so that Kelsey could become pregnant through an insemination service. The Bentons’ baby was born the next year in Kansas. Kelsey, now 32, then acted as a surrogate for the Cardenases and birthed the Arizona couple’s child in July.

...

"the couples bought an insemination kit and wrote up a surrogacy contract with an attorney’s assistance. Kelsey tracked her menstrual cycles; John, who’s now 41, took pills and adjusted his diet to produce healthy sperm."

Dealing with shortages of deceased donors in a future with fewer automobile accidents

Sometimes you find out that someone has already worried about something that you haven't even thought of worrying about.  I worry about some aspects of transplantation, and I sometimes think about driverless cars, but here's an article about a worry that is nowhere near the top of my list.  However the short article below (it's a comment on another article) raises some interesting points about how society may want to rethink increasing organ donation as we see (I hope) ever fewer deaths from automobile accidents:

How Do You Donate Life When People Are Not Dying: Transplants in the Age of Autonomous Vehicles

Zoe Corin, Roee Furman, Shira Lifshitz, Ophir Samuelov & Dov Greenbaum (2018) , The American Journal of Bioethics, 18:7, 27-29, DOI: 10.1080/15265161.2018.1478024

"While there are differences of opinion as to when autonomous or self-driving cars will actually invade our roads—some car manufacturers are predicting consumer-ready self-driving cars as early as 2021—there is broad consensus that their inevitability is assured. And while there are clear positive social consequences that will result from self-driving cars and trucks, there are also a number of often less appreciated negative externalities. Balanced against the saved lives, minimized commutes, reduction in pollution, and general decrease in daily stress are the driving-related job losses and the reality that there will be fewer organ donors."
...
"There are no quick fixes, and current laws already place significant restrictions on the organ acquisition process. Buying and selling organs is nearly universally objectionable, unethical, and illegal (Ludin 2008). Some countries even ban any benefit, or any form of valuable consideration whatsoever, in exchange for an organ (Caulfield et al. 2014
Caulfield, T., E. Nelson, B. Goldfeldt, and S.Klarenbach, 2014. Incentives and organ donation: what’s (really) legal in Canada?Canadian Journal of Kidney Health and Disease 1: 7.[Crossref], [PubMed], [Google Scholar]). Some jurisdictions go even beyond this altruistic-only donor requirement, and allow live donations only among blood relatives (India 1994Government of India. 1994. Transplantation of Human Organs Act, 1994.http://wwwmedindianet/tho/thobill1asp. [Google Scholar]).

...

"However, even these universal attitudes have some specific exceptions: In many countries, blood donors are paid, and sperm and egg donors can receive thousands of dollars in remuneration. But just because a handful of tissue donations have been commodified (albeit sometimes obfuscated as gifts with financial consideration), it is not clear that this cash for contribution system will expand anytime soon to include other types of living donations, such as liver lobes or kidneys. To wit: While New York sperm donors can make more than a thousand dollars a month (Lewinnov 2016

Lewinnov, T. 2016. 10 things to know about being a sperm donor, New York Times, Nov. 3 2016. [Google Scholar]), surrogacy contracts are still void and unenforceable by law (New York 2014New York. 2014. N.Y. Dom. REL. Law §§ 121-124 Surrogate Parenting Contracts Organ Donation and Recovery Improvement Act (2004). [Google Scholar]).

Nevertheless, in light of the need for organs, a number of jurisdictions have tried to indirectly incentivize donation, either through financial or non-financial mechanisms. Such incentives include paying for funeral costs of non-living donors, or for the out-of-pocket expenses directly associated with transplantation (US 2004)."

Fertility tourism and the British ban on paying egg donors

The fertility treament covered by Britain's National Health Service causes many Britons to seek treatment privately, elsewhere in Europe, the London Times reports: 'Thousands of Britons' travel abroad for IVF, research finds.

"Restricted access to fertility treatment on the NHS, the high cost of private therapy at domestic clinics and a serious shortage of donated eggs are driving couples to visit overseas clinics for help in starting a family. "
...
"IVF patients who need donated eggs are particularly likely to travel. Domestic donors are in short supply because of the removal of anonymity and tough rules against selling eggs.Spain and the Czech Republic are prime destinations, due to laws allowing donors to be paid €900 (£765) and €500 respectively for eggs. British donors get no more than £250 in expenses. "

Now the ban on payment for eggs is being reconsidered:

Pay donors to end the shortage of IVF eggs, says watchdog
"A longstanding ban on selling sperm and eggs should be reconsidered to address a national shortage of donors, the head of the Government’s fertility watchdog says. Payments to donors could cut the number of childless couples travelling abroad for treatment, Lisa Jardine, of the Human Fertilisation and Embryology Authority, told The Times. The removal of anonymity for donors in 2005 and strict rules against payments have provoked a crisis in fertility treatment, forcing many couples to wait years for the therapy they need to start a family. A recent study showed that access to eggs and sperm was the main reason why hundreds of British couples became “fertility tourists” each month."
...
"Her move will raise concerns about a market in human tissue and exploitation of women as egg donation is invasive and involves an element of risk. In countries that allow payment, such as the United States, Spain and Russia, young women often donate to wipe out debts or to fund university fees. Professor Jardine said that the law already treated eggs, sperm and embryos differently from other tissues, so there was no danger of setting a precedent for the sale of organs such as kidneys. Payment would also ensure that more women were treated in licensed domestic clinics, rather than in countries with less stringent regulations. “I’m not saying the decision arrived at before I became chair wasn’t the right one at the time,” she said. “But given the evidence that egg shortage is driving women overseas, I feel a responsibility to look at it again.” "

Surrogacy law in Italy (moderated by subsequent court decisions)

The Italian law governing reproductive technology and surrogacy dates from 2004, but (although I don't think the law has been amended), some of the things it forbids have been modified by subsequent court decisions.

"This law prohibits research and reproductive cloning, the manipulation of embryos, the use of donated eggs or sperm for ART, and the cryopreservation of embryos (with the exception of severe injury/illness preventing embryo transfer). A maximum of three eggs can be fertilized and transferred per reproductive cycle. Sex-selection is only permitted through sperm sorting for sex-lined genetic diseases. All forms of surrogacy are prohibited. The use of preimplantation genetic diagnosis for the selection of embryos is generally prohibited, but has been allowed through the courts on a case-by case basis. Genetic testing for non-medical purposes is prohibited. The use of ART is restricted to stable heterosexual couples who live together, are of reproductive age, are over the age of 18, have documented infertility, and have been first provided the opportunity for adoption.”
(From G12 Country Regulations of Assisted Reproductive Technologies)

Surrogacy laws in Europe (mostly banned) and some countries where it is allowed

EuroNews has the story (and a map):

Where in Europe is surrogacy legal?

Families Through Surrogacy provides some information about countries around the world that allow surrogacy

The table below lists issues related to surrogacy in various countries which allow it.

COUNTRY	LIMITATIONS	EGG DONORS
AUSTRALIA	Altruistic surrogacy only available. No donor or surrogate matching available. Advertising for surrogates not legal. All donors must be identified Ethics committee approval often required. Foreigners cannot access surrogacy in Australia	User groups such as www.eggdonationaustralia.com.au can provide
CANADA	Altruistic surrogacy only available. Foreigners can access surrogacy	via seperate Egg donor providers
GREECE	Heterosexual couples and single females eligible. Foreign nationals allowed to engage. Surrogate cannot be compensated beyond out-of-pocket expenses	Donors, if required, must be anonymous. Eggs/embryos/sperm are able to be shipped directly from your registered clinic.
GEORGIA	Compensated surrogacy available  to heterosexual couples, including foreigners. Legal protections in place
INDIA	Only available for Indian residents	In-country donors are anonymous however donor photos may be available other details provided: age, height, weight, previous donation history, children, blood group, education level/ occupation
ISRAEL	Altruistic surrogacy available only to heterosexual Israeli residents
KENYA	Compensated surrogacy available to locals and foreigners. No legal protection
LAOS	Compensated Surrogacy available  to foreigners. Gestation & birth occurs in Thailand. No legal protection
MEXICO	Tabasco state closed to surrogacy. Other states have no legal protections. Embryo transfer occurs in Cancun or Mexico City often	Caucasian and Latin Sperm and Egg Donors available. Possible to bring your own surrogate and /or known donor. No waiting list
NIGERIA	Altruistic and commercial surrogacy available to Nigerian heterosexual residents	Egg donors available
SOUTH AFRICA	Altruistic surrogacy available to heterosexual South African residents
THAILAND	Only available altruistically to Thai residents
UK	Altruistic surrogacy only available. Advertising for surrogates not legal foreigners cannot access surrogacy in UK
UKRAINE	Only heterosexual married couples	Caucasian, offer photos with family history, occupation/ area of study, previous donor history and physical details.
USA	Gay and heterosexual foreigners can access surrogacy here see surrogacy laws by US state	Very wide range available from donor agencies or privately

COUNTRY	APPROX COSTS($US)	DONOR & SURROGATE SCREENING	YEARS EXPERIENCE	LEGAL ISSUES
AUSTRALIA	IVF: $25,000 Expenses: $10,000 Legals & counselling: $22,000	Donor screening offered only if through an egg bank	<5 td="" years="">	Transfer of legal parentage available 4-6 months post birth if uncompensated surrogacy used domestically.
GEORGIA	IVF: $8,500 Surrogacy: $26,000 + Local egg donor add $5,000 +	according to age, genetics and lifestyle, mental and physical health	10 years	Intended Parents named on birth certificate to meet the criteria of countries such as the UK, single surrogates are available and DNA testing is available
CANADA	$90,000		>15 years	Transfer of parentage. Canadian passport available
KENYA	$50,000		<3 td="" years="">	No legal protection
UK		Surrogacy UK, COTS	>15 years	Transfer of legal parentage available
USA	IVF costs: $25,000 Surrogacy: $68,000 Other costs: $20,000	Varies by agency	30 years	Parents names on the BC as mother and father
UKRAINE	IVF: $8,500 Surrogacy: $26,000 + Local egg donor add $5,000 +	according to age, genetics and lifestyle, mental and physical health	~5 years	Intended Parents named on birth certificate to meet the criteria of countries such as the UK, single surrogates are available and DNA testing is available. No eligibility for Ukraine citizenship
GREECE	IVF: $20,100 Surrogacy: $44,000 Legals: $10,000+ Local egg donor: $1,360		10+ years	Recently opened up to foreigners Parents names on the BC as mother and father. Court case prior to IVF ensures transfer of parentage occurs before embryo transfer
MEXICO	$80,000 (incl US egg donor)	unknown	<1 td="" year="">

Surrogate births, payments, and legal rights in Britain, continued

The Telegraph reports Childless couples win the right to pay surrogate mothers: Childless couples will be able to pay surrogate mothers large sums of money to have babies for them, following a landmark High Court ruling.

"A senior family court judge allowed a British couple to keep a newborn child even though they had technically broken the law by giving more than “reasonable expenses” to the American natural mother.


"Mr Justice Hedley said the existing rules on payments were unclear, and that the baby’s welfare must be the main consideration. Only in the “clearest case” of surrogacy for profit would a couple be refused the necessary court order to keep the baby.

"His comments, among the first in recent years on the subject by a senior legal figure, will be taken by many infertile couples as a welcome sign that they can now pay women to bear children for them without fear of breaking the law, and so be denied a family.

"Mr Justice Hedley warned that the courts would continue to consider the amount of money paid in each individual case, to ensure that a market is not established.

...
"Surrogacy was regulated in Britain in 1985, after Kim Cotton was paid £6,500 to carry a child conceived using her own egg but the sperm of a man whose wife was infertile, in what is known as “straight surrogacy”. In “host surrogacy”, embryos are created through IVF using the eggs and sperm of both intended parents are transferred to the surrogate mother.


"Under the Surrogacy Arrangements Act 1985, companies were banned from brokering deals between couples and potential mothers for profit. All arrangements have to be based on trust rather than money, and are not legally binding. Only “reasonable expenses”, which now can average £15,000, are allowed and must be agreed upon by the parties.

"In 1990, another law introduced the system of Parental Orders which couples must obtain following the birth in order to be regarded as the surrogate baby’s legal parents, rather than the natural mother.
...
"It is estimated that each year just 70 women in Britain have surrogate babies, but many more couples desperate to start a family now travel to countries such as India where the “reasonable expenses” will be far lower.


"In the current case, the unnamed British couple had made contact with a woman in Illinois, where no restrictions on payments to surrogate mothers apply. Her baby had been allowed to enter Britain on temporarily on a US passport, but the judge granted a Parental Order so it can now stay in the country with its new parents.

"Mr Justice Hedley agreed that the criteria, which also require that the surrogate acted of her own free will and that one of the couple must be a biological parent of the baby, had been “fully met” by the “most careful and conscientious parents”.

"However some have criticised the implications of his comments that payments above “reasonable expenses” were acceptable.

"Andrea Williams, director of the Christian Legal Centre, said: “Children are not commodities to be bought and sold. It is not the case that everybody has the right to a child, whatever the cost.

“The regulations that we have in this place regarding surrogacy are supposed to ensure that there is no element of profit in the whole process."
Here is my earlier post on this matter: Surrogacy, payments, and parental rights in Britain: Couples who pay surrogate mothers could lose right to raise the child.

Fertility tourism to the U.S.

The Washington Post suggests that the U.S.A. might be a good place to come if your neighbors at home disapprove of what you hope to do...

From sex selection to surrogates, American IVF clinics provide services outlawed elsewhere

"While many countries have moved in recent years to impose boundaries on assisted reproduction, the U.S. fertility industry remains largely unregulated and routinely offers services outlawed elsewhere. As a result, the United States has emerged as a popular destination for IVF patients from around the world seeking controversial services — not just sex selection, but commercial surrogacy, anonymous sperm donation and screening for physical characteristics such as eye color.
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"Numerous other countries also are tightening their regulation of the fertility industry. Last year, India banned commercial surrogacy. Next year, Ireland is set to join the Netherlands, Norway, Sweden, Switzerland, Finland, New Zealand and others in prohibiting anonymous sperm donation. And a large number of countries — including China, Canada and Australia — ban gender selection except in rare cases of medical need.
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"A survey published in March in the Journal of Assisted Reproduction and Genetics found that nearly 73 percent of U.S. fertility clinics offer gender selection. Of those, nearly 84 percent offer it to couples who do not have fertility problems but are considering IVF solely to control the pregnancy’s outcome."

Surrogacy and citizenship: bringing the babies home isn't always so easy

Even the U.S., which is a center of surrogacy, employs outdated rules to determine which surrogate children born overseas are automatically American citizens.  Here's a story from the NY Times which (among other things) involves reverse fertility tourism. The American male couple had a friend in Britain serve as the surrogate. (Mostly the tourism goes the other way, because British surrogates can't be paid, so they aren't easy to arrange....)

Both Parents Are American. The U.S. Says Their Baby Isn’t. By Sarah Mervosh.

"James Derek Mize is an American citizen, born and raised in the United States. His husband, who was born in Britain to an American mother, is a United States citizen, too.

"But the couple’s infant daughter isn’t, according to the State Department.

"She was born abroad to a surrogate, using a donor egg and sperm from her British-born father. Those distinct circumstances mean that, under a decades-old policy, she did not qualify for citizenship at birth, even though both her parents are American.
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"The interpretation [of the law] has led the State Department to regard births from assisted reproductive technology as “out of wedlock,” if the source of the sperm and the egg do not match married parents. Such a designation comes with extra requirements for transmitting citizenship, including showing that a biological parent is an American citizen who has spent at least five years in the United States."

"Black market" surrogacy in England, and subsequent legal complications

Organizing markets without a strong legal framework can be tricky; here's a British surrogacy story from the law blog Above the Law: I Want To Put A Baby In You: Underground Surrogacy And The Burger King Baby

"Last month, an English court held that a surrogate to an “underground” arrangement could nevertheless keep custody of the baby she carried. This was despite the fact that the surrogate was not genetically related to the child. Instead, she was hired via a “secret” matching service and matched with a gay couple. They hoped to be parents through surrogacy for a second time.

The intended parents and surrogate met only once for 30 minutes. Unfortunately, the meeting was at a Burger King. And now, this poor child is forever linked to the fast-food franchise.

After the meeting, the surrogate was flown to Cyprus. (As I mentioned previously, Cyprus is a hot destination for surrogacy arrangements.) There, she underwent the transfer of two embryos to her uterus. The eggs were from a donor, and one was fertilized by one of the intended parents and the second egg was fertilized with sperm from the other intended parent. The transfer was successful, and the surrogate became pregnant with twins. But sadly, she later miscarried one of the babies.

Issues continued to mount. The intended parents missed payment deadlines. The surrogate learned that the couple’s first surrogate had a negative review of the intended parents. Ultimately, the surrogate decided to keep the remaining child. She lied, and told the intended parents that she had miscarried both babies. But she was caught when the intended parents saw her very pregnant toward the end of the pregnancy.

The intended parents brought legal action against the surrogate to try to obtain their child. But they also had unclean hands. They had offered to “pay” the surrogate 9,000 pounds in exchange for carrying the baby. While British law allows “reimbursement” of expenses to a compassionate surrogate, no “paying” of a surrogate is permitted. Additionally, the court held that the surrogate herself had a learning difficulty that made her consent to the agreement invalid.

Ultimately, the court awarded full custody to the surrogate—I hope that learning difficulty isn’t too severe—while the intended parents get very limited visitation rights:  one weekend every eight weeks.

While it sounds shocking to award a surrogate the parental rights over a child to which they have no genetic connection, this unfortunately happens throughout the world. Even in the United States. And “underground” surrogacy arrangements are not unusual.
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"the Chinese Ministry of Heath all but outlawed surrogacy in 2001. So the estimated 10,000 surrogacy births in China a year are all via its underground surrogacy industry. And due to the illegality of the arrangement, intended parents in China can lack legitimate parental rights to their children born via surrogacy."
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"It Happens To U.S. Too. Surrogates change their minds in the United States as well. In the Robinson case, a gay couple in New Jersey asked the sister of one of the men to carry their children for them. Like the China case, this one also involves twin girls. The children were not related to the sister, but the result of an anonymous egg donor and the sperm from the spouse of her brother. After the girls were born, the relationship between the surrogate and the intended parents deteriorated..."

The changing market for surrogate wombs

Here is a longish set of excerpts from a very interesing NY Times Magazine story about surrogacy: Her Body, My Baby . It touches on a number of issues that also come up in discussions of organ transplantation, and the controversy about compensation for donors.

"Before I.V.F. became a standard fertility treatment, about 15 years ago, the only surrogacy option available to infertile couples who wanted some genetic connection to their child was what is now called traditional surrogacy. That is when the woman carrying the baby is also the biological mother; the resulting child is created from her egg and sperm from the donor father. When the surrogate mother is carrying a child genetically unrelated to her, she is gestating the child, and the process is called gestational surrogacy. Now that there are hundreds, if not thousands, of doctors in the United States who can perform I.V.F., surrogacy agencies report that the numbers have shifted markedly away from traditional surrogacies toward gestational surrogacies.
There are no national statistics documenting this shift, however, or documenting much of anything about surrogacy. Shirley Zager, director of the Organization of Parents Through Surrogacy, a national support group, told me that there have probably been about 28,000 surrogate births since 1976, a figure that includes gestational and traditional surrogacies. Sherrie Smith, the program administrator for the East Coast office of the Center for Surrogate Parenting, a surrogacy and egg-donation agency, said that of the 1,355 babies born in their program since 1980, 226 were created through artificial insemination — traditional surrogacies — and the rest were gestational surrogacies, using either a donor egg or the intended mother’s own egg."
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"Surrogacy is unregulated, and laws vary by state. In the states where it is legal, there is no box on the birth certificate to check “surrogate birth.” In many states that don’t expressly prohibit surrogacy — like Pennsylvania, where our child was eventually born — the genetic parents’ names could be the only ones that appear on the birth certificate. If, however, our baby had been born in New York, where we live and where it is illegal to compensate someone for surrogacy, we would have had to adopt our biological child from Cathy, the woman who carried our child, and her husband. But our contracts were signed in New Jersey, and the consent form that Dr. Fateh had Cathy sign skirted any remaining legal issues."
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Of the potential surrogate moms:
"None were living in poverty. Lawyers and surrogacy advocates will tell you that they don’t accept poor women as surrogates for a number of reasons. Shirley Zager told me that the arrangement might feel coercive for someone living in real poverty. Poor women, she also told me, are less likely to be in stable relationships, in good health and of appropriate weight. Surrogates are often required to have their own health insurance, which usually means the surrogate or her spouse is employed in the kind of secure job that provides such a benefit.
While no one volunteering to have our baby was poor, neither were they rich. The $25,000 we would pay would make a significant difference in their lives. Still, in our experience with the surrogacy industry, no one lingered on the topic of money. We encountered the wink-nod rule: Surrogates would never say they were motivated to carry a child for another couple just for money; they were all motivated by altruism. This gentle hypocrisy allows surrogacy to take place. Without it, both sides would have to acknowledge the deep cultural revulsion against attaching a dollar figure to the creation of a human life.
In fact, charges of baby selling have long tarnished the practice of traditional surrogacy, and charges of exploiting women have lingered even as more couples opt for gestational surrogacy. We were not disturbed by the commercial aspect of surrogacy. A woman going through the risks of labor for another family clearly deserves to be paid. To me, imagining someone pregnant with the embryo produced by my egg and my husband’s sperm felt more similar to organ donation, or I guess more accurately, organ rental. That was something I could live with. "
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"THE PREVIOUS WINTER, a Catholic priest, upon hearing of our impending birth and my plans to raise the boy in the same liberal Catholic tradition in which I was raised, sniffed and said to me, “You know, the church frowns on science babies.” "