How to Choose the Destination for Surrogacy Process?

By (embryologist), (gynecologist) and (babygest staff).
Last Update: 03/13/2017

Since surrogacy is not legal in a lot of countries, one of the first questions a person or couple who needs this method to have a child asks is about the country or destination in which to perform this technique.

Once you know where surrogacy is allowed, the future parents have to stay in their country if it is legal or to choose the one that best suits their conditions and needs. In this article we give you some tips to keep in mind when choosing the right destination.

Although there are several countries whose legislation provides for surrogacy, each of them sets out a number of conditions and requirements. Therefore, it is essential to know in detail the legal requirements of each destination to choose the most appropriate.

The United States, Canada, Russia, Ukraine, Greece and Georgia are currently the most common destinations. However, depending on the characteristics of each situation, there will be one destination better than others. The aspects that we must consider when looking for destinations are:

  • Type or model of family
  • Need for egg and/or sperm donation
  • Price of treatment
  • Choice and relationship with the surrogate
  • Type of Surrogacy
  • Determination of parentage
  • Availability to travel

The choice of destination country requires an ethical and moral responsibility on the part of the intented parents. Therefore, it is important to assess all these factors and choose the destination that offers more security and confidence based on our preferences.

In this link you can obtain some recommendations on the most suitable and safe destinations: International Surrogacy – Laws & Options for Surrogacy Abroad

Factors to consider

Next we explain the different aspects that must be considered in order to choose the right destination.

Types of families

If you are a heterosexual couple or an unmarried woman, the range of possibilities is wide. If, on the other hand, you are a male homosexual couple or a single man, then the options are reduced. This is something you should keep in mind because the type of family you are or want to be directly conditions your choice.

In the following image we can see a summary table with the conditions of the most common destinations in reference to the family models that the law allows to perform uterine surrogacy.

As we can see, the United States and Canada allow surrogacy to anyone regardless of their sexual status and marital status. In contrast, Russia and Greece only allow heterosexual couples and single women.

Finally, we find the most restrictive destinations: Ukraine and Georgia. In these countries, subrogation is only allowed for married heterosexual couples.

Egg and Embryo Donation

On numerous occasions, the inability to gestate does not affect ovarian function and, therefore, the future mother can provide her eggs. However, there are cases in which it is not possible to use the eggs of the intended mother and, therefore, egg donation is used.

The same is true for homosexual couples and single men, who will undoubtedly need egg donation.

Although less common, it is also possible that the seminal quality of the future father is affected and does not allow viable embryos to be obtained. In this case, and also in the absence of a male partner, sperm donation will be required.

In this sense, there is also variation between countries. For example, the United States allows both egg and semen donation in subrogation processes. However, in countries such as Russia, Ukraine or Georgia, at least the future father (and preferably both parents) will have to provide the sperm, as the paternal parentage upon returning to his country will be determined on the basis of the genetic endowment.

Price of treatment

This is one of the factors that most determines the choice of destination, as the variety of prices between countries is significant.

The average cost of a surrogacy process in the United States is around 100,000-150,000€ and in Canada it is around 60,000€-80,000€. On the other hand, in European destinations, the cost is reduced, as well as the expenses related to the trip. The approximate prices are between 35.000 and 55.000€.

The variation is not only due to the financial compensation given to the pregnant woman but also to the cost of health care in the particular country. For example, the U.S. has the most expensive health care system in the world; it does not have public health and, for this reason, it is the country with the most expensive surrogacy treatments. On the other hand, it is also the country with the best rates in assisted reproduction and the most experienced in surrogacy.

On the other side, there are countries such as Russia or Ukraine, which have prices very similar to each other and much lower than in the United States. They have a cheaper health, both in terms of childbirth and assisted reproduction treatment itself, which undoubtedly makes their prices can be cheaper.

If you want more information about the prices of this treatment, you can consult this article: Surrogacy Cost Breakdown – Agency & Gestational Carrier Fees.

Choice and relationship with the surrogate

The relationship you want to have with the surrogate is also an important factor when choosing one country or another.

In the U.S., the surrogate and the intented parents must know and choose each other. For this reason, most families have a relationship with the surrogate during the pregnancy and even after the continue to maintain contact. For them, the surrogate mother is an important person in their lives.

Surrogate or surrogate mother are considered erroneous concepts because the surrogate will not be the mother of the baby but simply the woman who has helped his/her birth by carrying the pregnancy to term.

The case of Canada is very similar, one can even say that it goes a step further. In this country, surrogacy is only permitted on an altruistic arrangement. Therefore, the motivation that leads them to gestate other people's baby is purely and exclusively their intention to help others to form a family. That is why most of them want a close relationship and frequent contact.

In Russia, Ukraine and Georgia, generally, the choice of the surrogate is the responsibility of the surrogacy agency. In many cases, intended parents do not get to know the surrogate during treatment and pregnancy, and if they do, their relationship is not as intense as in the United States or Canada. The following link talks about the advantages and disadvantages of having a relationship with the pregnant woman.

Type of Surrogacy

As we have commented, in Canada, legislation only permits altruistic surrogacy. If this destiny is chosen, the intented parents must take this into account, because the fact that the only motivation of the surrogate is solidarity, is something ethically important for many and an aspect to consider in the choice of destiny.

In other destinations, surrogacy is commercial, although the compensation given to surrogate is different.

On the other hand, although in the most common destinations only gestational or complete subrogation is carried out, there are less secure destinations in which traditional subrogation is still carried out today, i.e. where the surrogate also provides the egg (genetic load).

This can also be a point to consider when choosing a destination. You can get more information here: What Are the Different Types of Surrogacy? – Names & Definition.

Determination of parentage

The way in which intented parents are determined to be the legal parents of the child is not the same in all countries and is therefore also a factor to be taken into account.

In the United States and Canada, filiation is determined, even before childbirth, by a court decision. This ruling is subsequently recognised in many countries, which allows direct parentage in favour of the future parents.

In Russia, Ukraine and Georgia, there is no pre-birth trial in which filiation is determined, but rather it is awarded to the father, who has contributed the genetic endowment, and to the surrogate. Subsequently, with the resignation of the surrogate, the future mother may adopt the child who is legally her husband's child. In this way, both will be recorded as legal parents of the newborn in the eyes of the registry.

Availability to travel

Although this is not usually a determining factor, it should not be put aside.

For Europeans, the United States and Canada are distant destinations and therefore require more travel time. By contrast, Ukraine, Russia, Greece or Georgia are European destinations, so in addition to showing more facilities in relation to visas and special permits, it means less travel time.

On the other hand, for U.S citizen who wants to undergo surrogacy in Europe, it is necessary to think about the travels necessary during the process.

In this sense, it is important to know the culture and way of life of the chosen country.

For this reason, it is recommended to travel to the destination before starting treatment. Whatever destiny you choose, you cannot ignore the fact that you are choosing the country where you want your child to be born: it cannot be a decision taken lightly. You have to think about it and choose the best option.

FAQs from users

How many times will I have to travel to my destination country for surrogacy?

By Dr. Joel G. Brasch (gynecologist).

Only twice! The first time is for medical screening and embryo creation, and the second time is to pick up your newborn baby at childbirth!

What is the country with the most experience in surrogacy?

By Andrea Rodrigo (embryologist).

The country with the most cases of surrogacy is the United States, which has been using this reproductive technique for more than 30 years. In fact, one of the first known cases took place in California in 1986.

Are there countries where surrogacy is not allowed for foreigners but for nationals?

By Andrea Rodrigo (embryologist).

Yes, there are destinations where nationality is required in order to apply the process. This is one of the requirements of India's new legal proposal. Mexico is another example of this.

Suggested for you

At the beginning of the article we commented that, in order to be able to choose the country where to carry out the surrogacy, first of all we must know the legal conditions of each one of the options. Discover them in this article: Surrogacy Laws by Country – Where Is It Legal?

Once the destination has been chosen, the next step in the surrogacy process is the choice of the professionals that will be involved in the process. In this article we give you some tips for this step: Professionals Involved in Surrogacy – Agencies, Attorneys & Clinics

Our editors have made great efforts to create this content for you. By sharing this post, you are helping us to keep ourselves motivated to work even harder.

References

Authors and contributors

 Andrea Rodrigo
Andrea Rodrigo
Embryologist
Bachelor's Degree in Biotechnology from the Polytechnic University of Valencia. Master's Degree in Biotechnology of Human Assisted Reproduction from the University of Valencia along with the Valencian Infertility Institute (IVI). Postgraduate course in Medical Genetics. More information about Andrea Rodrigo
Dr. Joel G. Brasch
Dr. Joel G. Brasch
Gynecologist
Dr. Joel Brasch is the Medical Director of Chicago IVF, founded in 2005. He is board certified by the American Board of Obstetrics and Gynecology, and has over 25 years of direct experience in fertility treatment and reproductive care. He is also the Director of Mount Sinai Medical Center’s Division of Reproductive Endocrinology and Infertility. More information about Dr. Joel G. Brasch
 Marie Tusseau
Marie Tusseau
Babygest Staff
Editorial Director of Babygest magazine in French and English. More information about Marie Tusseau

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