How to Have an Ethical International Surrogacy Journey
- Mar 18
- 8 min read
Updated: Mar 19
Written by Bryan McColgan, Physician Journalist
Dr. Bryan McColgan is an international authority on IVF and surrogacy for gay men. He is the founder of the Gay Dad Reporter, the world’s first online platform dedicated to news about surrogacy and rainbow families with a focus on gay men.
My husband and I are pursuing international surrogacy in the United States from Sweden, but surrogacy in the U.S. is not a viable financial option for many international intended gay dads. On my website, Gay Dad Reporter, I published an article about the cost of surrogacy in the U.S. compared to other destinations. The truth is that surrogacy journeys in the U.S. can be almost twice as expensive as countries such as Mexico and Colombia.
While you can’t put a price on your family, most intended dads do have a limit on what they can spend. This makes these more affordable destinations the only real option.
However, surrogacy has recently come under intense scrutiny, especially after a report to the United Nations claimed that surrogacy should be abolished as it causes ‘exploitation and abuse of women and children.’ While this report has been widely criticized for its bias, it does highlight that, no matter the country, surrogacy must be ethical, or else it could be banned everywhere.
What do I mean by ‘ethical surrogacy’? Ethical surrogacy is a journey in which there are protections in place to ensure the complete understanding, consent, and safety of all parties involved, intended parents (IPs), egg donors, gestational carriers (GCs) or surrogates, and children. There is no coercion, no desperation, no remorse, and no regrets. Everyone involved knows what they are doing, and they are doing it to help create a family.
Essentially, an ethical journey is a story that the parents are proud to tell their children. After all, this is their origin story. It’s how they came to be in the world, and so there should be no element of this process that cannot be told explicitly to young children, as the research shows that kids do better when they learn early about their assisted reproductive origins.
I wanted to outline the minimum criteria that gay men should have when engaging in IVF and surrogacy outside the U.S. I believe that if a lawyer, 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:
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.
Surrogate criteria:
Is healthy with no chronic medical conditions.
Has had at least one child without complications.
Has social support.
Can communicate independently with the IPs.
Legal representation
Even though I am a physician, I wanted to start with the legal aspect because it is incredibly important to ensure an ethical journey. In fact, it is so important that I even thought about going back to law school to be able to provide this support to other gay intended fathers. Unfortunately, my crippling educational debt from medical school prevents me from embarking on any additional degrees.
The most important aspect of legal representation is that every party, at every stage, needs their own, independent lawyer. This is non-negotiable, and it ensures that everyone’s voice is heard, everyone’s needs can be addressed, and 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 surrogate.
The independent lawyers also need to ensure there are detailed contracts for every step in the journey (e.g., egg donation, surrogacy). These contracts need to be in place before any procedures, and they are integral to an 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 surrogate. 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 surrogate, how we felt about becoming parents, and discussing the overall process of assisted reproduction. This is called psychoeducation, and even for those with no mental health issues, it’s critical to have a professional discuss what you may experience on your journey to parenthood.
I strongly believe a similar evaluation should be done for egg donors and surrogates 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 to handle it. Having this space to openly talk without judgment can help women realize that maybe this isn’t for them. This mental health experience is essential to helping screen and prevent someone from having issues or regrets.
I also believe that mental health services for IPs and surrogates should be available during the pregnancy. There are so many issues and communication challenges that can arise from an international surrogate pregnancy. It would be ethical to ensure that everyone involved has access to mental health services throughout the process.
Financial clearance
This is one of the more ‘contentious’ aspects of ethical surrogacy. I strongly believe that the women who donate eggs or act as surrogates 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 to provide basic necessities.
Egg donation and surrogacy 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 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 exactly how this can be carried out in other countries, but I would strongly advocate that IPs on a journey in any country have evidence that the women who are helping them start a family are not doing this because they absolutely need the money to survive.
Surrogate criteria: Medical history, family planning, social support, & communication
The surrogate is, understandably, the most complicated part of the journey to fatherhood for gay men. Because of this, I believe that the surrogates deserve to have extra guardrails in place to ensure that the journey is ethical.
Medical history
It is essential and ethical that potential surrogates are medically screened and in good health. Surrogates should not have any medical issues that could complicate the pregnancy. Common conditions like hypertension (high blood pressure) and diabetes should not be allowed. Even if these or other conditions can be treated or controlled during pregnancy, a surrogate pregnancy should not have this additional risk. As a physician, I strongly believe that any woman who becomes a surrogate should be completely healthy and without any medical history that could compromise her or the baby’s safety.
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 substitute for having this experience, and it is necessary to know she is capable of having an uncomplicated pregnancy and delivery. This is important for her, the baby, and the IPs.
Ideally, 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 may be permanently damaged or removed, preventing her from having any future children.
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 respectful of her by allowing her to prioritize her body and family above someone else’s.
Social support
Being a surrogate 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. Their support is geographically very limited. The surrogate needs the support of her partner, her children, and/or her close friends and family.
There should be no judgment or secrecy for the surrogate, otherwise, she will experience undue stress and potential complications during the pregnancy as a result.
Communication
While every relationship between IPs and a surrogate is different, there should always be the ability for the IPs and the surrogate to communicate independently.
What I mean by this is that the IPs and surrogates should be able to speak whenever and however they want, and in a common language. For example, I don’t speak Spanish, so to have a surrogate in Central or South America, they would need to speak fluent English, otherwise, we would have to communicate through the agency, Google Translate, or another third party.
Going through a pregnancy together without being able to confidently comprehend everything the other person is sharing is not actually going through it together. The nuance of how someone is feeling, emotionally and physically, needs to be understood.
Questions to ensure your international surrogacy journey is ethical
Anyone considering an international surrogacy journey should use these questions when talking with lawyers, clinics, agencies, or directly with egg donors and surrogates in an independent journey:
Does every person have their own lawyer for every step of the journey?
Are their contracts in place before every step?
Is there a mental health evaluation for every person involved?
Is there mental health support throughout the journey for everyone involved?
What are the background and financial checks on egg donors and surrogates?
How are egg donors and surrogates determined to be financially stable?
Are the egg donor and surrogate completely informed of all medical and psychological risks?
Does the surrogate have any medical issues?
Has the surrogate had at least one uncomplicated pregnancy?
What is the surrogate’s social support?
Does everyone in the surrogate’s family and close circle of friends know about the surrogacy journey?
Are there any restrictions or limitations on contact with the surrogate?
Can I/we communicate directly with the surrogate in a language we all understand?
This is by no means an exhaustive list of questions for an ethical surrogacy journey, but I do believe these would be the minimum. Depending on the answers, you can continue to ask other questions and get a deeper sense of how ethical the process will be.
Will this add cost to the process? Absolutely.
These ethical criteria are partially why IVF and surrogacy in the United States are more expensive. These elements are included in any journey there, and I believe they should be included in any journey, anywhere.
In a surrogacy journey, it’s important to take a step back and think about what you are doing. This is a process to create a life and your family. Also, this is your child’s story. You want it to be one they and you can be proud of.
There should be no cutting corners. This process doesn’t have to be prohibitively expensive for everyone, but it should at least have these elements to help guarantee an ethical journey. This will also help sustain international IVF and surrogacy for future generations of intended parents.
Read more from Bryan McColgan
Bryan McColgan, Physician Journalist
Dr. Bryan McColgan is a Stanford and Columbia University-trained physician who is currently on his first journey to fatherhood through surrogacy. Navigating IVF and surrogacy in the United States from his current home in Sweden led Bryan to start the Gay Dad Reporter, the leading online platform dedicated to assisted reproduction for gay intended fathers. His mission is ethical surrogacy for gay intended dads everywhere.
