Co-authored by Shaun Thomas, Founder of The Surrogacy Father & Stephanie Caballero, Esq., Founder of The Surrogacy Law Center
Surrogacy in the United States is widely regarded as one of the safest and most established routes to parenthood. With a combination of world-class medical facilities and legally supportive states, the U.S. continues to attract intended parents from around the globe. However, while the infrastructure may be advanced, the process itself is anything but simple. For international intended parents, in particular, navigating the complexities of U.S. surrogacy—from legal paperwork to relationship building and post-birth logistics—requires patience, planning, and expert support.
In this joint article, Shaun Thomas of The Surrogacy Father offers insight into the real-world, practical aspects of pursuing surrogacy in the United States. Stephanie Caballero, founder of The Surrogacy Law Center, brings her legal expertise to unravel the intricate legal frameworks that shape the surrogacy journey. Together, we aim to help you make informed, confident decisions about growing your family through U.S. surrogacy.
One of the first and most significant factors intended parents encounter is the cost. Surrogacy in the U.S. is not inexpensive; depending on the specific circumstances of the journey—such as surrogate compensation, use of an egg donor, clinic fees, legal services, and insurance—the total cost can range from $120,000 to over $250,000. For many international families, these figures can be overwhelming. It’s important to build a financial plan that not only accounts for the expected costs, but also includes room for unexpected expenses, such as complications during the pregnancy or delivery, extended NICU stays, or additional legal or administrative steps post-birth.
Selecting the right surrogacy agency and fertility clinic is equally crucial. Reputable agencies serve as the cornerstone of a successful journey, helping to match you with a suitable surrogate, coordinate the necessary legal and medical steps, and provide emotional and logistical support throughout. Similarly, working with a clinic that has experience supporting international intended parents can streamline everything from embryo creation to cross-border medical coordination.
For international families, travel and visa logistics play a large role in planning. Most intended parents may need to travel to the U.S. a couple of times — at the start of the journey and again for the birth. It’s also common for parents to remain in the U.S. for a few weeks after the baby is born in order to complete the necessary legal paperwork before flying home. Each country has its own visa policies, so it’s wise to consult with both immigration advisors and legal experts early in the process.
Medical insurance is another critical consideration. While U.S. healthcare is among the best in the world, it is also among the most expensive. Intended parents must ensure that their surrogate has appropriate pregnancy insurance—whether that’s through an existing policy or a surrogate-specific plan—and that the newborn will be covered, either via short-term U.S. insurance or a plan that can bridge into coverage in the parents’ home country.
Building a meaningful relationship with your surrogate is another aspect of the journey that deserves thoughtful consideration. Some intended parents prefer to have regular video calls, exchange messages, or even visit in person, while others keep the relationship more formal. Whatever the dynamic, mutual respect and clear communication are key, and surrogacy agencies often play an essential role in helping to facilitate and maintain this connection across distances and cultures.
After the birth, there are often several important administrative tasks to complete before heading home. This will include obtaining a U.S. birth certificate, applying for a U.S. passport, and completing any paperwork required by your home country for recognition of parentage or citizenship. Some countries are more surrogacy-friendly than others, so consulting a U.S. attorney who specializes in American law, along with a separate lawyer in your home country who understands your home country legal requirements, is essential to avoid delays or complications.
Another often-overlooked consideration is the tax status of your child. A baby born in the U.S. will automatically become a U.S. citizen under the 14th Amendment, which carries long-term financial implications. U.S. citizens are subject to global income tax reporting, FATCA compliance, and potentially even an exit tax should they choose to renounce citizenship in the future. Engaging a financial advisor familiar with international tax obligations can help families plan effectively for their child’s financial future.
Legally, surrogacy in the U.S. presents a number of advantages with only some complications. While the country is home to some of the most favorable legal frameworks for surrogacy in the world, these laws are not uniform nationwide. Each state sets its own surrogacy laws, resulting in a complex legal patchwork that intended parents must navigate with care.
States such as California, Illinois, and Washington are considered surrogacy-friendly, allowing pre-birth parentage orders, protecting the rights of both intended parents and surrogates, and supporting non-biological and LGBTQ+ parentage. California, for example, allows intended parents to obtain a pre-birth order even if they have no genetic link to the child, and courts routinely recognize international parents as the legal parents from the moment of birth.
In contrast, states like Louisiana restrict surrogacy arrangements to altruistic agreements between married heterosexual couples using their own gametes, and do not permit compensated surrogacy or participation by single or LGBTQ+ parents. Michigan, long known for prohibiting compensated surrogacy, enacted new legislation in April 2025 allowing for fully legal compensated gestational surrogacy, marking a monumental shift for families hoping to grow through surrogacy in that state.
Adding to the legal complexity is the fallout from the 2022 Supreme Court decision in Dobbs v. Jackson Women’s Health Organization, which effectively overturned Roe v. Wade. The ruling gave individual states full control over abortion laws, creating a national patchwork of reproductive rights. While the decision did not directly affect surrogacy, it has prompted surrogates and intended parents alike to more carefully consider where a journey takes place, especially in the event that pregnancy termination becomes medically necessary. Surrogacy contracts have since evolved to include more detailed provisions around medical decision-making and contingency planning.
Legal parentage is another key issue, particularly for international families. In surrogacy-friendly states, pre-birth or post-birth parentage orders legally assign parental rights to the intended parents, often before the child is even born. However, these court orders—while valid in the U.S.—may not be recognized in the intended parents’ home countries. Nations like the UK, France and Italy do not recognize surrogacy contracts at all, requiring parents to pursue additional legal processes to be recognized as legal guardians. Others, like Israel and India, impose strict limits on who can participate in or benefit from international surrogacy arrangements.
The issue of U.S. citizenship for children born through surrogacy also made headlines in early 2025, when President Donald Trump signed an executive order aimed at ending birth right citizenship for children born to non-citizen parents. The order was quickly blocked by federal courts, which cited constitutional protections under the 14th Amendment. Legal experts widely agree that such a dramatic change to U.S. citizenship law would require a constitutional amendment—an unlikely outcome in today’s polarized political environment. For now, birth right citizenship remains intact, offering a path to a U.S. passport for children born via surrogacy in the U.S.
After the birth, families need to undertake some administrative tasks before returning home. These could include embassy interviews, DNA testing, translation of legal documents, or processing travel documents. In most cases, intended parents only remain in the U.S. for a couple of weeks to complete the legal process and obtain clearance from both U.S. and home country authorities.
Finally, ethical standards and contractual safeguards are foundational to a successful surrogacy journey. In states that allow surrogacy, contracts must include clear terms around compensation, medical decision-making, custody rights, and contingency plans for multiple births, miscarriages, or pregnancy complications. Many states require that both the surrogate and intended parents have separate legal counsel and undergo psychological evaluations to ensure informed consent. Escrow accounts are often mandated to securely manage funds and protect the surrogate’s financial interests.
Conclusion
Surrogacy in the United States offers a secure and ethical path to parenthood for many families, including international and LGBTQ+ intended parents. But it is not a journey to undertake lightly. From managing costs and travel logistics to navigating state laws and cross-border legal recognition, every step requires thoughtful preparation and professional support.
Whether you’re exploring surrogacy for the first time or actively planning your journey, having a trusted team—including experienced legal professionals, fertility experts, and agencies—can make all the difference. By understanding both the practical and legal dimensions of U.S. surrogacy, you can approach the process with confidence and clarity.
To learn more about international surrogacy from a parent’s perspective, visit The Surrogacy Father. For in-depth legal guidance, visit The Surrogacy Law Center.
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