With surrogacy options changing on a seemingly daily basis, I think reviewing the status of the various locales, media, laws, challenges, benefits and costs is a good idea. I personally have experience in just two countries but I have done a fair amount of research on the other available options and I feel I can relay fairly the options here. I do encourage discussion or addition of information in case I miss something, something has changed or I get something wrong. In this posting, I will address the good and the bad of the US.

Stars & Stripes

United States - I think it makes sense to start here because the US has a long history of surrogacy and most see it as the most sound and safe location for their journey. It is also considered the most expensive. US surrogacy has several advantages as the laws are somewhat clearer in many states, there is a long history of case law on the side of Intended Parents, agencies have been doing it for quite awhile in most cases so there is less guess work. I will list some of the positives and negatives below.

Positives of the US
  • Long history with legal security, case law and agencies who know what they are doing. The US has been doing surrogacy since 1985 (http://en.wikipedia.org/wiki/Surrogacy). We in the US have gone through some big issues and successes which have all helped to shape surrogacy in the US today. Our courts have seen many variations of contracts and situations and most issues have an expected solution which makes problems less overwhelming.
  • Tried, true and trusted medical care. Medical care in the US has a great history of being some of the most leading care in the world. Though it is expensive, you can typically assume easy access to great neonatal facilities in major cities. Also, having your medical team speak English can be a huge relief (unless of course you don’t!). 
  • The US is a first world country with presumably first world living conditions and pre-natal care. When you work with a surrogate in the US, you typically assume she and her family is well nourished. This means the money she is receiving isn’t going toward the basics needed to care for her family. Ideally, the money your surrogate receives for her monthly expenses go toward additional nutritional food for the pregnancy and prenatal vitamins. Even if your surrogate lives in a small town (most Surrogates do not come from major cities), she will likely be in reasonable driving distance to a major hospital offering level four NICU care. This is especially important with twins as they are often premie and in need of medical intervention (more on this later). 
  • There are clear Intended Parent rights (in most states). As you can see by the map here (http://www.creativefamilyconnections.com/state-map-surrogacy-law-practices) the laws are very different in different states but there are quite a few where surrogacy is considered very safe and well defined. Surrogacy is also becoming more widely accepted and laws are loosening in some previously unfriendly states. As long as you make sure your surrogate lives in one of the “green” or “orange” states, you shouldn’t experience any issues in your journey with legal blocks. 
  • You will have the ability to have a larger role in your surrogacy if you live nearby (you can possibly attend appointments or at least visit frequently with your surrogate). This can be nice if you want to feel more connected to your process. It can be fun to attend some of the appointments where the major ultrasounds take place. You might think you want to attend all appointments but as someone who has had three pregnancies – the non-ultrasound appointments are pretty boring.  
  • You are protected by HIPPA and other privacy regulations with your agency and medical professional (this doesn’t cover your surrogate’s ability to speak out about your process however).  Your agency is restricted from saying anything publicly about your process even if things turn sour. They are bound by the same HIPPA regulations as are your doctors. Record handling and medical information sharing must be in line with regulations. 
Negatives of the US
  • The cost is much higher in the US than any other location. It is 2-3x higher than it is in most other countries. This is due to agency fees, surrogate fees, legal fees but mainly medical costs. In the US, you should expect to spend between 120k – 180k on average if you are using a donor as well as a surrogate. If you are not in need of a donor, you can expect to spend 70k – 90k on average assuming you don’t need multiple egg retrievals to achieve a pregnancy. 
  • State variance can be an issue if your surrogate ends up needing to relocate during your pregnancy or decides to relocate for any reason. You could start your surrogacy in one state where your rights are well founded and the delivery could happen in a much more restrictive or complicated state. 
  • Due to social media, your journey could be made much more public than you bargained for. There is no real way (even through contracts with the best attorneys) to make your journey 100% private and keep your surrogate for sharing things with family, friends or even the world via Facebook, Twitter, Instagram or any other social media site. 
  • Expenses could sky rocket. I addressed the cost above but that doesn’t assume something going very wrong with your delivery or pregnancy. Due to the cost of medical care in the US, you could end up with hundreds of thousands of dollars over budget and an insurance company denying your claim due to it being a surrogacy. 
  • Your relationship with your surrogate might not go as planned. While most surrogacy cycles are a wondrous experience for both parties, it does happen that either the Intended Parent or the Surrogate begins to behave badly. I have seen both sides and neither is fun for anyone. Though your surrogate signs an agreement saying she will eat Organic, you can’t really legally obligate her to do so. If you wanted to terminate a pregnancy due to medical issues, you can’t force her even if she agreed to at the start. If she was single when she started, this doesn’t mean she won’t become entangled in a relationship that could add complications while she is pregnant. For the Surrogate, though you both decided to give each other space, Intended Parents have been known to overstep and become very controlling. Intended Parents have also been known to not set enough money aside to complete their journey in case of an issue arising making the payment process difficult for all. Also, Intended Parents who committed to being involved can instead end up very distant and not providing the expected support or interaction. 

While there are many other things that are good and bad about surrogacy, the goal with this post is to address those which differ depending on the country where you complete your journey.