Multifetal Pregnancy Reduction

Multifetal pregnancy reduction (MFPR) is the medical procedure that reduces the number of fetuses carried during the multiple pregnancy.  It might be a very depressing subject for the intended parents to discuss, however, in long term perspective, MFPR can lead to a healthier pregnancy.

It is a fact that multiple pregnancy is a common occurrence during the In vitro fertilization treatment. The reason is that in order to increase the chances of a successful transfer, 2 or 3 embryos are often transferred at a time. When all of them implant successfully, intended parents are often surprised with twins of triplets. MFPR is not performed when a female carries twins, but may be done to decrease the number of fetuses from 3 or more to 2.

In most of the cases, the aim of the multifetal pregnancy reduction is to increase the chances of a healthy pregnancy. More fetuses are unfortunately  linked to higher chances of miscarriage, stillbirth and lifelong disabilities.



The procedure itself is performed early in the pregnancy (9-12 weeks), when the size of the fetus is very small. Widely used method includes injecting potassium chloride in the fetus via a needle, which is inserted in woman’s abdomen.

As already mentioned, multifetal pregnancy reduction is not performed during the twin pregnancy. The risk of this medical procedure is to unintentionally harm other than selected fetus(es). In order to avoid termination of the pregnancy, most of the fertility doctors and surrogacy agencies will strictly refuse to perform MFPR in case of twins.


How to feel about multifetal pregnancy reduction?

The procedure is undoubtedly mentally traumatizing and has a heavy emotional load. However, as strange as it may sound, intended parents should realize that it is done in  sake of a more successful and healthy pregnancy.


Surrogate Mother Selection Criteria

In reality, it is not that simple to formulate the golden standards for the surrogate mother selection. Criteria can sometimes  be different across the countries and agencies. However, it is important that intended parents have the general understanding and have an idea of what should they expect and how their surrogate mother is controlled before being finally  chosen for the program.

Intended parents need to be ensured that the agency will do it’s best, double check medical condition of the surrogate mother and choose the most appropriate candidate with the highest likelihood of success.

Does not matter whether baby is genetically connected to the surrogate mother or not. There exist a number of medical complications and conditions  which may occur or transmit  while the baby is being carried by the surrogate.

Most of the surrogacy agencies will require that surrogate mother does or provides the results of routine medical tests, such as : complete blood count, HIV test, hepatitis C,  measurement of hormone levels, pap smear test  and more.

The list of tests and requirements may vary across countries and agencies.  In some cases, apart from the ordinary tests, the surrogate should provide additional reports:


  • Chest X-ray and the conclusion that surrogate does not have tuberculosis.
  • Conclusion from the breast physician.
  • It is often required that the surrogate mother has her own children. It is important to check the report from the pediatrician and make sure that surrogate’s biological children are healthy and do  not have any medical problems.
  • Conclusion from the narcologist.
  • Report from the psychologist – yes, it is important to know that a surrogate mother is mentally healthy and completely ready to get started with the program and such a responsible journey.
  • The reports should of course include the final conclusion that the surrogate mother is healthy and does not have any pregnancy related issues.


During the introduction to the agency and the preliminary discussion, intended parents can require the list of surrogate mother selection criteria and double check that their candidate is satisfying them.

Huge amount of tests does not necessarily mean more qualitative check up and service. It is crucial that all of the tests have their purpose and are connected to the pregnancy. Intended parents should not hesitate to ask as many questions as needed and desired.


Surrogacy in Greece

In Europe, there is a lack of countries where surrogacy is allowed. In many cases, European couples have to leave the continent in order to find a suitable surrogacy destination. Greece is one of very few European countries where surrogacy is regulated and legal. Since 2014, surrogacy in Greece has been available for non-EU citizens too and has become an international destination for couples seeking surrogacy services.


In Greece, intended parents do not need to be married and single females are eligible for surrogacy services too. As for 2017, same-sex couples and single males are not currently allowed to become parents through a surrogacy program. Intended parents are required to provide medical proof that they are not able to have children without the assistance and fertility treatment such as IVF.


Although the law states that surrogacy should be altruistic, it is not completely so. Regulations allow surrogate mother to be paid up to 10,000 Euros. This amount is considered as a compensation for the loss of the regular job. It can be evaluated based on surrogate mother’s skills and qualifications –  how much would she earn as an employee.


Embryo transfer cannot occur without the permission of the court. Court has to allow a surrogate mother to participate in a program and intended parents should submit their medical records too. After about 8 weeks, court will notify the decision to the participating parties.


Of course surrogacy agencies and clinics will screen surrogate mother closely, however, it can happen that medical preparation of the surrogate does not go  as expected or she has to be replaced due to a private or medical reason. In this case, a new candidate will need to be presented to the court , whose approval will take an additional time. In this case, the total approval time may take up to 6 months.


Intended mother will be baby’s legal mother and her male partner – baby’s legal father. According to the Greek Civil Code, surrogate mother has no rights to request custody.


Total costs of surrogacy will of course depend on concrete services that intended parents need. Prices of surrogacy services are not very affordable in Greece and may sum up to 60,000 EUR.


Whether Greece is an attractive surrogacy destination depends on an individual case.  Intended parents will have to make a decision based on financial and other private matters, as well as after the communication with surrogacy agencies operating in the country. Meanwhile, we have provided several highlights that summarize surrogacy in Greece:  



  • Court approval and involvement prevents legal controversies
  • Intended parents are legal parents
  • Greece is a famous tourist destination with well known resorts



  • Approval process might get delayed
  • Not affordable
  • Surrogacy is not allowed for same-sex couples and single males


HIV and Surrogacy

Human immunodeficiency virus (HIV) is a kind of a virus that attacks immune system. Immune system is body’s way of fighting illnesses, bacteria, any unknown or threatening viruses. As HIV destroys the immune system, more concretely the cell called T-helper, body becomes gradually less capable to deal with infections and diseases.


HIV and surrogacy

HIV is found in breast milk, vaginal fluids and blood. For that reason, when we talk about HIV and surrogacy,in sake of safety, we refer to intended biological fathers only. As for males, HIV is found in semen, but after a procedure called ”sperm washing”, it is safe to proceed with IVF. Sperm itself, is resistant to HIV virus.


Sperm washing

During sperm washing, sperm is separated from semen. The procedure removes dead sperm, debris, white blood cells and other chemicals that may lead to unexpected or undesired reactions and results during IVF. Sperm washing is performed not only in case of HIV, but also when males have lower sperm count or decreased sperm mobility, even when they experience unexplained infertility.

Sperm wash is usually performed in IVF clinics. The method may vary according to the clinic and individual characteristics of each case. Techniques include: centrifugation wash, density gradient wash and swim up technique.

After the molecular based sperm wash is performed, the clinic will usually double check the sample on HIV virus. After completing and confirming the procedure successfully, there is practically no chance of transmitting the HIV either to carrier(intended mother/ surrogate) or to the baby.

As sperm washing requires special equipment, different facilities and strong skills. Surrogacy agencies will usually charge  a different fee for the HIV programs.


Requirements and communication with a surrogacy agency

Result oriented  and professional surrogacy agencies, have requirements before they admit an HIV positive father to a program. In order for the IVF to make sense and be successful, it is essential to be under a treatment. Antiretroviral therapy is used to control the virus. Agencies will also require results of the tests that confirm that viral load is undetectable. The test should not be performed earlier than 6 months and should be followed by the second one at the time of going to the agency. Surrogacy agency will require additional medical tests such as HIV in semen, HBV/HCV in semen and so on.

If the viral load is too high, agencies will not be able to currently accept an intended dad to the program.

Assisted reproductive technologies(ART) have undoubtedly reached a high level of development.Thanks to medical breakthroughs, more and more people are becoming able to enjoy the magnificent joy of parenthood. Before choosing a surrogacy agency, we would recommend to have a very detailed conversation, because the case of HIV and surrogacy is still different from other IVF cases. Make sure that the agency supports you, understands your case and has a very specific action plan.

HIV positive dads should not feel confused or offended if the agency asks for too much details or tests. Vice versa, this is all done in order to ensure baby’s safety.


Communication With Surrogate During Pregnancy

Surrogate pregnancy is a very emotional journey. On one hand, there are intended parents who have finally fulfilled their dream of becoming parents. In most cases, they have already gone through a lot of stress, disappointment, fear and struggle. On the other hand there is a surrogate mother, who independent from her motivation goes on a complicated journey of pregnancy and makes the dream of intended parents come true.


Surrogacy agency is responsible for informing intended parents about every single aspect of pregnancy : results of prenatal tests, condition of a surrogate mother, overall evaluation of course of pregnancy. While the information exchange process has to be regular, surrogacy agency should not be the only one having communication with surrogate mother. Intended parents too, should be involved in the pregnancy process. We have provided several reasons why parents might want to have communication with surrogate mother:


Express appreciation

During pregnancy, surrogate mother may not be feeling well. She might have nausea, lack of energy, change in appetite and mood swings. While this kind of discomfort is common during pregnancy, intended parents should express their appreciation that surrogate goes through this for them and their baby. Surrogate mothers need to be supported, know that their commitment is not taken for granted and that their health and condition matter a lot too. People are always more encouraged and motivated when their dedication has a value.


Why not double check?

While intended parents are getting all essential information from the agency, it is a good practice to ask surrogate directly. Intended parents might want to know how is she feeling, whether she has everything she needs. It is important to trust a surrogacy agency, however, hearing the same from surrogate is more calming and sometimes more valuable.


Discuss postnatal issues

After the delivery surrogate can be experiencing discomfort and weakness. This is not the best time for discussing issues that are needed to complete the surrogacy journey. For example parents might want a surrogate to breastfeed a baby for even a short period of time. This has to be clarified in advance because surrogate might be planning to dry up her milk with medication.


On the other hand, in some countries, completing the journey is only possible when the surrogate gives her consent and signs documents that confirm the parenthood rights of intended parents.  For example in Russia,where surrogacy is not regulated by law , there have been several court cases because of a surrogate refusing to abandon her parenthood rights and her role as a mother. Earlier communication with surrogate can help to avoid similar issues.


Often there establishes such a strong bond between parents and surrogate, that they stay in touch even long after the delivery.


There are several factors that may hinder the communication with surrogate mother. For example, it happens that surrogate is several countries away and intended parents can not visit her often. Parents should not be scared of distance and should arrange Skype/phone calls with their surrogate. Another issue that may arise is that surrogate and intended parents do not always speak the same language fluently. However, this should never be an obstacle. Sometimes just seeing and feeling that surrogate is doing good and baby is gradually growing in the belly can be as exciting as an hours of conversation and communication.


Intended parents should trust their surrogacy agencies, request and clarify all the information they need. However, at the same time, they should remember that establishing a communication with surrogate is always a step forward to having a good surrogacy experience. One more advice would be to keep the agency posted about the relationship with surrogate mother and arrange meeting through their mediation.


Golf Ball Syndrome

On about 20th week of pregnancy, it is common to have a mid-pregnancy scan. During this procedure, ultrasound will reveal how baby’s organs(including heart), are developing. During the examination process, sonographer, (doctor performing the scan) may notice small bright spots on the baby’s heart. Because of their visual appearance, these white spots are referred to as gold balls and we would normally say that baby has a gold ball syndrome. Medical term for the spots is echogenic foci/focus.


Golf balls are found in up to 5% of fetuses. Their amount could vary from one to higher and are commonly located in the left ventricle of the heart. Usually their presence is not considered to be threatening : normally, they indicate neither fetal  heart defect nor a heart dysfunction. Medically the process is explained as the mineralisation within a papillary muscle.  


However, in some rare cases golf ball syndrome could be related to heart defect too. Additionally there has been identified a bond between golf balls and chromosomal abnormality, trisomy, causing the down syndrome. The suspicion about golf ball syndrome resulting in trisomy usually raises when mother has other medical problems and further fetal problems have been identified during the ultrasound.


Absence of other risk factors such as no medical issues and young maternal age, decrease the chance of a down syndrome significantly.


It is usually advised to perform an additional scan in about 3 weeks. First of all, because the golf ball syndrome has the tendency to disappear itself. If not, the detailed scan will reveal if there are any additional defects or whether the amniocentesis needs to be performed.  When there is an uncertainty about harmlessness of golf balls, followed by certain pregnancy complications and risks, amniocentesis is a definite way to figure everything out.


During pregnancy, baby is surrounded by the sac of fluid, which is called amniotic fluid. Baby’s skin cells are shedded in the fluid and examination of this cells gives the opportunity to identify whether the baby has correct number of chromosomes. This medical procedure is called amniocentesis or chorionic villus sampling and is performed via passing a relatively thin needle through mother’s abdomen into the amniotic fluid. Amniocentesis is a very accurate representation of baby’s chromosome number and accordingly, gives a trustful impression whether baby could have a down syndrome.


Amniocentesis is not always recommended to perform and healthcare providers will only advise making the procedure when they have a reasonable suspicion about chromosomal abnormality.


Complications following the procedure could include bleeding, leakage of amniotic fluid, miscarriage or severe cramping. The complications are not common, however are worth to be taken into consideration.
In case of a surrogacy pregnancy, agency and clinics should simultaneously organize further scans in coordination with intended parents.  Parents, on other hand, may like to be informed in advance about how much is the agency prepared for such occurrences and which procedures do they use to identify baby’s condition as clearly as possible.


Surrogacy and Preeclampsia

Preeclampsia is a medical condition that appears only during pregnancy. It’s characteristics may be quite distinct. However, if the condition is mild, it is important to be familiar with all common symptoms and contact the doctor in a timely manner. There is also a connection between surrogacy and preeclampsia. Further we will additionally discuss what can intended parents do to make their parenthood journey less complicated.


What is preeclampsia?

Preeclampsia is a complication that may appear only during pregnancy. It will usually start after 20 weeks of gestation. It is important to diagnose preeclampsia and treat it on time. Otherwise, the condition can lead to fatal consequences for baby and a mother.

The most common symptoms of preeclampsia are high blood pressure (more than 140/90 mmHg) and protein in the urine (proteinuria).

High blood pressure solely does not necessarily indicate preeclampsia. For example, gestational hypertension is a condition of having high blood pressure during pregnancy, but without extra protein in urine  or problems with  any other organs. However, there are cases when gestational hypertension ultimately develops to preeclampsia.

When the condition is more severe, symptoms can be accompanied with:


  • severe headaches
  • abdominal pains
  • blurred vision or sensitivity to light
  • shortness of breath
  • seldom urination


Swollen hands and legs can sometimes characterize preeclampsia.

Fatigue, dizziness and nausea may also be signs of preeclampsia and in order not to confuse them with the symptoms of pregnancy, it is essential that pregnant females attend prenatal checkups regularly.

On the appointment, doctor will check blood pressure, make urine and blood tests. Usually doctors will check kidneys, because preeclampsia can affect them too.  Ultrasound may be needed to make sure that baby is growing as supposed.

We already know that during pregnancy, baby gets oxygen and food through placenta. Preeclampsia can prevent placenta from getting enough blood. Insufficient blood flow to placenta means that baby will get less nutrients and oxygen finally resulting in premature birth. Preeclampsia can also be the reason of placental abruption(placenta separating from the uterus) finally resulting in a stillbirth. Preterm labour is also a common occurrence when having preeclampsia.


Risk factors

There are no known causes of preeclampsia. However, several factors have been identified to be potentially risky:

  • Having experienced preeclampsia during previous pregnancies
  • Chronic hypertension (high blood pressure)
  • Being pregnant with multiple babies (ex: twins, triplets…)
  • Being pregnant for the first time
  • Babies from different partner on second or further pregnancies
  • Having body mass index (BMI) 30 or higher, referred to as obesity
  • History of chronic high blood pressure, kidney diseases , blood clotting before pregnancy.
  • Age (younger than 20 or older than 40)
  • Genetic factors (sister or mother had preeclampsia)



Preeclampsia is not only a threat to a baby. In future moms, it can cause complications including :

  • stroke
  • seizure
  • fluid in the lungs
  • heart failure of cardiovascular disease
  • problems in kidneys, liver or even eyes. If severe, preeclampsia can seriously affect other organs.


Complications may also include:

Hemolysis (HELLP) which is a more complicated and severe form of preeclampsia and can cause fatal consequences for mother and a baby. HELLP causes the disruption of red blood cells, erythrocytes. Hemolysis is a threat for other organ systems.

If preeclampsia is accompanied by seizure, then the condition develops to eclampsia. Because of its severnes, independant from the stage of pregnancy, the delivery becomes unavoidable.


Treatment and consequences

If the symptoms are mild and the baby is not yet developed sufficiently, doctor may advise  a bed rest, consumption of plenty of water as well as  food rich in proteins. Medicines to lower  blood pressure may be prescribed. Regular prenatal checkups are required to control the course of pregnancy. With the help of ultrasounds, doctor will have to check the heartbeat of a baby. Steroid injections are sometimes used to accelerate the development of baby’s lungs.

Actually, the only cure to preeclampsia is the delivery. Doctor may have to induce the labour, even if mother is not close to term. When preeclampsia is severe and fetus is on the early stage of development, parents and doctor might have to discuss fatal consequences that could be caused by keeping the fetus.

Of course, it is better to be as close to due date as possible. For example after 37 weeks of gestation, when the baby is usually developed enough, delivery is the only option to keep preeclampsia from getting worse. In this case, usually both, mother and baby do just fine.


Surrogacy and Preeclampsia

Professional surrogacy agencies control the health of a surrogate mother regularly. Basically one of the main things intended parents should ensure is that their agency is going to screen the surrogate frequently. It is important that parents are always updated with the information about health of a surrogate and their baby.

Experienced agencies and clinics are already familiar and have experienced patients with most of the pregnancy complications. While some of the conditions are easier to control and manipulate than preeclampsia, the agency will not hesitate to explain their approach to this health condition and share best practices from their experience.

Remember, that the desired results are not always achieved on the first try. In fact, a lot of good things come after times of struggle and failure. There is certainly quite a high possibility to make everything work out just fine, however, it’s important to have a solid, stable and well thought backup plan(s). Same applies for surrogacy agencies and at some point, this is what intended parents should care about in the beginning too.


Tuberculosis and Pregnancy

Back in the previous centuries, tuberculosis was one of the leading infections responsible for death of thousands and thousands of people. Nowadays, recovery can take a long time and the infection is usually cured with the help of antibiotics. It is possible to get infected during pregnancy and pregnant females who have discovered they have tuberculosis, should consider getting treatment as soon as possible. Further we will discuss the relationship between tuberculosis and pregnancy, symptoms, consequences and action plan in different situations.


About Tuberculosis

Tuberculosis (TB) is a contagious infection that is caused by the bacteria called “mycobacterium tuberculosis”. Mostly, TB  attacks lungs, but can also affect other parts of the body, for example : bones, brain, spine and kidneys.

Infected person may have tuberculosis in two forms, active or latent.

Latent tuberculosis means that the immune system is able to block the germs(microbes) from spreading. Latent TB is not infectious and does not cause any symptoms. However, the bacteria is present and the infection may once get activated. Medicines can diminish the probability of activation.

Active tuberculosis, on the other hand, is contagious. The microbes are multiplying, spreading and causing symptoms.

As latent TB doesn’t cause symptoms, it is only possible to identify the infection through medical tests. Active TB , however, has somewhat distinctive symptoms including :


  • A long-lasting cough (21 days or more)
  • Cough that brings up phlegm, sometimes bloody.
  • Pains in the chest
  • Loss of appetite and weight
  • Constant fatigue
  • Fever and night sweats
  • Nausea


Tuberculosis can be transmitted like flu or cold. Microbes can be spread when an infected person speaks, sneezes, coughs, laughs and so on. However, the infection is not easy to catch. A healthy immune system has the ability to fight and even kill the bacteria. It’s also not likely to get infected after having a brief contact with the infected person. The microbes grow relatively slowly and a frequent/long contact is required to catch the TB.

Smoking is proved to greatly increase the risk of getting Tuberculosis.


Tuberculosis and Pregnancy

After introduction to common symptoms of tuberculosis, it is not hard to notice a coincidence with the ones of pregnancy(change in appetite, nausea, fatigue). For that reason , sometimes the only noticeable symptom of TB during pregnancy can be coughing accompanied by the phlegm.

After noticing any of the symptoms, doctors will usually advice to do the phlegm, blood or skin tests. Chest x-ray may also be needed. Mendel-mantoux test, also known as tuberculin sensitivity test is another way to screen for the TB bacteria. A small injection in the skin followed by a swelling in the area is a sign of existence of TB bacteria. The swelling may appear throughout 2-3 days after the injection and it’s presence, doesn’t necessarily indicate the active form of tuberculosis.

Parents should not fear of the tests, as if not identified on time, tuberculosis has the potential to be very harmful for a baby. The consequences may include:


  • Miscarriage
  • Premature birth
  • Preterm labour
  • Baby getting infected with TB (If TB is active and mother has not started treatment yet, there is a chance that baby gets infected during labor. Doctors will make the test after the baby is born.)


The treatment includes antibiotics and can kill the infection if are taken regularly, according to doctor’s prescription. Majority of medicines are safe for both, mother and baby. The treatment may last up to 9 months, until the bacteria is finally killed. However, unfortunately, there are cases when tuberculosis is resistant to medicines(drug-resistant TB) and treating it can be more difficult.

Pregnant females should combine doctor’s treatment with the lifestyle that will make their immune system stronger. Eating healthy food and getting as much fresh air as possible, play an important role in the recovery.


Tuberculosis and Surrogacy

Of course the surrogacy agency and clinic will screen a surrogate mother on tuberculosis. However, it is possible that surrogate mother catches the infection during pregnancy – just like any other pregnant female. It is important that the surrogacy agency is not only monitoring the pregnancy, but has the ability to act operatively in similar situations. If surrogate gets infected, the agency should act accordingly and promptly to perform the steps that are needed to eliminate the issue. Surrogate mother should receive immediate treatment, get checked regularly and be controlled to lead the lifestyle that will increase the chance of a successful pregnancy to maximum.

Intended parents may want to get informed about surrogacy agency’s action plan in similar situations before the beginning of the program.

Parents have to stay positive. Despite the fact that tuberculosis is not a desired condition, especially while expecting a baby, it is better to be aware of it  and receive  treatment in a timely manner. There is always a way to make the situation better, especially with the disease that is proven to be treatable.


Surrogacy in Kenya for Gay Parents

Kenya is one of the most popular and cost effective options for LGBT, heterosexual, married and single parents.  Legislation in neither promoting, nor banning surrogacy, meaning that it is not regulated by the law. However,  a number of professional clinics and agencies are offering effective treatments and  gay parents are wholeheartedly welcome.  If you are considering Kenya as a surrogacy destination, you can inform yourself about legislation, service and other details here.


Lately there has been a discussion about how much gay friendly Kenyan society actually is. A lot of sources reinforce the idea that same-sex couples, in general, are strictly discriminated and prejudiced in Kenya. They also suggest to keep sexual orientation discrete not only from the society, but from the fertility clinics as well. The advice is mostly based upon the fact that a lot of religious leaders are quite skeptical about same-sex relationships, not to tell anything about their parenthood rights.


Hiding sexual orientation, not being honest with health care provider on such an important journey is definitely not something gay parents will choose. Why is Kenya such a popular destination then? Why are gay parents having successful results? Why do patients have positive experiences with their clinics? – Just because the spread information and belief is misleading.



Nairobi , the capital city of Kenya,  is developed and modern – even closer to European cities than some cities in Southeast Asia. Travelling there is safe and a pleasant experience. Parents can even combine their visit with unforgettable safari holidays. Tourism is an important sector for Kenya’s economy . Society and doctors too, are usually very welcoming towards tourists, including LGBT couples.  It would not be professional if doctors discriminated their patients based on their private lives. What about branches of international and professional surrogacy agencies? Would they send patients to clinics where they will not get treated or will be prejudiced? It simply can not be in their interest.


All around the globe, we encounter members of the society that are accepting, fighting or feeling neutral about every single subject. Attitude towards gay parents, like everything else, is disputable too. Stopping random people, asking for their opinion and  inspecting the actual reality are two different things. One should make reasonable assumptions based on experiences and outcomes of others. A good surrogacy agency will not refuse to clarify the issue parents are concerned about – may it be past experiences, statistics or concretely the attitude towards gay parents.


Surrogacy in the USA

Surrogacy legislation in the United States varies from state to state and is a subject to regular change. While searching for surrogacy options across the country,  it is likely to encounter states where it is permitted, banned or not mentioned at all.


There is also a variation between states that do not prohibit surrogacy in terms of accepting commercial surrogacy, unmarried couples, naming intended parents in documents and etc. To save time and narrow down the list of options significantly , we have chosen surrogacy friendly destinations based on best experiences and following criterias :


  • Surrogacy is permitted (for heterosexual couples, same-sex couples and single parents)
  • Parents are named on birth certificate and have legal assurances


Surrogacy friendly states
  • California
  • Connecticut
  • Delaware
  • Maine
  • Oregon
  • Rhode Island


If intended parents come across a successfully operating surrogacy agency in any other state, it may be still worth a try. Going through surrogacy legislation by state, it is common to find regions where court is generally very favorable despite of not having a corresponding law.


States that intended parents should NOT consider due to the explicit ban currently include : New York, New Jersey, Indiana and Michigan.


It is not simple to talk about surrogacy in the USA due to constant alterations. When reaching out to the surrogacy agency , commissioning parents should clarify all kinds of information about:


  • Current surrogacy legislation in the state, recent and possible future changes
  • Post and pre-birth orders, who will be mentioned in the birth certificate?
  • Requirements for parents (heterosexual, married or in committed relationship, single, same sex and etc)


California, for example, meets expectations for intended parents independant from marital status and sexual orientation – everything accompanied by a guarantee of parenthood rights based on legal documents.



Taking into account the scales and level of development we are talking about, it is not a problem to find a well equipped clinic in the United States. However, intended parents should know in advance that the average cost for gestational surrogacy in the USA is between $100-140 000. This is not an affordable option for many parents. Fortunately, there is a number of cost effective options for heterosexual and LGBT parents worldwide.