More Americans are turning to surrogacy to build their families, as the practice becomes more common and more publicly discussed.

Why it matters: As surrogacy becomes more visible and accessible, ethical, legal and cultural tensions become harder to ignore.

How it works: A surrogate carries a pregnancy for intended parents — typically via IVF with an embryo that uses a donor or the intended mother's egg.

• That's called gestational surrogacy, and the surrogate can be referred to as the gestational carrier. (When a surrogate uses her own egg, that's called traditional or genetic surrogacy.)

It's an option for people who want biological kids but can't — or can't safely — carry a pregnancy.

• It's "not something I would recommend for somebody who doesn't have a medical indication or a reason to do it," says Laura Meyer, reproductive endocrinologist at Illume Fertility.

By the numbers: U.S. clinics reported more than 11,500 gestational carrier cycles in 2023 — nearly seven times as many as were done in 2004, when the American Society for Reproductive Medicine (ASRM) began tracking the data.

• And pregnancies via gestational carrier increased by 55% from 2017 to 2020, according to a national analysis cited by ASRM.
• Yes, but: Births from gestational carriers account for only 13.7 per 100,000 deliveries nationwide between 2017-2020, and less than 2% of fertility treatment cycles.

State of play: Surrogacy has undergone a quiet cultural transformation.

• What once seemed like an inaccessible or poorly understood method of family-building has become something more people actually picture for themselves, because there are more public figures talking about pregnancy challenges and surrogacy, Meyer says.

The big picture: The topic of surrogacy remains fraught, because it involves complex health and rights implications for everyone involved — surrogates, intended parents, donors, and the children born.

• Figures from the late Pope Francis to activist Gloria Steinem have opposed surrogacy because they saw it as exploitative of women and/or babies.

What they're saying: Because for-profit surrogacy agencies and fertility clinics measure success by the birth of a "healthy" child, that can skew incentives and create power imbalances, says Emily Galpern, a consultant for the Center for Genetics and Society.

• Intended parents pay far more than surrogates receive, Galpern says.

The other side: Meyer says agencies build in "a lot of care," including counseling with social workers and psychologists to align expectations.

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Without a federal law, surrogacy in the U.S. is governed by a patchwork of state regulations that can determine anything from whether agreements are legally binding to who is recognized as a parent at birth.

Why it matters: More Americans are turning to surrogacy to build their families.

Major differences between state laws include:

• How a surrogate must be compensated (if not considered "altruistic").
• Who becomes the legal parents of a child born via surrogate.
• Whether genetic surrogacy (when the surrogate uses her own egg) is even allowed.

The bottom line: Often, surrogacy agreements happen across state lines, so multiple state laws might need to be considered.

Go deeper

Surrogacy in the U.S. can cost from $100,000 to more than $250,000.

Why it matters: High costs and limited insurance coverage make surrogacy inaccessible for many people seeking to build families.

By the numbers: According to data compiled by fertility benefits company Carrot, average costs for surrogacy include:

• Surrogacy compensation through an agency: $30,000- $65,000 (doesn't include additional expenses like travel).
• Agency fees: $15,000- $45,000 (could include legal and other services).
• Legal fees: $15,000-$20,000 (includes representation for all parties).
• IVF and other medical expenses: $25,000- $50,000 (more if you do multiple cycles and transfers).

Between the lines: Coverage for surrogacy is improving, but major gaps remain.

• Employers reported a 39% increase in adoption or surrogacy benefits offered year over year, according to a 2026 Maven report.
• When insurance doesn't cover surrogacy, prospective parents often purchase specific policies for surrogacy that can cost another $30,000, per data collected by RESOLVE: The National Infertility and Family Building Association.

Options for reducing costs are limited, especially if you're unable to negotiate every step of your process.

• Working with a known surrogate — a friend or family member — can eliminate fees, though it comes with its own emotional and legal complexities.
• Some grant and assistance programs exist, but they don't serve all intended parents.

Tell a friend considering surrogacy