“How much do I cost? Like, a hundred dollars? How would you buy a ‘me’?”
My six-year-old asked this after a conversation he overheard between my husband and me about medical bills. I told him the truth: “You can’t be quantified in dollars, baby. Apples to stardust. You are priceless.”
Later that night, as I was reading reports on the booming surrogacy industry, his question clung to me because in today’s America, if I had been desperate enough or rich enough, my son could have been bought.
The Gig Economy of Reproduction
Surrogacy is marketed as altruism. In reality, commercial surrogacy is the gig economy of reproduction. Women are promised base compensation, stipends, reimbursements, and bonuses for the use of their bodies. Experienced surrogates are often paid more, as if once you’ve “bought in,” you can be bought again.
The surrogacy process in the United States costs as much as $200,000. Current U.S. agency materials routinely advertise compensation packages that can reach tens of thousands of dollars, with base pay and additional benefits varying by experience, location, medical factors, transfer fees, maternity clothing, travel, lost wages, invasive procedures, multiples, and delivery method.
The medical establishment itself concedes the weight of what is being purchased. The American Society for Reproductive Medicine says compensation to gestational carriers should account for “time, inconvenience, and risk” associated with embryo transfer, pregnancy, and delivery, while warning that payment should not create “undue inducement” or exploitation. The American Society for Reproductive Medicine also instructs carriers to consider nine months of possible illness, employment risk, burdens on family members, and the realities of pregnancy before agreeing to the contract.
This is the strange moral theater of commercial surrogacy. Everyone knows pregnancy is not casual. Everyone knows it can reorder a woman’s health, marriage, children, work, sleep, finances, and future. The very process that mothers are told to treat as sacred is, under contract, treated as transferable labor when someone else can afford the invoice.
Infertility Is Real. So Is the Market.
Any serious critique of surrogacy has to begin with recognition of the devastation of infertility. That is precisely why the industry’s marketing works so well.
The public story begins with suffering. It ends with a baby. Between those two points sits an enormous system of clinics, agencies, lawyers, contracts, screenings, embryo transfers, escrow accounts, insurance negotiations, donor eggs, donor sperm, frozen embryos, medications, genetic testing, and carefully managed vocabulary.
The data clarifies what this system is actually doing. Wealthy women are not shown to be biologically more infertile than poor women. A National Health and Nutrition Examination Survey analysis of women ages 20 to 44 found reported infertility at 12.5% and found no significant differences in infertility by education, income, insurance, race or ethnicity, citizenship, or usual source of health care. The same study did find differences in who accessed care: women with household income below $25,000 were less likely to seek infertility care than women with household income above $100,000, 5.4% compared with 11.6%.
Centers for Disease Control and Prevention and National Center for Health Statistics data from 2015–2019 tell a similar story. Household income was not significantly associated with infertility after adjustment, while age and parity were far more predictive. Among all women ages 15–49, 13.4% had impaired fecundity; among married women ages 15–49, 8.5% were infertile. The strongest risk patterns clustered around age, especially among women with no prior births.
At the same time, fertility-service use distinctly rises with income and insurance. The CDC/NCHS reported that in 2022–2023, 9.5% of women below 150% of the federal poverty level had ever used fertility services, compared with 17.2% of women at or above 450% of the federal poverty level. Medical help to get pregnant showed an even wider split: 5.0% below 150% FPL compared with 14.8% at or above 450% FPL. Private insurance showed the same pattern: 13.6% of privately insured women had used medical help to get pregnant, compared with 4.4% of publicly insured women and 5.4% of uninsured women.
Infertility cuts across class lines, but use of fertility treatment does not: poor women can suffer infertility without diagnosis, treatment, or recourse. Wealthier adults can move through clinics, agencies, attorneys, contracts, screenings, payments, and embryo transfers. At the far end of that system, treatment leaves the wealthy patient’s body and enters another woman.
Still, the question lingers, tinged with fear of unmet desire: how far would I go to bring my children here? My family already contributes maximum allowable amounts to a Health Savings Account to accommodate some medical needs I have. I am relieved when I can call my brothers who are physicians and receive “insider” advice from their decades of expertise and study. If my child were sick, I would work myself to the bone to pay for their treatment needs. Other demographics aside, what separates a woman desperate to become a mother from a mother desperate to heal her child?
The Affluence Trap
There is another uncomfortable layer: wealth often delays motherhood, volitionally.
Education and professional formation tend to move first births later. The National Center for Family & Marriage Research at Bowling Green State University reported that women with more education tend to have their first child at older ages: the median age at first birth was 20 for women with less than a high school degree, 23 for women with a high school diploma or GED, 27 for women with some college, and 31 for women with a bachelor’s degree or higher.
Female fertility is not endlessly elastic. The CDC/NCHS report on infertility and impaired fecundity found age to be one of the clearest predictors of infertility and impaired fecundity, especially among women without previous births.
The modern professional class often lives inside a contradiction. Women are encouraged to build credentials, income, influence, independence, and optionality before motherhood. Then, when biology refuses to honor the professional timeline, the marketplace appears with an answer. Freeze the eggs. Buy the sperm. Test the embryos. Rent the womb. Finance the future.
The industry benefits from both messages. Delay motherhood now. Purchase motherhood later.
Same-Sex and Single-Male Surrogacy
The first regulatory problem is the category shift. Gestational surrogacy is often defended through the image of the married couple facing devastating medical infertility, yet ASRM’s own practice guidance already moves beyond that case. It lists medical conditions that prevent or endanger pregnancy, but it also includes “biologic inability to conceive or bear a child,” including a “single male or homosexual male couple.”
The industry expands its market by transforming surrogacy from treatment of a pathology into a family-building pathway for adults whose desired family structure lacks a maternal body. ASRM’s ethics opinion says gestational carriers were first used primarily by heterosexual intended parents with fertility or medical problems that prevented pregnancy, while the process is now used by unpartnered individuals and LGBTQIA+ intended parents.
The Barrie Drewitt-Barlow case shows why adult desire, celebrity, money, and public sympathy cannot function as safeguards. ITV reported that Drewitt-Barlow, known as Britain’s first gay surrogate parent, and his husband appeared in court facing charges including rape, sexual assault, and modern slavery trafficking for sexual exploitation.
Same-sex and single-male surrogacy require the deliberate division of motherhood into purchasable parts: egg provider, sperm provider, gestational carrier, and legal parentage. The maternal body becomes the missing input. The child enters the world through a planned separation from the only motherly body he has known.
The Married, Heterosexual, Infertile Couple
The married infertile couple is the most difficult demographic to deny surrogacy because their longing may be deeply ordered toward family, fidelity, and life. Their grief is real. Their medical history may be devastating. Their marriage may be generous and stable. Their desire for a child may come from the best parts of them. Can regulation of the industry allow for science to close this gap?
It is standard practice in the industry to use prenatal testing to terminate pregnancies, perpetually freeze embryos, and engage in genetic and gender selection, often discarding less desirable or “wrong-gendered” embryos. Those are foreseeable conflicts created by splitting pregnancy between the woman carrying the child and the adults expecting the child.
The carrier also remains the patient. ASRM says the gestational carrier is the sole source of consent for medical care throughout embryo transfer, prenatal care, labor, delivery, and aftercare. That principle is necessary because the state cannot force a woman to undergo procedures, continue a pregnancy, terminate a pregnancy, accept fetal reduction, deliver early, or submit her body to another party’s reproductive plan.
A surrogacy contract must either be enforceable or unenforceable. If enforceable, the state stands behind private expectations over pregnancy, birth, and relinquishment. If unenforceable, the industry sells intended parents a promise the law cannot finally guarantee. Surrogacy does not allow for this type of authority from the purchasing parents, and there is no legislative protection for the gestating babies to prevent termination based on their health profile, gender, eye or hair color, or other features.
The Human Fertilisation & Embryology Authority tells intended parents that the surrogate is the legal mother at birth unless and until a court grants a parental order, even when she is not genetically related to the child. The UK government’s surrogacy pathway guidance says the surrogate, and in some cases her spouse or civil partner, will be the legal parent at birth.
The Law Commission’s reform proposal is even more revealing. Its plan would modernize the system, clarify payments, create a surrogacy register, and preserve altruistic surrogacy, but it still says surrogacy arrangements will remain unenforceable because the surrogate could not be forced to give the child to the intended parents under an enforceable contract. The law cannot turn pregnancy into a contract without eventually choosing between the intended parents’ expectations and the carrier’s bodily authority.
Why the Industry Will Not Stay Inside the Box
A medical-necessity-only rule also fails because the industry has already expanded the definition of necessity. ASRM’s practice guidance includes single men and male same-sex couples under “biologic inability” to conceive or bear a child. That may be internally consistent for an industry committed to adult family-building, but it shows why regulation cannot hold the narrow married-infertile-couple line.
The definition moves quickly from disease to inability, from inability to desire, from desire to identity, and from identity to entitlement. The exception becomes the category. The category becomes the market.
Apples to Stardust, or Dollars and Contracts?
My own desire for a tightly regulated exception cannot survive the realities of the practice. This is our generation’s Faustian bargain.
We can keep pretending commercial surrogacy is generosity, or we can name what the contract creates, considering both its promises and its implications. One party supplies the money. Another supplies the womb. The industry supplies the language of compassion.
The devil has always offered shortcuts. Surrogacy is just the latest deal on the table.
Jillian Tymo is a researcher, writer, and host of the podcast “Rebranding Motherhood,” founded by Dr. Abby Johnson and produced by ProLove Ministries. She examines culture, politics, and religion through her work and academic studies at Georgetown University.
Instagram: @jilliantymo @rebrandingmotherhoodpodcast