United States

There is no single cost that applies to every case. In fact, the price is closely related to a number of variables such as whether or not egg donation is required, the type of program requested from the IVF clinic, the surrogate's state of residence and where she gives birth, the U.S. state in which the surrogacy program takes place. Having clarified all aspects regarding possible variables, an estimate based on the case histories we have had so far allows us to state that the average price for a program with egg donor, gestational surrogate, assisted reproduction clinic and legal support is $150,000 today. When embryo have been instead previously created, the average price for a program with surrogate, IVF clinic and legal support is roughly $120,000.

In recent years, a trend has arisen on the part of some U.S. and non-U.S. agencies to create Hybrid or cross-border surrogacy programs to which various designations are added depending on the agency promoting them. In fact, there is no single term or proper name to define a program in which a surrogate mother, for example American, undergoes in vitro fertilization and embryo transfer in another country where the cost is lower, and then returns home until delivery. The nature of these variations is an attempt to bring down the excessive cost of the surrogacy program in the United States by performing the medical part in countries such as Canada or England where costs are more acceptable. It should be noted, however, in cases where this variant is possible (because the gestational surrogate must have specific requirements, including eligibility to travel and approval from the foreign clinic) that the costs are not significantly lower. However, this is still a way to save money compared to a program which takes place from start to finish on U.S. soil

Many intended parents who resort to surrogacy, see this technique as a"last resort" for the realization of their dream. There are frequent cases in which medically assisted procreation has been used due to a woman's difficulty in conceiving either with Homologous artificial insemination (creation of embryos in which both gametes come from the couple) or Heterologous artificial insemination (creation of embryos in which one or both gametes come from a donor outside the couple).
In the cases where pregnancy is not achieved despite the use of IVF, using a surrogate becomes almost a natural path. The United States, on a par with Mexico and other countries over surrogacy in Portugal, offers an alternative program with one’s own embryos. This program ranges from one embryo transfer to unlimited transfers (i.e., until all available transferable embryos/blastocysts are exhausted). Among other things, this option is accessible at a significantly lower total cost. However, a great deal of attention must be paid here to the country of origin of the embryos, i.e., the state in which they were created and the relevant regulations. In fact, some IVF clinics do not easily grant clearance to ship genetic material abroad for purposes other than those for which they were taken. Therefore, it becomes crucial to have experts help navigating the regulations governing surrogacy in the US both before (when possible) and after the creation of the embryos. This includes applying for the necessary permits for sending them abroad.
Another alternative is the creation of embryo directly in the Mexican clinic where the embryo transfer to the gestational surrogate will take place.

Fraternal Twins (also called dizygotic twins) is a popular surrogacy option for same-sex couples in the US. This program conceives two sets of embryos using sperm from each of two fathers, but with eggs from the same egg donor. The result is that the babies are genetically related through the egg donor, but each carry the DNA of the respective father.
Actually the babies are half-twins, sharing DNA only from one parent. What makes them "twins" is that they are conceived and are intended to be born at the same time.
Unlike other countries, sharing a surrogate may be possible in the US, but most clinics will recommend against it, and the ASRM guidelines explicitly instruct clinics not to do this since a twins pregnancy does have risks and complications . Twins have a high probability of premature birth (about 65% of twins pregnancy ends prematurely.)

The U.S. is the country with the most experience in surrogacy, although the cost is the high, the relevant legislation makes this country the most guaranteed destination for international intended parents. California, Illinois, Connecticut and New York are the states considered “surrogacy friendly” as of 2021, due to timely legislation on the process. In fact, the law regulating surrogacy in the United States is not uniform. Each state establishes its own regulations, even though the majority of them are in favor of its application even if they do not have express regulations. In the United States, as in Mexico, there is "ius soli", (birthright citizenship) which stipulates that citizenship is acquired if born on the territory of the state. Therefore, the child can obtain a U.S. passport from birth, by the mere fact of being born on U.S. soil. This will result in an additional advantage at the time of expatriation. In addition, even if the commissioning parents have citizenship from another country, the unborn child can later help them acquire US nationality as well, according to the laws of their home state. To travel to the United States, you do not need a visa

Pivotal to the U.S. legal system on surrogacy proceedings is Pre Birth Order, which we can define as an act or ruling which precedes the birth of the child and by which legal parentage is established between the unborn child (still gestating) and the intended parents. Typically, the relevant procedure is initiated in the second trimester of pregnancy and documents are signed and submitted at least two months before the birth. This "pre-birth" order should be obtained as soon as possible, ideally during the second or third trimester in case the baby is born before the due date. Not all pre-birth orders are the same, but they all establish the bond legally. In fact, some pre-birth orders alert hospitals to inform the appropriate office, namely the state's Office of Vital Records, to name the intended parents on the baby's birth certificate

Health care in the United States is private, so U.S. citizens generally take out health insurance to cover medical expenses. In this context, after choosing a gestational surrogate, it is important to check through the chosen U.S. agency whether her health insurance covers surrogacy, which is likely but not a given. In the event that the surrogate mother's insurance does not include this procedure, it is recommended that intended parents bear the necessary costs of adding surrogacy to the surrogate mother's policy. It is also mandatory to take out life insurance for the same. Careful attention should be paid to which events are covered or not by the insurance taken out so that unforeseen expenses do not occur. Some examples of unforeseen or possible costs to consider are twin births, the need for an incubator, cesarean delivery, or surgery for the newborn

The pre birth order process involves certain mandatory requirements for admission to the procedure, including the absence of pending criminal charges and a demonstrable ability of having the economic and material means to educate, support and raise the child. In the case of couples, whether heterosexual or homosexual, the intended parents are entitled to legal parentage even without being united in marriage or other civil unions

The birth certificate always bears the first and last name of the intended parents