While surrogacy is often seen as a solution for couples facing infertility, some experts are raising concerns about how it is being used—and misused—around the world.
Kallie Fell, a perinatal nurse who began her career as a scientist in the Department of Obstetrics and Gynecology at Vanderbilt University Medical Center, is sounding the alarm. She says the industry has a darker side that is often overlooked.
Fell points to a study based on data collected before 2020. It found that over 32% of U.S. surrogacy cases involved parents from outside the country—mostly men from Asia over the age of 40.
“Alarm bells should be going off,” Fell told Nicole Shanahan in a recent interview. “Why are we allowing women in the United States to sell or rent their wombs to foreign nationals, just so the child can be taken overseas?”
She emphasized that the issue is not limited to single men.
While working as a labor and delivery nurse in San Francisco, Fell noticed another concerning trend: women from Asia flying to the U.S. to give birth, ensuring their children would gain American citizenship. She says this same strategy is now being used by couples and individuals using U.S. surrogates.
“There are no laws preventing this,” Shanahan added during their discussion. “It’s a path to citizenship.”
Another group commonly using surrogacy and in vitro fertilization (IVF) is gay couples. Fell explained how two men wanting to start a family might use both an egg donor and a surrogate—two separate women—to intentionally avoid legal claims of motherhood.
“The egg donor is usually a healthy young woman,” she said. “She’s given large doses of hormones to produce as many eggs as possible.”
Although guidelines exist for how many eggs can be extracted, Fell claims they are often ignored. Some donors have had 50 to 60 eggs taken in a single cycle.
These hormone treatments aren’t without risk. Fell warned about ovarian hyperstimulation syndrome, a condition that can cause serious complications such as stroke and infertility.
Even more troubling, she said, is the lack of long-term research.
“Once these women donate eggs, they disappear from the system,” she said. “They’re lost in medical history.”
She also stressed that women are born with all the eggs they’ll ever have, and there are no long-term studies examining how hormone treatments at a young age affect future fertility or cancer risk.
As fertility technology advances, Fell urges society to ask difficult questions. “We need to think critically about how we treat women’s bodies,” she said. “And we must not ignore the ethical consequences.”
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