Reassessing Reproductive Tourism in the U.S.

The Supreme Court’s decision on birthright citizenship has sparked discussions on banning foreign nationals from using American surrogates. However, the U.S. should consider restricting all forms of reproductive tourism. While surrogacy is significant, most foreign visitors seek in vitro fertilization (IVF).

Reproductive tourism involves the creation and selection of human embryos, the trade of human eggs and sperm, and potentially an American passport due to birthright citizenship. Between 2014 and 2022, non-U.S. residents accounted for 59,246 assisted reproductive technology cycles as per the national IVF registry. China led with 19,718 cycles, far surpassing other countries. Foreign patients frequently utilize pre-implantation genetic testing (68% versus 43% among U.S. residents) and donor eggs (52% versus 9%). A CDC report showed similar trends from 2006 to 2013.

Customers seek advanced IVF technology and genetic screening, restricted or banned elsewhere. For instance, the UK abolished donor anonymity, advocating children’s rights to know their origins. Nations like Canada, France, and Australia limit non-medical sex selection. Prohibitions on cross-border commercial surrogacy in various developed countries contrast with practices allowed in the U.S.

Foreign nationals navigate a straightforward process using B-2 medical visas, medical arrangements, and funds. They might even ship embryos into the U.S. for genetic testing or surrogacy.

Consider what is being sold:

Human embryo creation on an industrial scale. Standard IVF yields surplus embryos to increase success rates. Currently, about 1.5 million embryos are stored in American facilities, pending decisions on their future. Reproductive tourists contribute to this surplus.

Selection of embryos and gametes. Clinics market “family balancing”. Individuals from countries that restrict sex-selection practices travel to the U.S. to design specific child traits, shifting focus from infertility to creating particular types of children.

Purchase of genetic traits. Agencies offer egg donors based on height, race, educational qualifications, etc. Alysa Liu, an Olympic figure skater, is an example, conceived using an American egg donor and separate surrogate.

Citizenship acquisition. The Supreme Court ruled that nearly every child born on American soil receives citizenship per the Fourteenth Amendment, allowing foreign nationals to obtain U.S. citizenship for their children.

U.S. clinics, such as the California Center for Reproductive Health, promote services like egg donation, IVF, and gender selection to international clients. Institutions like Western Fertility Institute in Los Angeles and the San Diego Fertility Center offer “concierge packages” including translations and accommodations. Clinics like Pacific Fertility Center make visits especially brief.

The ease of accessing reproductive services in the U.S. raises questions about its broader implications. The nation must address its infertility issues without commodifying embryos, eggs, and citizenship for foreign consumers.

Reproductive tourism in the U.S. suggests a proposition that children can be commercial products, engineered and sold globally. This challenges societal values around family and birthrights. Until restrictions on reproductive technology borders are enforced, the international community may view the U.S. as a marketplace rather than a supporter of its citizens’ rights to bear children.

Emma Waters is a Policy Analyst at The Heritage Foundation’s Center for Technology and the Human Person.