The surrogacy trade: proliferating bans and an opportunistic industry raise a worrying health risk

It is March 2023, and in the Tblisi office of BeParent, a commercial surrogacy agency with outposts in Georgia, Cyprus, and Mexico, smiling staff look at computer screens as “intended parents” (parents who seek to commission a surrogate birth, in industry parlance) are ushered into a consultation room with a hotel lobby-style sofa and walls decorated with close-up black and white images of newborn babies.

Naia, a managing partner of BeParent, runs through the process of commissioning a surrogate birth. BeParent Georgia’s surrogates are aged 23 to 39 years old, have their own children, and hail from Georgia or Kazakhstan. Egg donations, where these are required, come from a separate list of women; a list of prospective donors is later emailed to me with photographs and details including the donors’ age, “race,” height, education level, and blood group. Surrogates and donors are “prepared” for gamete harvesting and embryo implantation within three months of an intended parent depositing a $5000 (around £4000) “commitment fee” to the agency.

To proceed with a surrogacy arrangement in this orthodox Christian country—where residents have an average annual income of £1298, and 10% of women were registered as unemployed in 2022—a couple must send, along with this fee, a marriage certificate with an accompanying state certificate to confirm they are heterosexual and married, as well as a complete sperm analysis and blood analysis (for HIV, hepatitis B, hepatitis C, and syphilis) of the baby’s proposed genetic father. “We have made many happy families,” Naia says.

But in the weeks after The BMJ visited, Georgia became the latest nation to announce a …