The recent Supreme Court decision on birthright citizenship has sparked debates on banning foreign nationals from using American surrogates. However, policymakers should expand their focus to address all forms of reproductive tourism. Surrogacy forms a part of a broader reproductive industry. The majority of reproductive tourists pursue in vitro fertilization (IVF).

Before making changes, Congress should consider the core question: What does the U.S. reproductive industry offer? Stripping away the terms like ‘family-building,’ the industry sells the creation and selection of human embryos, trading in human eggs and sperm, and potentially providing an American passport due to birthright citizenship.

The industry’s own data illustrates the situation clearly. Non-U.S. residents engaged in 59,246 assisted reproductive technology cycles from 2014 to 2022, originating from 182 countries. China accounted for 19,718 of these cycles, a significantly larger figure than any other country.

These patients access U.S. clinics differently than Americans. They prefer advanced technologies like pre-implantation genetic testing and donor eggs. According to CDC analyses, the share of cycles involving tourists doubled between 2006 and 2013.

Attracting foreign customers, U.S. reproductive tourism hinges on ethically complex services. Many countries restrict or ban such practices. Britain ended donor anonymity for ethical reasons, asserting children should know their origins. The U.K., Canada, France, and Australia generally prohibit non-medical sex selection. Italy and Turkey impose travel restrictions for third-party reproductive services. Most developed nations disallow cross-border commercial surrogacy, highlighting the U.S. as an outlier.

Lacking comprehensive federal or state laws beyond FDA guidelines, clinic preferences dictate available services. For foreign nationals, the process is straightforward: obtaining a B-2 medical visa, arranging medical documentation, and ensuring adequate funds. They can also import their own embryos for genetic testing or surrogacy.

Consider what the industry offers. First, the mass creation of human embryos. IVF regularly generates more embryos than needed, boosting success rates. Approximately 1.5 million human embryos reside in U.S. storage facilities, awaiting decisions from their progenitors. Reproductive tourists contribute to this surplus without enforceable regulations dictating embryo fate.

Second, selection. Clinics promote ‘family balancing’ to international clients. Couples from countries that restrict practices like embryo selection based on sex, travel to the U.S. for such services.

Third, trading bodies and origins. Agencies present egg donor menus varying by attributes like race and educational achievements. The example of Alysa Liu, an Olympic gold medalist, illustrates someone conceived through donor eggs and surrogacy in the U.S.

Finally, citizenship. The Supreme Court’s decision reaffirms the Fourteenth Amendment, granting citizenship to virtually every child born on U.S. soil. This allows foreign nationals to gain a U.S. passport by commissioning a birth.

Clinics openly market their offerings. California Center for Reproductive Health provides services in several languages. Other centers, like Western Fertility Institute and Pacific Fertility Center, offer extensive packages and international outreach.

Considering these aspects indicates how accessible services are to foreign nationals, emphasizing a need for U.S. introspection. Should the U.S. serve its citizens’ infertility needs, or prioritize a global market selling designed children? Until restrictions are imposed on reproductive technologies, assumptions about U.S. intent persist.

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

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