The Supreme Court's recent ruling on birthright citizenship has sparked a push to bar foreign nationals from using American surrogates. But that approach is too narrow. The United States should restrict all forms of reproductive tourism, not just birth tourism, because the industry's core business goes far beyond surrogacy.
Most reproductive tourists come for in vitro fertilization (IVF), not surrogacy. Before lawmakers prune the branch, they should examine the whole tree and ask a blunt question: What exactly is the U.S. selling?
Strip away the euphemisms of "family-building" and "fertility journeys," and the answer is clear: the industry sells the creation and selection of human embryos, the buying and selling of eggs and sperm, and, thanks to birthright citizenship, the potential for an American passport. This is a multi-billion-dollar trade that operates with minimal federal oversight.
The scale of the trade
Data from the national IVF registry show that non-U.S. residents accounted for 59,246 assisted reproductive technology cycles between 2014 and 2022, originating from 182 countries. China alone generated 19,718 cycles—nearly three times as many as the next-closest country. These patients use U.S. clinics differently than Americans: they are far more likely to use pre-implantation genetic testing (68 percent versus 43 percent) and donor eggs (52 percent versus 9 percent). A CDC analysis found the tourist share of cycles more than doubled between 2006 and 2013.
The international clientele is buying services that are restricted or banned in their home countries: advanced IVF technology, genetic screening, and the selection of embryos and gametes purchased from American donors. The lure of the U.S. reproductive tourism industry relies on these ethically fraught practices to draw in foreign customers who cannot access them elsewhere.
What the rest of the world bans
Britain abolished donor anonymity because it concluded children have a right to know their origins. The UK, Canada, France, and Australia all ban non-medical sex selection in most cases. Italy and Turkey limit their own citizens' ability to travel for third-party services. Most developed nations prohibit cross-border commercial surrogacy, making the U.S. a major outlier on all counts.
With essentially no federal or state laws governing these practices beyond the FDA's infectious-disease screening, clinic policies are the only guide. For foreign nationals, the process is straightforward: apply for a B-2 medical visa or travel authorization, provide proof of medical arrangements, and bring sufficient funds. They can even ship embryos into the country, classified as "human cells and tissues," for genetic testing or surrogacy.
What the U.S. is really selling
First, the U.S. sells embryo creation on an industrial scale. Standard IVF produces more embryos than will ever be transferred, because surplus boosts success rates. An estimated 1.5 million human embryos now sit frozen in American storage tanks—a population larger than most American cities—while their progenitors decide whether to implant, donate, discard, or simply stop paying storage fees. Every reproductive tourist adds to this inventory, and many fly home, leaving behind embryos whose fate no American law meaningfully governs.
Second, the U.S. sells selection. Clinics market "family balancing" to international patients. Couples travel from countries that outlaw culling embryos by sex and, increasingly, as polygenic screening companies enter the market, by predicted traits. This shifts the focus from infertility or the creation of a child to designing a certain kind of child.
Third, the U.S. sells other people's bodies and origins. Agencies openly advertise menus of egg donors by height, race, SAT score, and Ivy League degree—a form of catalog shopping for human characteristics that would be recognized as grotesque in any other context. A recent example is Alysa Liu, the 2026 Olympic gold medalist in women's figure skating, whose Chinese father used donor eggs from an American and IVF for her conception, and a separate surrogate for gestation and birth.
Finally, the U.S. sells citizenship. The Supreme Court ruled in June that the Fourteenth Amendment guarantees citizenship to virtually every child born on American soil. That answers the constitutional question for now, but sharpens the policy question: any foreign national who commissions a birth here is purchasing, along with everything else, a U.S. passport, birth certificate, Social Security number, and all the benefits of citizenship.
Clinics are not shy about this. The California Center for Reproductive Health advertises an international menu listing egg donation, IVF, and "gender selection" side by side, with interpreters in Chinese, Russian, German, and Hebrew. The Western Fertility Institute in Los Angeles markets itself abroad as a "one-stop shop." San Diego Fertility Center courts patients who struck out under their home countries' rules, promising beaches alongside the lab work. Pacific Fertility Center runs a dedicated affiliate for Japanese patients and has compressed the required visit to as short as 10 days. New York's Center for Human Reproduction boasts of an international clientele that barely needs to set foot in the office.
Others offer full concierge packages—airport transfers, hotels, legal coordination—and state the value of the American passport outright. The policy debate should not be limited to birth tourism. It should address the entire reproductive industry and what it is willing to sell to the highest bidder.
