SAN FRANCISCO—The 10th-floor ballroom of San Francisco’s Marines’ Memorial Club & Hotel has high, coffered ceilings and baroque-style drapes and chandeliers. As 250 men in business casual filled the room early this year for the city’s fourth annual “Surrogacy Conference and Expo,” all eyes were on four female panelists at the front. The topic: how gay men can have babies using surrogates.

The men want biological children, and surrogacy—along with in vitro fertilization (IVF)—promises a method by which they can have them. But many of the countries that used to permit the practice now ban it.

That makes the United States one of the few countries to allow commercial surrogacy and California the state with the most-surrogacy-friendly laws. If homosexual activists get their way, more states will follow California’s lead and adopt similar laws and “ethical guidelines.”

Surrogacy is costly—typically more than $150,000—but even men with money must still find donor eggs and a “gestational surrogate”: That’s a woman willing to “rent” her womb by becoming pregnant and giving birth to a child unrelated genetically to her. In San Francisco, money and eggs are easy to come by, but finding a surrogate is by far the biggest roadblock according to one conference attendee—a gay man four years into the IVF process with his partner.

The roadblock is becoming bigger as an unusual alliance of conservatives and women’s rights groups opposes commercial surrogacy. In recent years The Center for Bioethics and Culture (CBC) has produced a documentary, Breeders: A Subclass of Women?, and launched internationally the “Stop Surrogacy Now” campaign: CBC has collected more than 6,000 signatures from leading Catholic, evangelical, feminist, and liberal activists who consider surrogacy a human rights violation that exploits women and children.

At San Francisco’s Surrogacy Expo, hosts encouraged men to “shop around” for a surrogate. Event sponsors—dozens of West Coast fertility clinics, egg banks, and surrogacy agencies—set up displays explaining their services. Breakout sessions included information on budgeting, creating “optimal” embryos, and surrogate compensation. “The wall you are up against is that you don’t have a uterus,” one of the female panelists said, drawing laughter.

In 2011 the Society for Assisted Reproductive Technology (SART) reported 1,593 babies born in the United States to gestational surrogates, as tracked by its member clinics. This is up from 1,353 in 2009, and 738 in 2004. These numbers are likely much higher since many surrogate births go unreported.

Still, surrogacy carries risks for intended parents (IPs) and women. Many IPs remember the 1986 Baby M case, where biological father William Stern and his wife battled for custody with surrogate Mary Beth Whitehead, the baby’s biological mother. That messy case, along with IVF improvements, initiated a shift from “traditional” surrogacy to gestational surrogacy, where the surrogate has no genetic connection to the baby. Surrogacy advocates believe women are less likely to become attached if they carry a baby who began life in a lab using donor or would-be parents’ eggs and sperm. One panelist in San Francisco reassured the audience that fears of a surrogate attaching to the baby are misplaced: “Those fears don’t exist. They exist in our minds.”

New York state Sen. Brad Hoylman (left) and David Sigal with their daughter, Silvia Hoylman-Sigal, 3, who was born via a surrogate mother, at their home in New York. Nicole Bengiveno/The New York Times/Redux

But maternal attachment is hard to predict, especially when dealing with a woman’s most intimate experience. California gestational surrogate Melissa Cook last year filed a lawsuit against the biological father of the triplets she was carrying after he demanded she abort one of them. She had signed a 75-page contract permitting him to “reduce” a multiple pregnancy and now faces financial ruin for her refusal. Cook told The New York Post, “I bonded with these kids.”

Many states, including New York, Indiana, and Michigan, ban commercial surrogacy, while other states either have laws prohibiting compensation or contracts, or no laws at all. California is unique because it allows for paid surrogate contracts that give IPs legal, full-custody rights to the child prior to birth. That’s different from adoption, where birth mothers give up parental rights only after children are born.

The internet is now littered with ads seeking women in states that allow paid surrogacy: “Earn up to $67,000!” “Guaranteed speedy match!” “Perfect for my college loans,” and “Surrogacy helped our Military Family buy a home.”

The surrogacy agencies placing these ads are unregulated. Some agencies pop up for a few months and then disappear. Many fail to screen would-be parents. Scandals and fraud are rampant. In 2012, authorities caught San Diego surrogacy broker Theresa Erickson running an international baby-selling ring. She told NBC San Diego her case represented the “tip of the iceberg” of a corrupt industry.

Men Having Babies, the nonprofit that hosts surrogacy conferences, recently drafted “ethical guidelines” that will purportedly rein in abuses. The guidelines proclaim a woman’s right to act as a surrogate and call for uniform laws establishing enforceable contracts between surrogates and “intended parents.” At one New York City conference, state legislator Brad Hoylman, a gay father, encouraged “iron-clad, enforceable agreements.” He told men, “The more we press our political leaders, the more willing they will be to consider it.”

But iron-clad, enforceable agreements often put women and babies at risk. The Center for Bioethics and Culture’s Jennifer Lahl says too often “things go terribly wrong.” Some surrogates suffer health problems. Some IPs bully them. One 41-page redacted contract, sent by a California surrogate, required her to “substantially reduce” soda and processed and fast-food intake: She had to get permission for hair dye, herbal supplements, and routine teeth cleaning. The contract gave IPs the legal right to “make all fetal reduction decisions,” including “therapeutic” abortion, killing one or two triplets, and killing children in the womb “for any medical reason, or if there is any indication of any physical or neurological defect or abnormality.”

HEATHER RICE DECIDED to try commercial surrogacy after seeing an ad on a parenting website. At 19, the Arizona single mother of two was working two low-paying jobs. She wanted to stay home with her children. Rice’s first experience was “amazing”—she conceived easily and birthed twin girls for a couple, earning $1,750 a month. “I thought, I can do this again,” she said in a phone interview.

But Rice’s second experience for an infertile, heterosexual couple turned bitter. She miscarried twice—the second baby, a girl diagnosed with Down syndrome, died at 31 weeks. Rice’s third pregnancy for the couple was twin boys. One died at 8 weeks. Then a routine 20-week ultrasound revealed the other boy had a rare brain cleft. During the ultrasound, Rice says, “Mom just got up and left the room.”

Rice’s mothering instincts kicked in when the genetic mother called her a week later and told her to abort: “To her it was just an embryo made in a lab. To me it was a living, kicking, moving human being inside of me.” Naming the boy “M.J.,” Rice hired a lawyer and began researching his condition, feeling hopeful after talking with brain experts and sending them medical scans.

At 28 weeks the boy’s cleft had closed in what Rice called “a miracle from God.” The parents indicated they wanted him, saying they had set up a nursery and bought baby clothes, but when Rice went into labor, the mother never showed up at the hospital. Rice called the father crying and begging him to come see the boy and cut the cord. He came, cut the cord, and took the baby.

Rice, now 32, has no idea what happened to “M.J.” She recently found the couple on Facebook but saw no trace of him. She suspects they decided on adoption. Especially on Mother’s Day, the day “M.J.” was born, Rice wonders, “Is he hungry? Is he dirty? Is he OK?” She says, “I’m still determined to find him one day.”

Kids as commodities

Catholics have clear teaching opposing IVF and surrogacy. Evangelicals aren’t as clear. Some accept surrogates helping infertile heterosexual couples have biological children, provided they do not have abortions. The CBC’s Jennifer Lahl said many couples tell her they received their pastors’ consent and even sought financial support from their congregations.

But have those who applaud use of surrogates thought it through? Children born to surrogate mothers are more likely to suffer emotional problems, according to a 2013 University of Cambridge study. Jessica Kern was “devastated” at age 17 when she learned from her medical records that she was “bought” for $10,000 in a traditional surrogacy arrangement. She describes an abusive upbringing and further rejection after she met her biological mother. At a recent CBC event, Kern said many people tell her “you should just be grateful you’re here … as if that makes it all OK and we shouldn’t look deeper into these issues.”

A 28-year-old Indian surrogate mother at the Surrogacy Centre India clinic in New Delhi. Sajjad Hussain/AFP/Getty Images

Looking deeper leads some to point the finger at the unregulated surrogacy agencies brokering deals involving little screening and lots of cash. Surrogacy forums are filled with warnings of fraudulent agencies and individuals. In 2013 the owners of Modesto-based SurroGenesis pleaded guilty to defrauding clients of millions of dollars, leaving some IPs unable to pay already-pregnant surrogates. In another case, Los Angeles–based Planet Hospital founder “Rudy” Rupak pleaded guilty in March to stealing millions from IPs in an international surrogacy ring. He faces up to five years in prison.

These cases and others reveal the market for children often crosses national borders. Many couples come to the United States for babies, while others seek to cut costs by traveling to poorer countries where impoverished women rent their wombs for a meager sum, often living in crowded dormitories far from home during pregnancy. Last year, authorities arrested an Australian broker who charged IPs $50,000 while paying Cambodian surrogates $400 a month and promising $6,000 more when they give up the babies after birth.

Children are often lost in the mix. In 2014, an Australian couple paid a Thai surrogate to birth twins but abandoned one born with Down syndrome. Another recent case, dubbed “the baby factory,” involves a 24-year-old Japanese businessman who fathered more than a dozen children using different Thai surrogates. He reportedly desired to father hundreds more.

Nations famous for “fertility tourism”—including India, Nepal, Cambodia, and Thailand—have recently banned commercial surrogacy. Government officials admit to exploitation of poor women and a lack of safety and oversight. Lahl says, “The world is closing its borders … but we say, ‘Come to California! Buy the baby of your dreams!’” —M.J.