The process isn't always easy. Dean notes that some Chinese couples see the procedure as strictly a business transaction, viewing the surrogate mother as a hireling. American surrogate mothers, she said, tend to want to have a relationship with the couple whose child they are bearing.
"We have to educate [Chinese couples] that the surrogate is not an employee, that it's more than a business transaction," Dean said. "We have to say it's very disrespectful to the surrogate mother, and a lot of Chinese culture is about respect and not being disrespectful, so they can understand that part and relate to it."
Cultural differences aside, the procedure is also time-consuming — and doesn't always go according to plan.
Amy Lee, 42, and her husband, Harry, 48, of Hong Kong first flew to Los Angeles in 2010 to begin surrogacy procedures. The couple, who used their American nicknames, had always wanted a child, but their careers — she as a film professor, he as the manager of a tech company — had gotten in the way.
Their surrogate became pregnant but miscarried two months later. Later that year Lee went to Beijing to an underground surrogacy clinic. Her surrogate there miscarried too, and Lee decided not to try again in China.
So last year Lee came back to California three times to work with two surrogates. The first attempt did not result in a pregnancy, and the second attempt ended in a miscarriage.
The couple tried again in December with a different surrogate. That resulted in a pregnancy, and they are hoping it goes full term.
"There is a great demand for this in China, but it's illegal in China," Lee said. "So what are couples supposed to do?"