What Is Surrogacy, and What Does It Actually Involve?

Sophie Miura

The birth of Kim Kardashian West's third child didn't just prompt conversations about the choice of the baby's name, Chicago—it also ignited new discussions about surrogacy. West's surrogacy story is hardly indicative of the norm (sources say she was "pampered" by the couple during pregnancy), but her decision to give birth via surrogate is certainly in line with modern parenting trends. While it has been around for more than 30 years, gestational surrogacy transfers have nearly doubled since 2015.

"The whole surrogacy process is both a medical and emotional journey," says Daniel Kaser, MD, a reproductive endocrinologist who oversees the third-party reproduction program at Reproductive Medicine Associates of New Jersey. RMANJ defines surrogacy as a "method of assisted reproduction," whereby a third party carries the baby. While many have a basic knowledge, though, Kaser notes that there are also a lot of misconceptions about the process and what it actually involves.

Consider this a 101 guide: what surrogacy is, what the process involves, and whether it might be right for you.

Traditional vs. Gestational Surrogacy

There are two types of surrogacy, which differ based on the carrier's genetic connection to the child. In traditional surrogacy, the "surrogate is not only carrying the pregnancy, but also donating her own egg. The surrogate is genetically connected to the child," Kaser explains.

West opted for gestational surrogacy, whereby the "surrogate receives an embryo that has already been fertilised by the intended father and mother—or from a separate egg donor if the intended mother is unable to carry herself," he says. In this scenario, the surrogate has no genetical connection to the child.

How Do You Know If It's Right for You?

There is a multitude of reasons parents opt for surrogacy, but as Kaser points out, most are medical: "Patients who don't have a uterus, couples who struggle with infertility, single males, same-sex couples, someone who has had a hysterectomy or was born with genital defects" are some examples. "Often patients have gone through IVF and then turned to surrogacy," he says.

A key misconception is that surrogacy is an easy choice, West said in a post on her website. "Anyone who says or thinks it's the easy way out is completely wrong," she writes. "People assume it's better because you don't have to deal with the physical changes, pain, or complications with delivery, but for me, it was so hard to not carry my own child, especially after I carried North and Saint."

Kaser says the process can be emotionally taxing for women who aren't able to become pregnant themselves. "For a lot of women, the biggest factor is to grieve the loss of not carrying the baby," he says, adding that his clinic offers "several processes and counseling options" to support parents as well as surrogates.

Do You Get a Say in Who Your Surrogate Is?

There are generally two ways to choose a surrogate: You can select someone you know who is open to and comfortable with the process, or you can find a candidate via an agency. Regardless of the route, Kaser says all potential candidates are thoroughly vetted and tested to ensure they meet all the requirements.

"All gestational carrier candidates undergo a thorough review of their medical and obstetric records," he tells MyDomaine. "They also undergo a clinical interview by the clinic's physician and mental health teams prior to becoming available to match."

A legal contract is also a must. "Surrogate agencies and mental health teams help with aligning the surrogate and parent concerns to include in contract," he says. "One of the main inclusions is usually about what type of contact they want to have with each other throughout and after pregnancy." Surrogacy laws vary from state to state, so it's important to check your local rules and obtain legal help with preparing the contract, he stresses.

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