What Is Surrogacy, and What Does It Actually Involve?

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. It is illegal in most states and rarely if ever, done anymore.

West opted for gestational surrogacy, whereby the "surrogate receives an embryo that has already been fertilized 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 without a uterus" 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. The main purpose of the contract is to establish the intentions of legal parentage after delivery."

"Other aspects include preferences regarding the number of embryos to transfer, financial allowances, what to do in the case of an abnormal pregnancy, and what type of contact they want to have with each other throughout and after pregnancy," he adds. 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.

What Does It Cost?

Surrogacy engagement fees range from an estimated $75,000 to 125,000, but it's worth noting that these costs vary depending on each situation. Why the high price tag? This quote encompasses a number of services and fees, including the medical and psychological screenings gestational carrier compensation, IVF (which, can cost up to $20,000 on its own), and legal costs.

If you're weighing a number of different options, Bankrate's cost comparison might prove helpful. The company tallied the average cost of four popular alternatives for parents who can't naturally have children alone. Compared to surrogacy, they found international adoption costs up to $50,000, private domestic adoption costs up to $35,000, and foster care adoption carries "virtually no cost."

While the path to having a child might seem overwhelming, West says it was all worthwhile the second she held her baby girl. "The connection with our baby came instantly, and it's as if she was with us the whole time," she said. "Having a gestational carrier was so special for us, and she made our dreams of expanding our family come true." There's no doubt it was an emotionally taxing journey, but one that resulted in the biggest miracle of all: life.