For couples who are unable to conceive naturally, surrogacy could be an option.
The path to parenthood isn’t always as simple as many of us envision it to be and a variety of issues can sometimes make it difficult, or impossible, for a woman to carry a child, while same-sex couples who are eager to expand their family can also choose this route.
The 38-year-old reality star gave birth naturally to daughter North, and son Saint, while the couple's third child, Chicago, was born via surrogate in January 2018.
The decision to follow the path of surrogacy came after Kardashian West suffered from a life-threatening condition called placenta accreta during her two pregnancies and was warned by doctors to not carry her own baby again.
According to Tommy’s – the largest charity funding research into the causes of miscarriage, stillbirth and premature birth – placenta accreta occurs when all or part of the placenta remains attached to the uterine wall after childbirth.
With reports that the surrogate carrying the couple’s fourth child is in labour, here’s everything you need to know about how surrogacy works, from the different types to what the law says in the UK.
What is surrogacy?
According to Surrogacy UK – the leading UK non-profit surrogacy organisation – surrogacy is the act of a woman carrying a pregnancy and giving birth for the child’s parents, as they are unable to carry a child themselves.
While the reason people choose to use a surrogate can vary, the most common include recurrent miscarriage, repeated failure of IVF treatment, premature menopause and an absent or abnormal uterus.
Surrogacy first became legal in the UK in 1985 under The Surrogacy Arrangements Act and since 2010, same-sex couples have also been able to become intended parents in the UK.
Are there different types of surrogacy?
Yes. There are two types of surrogacy arrangements: straight/traditional and host/gestational.
Host surrogacy involves IVF to induce pregnancy in the surrogate using the egg of the intended mother or a donor egg, Surrogacy UK states.
This means that the surrogate has no genetic link to the baby as the embryos are either fully made up of both intended parents’ genetics, or made up of one intended parents’ genetics plus either donor eggs OR donor sperm.
In traditional surrogacy, the surrogate uses an insemination kit to become pregnant using the intended father’s semen and her own egg.
How does it work?
According to Surrogacy UK, there are three stages to host surrogacy - egg donation, fertilisation and transfer.
The first stage - egg donation - is when the mother or donor undergoes a procedure to extract a number of her eggs.
The second stage - fertilisation - then takes place in the lab using the father’s semen.
The final stage - transfer - is the transferral of up to two of these fertilised eggs into the womb of the surrogate.
How much does surrogacy cost?
While it is illegal to pay someone to be your surrogate in the UK, intended parents are expected to cover expenses.
Brilliant Beginnings – an organisation that supports gestational surrogates – states that expenses in the UK can include anything from travel costs, treatment costs, maternity clothes, counselling or professional support in connection with surrogacy, childcare costs and any loss of earnings.
Reimbursement can be agreed as a lump sum or paid on a case by case basis as the expenses arise.
Intended parents should also consider the cost of fertility treatment and any other legal fees including the drawing up or help with parental order applications via an organisation.
The average cost for expenses is estimated to range from around £7,000 to £15,000.
What does the UK law say?
The laws surrounding surrogacy vary between different countries, and in cases like the USA, can even differ between states.
In the UK, surrogacy is legal but it cannot be advertised or commercialised, meaning you are not allowed to pay someone to be your surrogate, or advertise surrogacy as a service.
However, in the US, intended parents can pay a surrogate through what is known as an "inconvenience fee" in addition to expenses. This is typically valued between $20,000 (£15,380) and $35,000 (£26,915).
According to UK law, when a baby is born, the woman who gives birth is the legal mother – whether or not she is biologically related to the child – and if she’s married or in a civil partnership, her spouse is the other legal parent.
If the surrogate doesn’t have a partner - (including marriage or in a civil partnership) the child will have no legal father or second parent unless the partner actively consents.
Legal parenthood can be transferred by parental order or adoption after the child is born.
If there is disagreement about who the child’s legal parents should be, the courts will make a decision based on the best interests of the child.
The intended parents and surrogate can record how they want the arrangement to work in a surrogacy agreement.
However, surrogacy agreements are not enforceable by UK law, even if you have a signed document with your surrogate and have paid their expenses.