Kim Kardashian Is Looking into Using a Surrogate for Baby #3—But What Does That Mean?

“So I’ve come to the conclusion,” she says, turning Kris Jenner, “that I just want to explore surrogacy.” (Kris looks completely shocked.) And, of course, that’s all that’s being revealed for now.

But what does getting a surrogate actually entail? First of all, while the term is often applied broadly, a true “surrogate” pregnancy uses the surrogate’s own eggs to create an embryo. It’s likely Kim is actually interested in a gestational carrier, who will carry an embryo created from her own eggs and Kanye’s sperm during IVF. That embryo is then transferred to the gestational carrier. 

John Rapisarda, M.D., of Fertility Centers of Illinois, says that people typically turn to surrogacy or a gestational carrier if they have a medical condition that prevents them from safely carrying a pregnancy, have an abnormal uterus, have had a hysterectomy, or have a history of repeated pregnancy losses that is thought to have something to do with their immune system.

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Kim is already mom to her daughter North, 3, and son Saint, 11 months. A Kardashian source told People last year that it’s unlikely Kim will give birth to more children because she had several complications with both pregnancies. “Doctors have advised that [trying for another] could be dangerous,” the source said. (Heal your whole body with Rodale’s 12-day power plan for better health.)

Shahin Ghadir, M.D., founding partner of Southern California Reproductive Center, says couples may also choose to use a gestational carrier if the mom has a uterine problem that doesn’t allow for safe implantation.

While it’s possible Kim could find a friend or family member to carry the baby, Shannon M. Clark, M.D., an associate professor of maternal-fetal medicine at UTMB-Galveston, and founder of BabiesAfter35.com, says gestational carriers and traditional surrogates are often found through an agency. (Most fertility centers can recommend an agency, she adds.)

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The process of finding a gestational carrier takes time and careful vetting. Rapisarda says that gestational carriers undergo medical and psychological screening, as well as a uterine evaluation. “Once approved, medical treatment begins,” he says.

That includes hormonal supplementation (including estrogen and progesterone) to prepare the gestational carrier’s uterus for the embryo, and IVF for the future parents. There are many ways in which IVF can be used, depending on if a couple is using a donor egg or sperm or eggs from a female partner and sperm from male partner, says Clark. “It can get quite complicated,” she adds. Finally, an embryo is transferred to the gestational carrier’s uterus, and she carries the baby to term.

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If Kim and Kanye have frozen embryos from a previous cycle of IVF, those could be used as well, says Tina Koopersmith, M.D., of West Coast Women’s Reproductive Center. “There are many variables when using a surrogate,” she says. “Couples should speak with their fertility expert to clearly understand all the options.”