From the outside, surrogacy may sound simple: an embryo is implanted into the surrogate’s uterus, and she carries the pregnancy for the intended parents. However, it involves thorough screening, careful timing and highly individualized medical care to ensure a successful surrogate pregnancy. If you are planning to become a surrogate, you should prepare for an intensive, yet rewarding, medical process.
In this article, find an overview of what to expect through each step of the surrogacy medical process, from medical screening requirements to the embryo transfer and more.
1. Medical Screening
Before beginning medical procedures, it is important to ensure your body is truly ready to carry a surrogate pregnancy. Some of this medical screening may be done before you are matched with intended parents, while some will take place after you have found a match, depending on your surrogacy agency.
The medical screening process involves a variety of exams and procedures, including:
- Pap smear and physical
- Bloodwork to check you and your partner for infectious diseases, such as HIV or hepatitis
- Hysteroscopy, which involves a thin scope inserted through the cervix to determine the shape and the size of the uterus and ensure the fallopian tubes are unobstructed
- Saline sonogram, which flushes the uterus with saline solution to check or fibroids or anything else that would interfere with the pregnancy
- And more
Before moving forward with the medical process, you will also need to complete any social or psychological evaluations your agency requires, if you have not done so already.
2. Mock Cycle
Most surrogates undergo a mock cycle before the transfer cycle. In a mock cycle, the reproductive endocrinologist will put you on the same medications you will take to prepare for the real transfer. This will give them the chance to check your uterine lining and ensure it is responding well to the medications. You will undergo multiple ultrasounds and bloodwork during the mock cycle to check your hormone levels and the lining in your uterus.
You may also do a trial transfer to check the angle of your cervix and the length of your uterine cavity. This helps prepare the doctor for how to insert the catheter when it is time to implant the embryos.
3. Preparing for the Embryo Transfer
If all goes well during the mock cycle, you will be ready to start preparing your body for the embryo transfer. The timing of the transfer will vary depending on whether you are using a fresh cycle or frozen cycle.
If the embryos are frozen, the transfer is done according to your cycle. Usually, embryos are frozen at day five of development, so they should be transferred five days after your mid-cycle. This is because in a regular pregnancy, it takes the embryo about five days to transfer through the fallopian tube before implanting.
A little more coordination is involved in a fresh cycle, in which the intended parents are making the embryos to be transferred using the intended mother’s or donor’s eggs. The intended mother’s or egg donor’s cycle has to be synced with your cycle. This is usually done using birth control pills and Lupron injections, which help shut down hormone production and give the doctors more control over your cycle. Using Lupron, your doctor can ensure your uterus is ready to receive the embryos at the exact right time.
Meanwhile, the egg donor or intended mother will be taking injectable fertility hormones to stimulate her ovaries to produce several eggs. Once her follicles are the right size, she will be given a shot to help mature the eggs, and the egg retrieval will be done 36 hours later.
The collected eggs will be fertilized and incubated for five days to mimic the natural conception cycle. At this point, the date and time of the actual embryo transfer can be scheduled.
4. Embryo Transfer Procedure
The day before the egg retrieval, you will stop taking the Lupron injections and will begin taking progesterone. Progesterone helps maintain the correct level of hormones to maintain you uterus’ condition and support a stable pregnancy.
Progesterone may be given orally, through suppositories, or through intramuscular injections. The daily intramuscular injections are required in most cases and may be administered at home by your partner or by the doctor’s office.
By this time, you will likely also be taking estrogen replacements, which can be in the form of pills, patches or shots. You will continue taking the progesterone and the estrogen until the twelfth week of pregnancy, when the placenta generally takes over hormone production.
Once the embryos have been incubated for five days and you are five days past mid-cycle, the embryo transfer will take place. Depending on your agreement with the intended parents, one or two embryos will be transferred using a syringe with a thin, flexible catheter at the end. The syringe is inserted through the cervix into the uterus, using an abdominal ultrasound to ensure exact placement of the embryo.
The transfer is usually a relatively quick and painless procedure that does not require anesthesia. You may be required to rest for a few days after the transfer.
5. Confirmation of Pregnancy
Around nine days after the embryo transfer, you will return to the fertility clinic to do an HCG, which measures your pregnancy hormone levels. The count should be at least 50 or higher to indicate a positive, stable pregnancy. A count over 200 may indicate a multiple pregnancy.
Two days later, another HCG test will be administered to verify that your HCG levels are going up; they should double about every two days.
This is a very exciting time in the surrogacy process — you are officially pregnant! However, keep in mind that multiple embryo transfers are often required to achieve a successful surrogate pregnancy, and you will need to continue to be closely monitored to ensure the pregnancy remains viable.
6. Six-Week Ultrasound
If your HCG levels were positive following the embryo transfer, an ultrasound will be done around the sixth week of pregnancy to check for a heartbeat. If the heartbeat is heard, you may be released to your OBGYN that you will work with for the remainder of your pregnancy. Depending on your fertility clinic and your agreement with the intended parents, another ultrasound is sometimes required around 12 weeks before you are released from the fertility clinic’s practice. Between the six- and 12-week marks, you will continue with regular appointments to check your hormone levels and ensure the pregnancy is still stable.
7. Prenatal Care
Once you are released to your OBGYN, you will continue to receive prenatal care as you would with any other pregnancy — though you may have more frequent appointments to ensure everything is going well. If you are carrying multiples, you may be sent to a perinatologist, an obstetrician who practices mainly high-risk maternal-fetal medicine.
8. Final Thoughts
This article provides a general overview of the surrogacy medical process, but each pregnancy is different, and your surrogacy journey may vary depending on your individual circumstances. Always follow your health care providers’ instructions, and if you have any questions about medications or procedures, ask for clarification.
The medical process for surrogates may seem overwhelming, but you will have a dedicated team of fertility specialists working with you to ensure that you and the baby are healthy and that you have the highest possible chance of success on your surrogacy journey.
Are you interested in learning more about surrogacy or starting the process? Complete our form to request free surrogacy information now.