The surrogacy medical process can be different for every surrogate mother — but there are usually a few steps that every surrogacy process has in common. While being a surrogate can be a wonderful and rewarding experience that changes lives, it can also be an intimidating, even confusing time for surrogates and intended parents. As a surrogacy agency, we believe that intended parents and the surrogate need to have all the medical information necessary before the process ever begins.
If you’re considering embarking on the surrogacy journey, this guide will take you inside the requirements and medical process in easy-to-follow, general language, so you know what to expect each step of the way.
The surrogacy process also varies depending on what type of surrogacy you’re doing, such as traditional or gestational. At Joy of Life®, we specialize in gestational surrogacy.
In this article, we’ll address the following:
- General Overview of the Surrogacy Process
- The Medical Surrogacy Process: Step-By-Step
- Key Terms for Surrogates to Know
- What Intended Parents Should Know About the Surrogacy Process
- Frequently Asked Questions
Surrogacy can be a wonderful and meaningful way to build a family, but it’s important to take time to determine if the journey feels right for you. Explore the surrogacy process thoroughly, weighing all factors — from the emotional to physical to financial ones. Here are the general phases of the process:
1. Getting Prepared
Start by considering the risks, costs and impact on all relationships involved. Speak with professionals to determine if surrogacy is the best option for your unique needs and desires. Take your time with this decision — deeply reflect on what matters most as you educate yourself on the process.
When you find a potential surrogate match, take care to have in-depth conversations to understand each other’s hopes, values and preferences for the surrogacy process. The potential surrogate will undergo extensive medical, psychological and background evaluations during the match screening to ensure suitability.
2. Legal Steps
The legal side of surrogacy is founded on care and clarity for all. The surrogate and intended parents should each have their own legal representation to review surrogacy contracts and protect their interests. These contracts address compensation, schedules, insurance, health safety measures and other essential agreements between all parties. They also outline potential risks and resolution processes to provide guidance if difficulties arise.
Gestational surrogacy agreements (GSA) clearly outline the medical and financial aspects of the pregnancy and birth, respecting the surrogate’s autonomy. Attorneys will also draft parentage documents that grant full legal custody to the intended parents upon delivery. They also obtain pre-birth orders to reaffirm rights early on and final post-birth orders from the court confirming legal parenthood.
3. Gestational Surrogacy Process
Once the legal documents are signed, the medical process can begin. The fertility specialists carefully monitor the egg donor through her cycle, using specialized medications to stimulate optimal egg production and maturation. The eggs are then safely retrieved.
In the embryology lab, eggs are fertilized and tested until preferred embryos are selected. These embryos are then transferred to the surrogate’s uterus.
About two weeks after the transfer, a pregnancy test will confirm if implantation was successful. If positive, you will continue taking medications to support the pregnancy. Around one month after transfer, the embryos will have embedded further and begun remarkable development as they prepare to grow into a baby.
The surrogacy process medically concludes with childbirth, where the intended parents will be present for the baby’s delivery. After the birth, you’ll be discharged, and the intended parents take their baby home to begin their life as a new family.
If you’re interested in the medical process of surrogacy, including the screening process and what tests you’ll need as a surrogate mother, here is a step-by-step guide.
1. Medical Pre-Screening
The first step in the surrogacy medical process is screening. The intended parents must find a surrogate who is well-suited physically and emotionally to carry their baby.
You will need to undergo a medical screening process that includes a standard physical examination, blood testing and an ultrasound to examine the health of the uterus. This screening will ensure that the surrogate can provide a healthy home for the baby while it grows in the uterus.
The screening should also include a psychological examination. Being a surrogate can present a range of psychological pressures, so it’s vital to ensure your mental health is stable before beginning the pregnancy.
2. Mock Cycle
In most gestational surrogacies, you will undergo a mock cycle before embryo transfer. You’ll take the same medications and undergo monitoring to ensure your uterine lining responds well before the actual transfer.
These starting medications can include:
- Birth control pills
- Lupron to prevent premature ovulation by suppressing the natural hormones that control the menstrual cycle, allowing your cycle to be synchronized with the intended donor
- Progesterone to help maintain a stable pregnancy
- Aspirin to assist with cycle stimulation and implantation rates in the surrogate
- Doxycycline to treat potential bacterial infections in the pelvis
- Estrogen to thicken the uterine lining to help coordinate cycles
- MedFolio, a steroid to control the autoimmune system and encourages embryo implantation
3. Embryo Transfer Preparation & Fertility Medication
For frozen embryo transfers, the embryos are thawed and then gently transferred into your uterus around five days after you ovulate mid-menstrual cycle, mimicking nature’s timeline.
With fresh transfers, your cycle must be aligned with the egg donor or intended mother’s. Medications like birth control pills and Lupron injections will temporarily pause your hormonal fluctuations, allowing the doctor to ensure your uterus is ready to receive the embryos on time.
The egg donor receives injectable medications to help multiple follicles mature eggs for retrieval. When ultrasounds indicate that the follicles have reached the ideal size, the donor gets an hCG injection to finalize egg maturation. The eggs are then carefully retrieved around 36 hours later. After the eggs are fertilized and nurtured for five days, your embryo transfer date can be scheduled to match the natural conception process as closely as possible.
Before retrieval, egg donors may take birth control, corticosteroids, ovary-stimulating hormones, hCG and antibiotics. Doctors will provide you with all the medication details and timelines.
4. Embryo Transfer
If you’re using a donor’s eggs, these eggs will need to be implanted in your uterus. The embryo transfer process usually occurs one to five days after the egg is retrieved.
You will likely receive a mild sedative for the implantation, so the process should be painless, but you may experience mild cramping. The doctor will use a long, thin tube called a catheter to insert the embryo or embryos into your uterus.
5. Confirm Pregnancy
After the eggs have been fertilized and implanted, the next step will be to test for pregnancy. You usually return to the fertility clinic about nine days after the embryo transfer to do an HCG, which measures your pregnancy hormone levels. A count of 50 or higher indicates a positive pregnancy. Two days later, you’ll take another HCG to verify that your levels are rising. If they are, it’s time to celebrate! You’re officially pregnant; the rest of the process will be like any other pregnancy.
6. 6-Week Ultrasound
After a positive HCG test, you’ll have an ultrasound around the 6th week of pregnancy to check for the fetus’ heartbeat. If a heartbeat is detected, you may be released from the fertility clinic to continue prenatal care with your regular OB-GYN provider. Some clinics require one more ultrasound around 12 weeks before fully discharging you.
Between 6 and 12 weeks, you’ll have ongoing appointments to monitor hormone levels and ensure the pregnancy remains healthy and stable. Before transitioning you to standard prenatal care, the clinic wants to confirm everything looks good.
7. Prenatal Care
Once a healthy pregnancy is confirmed with your six-week ultrasound, your experience will be similar to any pregnancy. However, you may continue some medications through the first trimester and have more frequent prenatal visits to ensure stability. You’ll see your local OB-GYN during your pregnancy for your prenatal care.
As you near your due date, plans will be made for the delivery with input from you, the intended parents, and your healthcare team. Most intended parents choose to be present for the birth of their child. During labor and delivery, the intended parents often support you and eagerly await their baby’s arrival. They may cut the umbilical cord and spend those first precious hours bonding with their newborn.
Depending on your recovery time and health status, you and the baby will likely be discharged separately. The intended parents take their infant home while you return to your home to rest and complete your postpartum recovery.
Your formal surrogacy journey is now complete!
As you’re going through the surrogacy journey, you may encounter certain medical or legal terminology. It’s helpful to be familiar with these terms so you can understand the process.
Informed consent is your authorization to proceed with any medical tasks, with the understanding that there could be possible health consequences. Usually, the patient has to inform the doctor that they have perfect knowledge of any risks and or benefits. This includes the IVF clinic, the legal team and the surrogacy agency.
Personality Assessment Inventory (PAI)
This test is a comprehensive assessment of a person’s psychopathology, which may be relevant to any medical process. It lists 344 items, each ranked on a 4-point scale and takes 50-60 minutes to complete. This assessment is significant for any potential surrogate mother in order to evaluate her mental health before she carries a surrogate baby.
The monitoring clinic is an IVF clinic that does blood work and performs ultrasounds and other examinations of a surrogate mother before the embryo transfer. A monitoring clinic will determine her suitability for a transfer before she goes to a transfer clinic.
Selective Reduction and Termination
Selective reduction is the process of reducing the number of fetuses in multiple pregnancies, usually to prevent any severe risks to surrogate mothers during their pregnancies. If one of the fetuses has an incurable disease or is outside of the uterus, the termination process will occur so a baby is not born with serious health problems. This process differs from abortion because its underlying reason is a severe health issue. This two-day procedure was accepted in the 1980s when doctors became more aware of the health consequences of pregnancy.
The surrogacy journey as intended parents is filled with exciting milestones as you get closer to welcoming a child.
The intended parent(s) providing genetic material will undergo initial consultations and testing to ensure readiness. If the intended mother uses her eggs, she’ll complete ovulation induction, retrieval and freezing. If the intended father is providing sperm, he will complete testing as well.
After choosing a surrogate, she will undergo medical and psychological screening by the agency. Once cleared, her cycle is synchronized with the embryo transfer timeline. The agency thaws and transfers selected embryos at the optimal time. About 10 days later, a pregnancy test will hopefully confirm success. The surrogate will be monitored closely at first and then transition to routine prenatal care.
Throughout the journey, the agency will coordinate appointments, testing, legal paperwork and other key details so you can focus on the joy of your expanding family.
In addition to the general guide of surrogacy and the medical process above, we often get specific questions from our surrogate mothers. Here are answers to some of the most common ones.
Do surrogates get their medical expenses paid for?
Yes, the intended parents are responsible for covering all medical expenses related to the surrogacy, including doctor visits, medications, hospital bills for the delivery, and any other pregnancy-related costs. Learn more about surrogate compensation at Joy of Life.
How do surrogacy laws impact medical decisions around surrogacy?
Surrogacy laws vary by state and can affect what contracts are allowed, who can be a surrogate, how parentage is determined, and who makes medical decisions during the pregnancy. Understanding your state’s laws before embarking on the surrogacy journey is important.
What other types of surrogacy are there besides gestational surrogacy?
The main types are traditional surrogacy, where the surrogate uses her egg, and gestational surrogacy, where the egg is from a donor or intended mother. There is also altruistic surrogacy, with no payment beyond expenses, and commercial surrogacy, where the surrogate receives compensation. Learn more about different types of surrogacy.
How can surrogates choose the right surrogacy agency?
Seek out an agency focused on compassionately building families and supporting those on the surrogacy journey. Ensure the team has extensive professional experience navigating the intricacies of surrogacy. They should provide complete guidance, from thoughtful matching to legal, emotional and medical support throughout the process.
Do your research to find an agency with a proven track record of success and satisfied past surrogates. The right agency will feel like a caring community invested in you and your journey. Take your time to feel 100% comfortable with those who will guide you through this life-changing process.
Partner with Joy of Life for Worry-Free Surrogacy
The surrogacy journey can be truly beautiful, and we’re confident yours will be with us. Here at Joy of Life, our experienced team will guide you through every aspect of the process with compassion and care. As experts in our field, our team members have experience in the clinical, psychological and legal aspects of surrogacy. We’ll arrange your medical coordination, provide emotional support and handle everything at each milestone of the journey.
Apply today to become a surrogate with Joy of Life Surrogacy.
*The information on this page was written or reviewed for accuracy by Joy Millan, the founder and CEO of Joy of Life. Meet Joy and our team.