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The medical process of surrogacy is different than with a personal pregnancy, including the medications involved.

With surrogacy, the surrogate mother’s uterus requires preparation to support the upcoming pregnancy or implantation. Three hormones assist in this process, including estrogen and progesterone, which prepare the uterus by mocking the surrogate’s natural cycle, and Luprin (leuprolide) injections, which make sure the timing remains synchronized.

In this guide, we’ll go over what surrogates should know about Lupron, estrogen, and progesterone.


Estrogen is a group of hormones that play an important role in the growth and function of the female reproductive system. It may sound counter-intuitive, but as a surrogate, it’s typically required to take birth control pills to prepare for the surrogacy journey and coordinate the ovarian cycle. Estrogen helps thicken and build the uterine lining, maintaining early pregnancy.

Estrogen replacements are also given until the twelfth week of pregnancy. Why that particular week? That’s when the placenta takes over the job of hormone production. Estrogen can be administered through oral pills, suppositories, patches or injection.


Progesterone is a hormone your ovaries make that gets the uterus ready for a fertilized egg to implant. It also helps maintain your uterine lining during pregnancy.Your body makes progesterone after ovulation. Once uterine walls are thick enough, you start taking progesterone replacements to ensure successful implantation a few days before the embryo is transferred into the uterus. Progesterone signals the body to start making the correct nutrients to nourish the embryo.

As with estrogen, you stop progesterone replacements around the end of the twelfth week. It can be taken in the form of pills, suppositories or gels, but the typical administration form is by intramuscular injection. It’s just a pinch.

Lupron (Leuprolide)

With that influx of hormones, your body will naturally react and try to reassert its natural cycle. Lupron (Leuprolide) keeps the timing on track by safely blocking the hormones that control your cycle. Lupron is a synthetic hormone used to lower the levels of certain sex hormones in the body by acting as a gonadotropin-releasing hormone (GnRH) agonist. In other words, it’s like putting up a “Do Not Disturb” sign that helps to synchronize your cycle with the egg donor’s or intended mother’s cycle before the transfer.

You start taking Lupron about two weeks after you begin birth control and stop it days before the intended mother’s or egg donor’s egg retrieval. You receive Lupron by a self-administered injection with a half-inch needle.

As you take these hormones, you also receive weekly blood tests and ultrasounds to ensure everything is proceeding accordingly. You only need to supplement the pregnancy with hormones during those few weeks of the first trimester. After that, your body makes its own hormones naturally.

Surrogate Medications Besides Hormones

In addition to hormones like Lupron, estrogen, and progesterone, there are several other medications that surrogates may need to take during pregnancy that can vary depending on the individual. 

A common recommendation is prenatal vitamins that support a healthy pregnancy with essential nutrients. 

There are cases when a surrogate may need to use a low dose of aspirin in order to improve blood flow to the uterus and reduce the risk of blood clots during a transfer.

It’s also important to take proactive measures to prevent infection before embryo transfer, and to potentially treat existing bacterial infections. Doxycycline and Tetracycline are two antibiotics that are often used to keep the surrogate healthy and the reproductive process successful. 

While it’s not uncommon to have hesitations with medications, your doctor will guide you on how to reduce risks and cope with side effects.

Timeline for Taking Surrogacy Medications

The medication timeline is a critical part of the surrogacy journey that must be adhered to exactly to encourage a healthy and successful pregnancy. From egg retrieval, to embryo transfer and beyond, the right doses at the right times keep the process on track and reduce risks. 

Here’s a brief outline of the timeline. Of course, you should consult with your medical provider and surrogacy agency for your exact timeline and medication needs.

  1. Birth control pills: Initiate to synchronize the surrogate’s menstrual cycle with the embryo transfer schedule
  2. Lupron (Leuprolide): administered alongside birth control pills, typically for just under a month to regulate the menstrual cycle and prevent premature ovulation.
  3. Estrogen: Begins usually about two weeks after starting birth control pills and Lupron to stabilize the uterus for transfer and cause the body to produce the necessary tissue for embryo implantation​.
  4. Monitoring appointment: After around three weeks, a clinic appointment is scheduled to check the uterine lining’s thickness and estrogen levels to determine whether to proceed or adjust the medication​​.
  5. Progesterone: Starts five days before the embryo transfer to help the embryo adhere to the uterine lining post-transfer and continues until the 12th week of pregnancy​.

Need Guidance Along Your Surrogacy Journey?

Individual needs vary in pregnancy and surrogacy. Contact Joy of Life® today to learn more about these medication and the surrogacy process. As a leading surrogacy agency in California, our team includes medical professionals and past surrogates who have years of personal experience helping surrogate mothers and intended parents.

Apply to become a surrogate today.

*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.


Joy Millan

Author Joy Millan

I’m Joy, the founder and CEO of Joy of Life. With a professional background as a fertility clinician, I’ve spent thousands of hours working with surrogates and intended parents alike. As a mother of two, I often wished for more support and a deeper commitment to care for those embarking on non-traditional family-building journeys. This is why I established Joy of Life: to create a more robust, compassionate experience in parenthood for both parties involved with surrogacy. In 2021, I stepped back from daily operations at Joy of Life to fight cancer. Fortunately, the combined 20 years of experience from our incredible team has allowed me to focus on my health & recovery. I continue to provide company guidance and serve as the head liaison for our network of doctors, clinicians and caregivers.

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