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For surrogates, administering injections and medications is a significant aspect of their surrogacy, playing a crucial role in preparing their body for embryo transfer and supporting a healthy pregnancy. Surrogates typically need to take various medications throughout this process, including birth control pills to regulate their cycle, Lupron injections to prevent ovulation, estrogen to build up the uterine lining, antibiotics to prevent infection, and most importantly, progesterone injections to support the early stages of pregnancy after embryo transfer.

While this may sound overwhelming, with the right guidance, surrogates can approach this part of their journey with confidence and successfully navigate it. It’s important to remember that each step is designed to create the best possible environment for a healthy pregnancy, which is why surrogacy agencies and medical professionals provide comprehensive support, detailed instructions, practical tips, and emotional encouragement throughout the process.

In this guide, we’ll review the various aspects of surrogacy injections, helping you understand their role, manage the process effectively, and find the support you need.

Understanding the Role of Injections in Surrogacy

Preparation for Pregnancy

One of the primary functions of surrogacy injections is to prepare the surrogate’s body for the embryo transfer procedure. This preparation involves several steps:

  • Regulating the Menstrual Cycle: Surrogates may take birth control pills or other medications to control the timing of their menstruation and ovulation, ensuring that their body is synchronized for the next phase of treatment.
  • Suppressing Ovulation: Injections like Lupron are used to temporarily suppress the surrogate’s natural ovulation cycle. This step is crucial because it allows the medical team to control the timing of the embryo transfer and ensure that the surrogate’s body is in the optimal state for implantation.
  • Building the Uterine Lining: Estrogen injections, patches, pills and vaginal suppositories help thicken the uterine lining, creating a hospitable environment for the embryo to implant and develop.
  • Supporting the Pregnancy: Five days before the embryo transfer, surrogates will begin taking progesterone injections or suppositories. Progesterone is a crucial hormone in the treatment cycle. It supports implantation and early pregnancy by preparing the uterine lining to receive and nurture the embryo, significantly increasing the chances of a successful pregnancy.

These medications mimic the natural hormonal changes that occur during early pregnancy, supporting the implantation process and the development of the embryo.

When to Start Injections: A Timeline

Person holding a syringe close to their abdomen, preparing to inject, wearing a white shirt.

Before Embryo Transfer

The process typically begins several weeks before the scheduled embryo transfer date. Here’s a general timeline of the steps involved:

  • Birth Control Pills: The use of birth control pills (BCP) may vary from 4 months to as short as two weeks. These pills help manipulate and regulate the menstrual cycle to prepare for the next phase of treatment. Some IVF doctors prefer surrogates to start BCP before medical screening, while others may prescribe it during or after the medical screening and legal contracts are complete. On active birth control, the IVF doctor can trigger a cycle start when instructed to stop taking the pills.
  • Lupron Injections: Prior to the embryo transfer, surrogates will begin administering Lupron injections in the lower abdomen. These injections, taken for 2 to 4 weeks, suppress the natural ovulation cycle, allowing the medical team to control the timing of the transfer.
  • Estrogen: Surrogates start taking estrogen approximately three weeks before the transfer and for 8 to 10 weeks post-transfer. Estrogen comes in various forms, including pills, injections and suppositories. This medication is crucial for preparing the uterus by thickening the uterine lining to create a hospitable environment for the embryo to implant and develop.
  • Final Preparations: In the days leading up to the embryo transfer, surrogates may undergo additional tests and procedures, such as ultrasounds and blood work, to ensure their body is ready for the transfer.


After the embryo transfer, surrogacy injections continue to play a crucial role in supporting the early stages of pregnancy:

  • Progesterone: Starting five days before the transfer, surrogates will begin taking progesterone, which is vital for supporting the early stages of pregnancy. This medication is available in various forms, but the main ones used are suppositories and injections. Progesterone treatment continues for 8 to 10 weeks post-transfer, mimicking the natural hormonal changes that occur during early pregnancy to support the embryo’s implantation and development.
  • Duration and Adjustments: Surrogates will continue taking progesterone and estrogen for 10 to 12 weeks of gestation or 8 to 10 weeks post-transfer, as the embryo is already two weeks into gestation at the time of transfer. Under the guidance of the medical team, the dosages may be adjusted based on the surrogate’s response and the progression of the pregnancy.
  • Additional Medications: Surrogates may also be prescribed additional medications, such as low-dose steroids or aspirin, to support the pregnancy and address any specific medical needs.

It’s essential for surrogates to closely follow the instructions provided by their medical team and attend all scheduled appointments to monitor the progress of the pregnancy and make any necessary adjustments to the medication regimen.

Common Types of Surrogacy Injections

Subcutaneous Injections

Subcutaneous injections are administered just beneath the skin. These injections are commonly used for medications that need to be absorbed slowly into the bloodstream.

In surrogacy, there is only one medication administered via subcutaneous injection:

  • Lupron (Leuprolide Acetate): This medication (the only one given non-intramuscularly) suppresses the surrogate’s natural ovulation cycle, allowing for better control over the timing of the embryo transfer.\

Subcutaneous injections are generally considered less painful than intramuscular injections and can often be self-administered with proper training and guidance.

Intramuscular Injections

Intramuscular (IM) injections are administered deep into the muscle tissue, typically in the upper outer quadrant of the buttocks or the thigh area. These injections are used for medications that need to be absorbed quickly into the bloodstream.

Common medications administered via intramuscular injections in surrogacy include:

  • Progesterone in Oil: Similar to subcutaneous injections, progesterone in oil may also be administered intramuscularly after the embryo transfer.
  • Estrogen in Oil: Estrogen is often given in oil form and administered intramuscularly to support the early stages of pregnancy.
  • Human Chorionic Gonadotropin (hCG): This hormone is sometimes used in conjunction with other medications to support the early stages of pregnancy.

Administering intramuscular injections requires proper technique to ensure the medication is delivered correctly and to minimize discomfort. Here are the general steps for administering an intramuscular injection:

  1. Gather all necessary supplies: medication vial, alcohol swabs, syringe, and a sharps container for disposal.
  2. Clean the injection site with an alcohol swab and allow it to air dry.
  3. Gently pinch the muscle area to create a firm surface for the injection.
  4. Insert the needle at a 90-degree angle, using a quick and confident motion.
  5. Slowly inject the medication by pushing the plunger down.
  6. Once the medication is administered, remove the needle and apply gentle pressure to the injection site with a clean cotton ball or gauze pad.
  7. Properly dispose of the used needle and syringe in a sharps container.

It’s essential for surrogates to receive proper training from a healthcare professional on the correct injection techniques and to follow all instructions carefully to ensure the safe and effective administration of the medications.

Tips and Tricks for Managing Injections
A vial labeled "Estrogen + Progestin" next to a syringe and a face mask on a white surface.

Overcoming Fear and Anxiety

Administering injections can be a daunting task, especially for those who are new to the process. However, it’s important to remember that these injections are a necessary step in creating a healthy and successful pregnancy.

Here are some techniques that can help surrogates stay calm and overcome their fears:

  • Deep Breathing Exercises: Taking slow, deep breaths can help reduce anxiety and promote relaxation before and during the injection process.
  • Distraction Techniques: Engaging in activities that divert your attention, such as listening to music, watching a favorite show, or practicing mindfulness, can help take your mind off the injection.
  • Positive Self-Talk: Remind yourself of the incredible gift you’re giving and the strength you possess to navigate this journey.
  • Support System: Lean on your support network, whether it’s your partner, family, or fellow surrogates who have been through the process.
  • Personal Stories and Tips from Experienced Surrogates: Hearing from surrogates who have successfully navigated the injection process can provide valuable insights and inspiration. Many surrogacy agencies and support groups offer opportunities to connect with experienced surrogates.

Practical Tips and Techniques

In addition to addressing emotional concerns, there are practical tips and techniques that can help make the injection process smoother and more comfortable:

  • Proper Preparation: Ensure you have all the necessary supplies ready, including the medication, alcohol swabs, syringes, and a sharps container for disposal. Follow the directions provided by your healthcare provider carefully.
  • Use of Heat and Massage: Applying a warm compress and/or taking a warm shower before the injection can help relax the muscles and improve blood flow, making the injection more comfortable. Gently massaging the injection site after the injection can also help alleviate discomfort.
  • Numbing Creams and Cold Packs: Over-the-counter numbing creams or cold packs can be used to temporarily numb the injection site, reducing the sensation of the needle.
  • Injection Technique: Proper injection technique is crucial. Inject the medication slowly and steadily, and avoid moving the needle once it’s inserted. Your healthcare provider can work with you on the correct technique and provide guidance.
  • Rotation of Injection Sites: Rotating the injection sites can help prevent discomfort and bruising in one area.

Remember, every surrogate’s experience is unique, and it may take some time to find the techniques and strategies that work best for you. With patience, practice, and the support of your healthcare team and loved ones, managing surrogacy injections can become easier.

Dealing with Side Effects and Complications

Common Side Effects

While surrogacy injections are generally safe and well-tolerated, it’s important to be aware of potential side effects and complications that may arise. Being prepared and knowing when to seek help can ensure a smooth and healthy surrogacy for both the surrogate and the intended parents.

  • Soreness, Redness, and Bruising at Injection Sites: These are normal reactions to the injection process and should subside within a few days. Applying a warm compress or taking over-the-counter pain medication can help alleviate discomfort.
  • Mood Swings and Emotional Changes: The hormonal fluctuations caused by injections can lead to mood swings, irritability, or emotional ups and downs. Practicing self-care, engaging in stress-relieving activities, and seeking support from loved ones can help manage these emotional changes.
  • Headaches and Nausea: Some surrogates may experience headaches or nausea, particularly in the early stages of the injection process. Staying hydrated, getting enough rest, and following any dietary recommendations from your healthcare provider can help alleviate these symptoms.
  • Injection Site Reactions: In some cases, surrogates may experience more severe reactions at the injection site, such as excessive swelling, redness, or warmth. These reactions may indicate an infection or an allergic response to the medication.

When to Seek Help

In some cases, surrogates may experience more serious complications that require immediate medical attention. Signs to watch out for include:

  • Severe or Persistent Pain: If you experience severe or persistent pain at the injection site or elsewhere in your body, seek medical attention immediately.
  • Fever or Chills: A fever or chills can be a sign of infection and should be reported to your healthcare provider right away.
  • Shortness of Breath or Chest Pain: These symptoms may indicate a more serious complication and require prompt medical evaluation.
  • Severe Headaches or Vision Changes: These can be signs of a rare but serious condition called ovarian hyperstimulation syndrome (OHSS), which requires immediate medical attention.
  • Widespread Rash: A rash that spreads over your entire body could indicate an allergic reaction to the oil mixed with progesterone. Contact your healthcare provider immediately to discuss switching to a different oil base.

Remember, your surrogacy agency and medical team are there to support you throughout the entire process. Don’t hesitate to reach out to them with any concerns or questions you may have. They can provide guidance, reassurance, and prompt medical attention if needed.

Emotional Support and Resources

A smiling person with curly hair leaning their head against a pregnant woman's belly, hands gently touching the belly, both wearing sweaters.

Support Systems

Emotional support is crucial during the injection phase of surrogacy. Surrogates may experience a range of emotions, including anxiety, stress, and even feelings of isolation. Having a supportive network can provide the following benefits:

  • Surrogacy Agency Support: Reputable surrogacy agencies understand the emotional challenges surrogates may face and offer dedicated support services. Many agencies have experienced professionals, such as social workers or counselors, who can provide guidance, emotional support, and coping strategies.
  • Partner and Family Support: Involving partners and family members in the process can create a strong support system for surrogates. Open communication and understanding from loved ones can help surrogates feel valued and supported during this challenging time.
  • Fellow Surrogate Support: Connecting with other surrogates who have gone through or are currently experiencing the injection phase can be incredibly valuable. Sharing experiences, tips, and encouragement with those who truly understand the journey can provide a sense of community and validation.


Surrogacy, particularly the injection phase, can be emotionally and physically demanding. Having access to valuable resources can make a significant difference in helping surrogates navigate this experience with confidence and resilience.

  • Online Communities and Support Groups: There are numerous online forums, social media groups, and support communities dedicated to surrogacy. These platforms allow surrogates to connect with others, ask questions, and share their experiences in a safe and supportive environment.
  • Educational Resources: Many surrogacy agencies, fertility clinics, and organizations provide educational materials, such as videos, webinars, and informational guides, to help surrogates understand the injection process, potential side effects, and coping strategies.
  • Counseling and Therapy Services: Some surrogacy agencies offer counseling or therapy services to help surrogates manage the emotional challenges that may arise during the journey. These services can provide a safe space for surrogates to express their feelings and receive professional guidance.
  • Joy of Life® Resources: Joy of Life®, a leading surrogacy agency, provides a wealth of resources and support services for surrogates. Their experienced team offers emotional support and educational materials and connects surrogates with a community of fellow surrogates who can share their experiences and offer encouragement.

Apply to Become a Joy of Life Surrogate Today

At Joy of Life®, we understand that surrogacy can be both exciting and challenging. The injections and medications are an essential part of the process, but we’re here to provide you with the knowledge, guidance, and unwavering support you need every step of the way.

Our experienced team is dedicated to ensuring your emotional well-being throughout your surrogacy experience. We offer a wealth of resources, from educational materials to counseling services and much more, to help you navigate the injection phase with confidence and peace of mind. You’ll also become part of a supportive community of fellow surrogates who can share their experiences and offer encouragement.

If you’re ready to embark on this life-changing experience, apply to become a Joy of Life surrogate today. Together, we’ll embark on a journey filled with compassion, support, and the shared joy of making dreams of parenthood a reality.


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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