Part 2: fertility drugs, synchronizing the cycles and pregnancy.

By Mary Ellen McLaughlin

Once a candidate passes the psychological screenings and physical exam and has chosen her intended parents, she is ready to get started on actually becoming a surrogate. Medically, there is a lot to learn, and that can be scary if you don’t know what’s coming next.

The first step in this stage is the hysteroscopy (HCG), which is a visualization of the uterine cavity through a thin scope inserted through the cervix. This determines the shape and size of the uterus and whether the fallopian tubes are clear. She also goes through a series of infectious disease testing. This is done to ensure that all parties are clear of transmittable disease such as AIDS, herpes, hepatitis, etc.

Once the tests come back, the surrogate is ready to go through a mock cycle, which puts her on the same drugs that she’ll be on for the real transfer (except Lupron), so her physician can check her uterine lining’s response to estrogen replacement. The doctor also performs a trial transfer, where the angle of the cervix and the length of the uterine cavity are measured. This determines how far to insert the catheter loaded with the embryos for exact placement.

If all goes well, the surrogate and intended parent/egg donor synchronize their cycles using birth control pills. About 14 days into this stage, both the surrogate and intended parent/egg donor usually start taking Lupron, a hormone that dramatically lowers estrogen levels. (Check out our March post on terms it’s helpful to know.)

The surrogate is typically about a week or so ahead of the intended parent/egg donor to ensure her uterus will be ready when the eggs are retrieved and fertilized.

When the surrogate’s menstrual cycle starts while on Lupron, her Lupron dose is normally decreased by half and she starts adding estrogen replacement to the mix (in the form of pills, patches, or shots, depending on the doctor). Some doctors prescribe other medications as well (Dexamethasone to suppress male hormones to increase implantation, antibiotics to guard against any infection that might have gone undiagnosed, etc.).

The retrieved eggs are fertilized with sperm from the intended father/sperm donor and incubated for two to five days. The surrogate’s Lupron injections stop the day before egg retrieval. Progesterone replacement starts the day of the retrieval and continues until the 12th week of pregnancy or a negative pregnancy test. Estrogen replacement also continues until the 12th week of pregnancy (when the placenta takes over hormone production). Because the surrogate was on Lupron, her natural hormones were suppressed. She will need external sources of these very important hormones in order to maintain any pregnancy that occurs.

When the fertilized embryos are at the proper stage, they are loaded into a special syringe with a thin flexible catheter at the end. The catheter is inserted through the cervix into the uterine cavity where the embryos are “injected.” Most doctors will only transfer three to four two-day-old embryos or two five-day-old embryos. Any unused embryos are frozen for future use if a pregnancy doesn’t result from the fresh cycle. The surrogate is then put on bed rest. Some surrogates are on bed rest a couple of hours following embryo transfer. Others have been on bed rest for up to three days.

A quantitative HCG, in which the amount of pregnancy hormone is measured, is usually done 14 days after the egg retrieval. At that time they are looking for the HCG level to be 50 or higher. Anything over 200 is indicative of a multiple pregnancy. The surrogate will have a second quantitative HCG test two days later to verify that the pregnancy hormone numbers are going up (they should double about every two days). If the quantitative HCG is negative, all external hormones are discontinued and a menstrual cycle starts within five days.

If a pregnancy has occurred, an ultrasound is usually done at six weeks to check for a heartbeat, and again at 12 weeks before the surrogate is released to a regular OB/GYN. During this time, hormone levels are checked several times to ensure that the proper levels are being maintained for pregnancy. Once the placenta starts taking over the hormone production, the surrogate is weaned off the hormone replacements.

The rest of the pregnancy would be the same as any other pregnancy.

This is a long process and can take up to two years to complete from start to finish. But once you see that the new parents hold their child for the first time, everything you have done instantly has a greater meaning.

Mary Ellen is the Surrogacy Spotlight’s featured expert of the month! If you have questions or are looking for more information about surrogacy, visit