Surrogacy 101: The Medical Process

This series continues our Surrogacy 101 process:

Surrogacy 101: Medical process

The following is one example of the medical protocol that your Reproductive Endocrinologist or IVF Physician may decide to utilize in the surrogacy process. Of course, a different protocol may be used instead of or in addition to the below, and this is just given as an average example.

Once the contracts are complete and testing has finished, the Surrogate and the Egg Donor (who can be the Intended Mother or a donor) synchronize their cycles. This is usually with birth control pills. About 14 days into the birth control pills, both Surrogate and Egg Donor will start Lupron.  Lupron is a subcutaneous (just under the skin) injection to shut down the body’s normal hormone production used to control the cycle and ensure the Surrogate’s uterus is ready to receive the embryos at the exact time for the best chance of success.

The Surrogate is usually about a week or so ahead of the Egg Donor to ensure her uterus will be ready when the eggs are retrieved and fertilized, and because they can keep the SM in a holding pattern for up to 2 weeks once her uterine lining is at optimum.

When the menstrual cycle starts while on Lupron, the Lupron dose is usually decreased by half and the Surrogate will start adding Estrogen replacement to the mix (in the form of pills, patches, or shots depending on the doctor). Some doctors have you take 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 Egg Donor starts on injectable fertility hormones on her cycle day 3 to stimulate her ovaries to produce several eggs as opposed to just 1 or 2. Fertility hormones continue anywhere from 7 to 12 days depending on the Egg Donor’s response to the hormones. The Egg Donor is checked about 3 times a week via ultrasound and blood tests to determine her response to the drugs.

Once the follicles are the right size (about 18-20mm) she is given an HCG shot which induces an LH surge which also matures the eggs. Thirty-six hours after the HCG shot the egg retrieval is performed. Up until this time, the date/time of the transfer is flexible.

The eggs retrieved are fertilized with sperm from either the Intended Father or a sperm donor and incubated for 2-5 days. Lupron usually stops the day before egg retrieval in the Surrogate. Progesterone replacement (most often in the form of intramuscular injections, but sometimes with suppositories or Crinone gel) 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 7^th-12^th  week of pregnancy (when the placenta takes over hormone production). Because the Surrogate was on Lupron and had natural hormones were suppressed, The Surrogate will need to take external sources of these very important hormones in order to maintain any pregnancy that occurs.