So, you've found the perfect person or couple that you want to be a gestational surrogate for.  Where do you go from here?  What is the process and what is involved?

After you have decided you are going to work together, there will be a combination of physical and psychological testing which includes, but is not necessarily limited to:

Hysteroscopy/HCG -- visualization of the uterine cavity thru a thin scope inserted through the cervix or dye introduced into the uterus and fallopian tubes to determine the shape and size of the uterus and whether or not the fallopian tubes are clear.

Infectious Disease Testing to ensure that all parties are clear of transmittable disease such as AIDS, Herpes, Hepatitis, etc.

Current pap smear and annual physical

A mock cycle in which you are on all the same drugs you would be for a real transfer (except Lupron maybe), so they can check your uterine lining's response to estrogen replacement.

Trial transfer where they check the angle of the cervix and the length of the uterine cavity so they know how far to insert the catheter loaded with the embryos for exact placement.

Psychological testing and evaluation by a psychologist familiar with surrogacy issues including MMPI2 test and a minimum one hour one-on-one session with the program psychologist exploring your motivations, attitudes and commitment to the surrogacy process.

Once that's done, the surrogate and the egg donor (who can be the intended mother or a donor) synchronize their cycles.  Usually with birth control pills.  About 14 days into the birth control pills, usually both surrogate and egg donor will start Lupron.  Lupron is a subcutaneous (just under the skin) injection to shut down the bodies normal hormone production so the doctors can control your cycle and be sure 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 your menstrual cycle starts while on Lupron, your Lupron dose is usually decreased by half and you start adding Estrogen replacement to the mix (in the form of pills, patches, or shots depending on your 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 injectible 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.  36 hours after the HCG shot, they do the egg retrieval.  Up until this time, the date/time of your transfer is in limbo.

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.  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 12th week of pregnancy (when the placenta takes over hormone production). Because you were on Lupron and your natural hormones were supressed, you need to take 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 thru the cervix into the uterine cavity (sometimes with the assistance of abdominal ultrasound to ensure EXACT placement of the embryos) where the embryos are "injected".  Most doctors will only transfer three to four 2-day old embryos or two 5-day embryos.  Any unused embryos are frozen for a future attempt if a pregnancy doesn't result from the fresh cycle. Bedrest of anywhere from 2 hours to 3 days is usually required immediately following embryo transfer.

A Quantitative HCG in which the amount of pregnancy hormone is measured is usually done 14 days post egg retrieval.  At that time they are looking for the HCG level to be about 50 or better.  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 2 days).  If the quantitative HCG is negative, all external hormones are discontinued and a menstrual cycle will usually start within 5 days.

If a pregnancy has occurred, an ultrasound is usually done about 6.5 weeks to check for a heartbeat and again around 12 weeks before being released to a regular OB/GYN.  Usually during this time, hormone levels are checked several times to ensure that the proper levels are being maintained to ensure the pregnancy continues.  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.