So, you've found the perfect person or couple that you
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
necessarily limited to:
Hysteroscopy/HCG -- visualization of the uterine cavity thru a thin
inserted through the cervix or dye introduced into the uterus and
tubes to determine the shape and size of the uterus and whether or not
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
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
uterine cavity so they know how far to insert the catheter loaded with
embryos for exact placement.
Psychological testing and evaluation by a psychologist familiar with
issues including MMPI2 test and a minimum one hour one-on-one session
program psychologist exploring your motivations, attitudes and
the surrogacy process.
Once that's done, the surrogate and the egg donor (who can be the
mother or a donor) synchronize their cycles. Usually with birth
pills. About 14 days into the birth control pills, usually both
egg donor will start Lupron. Lupron is a subcutaneous (just under
injection to shut down the bodies normal hormone production so the
control your cycle and be sure the surrogate's uterus is ready to
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
her uterus will be ready when the eggs are retrieved and fertilized,
because they can keep the SM in a holding pattern for up to 2 weeks
uterine lining is at optimum.
When your menstrual cycle starts while on Lupron, your Lupron dose is
decreased by half and you start adding Estrogen replacement to the mix
form of pills, patches, or shots depending on your doctor). Some
you take other medications as well (Dexamethasone to suppress male
increase implantation, antibiotics to guard against any infection that
have gone undiagnosed, etc.)
The egg donor starts on injectible fertility hormones on her cycle day
stimulate her ovaries to produce several eggs as opposed to just 1 or
Fertility hormones continue anywhere from 7 to 12 days depending on the
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
Once the follicles are the right size (about 18-20mm) she is given an
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
or a sperm donor and incubated for 2-5 days. Lupron usually stops
before egg retrieval. Progesterone replacement (most often in the
intramuscular injections, but sometimes with suppositories or Crinone
starts the day of the retrieval and continues until the 12th week of
or a negative pregnancy test. Estrogen replacement also continues
12th week of pregnancy (when the placenta takes over hormone
Because you were on Lupron and your natural hormones were supressed,
to take external sources of these very important hormones in order to
any pregnancy that occurs.
When the fertilized embryos are at the proper stage, they are loaded
special syringe with a thin flexible catheter at the end. The
inserted thru the cervix into the uterine cavity (sometimes with the
assistance of abdominal ultrasound to ensure EXACT placement of the
where the embryos are "injected". Most doctors will only transfer
four 2-day old embryos or two 5-day embryos. Any unused embryos
for a future attempt if a pregnancy doesn't result from the fresh
Bedrest of anywhere from 2 hours to 3 days is usually required
following embryo transfer.
A Quantitative HCG in which the amount of pregnancy hormone is measured
usually done 14 days post egg retrieval. At that time they are
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
two days later to verify that the pregnancy hormone numbers are going
should double about every 2 days). If the quantitative HCG is
external hormones are discontinued and a menstrual cycle will usually
within 5 days.
If a pregnancy has occurred, an ultrasound is usually done about 6.5
check for a heartbeat and again around 12 weeks before being released
regular OB/GYN. Usually during this time, hormone levels are
times to ensure that the proper levels are being maintained to ensure
pregnancy continues. Once the placenta starts taking over the
production, the surrogate is weaned off the hormone replacements.
The rest of the pregnancy would be the same as any other pregnancy.