Medical screening, before anything else
Before you're matched with anyone, your fertility clinic runs a full evaluation to confirm gestational surrogacy is medically right for you. This includes a physical exam, uterine evaluation (ultrasound or saline sonogram), bloodwork and infectious disease screening, and a psychological evaluation with a licensed mental health professional.
Medications and the IVF cycle
Once you're matched and legal contracts are signed, your clinic begins synchronizing your cycle with the embryo. This typically involves:
Birth control pills
Used briefly to regulate and synchronize your cycle before the real prep begins.
Estrogen support
Builds the uterine lining to the right thickness for implantation, usually via patch or pill.
Progesterone injections
Daily injections for several weeks leading up to and after transfer — the part most surrogates ask about most.
Monitoring visits
Frequent ultrasounds and bloodwork to track your body's readiness in real time.
"The injections sound intimidating at first, but almost every surrogate says the same thing: it becomes routine within a week or two."
Embryo transfer day
This is a short, outpatient procedure — no anesthesia required. A thin catheter places the embryo directly into your uterus, guided by ultrasound. Most surrogates rest for the remainder of the day, then resume normal activity within 24–48 hours.
The two-week wait and confirmation
About 9–14 days after transfer, a blood test (not a home pregnancy test) confirms the pregnancy. If positive, you'll have a few follow-up bloodwork visits to confirm hormone levels are rising appropriately, followed by your first ultrasound around 6–7 weeks.
Pregnancy and prenatal care
Once your pregnancy is confirmed and stable, care typically transitions from the fertility clinic to a regular OB, who manages the rest of your pregnancy much like any other — regular checkups, standard prenatal testing, and a normal delivery plan, except your intended parents are involved in the appointments and decisions to whatever extent you've both agreed.
Common medical questions
Will I gain weight from the medications?
Some surrogates notice mild, temporary water retention or bloating from estrogen support, but it's not the same as IVF medications used for egg retrieval, which can cause more noticeable changes. Most surrogates don't experience significant weight changes from the protocol itself.
What if the first transfer doesn't work?
It happens, and it's not a reflection of anything you did. Your clinic will review the cycle and, with the intended parents, typically plan another transfer attempt if more embryos are available.
Is the pregnancy itself any different from a regular pregnancy?
Medically, no — a gestational surrogacy pregnancy carries the same risks and care needs as any pregnancy. The genetics of the embryo don't change how your body experiences pregnancy.