Medical Process For Surrogates
For in vitro fertilization (IVF), eggs are retrieved from a woman’s ovaries and inseminated with a man’s sperm in a laboratory dish. The eggs are then allowed to develop and are tested after three to five days. Healthy embryos will either be transferred to the surrogate in a “fresh” embryo transfer or frozen for transfer at a later date. Surrogates do not complete a full IVF cycle because they do not go through the egg retrieval procedure. An average IVF cycle takes from three to six weeks to complete.
The following is based on our experience for a typical embryo transfer cycle and is intended for general information purposes only. Doctors use different protocols and you must talk to your IVF doctor to understand what will be involved in your treatment plan.
STEP 1: MEDICAL SCREENING
After you have been matched with your couple, you will go to the IVF doctor for medical clearance, usually five to ten days after starting your menstrual cycle. The doctor will review your medical records from past deliveries and will conduct a physical exam, including a uterine exam to make sure there are no cysts or other structural problems. Some doctors perform a sonohysterogram (fluid injected into the uterus) combined with an ultrasound to create images of your uterus. Others conduct a hysteroscopy, in which a thin flexible viewing scope is inserted into the uterus, which lets the doctor see the uterine cavity on a video screen. Both you and your partner will be tested for communicable diseases at this time.
STEP 2: TREATMENT AND EMBRYO TRANSFER
Treatment begins at the start of your menstrual cycle closest to the proposed embryo transfer date. For a frozen embryo transfer, starting on Day Two of your cycle you will usually take estrogen (estrace) for two to three weeks to stimulate the development of your uterine lining. Once the lining reaches the desired thickness, the embryo transfer will be scheduled and you will start taking progesterone about five or six days before the transfer. Progesterone is a female hormone that can be taken by injection, vaginal cream or suppositories. You should expect one or two office visits for blood draws and ultrasounds during this phase of treatment. A frozen embryo transfer usually takes about three weeks from beginning the estrogen.
The process is slightly longer with a “fresh” embryo transfer because most doctors will use birth control pills to manage the timing of your menstrual cycle. This may be followed with a medication (Lupron) to keep you from ovulating and, later, with estrogen and progesterone (as above). A fresh embryo transfer usually takes about five to six weeks from beginning birth control pills. Some doctors use the same treatment plan for both fresh and frozen transfers, in which case you will begin treatment with birth control pills in either case.
The embryo transfer procedure is short (usually about 10 to 20 minutes) and is generally painless. The embryos are transferred to your uterus using a tiny, slender tube guided by ultrasound. Because multiple pregnancies are considered high risk, it is now common to only transfer a single embryo. This is especially true with genetically pre-screened embryos. Most doctors recommend 24 to 48 hours of bed rest after the transfer so you should be prepared to relax for a day or two afterwards. You will need to have someone drive you home or to your hotel after the transfer.
STEP 3: PREGNANCY TESTING AND CONFIRMATION
You will take a pregnancy blood test about two weeks after the embryo transfer. During this time, you will start medications to provide hormonal support to a pregnancy. It is very important to the pregnancy that you take these medications as prescribed. A positive pregnancy blood test is usually confirmed by a second blood test about two days later. The second test also helps the doctor determine the health of your pregnancy, since in a normal pregnancy the pregnancy hormone (hCG) doubles every 48 hours.
A couple weeks later, an ultrasound will identify a normal pregnancy and be able to detect the heartbeat of the new embryo. If all goes well, toward the end of the first trimester of pregnancy you will be released to your obstetrician for standard prenatal care. For out-of-town surrogates, this referral typically comes much earlier (upon pregnancy confirmation by ultrasound).
Although IVF success rates continue to improve, it can often take two or more embryo transfers for a healthy, full-term pregnancy to begin.