At Global Surrogacy Inc., we believe that understanding the medical process is key to feeling confident and empowered as a gestational surrogate. This in-depth guide walks you through every medical stage — from initial screening to embryo transfer and ongoing pregnancy care — with full transparency, ethical coordination, and unwavering support.

1. Pre-Transfer Medical and Psychological Screening – Ensuring Everyone is Ready

Before any medical treatment begins, thorough screening protects the surrogate, the intended parents, and the future baby.

Key screening components:

  • Comprehensive physical exam and pap smear
  • Blood tests for infectious diseases (HIV, hepatitis B/C, syphilis, CMV, etc.)
  • Genetic carrier screening (if requested by the clinic or intended parents)
  • Hormonal bloodwork (FSH, AMH, estradiol, thyroid panel, prolactin)
  • Uterine evaluation: hysteroscopy and/or “mock” transfer with sonohysterogram (saline ultrasound) to confirm cavity shape and accessibility
  • STD panel for surrogate and her partner (if applicable)
  • Psychological evaluation and counseling with a licensed mental-health professional specializing in third-party reproduction
  • Review of obstetric history to confirm prior easy, healthy pregnancies and deliveries

All screening is fully covered financially. Results are shared transparently with both the surrogate and intended parents (with consent).

2. Legal Clearance – The Bridge to Medical Treatment

Once medical and psychological clearance is obtained, independent attorneys draft and finalize the surrogacy agreement. Medical procedures cannot begin until the legal contract is fully executed in every jurisdiction we work in.

3. Cycle Synchronization and Ovarian Stimulation (for the Egg Donor or Intended Mother)

While the surrogate begins medications slightly later, the egg provider (either an egg donor or the intended mother) starts ovarian stimulation:

  • Daily injectable fertility medications (FSH + LH analogues) for ~10–14 days
  • Frequent monitoring ultrasounds and bloodwork
  • Trigger shot (hCG or Lupron) to mature the eggs
  • Egg retrieval under sedation

4. The Surrogate’s Medication Protocol – Preparing the Uterine Lining

Approximately 4–6 weeks after matching, the surrogate begins her own medications to build an ideal endometrial lining:

Common protocols:

  • Estrogen (oral pills such as Estrace, patches such as Climara, or injectable Delestrogen) – started shortly after the egg provider begins stimulation or on cycle day 2–3 if using a frozen egg/embryo bank
  • Progesterone support begins ~5–6 days before transfer:
    • Intramuscular (IM) progesterone in oil injections (daily)
    • Vaginal progesterone (Endometrin, Crinone, or suppositories) – often combined with IM
    • Occasionally oral or subcutaneous options
  • Additional medications sometimes prescribed:
    • Baby aspirin (81 mg) for blood-flow support
    • Prenatal vitamins + extra folic acid (at least 800–1000 mcg)
    • Vitamin D, iron, or thyroid medication if indicated
    • Medrol (short steroid burst) and doxycycline (antibiotic) around transfer in some protocols

5. Monitoring Appointments During the Preparation Cycle

Surrogates typically have 3–5 monitoring appointments (ultrasounds + bloodwork) to measure endometrial thickness and pattern. Ideal lining: ≥8 mm with trilaminar (“triple-stripe”) appearance.

6. The Embryo Transfer Procedure – The Big Day

  • A quick, outpatient procedure (10–15 minutes)
  • Performed under ultrasound guidance
  • A soft catheter passes through the cervix; embryo(s) deposited ~1–2 cm below the fundus
  • Usually painless; some feel mild cramping similar to a pap smear
  • No anesthesia required (though mild sedation offered at some clinics)
  • Full bladder required for best visualization
  • Intended parents are often invited into the room to watch on the ultrasound screen

Post-transfer instructions:

  • 10–30 minutes of bed rest in the clinic
  • Continue all estrogen and progesterone without interruption
  • Light activity for 24–48 hours; most surrogates resume normal life immediately
  • No heavy lifting (>10–15 lbs) or high-impact exercise for ~2 weeks

7. The Two-Week Wait (TWW) and Pregnancy Testing

  • Official blood β-hCG test ~9–12 days after transfer (clinic-specific)
  • Second β-hCG 48 hours later to confirm doubling
  • Early obstetric ultrasound scheduled ~6–7 weeks gestational age to confirm heartbeat

8. Pregnancy Care After Confirmation

Once a heartbeat is confirmed, care transitions as follows (varies slightly by location):

  • Continue estrogen/progesterone until 10–12 weeks gestation
  • Weekly or biweekly ultrasounds early on (especially with multiples)
  • Prenatal care with a dedicated OB who is surrogacy-friendly
  • Monthly stipend and expense reimbursements continue
  • 24/7 access to Global Surrogacy Inc. case managers
  • Coordination of appointments between surrogate’s local OB and intended parents’ preferences
  • Anatomy scan at 18–20 weeks; optional NIPT or genetic testing if parents elect

9. Common Side Effects & How We Manage Them

Medication-related:

  • Bloating, breast tenderness, mood swings from estrogen
  • Injection-site soreness or bruising (we teach best practices and offer progesterone alternatives when needed)
  • Mild constipation or fatigue

Transfer-related:

  • Spotting or light cramping (very common and usually harmless)
  • Rare risk of infection or ovarian hyperstimulation (in egg donors, not surrogates)

Pregnancy-related:

  • Standard pregnancy risks plus slightly higher chance of twins
  • Pre-eclampsia, gestational diabetes, placenta issues monitored closely with MFM (maternal-fetal medicine) referral when indicated

10. Frequently Asked Questions

Q: Is the embryo transfer painful?

A: Most surrogates describe it as mild pressure or menstrual-like cramps. No cutting, no stitches, no anesthesia needed.

Q: Do I have to stop working or exercising?

A: Most surrogates continue working and light exercise. We follow evidence-based guidelines; bed rest beyond the clinic’s short recovery is not required.

Q: How involved are the intended parents medically?

A: As much or as little as everyone agrees. Many attend monitoring appointments and the transfer; all receive direct ultrasound photos and lab updates.

Q: What if the first transfer doesn’t work?

A: Most contracts include 1–3 attempted transfers. Additional attempts are discussed and compensated fairly.

Q: When do I stop the estrogen and progesterone shots?

A: Typically between 10–12 weeks when the placenta takes over hormone production.

You’re Never Alone on This Journey

Global Surrogacy Inc. coordinates every blood draw, prescription refill, insurance authorization, and travel arrangement. Our experienced team has supported hundreds of successful surrogate journeys worldwide, always with ethics, transparency, and respect at the forefront.

Ready to start your medical journey with confidence and full support? Contact us today for a no-pressure consultation and complimentary screening review.

Global Surrogacy Inc. – Where compassion meets expertise. 💙