Medical note: This page is educational only. Testing, medications, embryo-transfer timing and follow-up should be determined by the treating fertility clinic.
1. Gestational-carrier medical evaluation
ASRM recommends a complete medical evaluation before a gestational carrier is accepted. This includes medical history, physical examination, infectious-disease screening, preconception counseling and review of prior pregnancy history. Evaluation of the uterine cavity is highly recommended.
2. Embryos and genetic contributors
If embryos do not already exist, the fertility clinic will determine the appropriate IVF plan for the intended parent or donor providing eggs and/or sperm. The process can include ovarian stimulation, egg retrieval, fertilization and embryo culture. Decisions about embryo testing such as PGT-A are individualized and should be discussed with the fertility physician rather than treated as a routine requirement for every case.
For budgeting, separate embryo-creation expenses from the gestational-carrier transfer cycle. The 2026 IVF and embryo-transfer cost guide explains which clinic charges may be one-time and which can repeat if another transfer is needed.
3. Legal clearance before treatment
ASRM recommends that a fully executed legal agreement and legal-clearance documentation be in place before treatment begins. The clinic and attorneys should confirm the exact sequencing for the specific journey.
4. Uterine preparation
The clinic may use hormonal medication and monitoring to prepare the gestational carrier's endometrium for transfer. The medications, duration and monitoring schedule vary by protocol and individual response.
5. Embryo transfer
Embryo transfer is performed by the fertility clinic using its own protocol. ASRM strongly recommends single-embryo transfer in gestational-carrier cycles because multiple gestation increases obstetric risk.
6. Pregnancy testing and early follow-up
The clinic determines when to perform pregnancy testing, repeat laboratory work and early ultrasound. Timing differs among clinics and should not be treated as a universal schedule.
7. Transition to obstetric care
Once the fertility clinic determines that the pregnancy is ready for routine obstetric management, care may transition to an OB or maternal-fetal-medicine team. Medication tapering and handoff timing vary by clinic and pregnancy circumstances.
If a transfer does not result in pregnancy
The fertility team should review the circumstances before deciding whether and when another transfer is appropriate. The next step can depend on embryo availability, carrier medical status, treatment protocol and the decisions of the participants.
Questions intended parents should ask the clinic
- What screening and records do you require for the gestational carrier?
- How will the uterine cavity be evaluated?
- When do you require legal clearance?
- What embryo-transfer policy do you follow?
- How do you determine the pregnancy-testing and early-ultrasound schedule?
- When do you usually transition care to the obstetric provider?
Related guides
IVF & embryo transfer costs · Legal process · Surrogate screening · Pregnancy and birth