Surrogate Medical Screening
The fertility clinic performs a comprehensive medical evaluation of your surrogate. This is separate from and more thorough than the agency's initial screening. Depending on the clinic and legal process, some evaluation steps may happen before the final Gestational Carrier Agreement, while embryo transfer medication and transfer itself generally require legal clearance and a fully executed GCA.
The clinic evaluation commonly includes uterine assessment via saline sonogram or hysteroscopy, full blood panel including hormone levels, infectious disease screening, drug screening, and review of prior obstetric records. The clinic's medical director makes the final decision on clearance — a surrogate who passes the agency screen may still be declined at the clinic level.
Creating Embryos (If You Don't Have Them Already)
If you don't have frozen embryos ready, an IVF cycle is needed. For intended mothers using their own eggs, this involves ovarian stimulation with injectable hormones, egg retrieval under sedation, fertilization in the laboratory, and embryo development for 5–6 days to the blastocyst stage. For same-sex male couples or those using donor eggs, the egg donor undergoes stimulation and retrieval instead.
Preimplantation genetic testing for aneuploidy (PGT-A) may be recommended in some cases depending on age, embryo history, miscarriage history, clinic protocol, and family goals. PGT-A screens embryos for chromosomal abnormalities before transfer and may reduce miscarriage risk in some situations, but it does not guarantee success and is not universally beneficial for every IVF patient. Discuss the decision with your fertility doctor before budgeting for it.
The Frozen Embryo Transfer (FET)
Most surrogacy embryo transfers today use frozen embryos. The surrogate takes estrogen for 2–3 weeks to build up her uterine lining, then adds progesterone before transfer. Lining thickness and development are monitored by ultrasound. When the lining is ready, the transfer takes approximately 10 minutes — a thin catheter passes through the cervix and deposits one embryo, or occasionally two in specific circumstances, into the uterine cavity. No anesthesia is usually required. The surrogate rests briefly and then goes home.
The Beta-hCG Test
Ten to fourteen days after transfer, the surrogate has a blood draw to measure beta-hCG — the pregnancy hormone. A positive result confirms implantation. A second beta is often drawn 48 hours later to confirm the level is rising appropriately. Rising levels lead to an ultrasound at approximately 6–7 weeks to confirm a heartbeat.
If the Transfer Fails
Failed transfers are common and don't mean surrogacy won't work. After a failed transfer, the clinic evaluates both the surrogate's uterine environment and embryo quality. After one full cycle of medical recovery, another transfer can usually be attempted. Budget for at least two transfer attempts when planning your overall costs.
After a Confirmed Heartbeat
Once a heartbeat is confirmed at 6–7 weeks, your surrogate usually graduates from the fertility clinic to her OB for standard prenatal care. The fertility clinic's role in the journey is largely complete at this point, although medication tapering and handoff timing vary by clinic.
The embryo transfer itself takes about 10 minutes. The preparation — medical screening, legal clearance, lining protocol, and monitoring — can take several weeks to a few months. Plan accordingly and do not underestimate the time from match to confirmed pregnancy.