After a surrogate has been accepted into your agency’s surrogacy program and is matched to you, doctors at your fertility clinic will prepare her for embryo transfer process. This is the process where your embryo(s) will be medically inserted into the surrogate’s uterus. If embryo transfer is successful, your surrogate will be pregnant with your fetus and 9 months later, you’ll have your own baby! In order to make this step successful, fertility doctors will do a number of things to prepare a surrogate.
We will look at the process of surrogate preparation and embryo transfer in detail.
Medical tests before embryo transfer
Even though the surrogate that is matched to you may have already been screened by your agency, your fertility clinic may still choose to perform a set of medical tests to make sure your surrogate is medically fit to undergo embryo transfer. These tests may include:
- Vaginal ultrasound (sonohysterogram) to examine the surrogate’s uterus. If the doctor finds cysts, fibroids, or endometriosis, the embryo transfer process may be delayed or cancelled.
- Blood tests may be done to make sure the surrogate is free from infectious diseases, AIDS, and sexually transmitted diseases.
- Pap smear may be required to screen for signs of cervical cancer.
After these tests are passed, the doctor may give the final medical clearance to the surrogate so she can be prepared for embryo transfer.
Mock cycle
In some clinics, a mock cycle is done before medical preparation of the surrogate for embryo transfer. A mock cycle is when the fertility doctor gives your surrogate the same kind of medications that are given before the actual embryo transfer. The purpose is to find out how the surrogate responds to the medications. The fertility doctor may use ultrasound to see if the uterine lining is thickening, and he or she might look at whether her hormone levels are changing in response to the medications. The doctor can also adjust the dosage of the medications during mock cycle to better suit the individual biology of the surrogate. If the surrogate responds as expected, she is ready for the next step.
Not all clinics in Mexico do mock cycle prior to medical preparation of the surrogate. Most of the time, medical tests are sufficient unless there is a reason to believe the surrogate may not respond well to the medication.
Medical preparation of surrogate for embryo transfer
The fertility doctor will prescribe birth control pills for your surrogate at the start of medical preparation. Also, the surrogate will be asked to abstain from sexual intercourse 2 weeks or more before the scheduled embryo transfer date in order to prevent the surrogate from becoming pregnant with her own child.
The surrogate will also receive estrogen in the form of injection, patches, or pills. Estrogen is a female hormone that helps thicken the surrogate’s endometrium, the lining of uterus where an embryo will be transferred to. This hormonal stimulation will last between 15 days and 18 days and the progress is closely monitored by the doctor. The surrogate will also receive progesterone in the form of injections or vaginal cream or patches. Progesterone is a female hormone that keeps the endometrium thick when pregnancy does occur. The surrogate will be given these hormone treatments until about 12 weeks of pregnancy when the placenta can produce these hormones on its own.
Note that individual women respond to hormonal treatments differently, and some women might not respond to stimulation well. The fertility doctor monitors the progress and alters the strategy so that the surrogate will be best prepared for embryo transfer.
If you are doing a frozen embryo transfer, the transfer will happen after around 5 days since your surrogate had her period. This is because a 5-day or 6-day embryo will normally be transferred to the surrogate. If you are doing a fresh embryo transfer, where egg retrieval from the intended mother, IVF to create an embryo, and embryo transfer take place at the same time, the menstrual cycle of the intended mother and that of the surrogate will have to be synchronized. The fertility doctor will achieve this by giving the intended mother and the surrogate a set of medications. Most embryo transfers for international intended parents in Mexico are frozen embryo transfers.
Embryo transfer
The day of embryo transfer is probably one of the most exciting days during the entire surrogacy journey in Mexico for many intended parents. Many intended parents would have been waiting for this day for months, or possibly up to a year in my own case.
During embryo transfer, your fertility doctor will load one embryo (or two embryos in the case of double transfer) into a fine catheter. With the guidance of ultrasound, he or she will insert the catheter through the vagina to uterus and deposit the embryo(s) onto the uterine lining. The surrogate is not usually under anesthesia, and the process is relatively quick and painless. After the procedure, the surrogate will be ordered to rest for 4 to 6 hours before being discharged. She will also be advised to rest for 24 to 72 hours at her home following the procedure. She will continue to be prescribed progesterone until 12th week of pregnancy. In addition, she will be advised to refrain from sexual intercourse for 2 weeks to 10 weeks after embryo transfer so she doesn’t get pregnant with her own baby.
After the embryo transfer
About 7 to 10 days after the embryo transfer, your surrogate will undergo a blood test to look for the sign of pregnancy. The doctor will look for an elevated count of hCG, which is a hormone produced by the placenta shortly after the embryo attaches to the uterine lining. If the hCG count is 50 or higher, it means there might be a positive pregnancy. If the pregnancy is healthy, hCG count will rapidly rise until the end of the first trimester. At around 6 weeks of pregnancy, the doctor will do an ultrasound test to check for a heartbeat of the fetus. Another ultrasound may be done at around 12 weeks. At this point, your fertility doctor may continue to care for your surrogate, acting as an OBG/YN or he or she may refer your surrogate to another OBG/YN at a hospital.