One of the most commonly asked questions when it comes to surrogacy is “how does surrogacy work?” At Surrogacy Simplified, we are here to demystify the process and break down the major components of surrogacy into digestible pieces. For the purpose of this article, we will describe gestational surrogacy as that is the most common type of surrogacy arrangement.

What is Gestational Surrogacy?

Gestational Surrogacy is when the surrogate (undergoes an embryo transfer and carries the baby for the Intended Parents. The embryo is created by combining the egg from one person (typically the Intended Mother or egg donor) with the sperm (typically the Intended Father or sperm donor) in a lab (fertility clinic). The gestational carrier does not have any biological connection to the baby.

How does Surrogacy Work?

Creation of Embryos

The Intended Parents will create embryos at a fertility clinic. Depending on the unique circumstances of each family, the embryo will be created by both parents or with a donor egg and/or sperm. 

The embryos are created through in-vitro fertilization (IVF). IVF occurs when eggs are collected from ovaries and fertilized by sperm at the fertility clinic or lab. For more information on the IVF process when using donor eggs or sperm, please visit this website.

Matching with a Surrogate

Matching with a surrogate can be done in a variety of ways. Intended Parents can match with the help of an agency, a surrogacy consultant, or independently. The length of time it takes to match with a surrogate can vary greatly depending on the method you choose (agency or independent). Even within one of those options, there is still significant variability of the time to be matched with a surrogate.

Finding a perfect, high-quality match is critical as it lays the groundwork for a beautiful surrogacy journey. At Surrogacy Simplified, we are hyper-focused on supporting you during the match phase and ensuring you are fully prepared before meeting with your surrogate. This way, you know the key talking points to determine if a connection is made and it’ll be a successful match.

Surrogate Evaluation (Psychological and Reproductive Health)

Once you’ve matched with a surrogate, the surrogate will also be evaluated by a psychologist or social worker who is trained in ART.  The exact assessment may vary based on the fertility clinic you are working with and their specific requirements. Most surrogates can expect an assessment that has two components; a session with the psychologist and completing a questionnaire that is part of a more formal measure such as the MMPI (Minnesota Multi-phasic Personality Inventory). 

The Intended Parents’ fertility clinic will review the surrogate's medical records and schedule a time for her to come to the office for an evaluation. At the evaluation, they will test her and her partner for infectious diseases and undergo a urine drug test. They will also meet with the Reproductive Endocrinologist to review the surrogate’s medical history and discuss the surrogacy process. Lastly, they will evaluate the surrogate’s uterus by either ultrasound or HSG hysterosalpingogram) to visualize the uterus and fallopian tubes.

Legal Process

Once you’ve gotten the green light from the fertility clinic, you will move to the legal phase of surrogacy. During the legal phase, the Intended Parents and surrogate will seek separate representation to create and execute the legal contract. The exact contents of the contract will vary based on the state but the legal contract ensures that everyone is protected (surrogate, Intended Parents, and baby). It acts like a “roadmap” for all of the “what ifs” in a surrogacy journey.

You will later establish parentage by either a pre or post-birth order, depending on the state. 

Medications and Embryo Transfer

Once the legal contract is created and executed, the surrogate will begin medications to prepare her body for the embryo transfer. While she is on medications, she will be regularly monitored by either the Intended Parents’ fertility clinic or an outside monitoring clinic that is closer to her home. They will do a combination of bloodwork and ultrasounds to examine the uterus and evaluate her hormone levels to determine whether any medications need adjustment and ensure her uterine lining has thickened appropriately to transfer the embryo. 

The embryo transfer occurs when the frozen embryo is thawed and inserted into the surrogate’s uterus through a catheter. The surrogate typically continues with her medications and returns to the fertility clinic about 10 days later for bloodwork to confirm whether the embryo transfer was successful. 

Next Steps

Our hope is that the first embryo transfer is successful and results in a pregnancy. In that instance, the fertility clinic will continue to monitor the surrogate until about 8-10 weeks, varying depending upon the RE's recommendations based on each unique situation.

If the embryo transfer is unsuccessful, in most cases, the surrogate will continue to be monitored by the fertility clinic and be advised when she can re-start medications and prepare for a second embryo transfer. During the legal phase, it is discussed and written into the contract how many times a surrogate will attempt embryo transfers.

Please Note

This is a simplified, reader's digest version of the process 😀 There are more components such as evaluation of the surrogate's health insurance and opening escrow that are also important aspects of the journey. My free e-book not only describes each of the contents above in greater detail, but goes into all of the other aspects (such as insurance, escrow, etc).

Be sure to sign up for our free e-book “A Beginner’s Guide to Surrogacy” as it breaks down the entire surrogacy process step by step.  I also offer an initial complimentary consultation where I educate Intended Parents on the process of surrogacy as well as learn about their unique circumstances that has brought them to pursue this pathway to parenthood.

*The exact examination will vary based on the selected fertility clinic