The Medical Process of Surrogacy

The surrogacy medical process is often one of the first things that women who are considering becoming surrogates ask about. It’s not a very well-known process, and like the legal steps of surrogacy, it can seem pretty complex.

Although the surrogacy medical process can be very technical and tedious, it’s rewarding in the most amazing way — you’re the person who helps someone else to become a parent. Remember that every woman’s surrogacy treatment will be unique, because everyone’s body is different. This article does not serve as medical advice, and you should always follow the directions given to you by your own doctors and fertility clinic. But generally, these are the eight standard steps of the surrogacy medical process in MD, VA, D.C. and beyond:

Step 1: Complete the Medical Screening

The medical screening process that all prospective surrogates must complete is meant to see if your body is prepared for the physical demands of a surrogate pregnancy. This will usually be completed with the fertility clinic that you and your intended parents will work with, and/or your regular doctor. The screening process will typically involve:

  • A pap smear
  • A physical
  • Bloodwork to check you and your partner (if applicable) for infectious diseases like HIV or hepatitis
  • A saline sonogram to check for uterine fibroids or anything that may interfere with pregnancy
  • A hysteroscopy to check that your uterus is a healthy size and shape and that your fallopian tubes are unobstructed
  • And more

Most surrogacy professionals will also require a psychological screening process to ensure that you’re emotionally prepared for the surrogacy process, and may have additional requirements that you’ll need to meet before proceeding with the medical stages of surrogacy.

Step 2: Undergo a Mock Cycle

In a mock cycle, the fertility specialist that you and the intended parents work with will prescribe you the fertility medications that you will take in preparation for the real embryo transfer cycle. Taking these fertility medications will allow the specialist to monitor your uterine lining and hormone levels to ensure that your body is responding favorably, and to make sure that there are no medical issues with surrogacy in your individual situation.

Step 3: Cycle Prep for the Embryo Transfer

If your body responds well to the mock cycle, you’ll move on to the real version.

If you and your intended parents are using frozen embryos, transfers are planned to match your cycle, so there won’t be much more preparation for you.

If you’re using fresh embryos, the intended mother or egg donor will need to sync her cycle with yours using birth control pills and Lupron injections. She will also be taking fertility hormone injections to stimulate increased production of eggs, which will be retrieved, fertilized and incubated for five days. Then, the day and time of the embryo transfer can be scheduled with you.

Step 4: Complete the Embryo Transfer

Following your doctor’s recommendation, you’ll cease Lupron injections and start taking progesterone (usually in the form of injections) to maintain the correct balance of hormones. You’ll also usually take estrogen replacements in the form of pills, patches or shots. You’ll continue taking both progesterone and estrogen until about 12 weeks into your pregnancy, at which point the placenta is usually able to produce those hormones on its own.

When the embryos have been incubating for five days and you’re five days past the middle of your cycle, the embryo transfer will occur at the fertility clinic. Transfers are generally quick and painless and do not typically require anesthesia. However, you’ll need to rest for a while at the clinic after the procedure, and then you’re usually asked to rest for a couple days following transfer to encourage implantation.

Step 5: Confirm the Pregnancy

You’ll return to the fertility clinic about nine days after the embryo transfer for an HCG test, which measures your hormone levels for potential pregnancy. If the count reads at 50 or higher, a positive, stable pregnancy is indicated. A count reading over 200 may mean that you’re pregnant with multiples.

You’ll return two days later for another HCG to check that your levels are increasing. HCG levels in a stable pregnancy should double about every couple of days.

It’s not uncommon to need multiple embryo transfers for a successful pregnancy to occur. When you’ve been confirmed as pregnant, you’ll need to be closely monitored to ensure that the pregnancy continues to stay stable in the early stages.

Step 6: Receive an Ultrasound Six Weeks after Confirmed Pregnancy

Six weeks after pregnancy confirmation through positive HCG levels, you’ll receive an ultrasound to check for a fetal heartbeat. If a heartbeat is confirmed, you can usually continue seeing your regular OBGYN for the rest of your pregnancy, although some fertility clinics prefer that you receive another ultrasound at about 12 weeks before that point, with regular appointments to monitor your hormone levels in an effort to keep an eye on the stability of the pregnancy.

Step 7: Prenatal Care and Checkups

When the fertility clinic is satisfied that your pregnancy is stable and strong, you can go about your pregnancy like you would with any other. You’ll see your OBGYN for regular prenatal care and routine checkups, and continue monitoring your health and the baby’s.

Step 8: Your Delivery

The involvement and roles of the intended parents and yourself throughout the pregnancy and the birth of the baby are discussed during the surrogacy contract stage, which is completed with Jennifer prior to the surrogacy medical process. That way, you’ll all know what to expect when you go into labor.

Typically, intended parents travel to support their surrogate when she’s in labor, and are there to welcome their baby with her. Again, this is something that you’ll discuss and decide together in advance. Today, hospitals are usually very accommodating of surrogate births, so simply let your chosen hospital know in advance.


The moment when a surrogate mother places a child into their parents’ arms for the first time is what makes the surrogacy experience so rewarding. Jennifer Fairfax is proud to represent surrogates throughout this journey. Contact us now to learn more about how to become a surrogate and make a difference in someone’s life.

“I believe in working with each of my clients—in support of their family dynamic—to make the dreams of parenthood a reality. Whether you are single or married; or gay; a step-parent, a surrogate or intended parent or a child of adoption, it is my mission to serve as your advocate. With a dedication to the ethical and sensitive nature of each situation, I will help you understand the laws within Maryland or Washington, DC for adoption or surrogacy, and pledge to be your partner throughout the journey.” - Jennifer Fairfax