The Surrogate will be put on birth control pills to coordinate her cycle with that of the Prospective Mother or Egg Donor. She will take a medication called Lupron, which is used to manipulate her ovaries and prevent them from releasing any eggs. The Prospective Mother/Egg Donor will generally commence the use of Lupron or equivalent medication to manipulate the timing of the release of eggs. At the appropriate time, the Surrogate will begin taking supplemental estrogen to influence the development of her endometrial lining and the Prospective Mother/Egg Donor will commence administration of ovarian stimulation medications. The clinic will monitor the development of the Surrogate's lining via internal ultrasounds and the Prospective Mother/Egg Donor's follicle development; both parties will have periodic blood tests to monitor hormone levels. Approximately three days prior to the embryo transfer, the Surrogate will commence taking supplemental progesterone to nourish the anticipated pregnancy. At the appropriate time, the Prospective Mother/Egg Donor will be told when to administer an hCG (Human Chorionic Gonadotropin) injection, which must be given at the precise time instructed, triggering ovulation. The egg retrieval procedure will take place 35-36 hours after the hCG injection is given. The eggs are harvested under a "light" general anesthesia. The eggs will then be fertilized with the Prospective Father's sperm (or donor sperm). Generally, three to five days later, a specified number of embryos (typically two) will be transferred into the Surrogate's uterus. After clinical confirmation of pregnancy by blood test (beta hCG) and another test two days later to confirm the number is going up appropriately, the Surrogate will be scheduled for a pregnancy confirmation ultrasound (approximately 4 weeks from the date of the embryo transfer) to see the fetal heartbeat. She will have two more ultrasounds to confirm fetal development until she is 9-12 weeks pregnant, when she will be weaned off the supplemental hormones and "graduate" from the clinic and begin obstetrical care.
The Surrogate will meet with the physician to monitor her cycle, and will typically have one or more ultrasounds to monitor follicle development and her uterine lining. Medications may be used (although typically for the first few cycles they are not), based upon the physician’s protocol and recommendations as well as the parties’ agreement. An ovulation predictor kit will be used to determine when a LH (luteinizing hormone) surge has occurred. Ovulation will generally occur 25-35 hours after the surge. When the ovulation predictor test is positive, the Surrogate will return to the fertility clinic for the inseminations. Most often, the clinic will perform an intrauterine insemination (IUI), depositing the semen directly into the uterus, thus bypassing potentially hostile vaginal secretions. Frequently, more than one insemination will be performed. Approximately two weeks later, a blood test or urine test will determine whether the Surrogate is pregnant. Traditional Surrogates will generally commence obstetrical care around 8-9 weeks of pregnancy.