Once the Surrogacy Agreement is executed, you will begin taking medication to synchronize your menstrual cycle with the woman who is providing the eggs – either the Intended Mother or a separate Egg Donor. For simplicity, we will use the term “Egg Donor” here to refer to the woman who provides the eggs. (Note that, as a Gestational Surrogate, you will never be the Egg Donor.)
It’s helpful to think about the cycling this way: Normally, only one woman fills all the roles in a pregnancy. In Gestational Surrogacy, there are two women involved – one to provide the uterus (the Gestational Surrogate) and a second woman to provide the eggs. For this complicated scenario to succeed, your menstrual cycles will be synchronized – to within an hour of each other.
To synchronize your cycle with the Egg Donor, some clinics use a combination of birth control pills and Lupron, a drug that is administered by injections with a small needle (much like a diabetic would use) into fatty tissue such as that in your abdomen. Others just use Lupron. The Egg Donor will also take Lupron. In both cases, it sends a signal to the brain, shutting down the natural menstrual cycles so that they can also be manipulated for the surrogacy process.
On a designated day, you will also begin to take hormones – first estrogen and then progesterone. These are needed to prepare your uterine lining to be receptive to an embryo. Because the Lupron shut down your normal cycle and prevented you from ovulating, your body didn’t receive the normal signal that you might become pregnant. These hormones will start the process that would otherwise have occurred naturally.
Some clinics administer the estrogen by patch, others by pill and suppository, and still others by injection. This injection, unlike the Lupron, is administered by an intramuscular injection. It must be injected into a muscle (usually on your buttocks) and requires a larger needle. Most of our Gestational Surrogates find it easier to have someone else (a husband, partner, roommate, sister) administer these shots. And, in all honesty, most do not find the intramuscular (IM) shots particularly pleasant, although they do tolerate them.
The clinic will test your uterine lining several times during this time period. Meanwhile, the Egg Donor will be taking daily fertility injections so that her ovaries will produce many eggs rather than the single egg that she would otherwise produce in one cycle. Typically, the fertility clinic hopes to retrieve about a dozen eggs. On the same day that the eggs are retrieved from the Egg Donor, the clinic will combine the sperm of the Intended Father with the eggs in the lab to form embryos. This process – combining the sperm and the eggs outside of the body – is called in vitro fertilization, or IVF. ”In vitro” literally means “outside of the body.”
On the same day that the eggs are retrieved and fertilized, you will take your first dose of progesterone, a hormone that will help keep your body from rejecting the pregnancy. As noted above, while some clinics administer this by suppository and pill, chances are you may need to administer this hormone by IM injection.
The day after the fertilization process has taken place, the clinic will evaluate the embryos to see how many have fertilized. They will then observe the embryos for the next few days. The embryos will be transferred to your uterus at either 3 or 5 days of development, in what is referred to as the “Transfer Procedure.”