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You’ve been approved as a surrogate, matched with intended parents, and signed the bottom line of your surrogacy contract. Now that you and your IPs have taken care of the paperwork, you’re ready to begin the first medical procedures of your surrogacy journey.

As surrogate and IP(s), what can you expect?

Unlike traditional surrogacy, gestational surrogacy requires an embryo transfer via in vitro fertilization (IVF), which involves ovarian stimulation, egg retrieval, fertilization, and finally, the long-awaited egg transfer.

For IPs and surrogates alike, the fertilization process is an exciting moment in the surrogacy journey. Here’s what you can expect as a surrogate or IP during the embryo transfer process.

Egg Retrieval/Insemination Process

If you are heterosexual partners using your own egg and sperm, you will need to prepare for egg and sperm retrieval respectively. Egg retrieval may be a more in-depth process, but it is still relatively quick and painless.

First, the intended mother contributing the egg will undergo a course of injected stimulants to encourage egg production over the course of a few days (here’s a sample calendar that shows what drugs will be prescribed for what days prior to the procedure).

The egg retrieval itself is a minor surgical procedure in which a hollow needle will retrieve however many eggs the couple and surrogate decide on from the pelvic cavity. The sperm sample will ideally be retrieved on the same day, or within a day of the egg retrieval, and insemination occurs the following day. Once the embryo is fertilized, it will be incubated until it’s ready for transfer.

Ideally, the embryo will evolve into an eight-cell blastocyst about five days after fertilization—eight is the magic number during fertilization—and it will be ready for implantation in the surrogate.

Embryo Transfer

As a surrogate, the embryo transfer process is a minor procedure. Prior to your scheduled embryo transfer, your nurse will provide specific instructions on what to bring and what to anticipate before the big day.

You will be instructed to arrive with a full bladder, which lets the doctor see the uterus more clearly.

As a surrogate, you’ll already have discussed the number of embryos to transfer with the IPs, and whether or not to conduct selective reduction when the time comes.

During the actual transfer, depending on your medical facility, you may have the opportunity to witness the process in real-time via monitor in the exam room.

The doctor will insert a small catheter with the embryo into the uterus, monitoring the placement via abdominal sonogram. A small puff of air strategically placed in the catheter will push the embryo up onto the uterine wall. The doctor will slowly remove the catheter to avoid any uterine contractions, and you’ll rest for about 5 minutes or so after the procedure.

Once the procedure is done, both surrogate and IP(s) will need to wait to see if the transfer was successful. If implantation is successful, then the surrogate’s hCG levels should be detectable around nine to twelve days following the procedure.

The main benefit to using IVF over artificial insemination (IUI) is that IVF can be attempted multiple times to result in a successful pregnancy. Then, you’ll be ready to begin the nine-month wait for the newest addition to your growing family.