Surrogate Medications: What to Expect Before & After Embryo Transfer

A guide to the common medications that surrogates take for their journey

When you’re first looking into becoming a surrogate, the medical side of the process can feel like a lot to take in. You may hear unfamiliar medication names, wonder what each one does, or feel unsure about how you’ll keep track of your medication schedule.

We put together this guide to help you understand common surrogacy medications and walk into your journey feeling more knowledgeable and confident. Most importantly, we want you to know that you won’t be expected to figure it out alone. Your fertility clinic will prepare you with detailed instructions, training, and medical calendars. And your Heartland team will be there to offer support, reassurance, and connections to the right resources along the way.

Understanding the Surrogate Medication Process

So, why do surrogates need to take medication? As a surrogate, you’ll take medications to help prepare your body for embryo transfer and support the earliest stages of pregnancy. Before the transfer, your fertility clinic may use medications (such as birth control) to help coordinate your cycle, prepare the uterine lining, and create the right hormonal environment for implantation.

After the embryo transfer, you’ll continue certain medications as directed by the fertility clinic. These medications help support the uterine lining while your body adjusts to early pregnancy. Every clinic’s protocol is a little different, so your exact medication schedule may depend on the provider, your body’s response, and the details of your transfer plan.

Your fertility clinic will provide a clear medication calendar, instructions, and screening schedule, so you won’t have to keep track of everything on your own. After transfer, they’ll continue guiding you through medication timing, bloodwork, ultrasounds, and early pregnancy monitoring. When the time is right, your clinic will let you know when to stop medications and when to transition care to your obstetric provider.

Preparing for Embryo Transfer

Often, surrogates start an IVF cycle by taking birth control pills. This gives the doctor control of the menstrual cycle and will prevent ovulation from happening in the treatment cycle. In some medication protocols, Lupron (an injectable hormone used to suppress the pituitary gland) will also be used for several weeks prior to decrease the chance of ovulation. The surrogate may also be advised to take a prenatal vitamin that contains at least 400 micrograms (mcg) of folic acid.

Surrogates then take hormone medication to prepare the uterus for an embryo transfer. Estrogen is used to build the lining of the uterus and is often administered through oral pills, patches, or intramuscular injections. Some clinics may also prescribe an oral antibiotic in the days preceding embryo transfer.

In preparation for embryo transfer, surrogates also take progesterone, a steroid hormone that “synchronizes preparation of the uterine lining with the treatment cycle to ensure the uterus is ready for embryo implantation.”

Embryo Transfer and the Two-Week Wait

Progesterone may be administered through intramuscular injection, vaginal gel, suppository, or a pill. Progesterone is used daily, with the start date timed to the embryo’s stage and the clinic’s protocol. Often, it is about 5 days before a blastocyst transfer. Progesterone use continues through week 8-12 of the pregnancy, when the placenta takes over production of this hormone.

Immediately prior to embryo transfer, some clinics offer medications such as Valium (a muscle-relaxing, anti-anxiety medication) to the surrogate. The doctor transfers the embryo(s) through a small plastic tube placed in the uterus. A blood draw performed approximately 9-14 days after the embryo transfer will measure hCG (human chorionic gonadotropin, the pregnancy hormone produced after implantation) to confirm a pregnancy. At this time, the doctor will advise the surrogate on how long to continue progesterone and other medications during the pregnancy.

Although there are many medications involved in this process, their use is often a short-lived aspect of the surrogacy journey. Training and support from the fertility clinic can help alleviate some of the nervousness people can feel about the use and possible side effects of these drugs. Before long, our clients often find the medication stage is behind them and they are well on their way to a successful pregnancy!

Ready for your journey?