A Look Inside the Medical Process in Surrogacy | Joy of Life Surrogacy

Have You Ever Considered Surrogacy? What Does Surrogacy Mean? What Is the Definition of Surrogacy?

Surrogacy is a wonderful alternative for the intended parent(s) when conceiving or carrying their own child is not an option. If you don’t understand the surrogate mother process completed prior to contracting with a surrogate mother, it can be a stressful experience, considering surrogacy’s medical, financial, and legal agreements, all of which are essential to the surrogacy process. While you will have a legal team assisting you along the way, it is crucial that anyone considering the surrogate mother process understand it in detail so that you feel a sense of comfort and involvement during the surrogate’s pregnancy. In addition, a trustworthy surrogacy agency will provide you with the guidance you deserve by answering any and all lingering questions you might have during the entire surrogacy process.

The medical process in surrogacy can be different for everyone — but there are usually a few things that every process has in common. It can be a scary, confusing time for everyone involved. We believe it’s crucial for the parents and the surrogate to have all the relevant information they need before beginning the process. If you’re considering embarking on the surrogacy journey, this guide will take you inside the medical process so that you know what to expect each step of the way.

Medical Process in Surrogacy: Overview


The surrogacy process can be a little overwhelming at first. Deciding to have children through surrogacy is a big step for both the parents and the surrogate. Luckily, the medical process is designed to make the journey as safe, transparent, and seamless as possible.

In both geostationary surrogacy, using in vitro fertilization, or IVF, and traditional surrogacy, your doctors should make sure that the parents and the surrogate are completely involved in all decision-making, medical tests, and updates about the progress of the pregnancy.

The Screening Process

The first step in the surrogacy medical process for parents is screening. It’s crucial that you and your partner find a surrogate who is well-suited physically and emotionally to carry your baby.

Your surrogate will need to undergo a medical screening process that includes a standard physical examination, blood testing, and an ultrasound to examine the health of the uterus. This screening will ensure that the surrogate can provide a healthy home for the baby while it grows in the uterus.

The screening should also include a psychological and social examination to ensure that the surrogate’s mental health is stable prior to beginning the pregnancy. Being a surrogate can present a range of psychological pressures, so it’s important to examine the surrogate’s mental state prior to beginning the process.

This screening process is crucial for both the parents and the surrogate. For the parents, it will reassure them that their surrogate is a suitable choice. For the surrogate, it will reassure them that physical or psychological complications are unlikely to occur.

Syncing Cycles

In gestational surrogacy, egg donation is a crucial step, as the surrogate’s eggs aren’t used. Syncing cycles is usually part of this process. It simply means that the donor and the surrogate’s menstrual cycles are synced up to maximize the chances of success.

This process makes pregnancy more likely, as the donated egg can be placed in the surrogate without delay. Synchronization can be done using fertility drugs. Both the donor and the surrogate should start carefully tracking their cycles as soon as possible to ensure the synchronization is as close as possible.

Medical Terms Regarding the Surrogate Mother Process

Informed Consent: Informed consent is your authorization to proceed with any medical tasks, with the understanding that there could be possible health consequences. Usually, the patient has to inform the doctor that they have perfect knowledge of any risks and or benefits. In surrogacy, this includes the IVF clinic, the legal team, and the surrogacy agency.

Personality Assessment Inventory (PAI): This test is a comprehensive assessment of a person’s psychopathology, which may be relevant to any medical process. This very thorough test lists 344 items, each ranked on a 4-point scale and takes 50-60 minutes to complete. This assessment is significant for any potential surrogate mother in order to evaluate her mental health before she carries a surrogate baby.

Monitoring Clinic: The monitoring clinic is an IVF clinic that does blood work and performs ultrasounds and other examinations of a surrogate mother prior to the embryo transfer. A monitoring clinic will determine her suitability for a transfer before she goes to a transfer clinic.

Selective Reduction and Termination: Selective reduction is the process of reducing the number of fetuses in multiple pregnancies, usually to prevent any serious risks to surrogate mothers during their pregnancies. If one of the fetuses has an incurable disease or is outside of the uterus, then the process of termination will take place so a baby is not born with serious health problems. This process is different from abortion because its underlying reason is a serious health issue. This two-day procedure was accepted in the 1980s when doctors became more aware of the health consequences that come with pregnancy.

Surrogacy Medical Process for Parents


So, what can parents expect when it comes to a surrogate pregnancy?

Starting Medications

Prior to egg retrieval, your doctor will want to put you on certain medications to improve your chances of success.

Egg donor medications include:

  • Birth control pills – to stabilise hormones and menstrual cycle for timing purposes.
  • Corticosteroids – to suppress hormones in the case of polycystic ovaries
  • Follicle-stimulating hormone – to help stimulate eggs that will be donated
  • A shot of Human chorionic gonadotropin – to fully mature egg prior to retrieval
  • Antibiotics – to reduce the risk of infection during retrieval

All of these medications come at specific times in the run-up to egg retrieval. Your doctor will be able to talk you through the details of what medications you can expect and when.

Egg Retrieval and Egg Freezing

In gestational surrogacy, the parent may donate an egg to be implanted in the surrogate. This means that an egg will need to be retrieved from the donor and frozen prior to fertilization and implantation.

Egg retrieval can be a little intimidating for some. After an ultrasound determines that your eggs are ready for retrieval, the process can begin. You’ll get an injection of human chorionic gonadotropin to finalize the growth of your eggs.

You’ll likely be under sedation for the retrieval procedure, so it shouldn’t be painful. The doctor will use a needle attached to an internal ultrasound probe to gently suction eggs and the surrounding fluid from within the egg follicles.


Once the egg has been retrieved and tested, a single sperm is injected into the egg, or the egg is mixed with sperm in a petri dish.

Being a Part of the Egg Transfer

Parents often want to be present for the egg transfer. Depending on your arrangement with your surrogate and doctor, this can be an exciting moment to share as your journey to parenthood really begins.

Medical Process in Surrogacy

Going Through Mock Cycle

In most gestational surrogacies, the surrogate will go through one mock cycle prior to the embryo transfer. During this mock cycle, the surrogate will receive the same medication that will be used in the real transfer. This will give your doctor a chance to ensure that the surrogate’s uterine lining responds well.

For the surrogate, surrogacy starting medications can include:

  • Birth control pills
  • Lupron – to prevent your natural hormones that control your cycle to prevent premature ovulation. Used to synchronize the cycles.
  • Progesterone – taken by the surrogate in the days prior to the embryo transfer to help maintain a stable pregnancy.
  • Aspirin – can assist with cycle stimulation and implantation rates in the surrogate.
  • Doxycycline – to treat potential bacterial infections in the pelvis.
  • Estrogen – to thicken the uterine lining to help coordinate cycles.
  • MedFolio – a steroid to control the autoimmune system and encourage embryo implantation.

Setting Up Surrogacy Calendar

Your doctor will go through a surrogacy calendar to ensure that you and your donor’s cycles match up and that the egg transfer can take place at the perfect time. The calendar will include dates and times for each appointment and the new course of medication.

Embryo Implantation

If you’re using a donor’s eggs, these eggs will need to be implanted in your uterus. This process usually occurs one to five days after the egg is retrieved.

During the implantation process, you will probably be given a mild sedative, so the procedure should be totally painless. You may experience mild cramping. The doctor will use a long, thin tube called a catheter to insert the embryo or embryos into your uterus.

Testing for Pregnancy and Beginning Prenatal Care

After your eggs or your donor’s eggs have been fertilized and implanted, the rest of the process will be like any pregnancy. The next step will be to test for pregnancy and begin your course of prenatal care.

Joy of Life Is Here To Help

Here at Joy of Life®, we are dedicated to making your surrogacy journey as seamless and worry-free as possible. We understand the process inside and out, so you and your family can rest easy. See some of our frequently asked questions below to learn more about surrogacy:


What is a gestational carrier?
The gestational carrier is a woman who carries a child that was conceived through in vitro fertilization, using the egg and sperm of the intended mother and father. Further, the gestational surrogate mother has absolutely no biological connection to the baby (the baby won’t look like the surrogate mother) and is therefore referred to as the baby’s “birth mother,” rather than “biological mother.”

What is an intended parent?
The intended parent is the person(s) who will be the baby’s parent when the baby is born, regardless of the genetic connection. Whether the child was conceived using the intended parent’s egg and/or sperm or that of a donor, there is a mutual agreement that the surrogate makes with the intended parent.

What is a domestic surrogacy?
A domestic surrogacy is arranged between a surrogate mother and the intended parent(s), both of whom reside in the United States.

How does surrogate mother pay work?
Compensation is the money a surrogate mother receives from the intended parent(s) for her time and effort during her pregnancy. These costs are not bound to medical or legal laws and can, therefore, vary, depending on the agreement made between the two parties.


How does infertility coverage work?
This is the health insurance given to the intended parent(s) for infertility and IVF treatments. Only 15 states currently provide insurance for these treatments, and it has remained the same since the 1980s.

How does surrogate health insurance work? 
This is the surrogacy insurance granted to the surrogate mothers during their pregnancy in case any problems occur.

How does comprehensive surrogacy insurance work? 
This surrogacy insurance is given to the surrogate mother and is purchased by the intended parent(s). It will give the surrogate mother the ability to see any doctor and give birth at any hospital.

How does newborn health insurance work? 
This is the health insurance purchased by the intended parent(s) to protect their new-born child. The coverage will be effective as long as the intended parent(s) enroll their child within the first 30 days of birth. If not enrolled within the first 30 days, the child risks being subject to a pre-existing condition exclusion.


What is a legal clearance agreement?
This is an agreement between the legal teams for both the surrogate mother(s) and the intended parent(s). The contract covers parentage, state laws, and financial and medical terms in order to protect all parties involved in the process. It is required by the surrogacy agency before there is any direct communication between the surrogate mother(a) and intended parent(s) to prevent any legal issues between the two parties.

What is an escrow account?
These accounts help you plan for future payments by ensuring money is set aside. In a surrogacy agreement, an escrow account is required in order to make sure the surrogate mothers receive their proper amount of compensation at an appropriate time.

What is an anonymous signature page, and how does it work?
This page is signed by the intended parents and the egg donor during the surrogacy process to ensure anonymity after the Direct Agreement between the two parties has been signed. It will be signed as “Intended Parent” and “Egg Donor,” and both parties will receive a copy of this page for their files.

How does a gestational surrogacy agreement (GSA) work? 
The GSA agreement describes the surrogacy law of direct agreement between the gestational carrier and the intended parent(s). The contract covers medical decisions during the pregnancy, medical bills, medical complications, medical history, financial considerations, and the involvement that the intended parent(s) will have during the surrogate mother’s pregnancy. This is one of the few documents that involve direct communication between the intended parent(s) and the surrogate mother(s).

What is a parentage document?
This document covers the legal process of the intended parent(s) to obtain full rights over the baby once he/she is born and for the surrogate mother to be relieved from legal responsibility for the child she is carrying. This process begins after the pregnancy commences and is handled by the in-state attorney. The process of parentage involves many legal documents in order to give full rights to the intended parent(s) and varies depending on the state’s surrogacy laws.

What is a pre-birth order?
This is one of the legal documents involved in assigning parentage to a child. These documents are usually started in the fourth month and completed by the seventh month of the surrogate mother’s pregnancy but may vary depending on which state in which the surrogate resides.

What is a post-birth order? 
This is a legal document that assigns you as the legal parent(s) of the child and is required by some states, depending on their surrogacy laws. The state court will sign off on the document once the baby is born as a final step in the parentage process.

Have More Questions? Contact Us Today

If you have additional questions about the surrogacy process, see more of our frequently asked questions, or contact us to speak with a member of our Joy of Life surrogacy team today.

Joy of Life

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