Getting pregnant – the fertility treatment process for UK surrogacy

Most surrogate pregnancies are achieved through a fertility clinic. Gestational surrogates (surrogates who conceive with an embryo which is not genetically theirs) always conceive through a fertility clinic since this is the only way of transferring an embryo to their uterus. Although some traditional surrogates (surrogates who conceive using their own eggs) become pregnant through home insemination, others also conceive at a fertility clinic.

Where will the eggs and sperm come from for the surrogacy?

An embryo is created when a sperm fertilises an egg, a procedure which in gestational surrogacy is carried out by an embryologist at a fertility clinic.  Some intended parents are able to use their own egg and sperm to create an embryo. Others need the help of an egg donor (or more rarely a sperm donor).  The availability of donated eggs and sperm in the UK is variable, and if intended parents need donated eggs or sperm to create their embryos they may need to register with a fertility clinic or agency/organisation which can match them with a donor, possibly subject to a waiting list. Others may have a friend or family member who has offered to donate for them. 

Finding a clinic

Intended parents often create embryos while they are searching for a surrogate, since embryos can be frozen and stored in readiness.  The Human Fertilisation and Embryology Authority has a search tool on its website for finding fertility clinics in the UK.  It is important to find a clinic that has experience of surrogacy, good success rates and if necessary a good donation programme. An initial consultation, or a visit for an open day, can be very useful to get information and also meet some of the key people at the clinic. If you are working with Brilliant Beginnings we will help you choose a fertility clinic and support you throughout the treatment process.

Creating embryos for surrogacy

Clinics have to keep either sperm or embryos in quarantine for a period of time before they can be transferred to a surrogate, so some parents bank sperm as a first step if they cannot immediately create embryos.

For whoever is providing the eggs, the clinic will do initial fertility testing and then start a cycle of IVF by suppressing and then controlling the egg provider’s natural cycle using hormone injections. This allows for more control and greater success over the subsequent stages. This stage can last for around two weeks. Next the clinic will stimulate the woman’s ovaries with hormones to increase the number of eggs that mature and can be collected in one cycle. This involves medication and can last for 10-12 days. Throughout this stage the clinic will monitor the ovaries carefully through regular ultrasound scans so they can see how the egg follicles are developing. Medication may be adjusted as things progress, and then a day or two before egg retrieval a hormone injection will be given which helps the eggs mature. The eggs will then be collected through a minor surgical procedure.  The woman will usually be lightly sedated, and the clinician will collect any matured eggs with a needle which is passed through the vagina and into each ovary with the guidance of ultrasound. This may be an uncomfortable process, but is a day procedure and the clinic will be on hand to help.

The eggs collected will be mixed with sperm from the intended father (or from one of them if a same-sex couple, or from an intended mother if she is transgender), and then checked after a day to see if fertilisation has occurred. It is usual for not all eggs to fertilise, but those that do will then be monitored for a number of days (up to six) to see how they develop.

If the surrogate is ready, the clinic may transfer an embryo at the end of this period.  More commonly embryos will be frozen at this stage to be stored until a surrogate has been found and is ready.

Preparing the surrogate for transfer

Once everyone is ready, the surrogate can start to receive treatment to prepare her womb lining for embryo transfer. There will be some initial tests carried out, scans of her womb, and general health screening, alongside counselling for everyone involved.  The surrogate’s womb lining then needs to be thickened in preparation for embryo transfer. Usually this is done through medication (which may be given orally, as pessaries or through hormone injections) and the clinic will carry out regular ultrasound vaginal scans to monitor how the lining is developing. Sometimes a surrogate’s womb lining may thicken naturally and she may need much less medication.  This typically takes between 19 and 21 days depending on how the surrogate responds.

Embryo transfer

When the clinic is satisfied that the surrogate’s womb lining is ready it will prepare or thaw one or two embryos ready for embryo transfer.  Most clinics transfer one embryo at a time to minimise the risk of a multiple pregnancy.

On the day of embryo transfer, the embryo will be placed into a long thin tube which will be passed through the vagina and cervix.  Under ultrasound guidance, the embryo will then be gently injected directed onto the womb lining.  This is a reasonably painless experience, a bit like having a smear test, but sometimes surrogates will be offered a painkiller afterwards if they have any discomfort. The usual advice after embryo transfer is to take things easy for the rest of the day.  Surrogates may also be asked to take medication (which may be orally, by pessaries or by injections) to help maintain the womb lining and encourage the embryo to attach and grow.

The two week wait

After embryo transfer there is nothing anyone can do for a couple of weeks, whilst everyone waits to see if the embryo transfer has resulted in a pregnancy. This is an emotionally tense time as everyone waits expectantly, so it is worth planning how things will be managed on test day and how the results will be communicated.

A normal home pregnancy test can be done after this time, but most clinics will want a surrogate to come to the clinic for a blood test to confirm HCG (pregnancy hormone) levels. A few weeks after this the clinic will want to do an ultrasound to check how the pregnancy is progressing and if there is a heartbeat. If the clinic is satisfied at this point they will then discharge the surrogate to the NHS for care during the remainder of her pregnancy.

What if it doesn’t work?

Sadly many embryo transfers do not result in pregnancies.  Many surrogates will be keen to try again as soon as possible but they will usually be asked to wait for a natural cycle of their own  before starting the process for preparing the womb again. The clinic may also look to adjust their medication to try and improve the chances of success, and should discuss the treatment plan with all of you so you are clear about what to expect.

It is common to need two to three embryo transfers before achieving a pregnancy, so it is important to prepare yourselves for a bit of a journey. There are lots of reasons why embryo transfer might not work, including the quality of embryos, but often there is no clear or definitive reason.