What is fertility treatment like for a UK surrogate?

Every gestational surrogacy journey involves fertility treatment, both for you as a surrogate, and your intended parents (who will typically be using their own sperm and/or eggs). 

Every clinic has its own protocols so this outline is a practical overview, but you will get more specific advice from your treating clinic and support team.

What initial appointments and tests can I expect?

Once a clinic has been chosen, you and your intended parents can arrange your first appointments with the consultant team. From there, you sometimes also your partner, will be asked to have various blood tests and screenings. This might also include the clinic reviewing your obstetric records (of previous pregnancies and birth) to make sure the treatment can proceed safely.

After the initial results are back, you will usually be asked to have a saline infusion sonogram scan (SIS) which is a specialist ultrasound to check your uterus.

All being well, most clinics will require you, your partner and your intended parents to attend implications counselling, with the welfare of the future child as the central consideration. Some clinics also require evidence of you having had legal advice, put in place wills and/or having signed a surrogacy agreement with your intended parents.

You will then usually have a treatment information appointment with the nursing team (usually together with your intended parents) to explain your treatment plan, review and sign consent forms, discuss likely timings, explain possible side effects of any medication they would like you to take, and show you how to take any prescribed medication or injections to help get your body ready for embryo transfer. This is also a good opportunity for everyone to ask questions.

What does the treatment itself look like?

The treatment phase from there will be individually designed depending on the protocols of the clinic, your and your intended parents’ preferences, and whether you are having a fresh embryo transfer or a transfer involving an embryo which was frozen. The aim is to make sure that your womb lining is ready for when the embryo is transferred into it to give you all the best chance of achieving a pregnancy.

Your treatment might include ‘down regulation’. This is where your natural menstrual cycle is paused using hormonal medication so the clinic can help coordinate the timing of your cycle with when the embryo needs to be transferred. You might also be given hormonal medication to help thicken the lining of your womb to optimise it for growing an embryo. The medications might be in the form of tablets, injections, pessaries or suppositories. Some surrogates have a natural cycle where fewer medications are used, although a completely medication-free approach is not always possible.

Alongside any medications you are given you will be monitored closely to see how you are responding and when the right time is for embryo transfer, usually through ultrasound scans at the fertility clinic.

What happens at embryo transfer?

Embryo transfer is usually a straightforward procedure and normally carried out in a treatment room close to the IVF laboratory. Depending on clinic policy and available space, your partner or whoever is supporting you can usually attend as well.

The procedure itself is often compared to a cervical smear. A speculum is inserted so your cervix can be seen clearly, while the embryo is prepared in the laboratory. One of your intended parents’ embryos will then be placed gently into your uterus through a small catheter tube, with an ultrasound scan guiding the nurse or doctor.

You don’t need an anaesthetic or sedation and can usually go home and return to your normal activities afterwards, though you may be advised to avoid heavy lifting, exercise and/or sexual intercourse.

What happens next?

Everyone waits for what can seem a long two weeks before you can take a home test pregnancy (and if positive then getting confirmation from the clinic). During the two week wait you will have medication to take (oestrogen and progesterone) to help support the embryo.

If pregnancy is confirmed, you will normally continue that medication until the clinic says otherwise (which is usually once the pregnancy is confirmed via an ultrasound scan two or three week later).

If the transfer is unsuccessful, you will usually be advised by your clinic to stop taking the medication and may then experience a heavier period than usual. This will of course be very disappointing for everyone, and it is important not to blame anyone but look after yourselves during this time before planning next steps. You can regroup with your clinic and decide what to do next.

Throughout this stage, Brilliant Beginnings supports both you and your partner, and your intended parents, ensuring that everyone is able to focus in on your relationship together. We help unravel the myriad of steps that you will be taking so that you are prepared for this exciting, but emotionally charged, time.