Weeks 4 to 5: confirming the pregnancy
A surrogate is released from the fertility clinic to her own OB at about 10 to 12 weeks of pregnancy. Until then, the intended parents' fertility clinic manages the pregnancy. This page walks through those weeks.
Pregnancy weeks are counted from a date about two weeks before conception, so a positive beta at 9 to 11 days after a day-5 transfer falls at about 4 weeks of pregnancy.
In weeks 4 to 5, the clinic repeats the beta hCG blood test to confirm that the number is roughly doubling. Each draw is done at a lab near home. You keep taking estrogen and progesterone exactly as prescribed. The two-week wait explains what the first numbers mean.
| Week | Milestone | Where it happens | Medications | Payment or support triggered |
|---|---|---|---|---|
| 4 | Positive beta | Lab near home | Estrogen and progesterone continue | Monthly allowance continues |
| 5 | Repeat beta to confirm doubling | Lab near home | Estrogen and progesterone continue | Case manager check-in |
| 6 to 7 | First ultrasound: gestational sac and heartbeat | Monitoring clinic near home or the fertility clinic | Estrogen and progesterone continue | Base compensation installments begin at confirmed heartbeat |
| 8 to 9 | Second ultrasound | Monitoring clinic near home or the fertility clinic | Clinic plans the taper | First prenatal nutrition consult with Julie Bendix |
| 10 to 12 | Medications tapered off; release to your OB | Fertility clinic, then your OB | Estrogen and progesterone stop on the clinic's instruction | Records sent to your OB |
Weeks 6 to 7: the heartbeat ultrasound and what it triggers
At about 6 to 7 weeks of pregnancy, roughly three to four weeks after transfer, you have your first ultrasound. It is usually a transvaginal ultrasound, because the pregnancy is still small. The clinic looks for a gestational sac in the uterus, a fetal pole, and a heartbeat. It also checks how many there are.
A confirmed heartbeat is the main milestone of early pregnancy. It triggers payments:
- Base compensation begins at confirmed heartbeat, in equal monthly installments through delivery. A first-time base is $60,000 (proposed); an experienced base is $65,000 to $70,000.
- If more than one heartbeat is seen, the multiples fee is added: $5,000 for twins, $10,000 for triplets.
A first-time PLS surrogate carrying one baby receives a typical total package of roughly $68,000 to $78,000. Payments are released by an independent licensed escrow agent, from an account the intended parents funded before you started medications.
That base compensation starts at heartbeat, rather than at the positive beta, is being confirmed with Nancy Block, RN, for PLS agreements.
Whether the intended parents join the first ultrasound, by video or in person, is something you agreed at the match meeting.
Weeks 8 to 10: the second scan and weaning off medications
At about 8 to 9 weeks you have a second ultrasound. The clinic checks that the baby is growing on schedule and the heartbeat is strong.
Around this time the placenta begins making its own progesterone and estrogen. As it takes over, the clinic plans to taper your medications. Do not stop either on your own, even if the pregnancy feels secure. Stopping progesterone too early is a risk the clinic manages for you with a written schedule.
Nausea and tiredness are normal in these weeks. If you cannot keep fluids down, call the clinic.
Weeks 10 to 12: release to your OB
Once the clinic is satisfied that the pregnancy is stable and your medications are finished or nearly finished, it releases you to your own OB. That is usually at about 10 to 12 weeks.
At release, the clinic sends your records to your OB. Your OB takes over routine prenatal care near your home. From there, prenatal care looks much like your own pregnancies did: regular visits, routine labs, the anatomy scan, glucose screening and growth checks.
Your case manager stays your point of contact through delivery and recovery. The full sequence of steps is on the surrogate process.
Choosing an OB and hospital as a surrogate
You can usually use your own OB, as long as the OB is comfortable with a surrogate pregnancy and delivers at a hospital that will work with the birth plan.
Before you are matched, ask your OB two questions. Will you care for me during a gestational surrogacy pregnancy? And does your hospital have experience with surrogate births? If yours does not, your case manager can help you find one who will.
The hospital matters because of what happens at delivery: who is in the room, who makes decisions for the baby, and where the baby goes after birth. Before delivery, PLS acts as liaison with your hospital and sends the documents staff need. See delivery and the hospital.
Intended parents at appointments
The intended parents may attend prenatal appointments if you agreed to it. That agreement is made at the match meeting and reflects what you are comfortable with. Some surrogates welcome the parents at every scan. Some prefer video for routine visits and in-person for the big ones, such as the anatomy scan.
Your OB's office needs to know who may attend and who may receive information. If the arrangement stops working for you, tell your case manager.
Nutrition and support in the first trimester
Once the pregnancy is confirmed, Julie Bendix, MPH, RD, LD, CLC, holds your first prenatal nutrition consult. Julie is the PLS registered dietitian and lactation counselor. Every PLS surrogate has at least six consults with her across the journey.
The first-trimester consult focuses on what you can eat when nausea makes eating hard, hydration, prenatal vitamins, and building toward the weight gain your OB recommends. See the nutrition program.
Your case manager checks in at each milestone, and mental health support from an independent licensed professional is available, paid by the intended parents.
If you are not yet in the process, start with the prescreen: see if you qualify.
Sources
- American College of Obstetricians and Gynecologists (ACOG), patient information on early pregnancy and prenatal care. https://www.acog.org
- American Society for Reproductive Medicine (ASRM), patient resources on frozen embryo transfer and gestational carriers. https://www.asrm.org
- Private Label Surrogacy compensation schedule, pending confirmation by Nancy Block, RN.