The day before: medications, travel and what to bring
Embryo transfer takes about 10 minutes and does not need anesthesia. Most of the work happens before you walk in.
Medications. Keep taking estrogen and progesterone exactly as scheduled, including the night before and the morning of the transfer. Do not skip a progesterone shot because you are traveling. If your clinic has prescribed a short antibiotic and steroid course or a baby aspirin, take those as written. See the medication guide for the full calendar.
Travel. Transfer happens at the intended parents' clinic, which may be in another city. PLS books and coordinates your travel, and the intended parents pay for it. Most surrogates arrive the day before so the morning is calm. Read how travel for transfer works.
What to bring:
- Your medications for the whole trip, plus needles, alcohol swabs and a sharps container.
- A water bottle. You need a full bladder for the procedure.
- Comfortable clothes and socks. Procedure rooms are cool.
- Your ID and insurance card.
- Something to pass the time while you rest afterward.
- Your support person, if you are bringing one.
Ask the clinic when to start drinking water and how much. Many clinics ask you to drink about 32 ounces about an hour before the transfer.
Step by step in the procedure room
Here is what happens, in order:
- Check-in. You confirm your name and date of birth, often several times. That is a safety check, not a mix-up.
- The embryo is thawed. The embryologist thaws one embryo, usually a day-5 blastocyst, and confirms it survived the thaw.
- Positioning. You lie on your back with your feet in stirrups, as you would for a Pap smear.
- Ultrasound. A nurse holds an ultrasound probe on your lower belly. Your full bladder lifts the uterus into view, which is why the water matters.
- The catheter. The reproductive endocrinologist places a speculum and passes a soft, thin catheter through your cervix, guided by the ultrasound.
- The embryo goes in. The embryologist loads the embryo into the catheter in a tiny drop of fluid, and the doctor releases it into your uterus. You may see a small flash of light on the ultrasound screen. That is the air bubble around the drop.
- The check. The embryologist looks at the catheter under a microscope to confirm the embryo is no longer in it.
- Rest. You rest for 15 to 30 minutes, then go home or to your hotel. You can usually empty your bladder right after the procedure.
It does not hurt. It feels much like a Pap smear. For most surrogates, the full bladder is the most uncomfortable part.
| Time | What happens | Who is present | What you do |
|---|---|---|---|
| Morning, before you leave | Last medications on schedule; start drinking water | You and your support person | Take your meds; follow the clinic's water instructions |
| Arrival | Check-in and identity checks | Clinic staff | Confirm your details; change into a gown |
| Shortly before transfer | Embryo thawed and checked | Embryologist | Wait; ask any last questions |
| Transfer, about 10 minutes | Catheter placed under ultrasound; embryo released | Reproductive endocrinologist, embryologist, nurse; intended parents if agreed | Lie still and breathe |
| 15 to 30 minutes after | Rest | Nurse; your support person | Rest, then empty your bladder |
| Rest of the day | Back to home or hotel | Your support person | Take it easy; keep taking medications |
Why one embryo is transferred
PLS clinics transfer one embryo at a time, consistent with guidance from the American Society for Reproductive Medicine (ASRM).
The reason is your health and the baby's. Transferring two embryos raises the chance of twins. A twin pregnancy carries higher risks of preterm birth, high blood pressure, gestational diabetes and a C-section, for you and for the babies. A single embryo transfer, with a well-developed blastocyst, gives a good chance of pregnancy without those added risks.
The number of embryos to transfer is part of your wish list at matching, and it is written into your contract. You will know the plan long before transfer day.
Can the intended parents be in the room?
Often, yes, if you agree and the clinic allows it. Many clinics let one or both parents in the procedure room. Some parents watch the ultrasound screen with you. Others wait outside.
It is your call. You decide in advance, usually when you first meet the parents, and it goes into the plan for the day. The surrogate process overview shows where that conversation fits. If you would rather have your own partner or a friend in the room instead, that is a reasonable request. Clinics vary in how many people they allow, so check ahead.
International parents who cannot travel sometimes join by video afterward. Your case manager helps arrange it.
The first 48 hours after transfer
You do not need bed rest. ASRM finds no benefit from bed rest after embryo transfer. Rest on the day of transfer, then go back to normal light activity the next day.
What that looks like in practice:
- Day of transfer. Rest at home or at the hotel. Watch a movie. Walk to the bathroom and the kitchen. You do not need to lie flat.
- The next day. Light activity: walking, desk work, looking after your children. If you flew in, you usually travel home the next day.
- Medications. Keep taking estrogen and progesterone exactly as scheduled. This matters more than anything else you do.
Mild cramping and light spotting can happen after transfer. They do not mean the transfer failed. Call the clinic if you have heavy bleeding, severe pain or a fever.
What to avoid during the two-week wait
The two-week wait is the time between transfer and the pregnancy blood test. For PLS surrogates, the test comes 9 to 11 days after transfer.
During that time, avoid:
- Heavy lifting.
- Hot baths, hot tubs and saunas.
- Intercourse.
- Alcohol, smoking and recreational drugs.
- Medications the clinic has not approved, including some pain relievers.
Your contract and your clinic's instructions set the exact restrictions after transfer and how long they last.
Home pregnancy tests during the wait are common and tempting. They can give an early false negative, or a false positive from medications in some protocols. The blood test is the result that counts. Read more on the two-week wait, including how to manage the waiting itself.
What is paid on transfer day
The $1,000 transfer fee is paid from escrow. It is paid from the independent escrow account the intended parents funded before you started medications, not by PLS.
Around transfer day you are also reimbursed for:
- Your travel, if it was not booked and paid directly.
- Your lost wages for travel and transfer days.
- Your partner's lost wages, if your partner travels with you.
Your monthly allowance of $300 continues as usual.
If you are thinking about becoming a surrogate, the first step is the prescreen: see if you qualify.
Sources
- American Society for Reproductive Medicine (ASRM), guidance on the number of embryos to transfer and on bed rest after embryo transfer. https://www.asrm.org
- Centers for Disease Control and Prevention (CDC), assisted reproductive technology and multiple births. https://www.cdc.gov