What medications does a surrogate take, and for how long?
A gestational surrogate takes medications to prepare her uterus for an embryo and to support the early pregnancy. She does not take the stimulation drugs or trigger shot an IVF patient takes, because she is not producing eggs. That makes her medication list shorter and her side effects different.
In a typical medicated frozen embryo transfer cycle, there are three main groups:
- Lupron, for suppression, at some clinics: about 2 to 3 weeks before estrogen starts.
- Estrogen, by pill, patch or injection: about 3 to 10 weeks, from the start of lining preparation through the early pregnancy.
- Progesterone in oil, by daily injection: about 7 weeks, from a few days before transfer until about 10 weeks of pregnancy.
Most clinics add supporting medications, covered below. If the pregnancy test is negative, everything stops within days. If it is positive, estrogen and progesterone continue until the clinic tapers them. The full calendar is on the frozen embryo transfer protocol page.
Most side effects come from the hormones themselves and are predictable. They usually end within days of stopping each drug.
| Drug | Route | Duration in a typical FET | Common side effects | Serious warning signs | Tips |
|---|---|---|---|---|---|
| Lupron | Small daily injection under the skin | About 2 to 3 weeks, at some clinics | Hot flashes, headaches, mood swings, injection-site redness | Severe headache; hives or trouble breathing | Dress in layers; rotate injection sites |
| Estrogen | Pill, patch or injection | About 3 to 10 weeks | Bloating, breast tenderness, nausea, headaches, skin irritation under patches | Calf pain or swelling, chest pain, shortness of breath, severe headache, vision change | Rotate patch sites; take pills with food if nausea is a problem |
| Progesterone in oil | Daily intramuscular injection | About 7 weeks | Injection-site soreness and lumps, fatigue, mood changes, constipation | Spreading redness, heat or fever at the site; hives or trouble breathing | Warm the vial; massage and heat the site; alternate sides |
| Baby aspirin | Pill | Set by the clinic | Usually none; mild stomach upset | Unusual bleeding or bruising | Take with food |
| Prenatal vitamins | Pill | Throughout | Nausea, constipation | None expected | Take at night or with food |
| Antibiotic, at some clinics | Pill | A few days around transfer | Stomach upset, sun sensitivity with some types | Rash, hives or swelling | Take as directed; avoid strong sun if advised |
| Steroid, at some clinics | Pill | A few days around transfer | Trouble sleeping, increased appetite, mood changes | Rarely serious at short courses | Take in the morning if allowed |
What side effects does Lupron cause?
Lupron temporarily switches off the signals from the brain to the ovaries, so the surrogate's own cycle is quiet and the clinic controls timing. Many clinics now skip it and use estrogen alone.
When it is used, the side effects come from lowered estrogen before estrogen replacement starts. They resemble a brief menopause:
- Hot flashes and night sweats.
- Headaches.
- Mood swings and irritability.
- Trouble sleeping.
- Redness or itching at the injection site.
These usually ease once estrogen is added and end within days of stopping Lupron. Dressing in layers, keeping the bedroom cool and staying hydrated help.
What side effects does estrogen cause, and what is the clot risk?
Estrogen builds the uterine lining. Its side effects are similar to those some women notice on birth control pills or early in pregnancy:
- Bloating and fluid retention.
- Breast tenderness.
- Nausea.
- Headaches.
- Skin irritation under patches.
- Mood changes.
The more serious concern is blood clots. Estrogen causes a small rise in the risk of a clot in a deep vein, usually in the leg, which can travel to the lungs. The risk is small for a healthy woman, but the warning signs are worth knowing: pain, swelling or warmth in one calf; chest pain; shortness of breath; a severe or unusual headache; or a change in vision.
Clinics reduce the risk by screening. A personal or family history of clots, a clotting disorder, migraine with aura, or smoking all change what a clinic will prescribe. PLS surrogates are non-smokers, and Dr. Mark Silverberg's review of each candidate's prenatal and delivery records flags relevant history for the clinic before matching.
What side effects does progesterone in oil cause?
Progesterone makes the lining receptive and supports the early pregnancy. In a medicated cycle the surrogate's body is not making its own, so the daily dose matters.
Common side effects:
- At the injection site: soreness, small hard lumps where the oil collects, and bruising.
- Fatigue, which can be strong.
- Mood changes.
- Constipation and bloating.
- Breast tenderness.
Many of these overlap with early pregnancy symptoms, which can make the two-week wait confusing. Warming the vial, injecting slowly, alternating sides, massaging the site and using heat afterward reduce soreness and lumps. The progesterone in oil page walks through the injection step by step.
Tell the clinic about a sesame allergy. PIO is also prepared in olive oil or ethyl oleate.
What are the supporting medications and their effects?
Most clinics add some of these around the transfer. Which ones, and for how long, varies by clinic.
- Baby aspirin. A low-dose aspirin a day, used by some clinics to support blood flow. Side effects are uncommon; it can cause mild stomach upset or easier bruising.
- Prenatal vitamins, with folic acid, started before the cycle and taken throughout. They can cause nausea or constipation.
- An antibiotic, at some clinics, for a few days around transfer. It can upset the stomach.
- A steroid, at some clinics, for a few days around transfer. Short courses can cause trouble sleeping, increased appetite or mood changes.
The surrogate should check with her clinic nurse before taking any other medication, including over-the-counter pain relievers. Most clinics prefer acetaminophen during a cycle.
Which symptoms need a same-day call to the clinic?
Call the clinic the same day, or go to an emergency room if it is severe, for:
- Calf pain, swelling or warmth, especially in one leg.
- Chest pain or shortness of breath.
- A severe or unusual headache, or a change in vision.
- Signs of infection at an injection site: spreading redness, heat, pus or fever.
- Signs of an allergic reaction: hives, swelling of the face or throat, or difficulty breathing. Call 911 for trouble breathing.
- Heavy bleeding or severe abdominal pain.
- A missed or late progesterone dose. Call immediately; the clinic will say what to do.
The first three can signal a blood clot. They are uncommon, but they are emergencies when they happen.
How does PLS support surrogates through the medication phase?
Support here means specific people and specific payments.
- People who have done it. Case managers Natalie Gaudio-Fricano and Jenni Symons carry the active matches, and both have been surrogates themselves. They have been through transfer cycles and the wait for a pregnancy test themselves.
- Compensation tied to the medications. PLS surrogates receive a $500 medication start fee from escrow when injections begin. The fee is compensation for starting injections. Medical care for complications is covered under the agreement and the insurance review.
- Nutrition support. Julie Bendix, MPH, RD, LD, CLC, a registered dietitian and lactation counselor, provides at least six nutrition consults per surrogate across the journey, which can help with nausea, constipation and bloating.
- Mental-health support, part of every PLS surrogate's package, for the mood effects of the hormones and the stress of the wait.
- After-hours help. Surrogates in active journeys can reach the PLS team after hours.
More on what surrogates receive is on the surrogate support page.
Are there long-term effects?
The medications a surrogate takes are hormones her body also makes in pregnancy, given for a limited period of weeks. Their side effects end within days of stopping each drug.
What a surrogate carries afterward comes mainly from the pregnancy and delivery, not the transfer medications. Injection-site lumps can take a few weeks to fully soften. If she has a history that raises her risk, such as a clotting disorder, her clinic will weigh it before prescribing, and her OB will follow it through the pregnancy.
If you have a specific medical question about your own history, ask the clinic. This page gives general information. It is not medical advice.
Sources
- ASRM (American Society for Reproductive Medicine), patient information on IVF medications and frozen embryo transfer. https://www.asrm.org/
- SART (Society for Assisted Reproductive Technology), patient information on IVF medications. https://www.sart.org/
- ACOG (American College of Obstetricians and Gynecologists), guidance on blood clots in pregnancy. https://www.acog.org/
- US Food and Drug Administration, prescribing information for each medication.