What is the difference between a failed transfer and a miscarriage?
A failed transfer means the embryo did not implant. The surrogate's blood pregnancy test, taken 9 to 11 days after transfer, is negative.
A miscarriage means a pregnancy was confirmed and then ended. Most miscarriages happen in the first trimester.
Between the two sits the chemical pregnancy: the first test is positive, but the hormone level does not rise as it should, and the pregnancy ends very early, often before an ultrasound can see it. Clinics usually treat it as an early loss rather than a failed transfer.
The distinction matters for three reasons. The medical follow-up is different. The surrogate's recovery is different. And the gestational carrier agreement usually treats them differently, because a confirmed pregnancy triggers payments that a negative test does not.
| Scenario | Medical follow-up | Surrogate recovery time | Contract payments | Next-step timing |
|---|---|---|---|---|
| Negative beta | Stop medications; clinic reviews the cycle | Usually one menstrual cycle | She keeps payments earned to date, including the transfer payment; future installments pause | Next transfer usually within 2 to 3 months |
| Chemical pregnancy | Repeat beta until negative; clinic reviews the cycle | Usually one to two cycles, per the clinic | Payments earned to date kept; [loss-related amount per PLS schedule] | Next transfer usually within 2 to 3 months |
| First-trimester loss | Ultrasound confirmation; her OB or the clinic manages the loss, sometimes with a procedure | Longer; next transfer only with her OB's clearance | Payments earned to date kept; [loss-related amount per PLS schedule]; future installments stop until a new cycle | Set by her OB's clearance and the clinic |
| Second-trimester loss | Managed by her OB, often in hospital | Longer still; physical and emotional recovery; OB's clearance required | Payments earned to date kept; [loss-related amounts per PLS schedule and agreement] | Set by her OB's clearance; the plan is reviewed with both sides |
How often does each happen, and why?
Both happen in surrogacy at rates driven mainly by embryo quality.
A PLS surrogate has already carried at least one healthy full-term pregnancy, and Mark Silverberg, DDS, MD, has read her prenatal and delivery records. Your clinic has evaluated her uterus. That screening removes most uterine reasons for failure. What remains is mostly the embryo.
- Failed transfers. Even euploid embryos, tested as chromosomally normal, fail to implant a meaningful share of the time. Untested embryos fail more often, mainly because some are aneuploid. Grade matters too. See embryo quality.
- Miscarriage. ACOG puts early pregnancy loss at roughly 10% of known pregnancies overall. Verify the current ACOG wording. Most early losses are caused by chromosomal problems in the embryo, not by anything the surrogate did or did not do.
That last point bears repeating to everyone involved. A surrogate who follows her medication calendar did not cause a negative test or a loss. Nor did you.
For how PLS reports its own results, see surrogacy success rates.
What does the clinic do after a negative test?
After a negative test, the clinic stops the surrogate's medications and reviews the cycle. Typically it looks at:
- The embryo: its grade, whether it was tested, and how it looked after thawing.
- The lining: its thickness and pattern on the last ultrasound before transfer.
- The timing: when progesterone started relative to the transfer.
- The transfer itself: the physician's notes on how it went.
- Her bloodwork during the cycle.
Most of the time the review finds nothing to change, and the clinic recommends another transfer with the next embryo. Sometimes it suggests an adjustment, such as a different medication protocol or an additional test of her uterus before the next cycle.
Your clinic's physician reviews the result with you. Your PLS case manager makes sure the surrogate hears the same plan.
What happens medically and emotionally for the surrogate after a loss?
Medically, a negative test means she stops her medications and has a period, usually within days. After a confirmed pregnancy ends, her OB or the clinic manages the loss. Depending on timing, that may mean waiting for it to pass, medication, or a short procedure. After a later loss, she may need hospital care. Before any new transfer, her OB clears her.
Emotionally, a loss is a loss for her too. She carried the pregnancy, felt its early symptoms, and often feels responsible for your hope. Some surrogates grieve. Some worry that you blame them.
What PLS support consists of:
- Her case manager. Natalie Gaudio-Fricano and Jenni Symons have both been gestational surrogates. They know what the days after a negative test feel like from her side.
- Mental-health support through independent licensed professionals.
- Nutrition support from Julie Bendix, MPH, RD, LD, CLC, which continues into the next cycle.
- Time. No one pushes her into the next cycle before she and her OB are ready.
What does the contract pay, and what stops?
The gestational carrier agreement sets the exact terms. In general:
- She keeps payments earned to the date of the loss. That includes the medication-start and transfer payments. On the current PLS schedule, these are $500 at medication start and $1,000 at transfer. Figures confirm with Nancy.
- She receives the loss-related amounts set in the agreement. [Loss payment amounts to be stated from the PLS compensation schedule.]
- Future installments stop until a new cycle. Monthly base compensation that depends on an ongoing pregnancy pauses.
- Expenses already incurred are reimbursed, including lost wages and travel tied to the cycle or the loss.
At PLS, escrow rolls to the next cycle. You do not close and reopen the account. The independent escrow agent keeps paying under the agreement, and you see every payment on your statement.
When can the next transfer happen?
After a negative test, the next transfer is usually scheduled within 2 to 3 months. The surrogate typically waits one menstrual cycle, then starts the medication calendar again.
After a miscarriage, the timing depends on her OB's clearance and on the clinic. It is longer than after a negative test.
A second transfer costs roughly $5,000 to $10,000 in clinic and medication fees, plus the $1,000 transfer payment to the surrogate. Estimate; confirm with your clinic and the PLS schedule.
Most contracts plan for up to three transfers with the same surrogate. The match stays intact unless the clinic identifies a carrier-related reason, which is uncommon.
When does a clinic recommend changing the plan: new embryos, a different protocol, or a rematch?
After one failed transfer, most clinics transfer the next embryo with the same plan. After two or more, they look harder.
- New embryos. If your remaining embryos are untested or lower graded, the clinic may suggest PGT-A, or a new retrieval to create more embryos. See PGT-A testing.
- A different protocol. The clinic may change the surrogate's medications, their timing, or add a test of her uterus.
- A rematch. Rare. A clinic recommends a new surrogate only when it identifies a carrier-related reason. A rematch adds the matching period again, which averages about 6 months at PLS.
The PLS Assured tier ($62,500) includes unlimited rematches and no new agency fee if the first surrogate does not succeed.
For the financial side of a journey that does not succeed, see what happens if the journey fails.
How PLS supports both sides after a loss
After a negative test or a loss, PLS does four things:
- Tells both sides the same plan. The clinic's review and next steps go to you and to your surrogate together, so no one is guessing.
- Checks in with the surrogate through her case manager, and connects her with independent mental-health support if she wants it.
- Checks in with you. Your case manager helps you decide on the next step with your clinic.
- Keeps the money moving correctly. Escrow pays what is owed under the agreement and pauses what is paused.
If you have a question this page does not answer, SurrogacyHotline.com, the PLS sister site, gives free expert answers within 24 to 48 hours.
Sources
- ACOG (American College of Obstetricians and Gynecologists), guidance on early pregnancy loss. https://www.acog.org
- ASRM (American Society for Reproductive Medicine). https://www.asrm.org
- SART (Society for Assisted Reproductive Technology). https://www.sart.org