How are the embryos created and where are they stored?
In gestational surrogacy, the embryo is created by in vitro fertilization (IVF) before it ever meets the surrogate. The intended mother or an egg donor takes stimulation medications, and the clinic retrieves her eggs in a short procedure. In the lab, the eggs are fertilized with the intended father's or a donor's sperm. The embryos grow for five or six days, to the blastocyst stage, and are then frozen.
Many parents choose PGT-A before freezing is complete: a few cells are biopsied from each blastocyst to check that it has the normal number of chromosomes. Grading, which every clinic does, describes how the embryo looks. PGT-A adds chromosomal information that grading cannot. See PGT-A testing and embryo quality.
The frozen embryos are stored at your fertility clinic or at a storage facility it works with. If your surrogate will transfer at a different clinic from the one that created your embryos, the clinics arrange a shipment.
Private Label Surrogacy (PLS) works with 14 partner fertility centers, including Kindbody, Shady Grove Fertility, Fertility Centers of Illinois and Oregon Reproductive Medicine. You can also bring your own clinic. Many parents already have embryos when they sign. Others create them during the matching period, which averages about 6 months at PLS. If you need an egg donor, PLS can match one: the egg donation match fee is $11,000, or $8,500 when combined with a PLS surrogacy journey.
What is a frozen embryo transfer and why is it standard for surrogates?
A frozen embryo transfer (FET) is the thaw and transfer of an embryo that was created and frozen earlier. In surrogacy it is the standard approach, for practical reasons:
- Timing. The egg retrieval happens in one woman's body and the pregnancy in another's. Freezing separates the two, so the surrogate's cycle can be planned on its own calendar.
- Testing. Freezing allows time for PGT-A results and for the clinic's required testing before transfer.
- Lining control. The clinic prepares the surrogate's uterine lining with medications and transfers when the lining is ready, rather than trying to synchronize two women's natural cycles.
- Flexibility. If a transfer is postponed, for a schedule conflict or a lining that needs more time, the embryos wait safely.
The medical cycle, from legal clearance to pregnancy test, takes 2 to 3 months at PLS. No medications start until the gestational carrier agreement is signed, the clinic has the attorneys' legal clearance letter, and escrow is funded.
What medications does the surrogate take and for how long?
Protocols vary by clinic. A typical frozen embryo transfer protocol for a surrogate looks like this:
- Cycle preparation. Some clinics start with birth control pills or another medication to time her cycle.
- Estrogen. She takes estrogen, by pill, patch or injection, for about 3 to 4 weeks to build her uterine lining.
- Lining check. A monitoring ultrasound and bloodwork at a clinic near her home confirm the lining is ready.
- Progesterone. She starts progesterone, usually by injection, vaginal suppository or both, a set number of days before transfer. The timing matches the age of the embryo.
- After transfer. She continues estrogen and progesterone after transfer and, if she is pregnant, into the first trimester until the clinic tells her to stop.
Monitoring visits happen at a clinic near the surrogate's home and are billed separately from your IVF clinic. Your case manager keeps the medication calendar with her and with you.
The cycle asks a lot of the surrogate: daily medications, often injections, several early-morning monitoring visits, and travel to your clinic, all while she is raising her own children. PLS case managers Natalie Gaudio-Fricano and Jenni Symons have both been through it as gestational surrogates themselves, and they are the people she calls with questions about a dose, a side effect or a schedule change. Nutrition support starts early too: Julie Bendix, MPH, RD, LD, CLC, holds at least six nutrition consults with each surrogate across the journey. Your part is to keep your clinic's paperwork and payments current so nothing in her calendar waits on you.
| Approximate timing | Step | Location | Payment trigger |
|---|---|---|---|
| Start of cycle | Baseline ultrasound and bloodwork | Local monitoring clinic | Medication-start payment to the surrogate, $500 |
| Start of cycle | Estrogen begins | At home | None |
| After about 2 to 3 weeks of estrogen | Lining check | Local monitoring clinic | None |
| Several days before transfer | Progesterone begins | At home | None |
| Transfer day | Embryo transfer | Your fertility clinic | Transfer payment to the surrogate, $1,000 |
| 9 to 11 days after transfer | Beta hCG blood test | Clinic or local lab | None |
| Early pregnancy | Repeat beta tests, first ultrasound | Fertility clinic or local monitoring clinic | [Base compensation start trigger to confirm] |
| After the clinic's final early ultrasound | Release to the surrogate's OB | Her OB's office | None |
Payment triggers shown are from the current PLS compensation schedule: $500 at medication start and $1,000 at transfer. Confirm triggers with Nancy.
What happens on transfer day?
The surrogate travels to your fertility clinic. Her travel is part of your third-party costs and is paid from escrow. If she lives far from the clinic, she may arrive the day before.
The transfer itself is a short outpatient procedure, about 10 minutes. It does not usually need anesthesia. The embryologist thaws the embryo and checks it. The physician then uses an abdominal ultrasound to guide a thin catheter through the cervix and places the embryo in the uterus. Clinics often ask for a full bladder, which improves the ultrasound view.
Afterward she rests briefly at the clinic. Instructions for the following days, such as activity limits and when to travel home, vary by clinic.
Whether you attend is something you agree on at matching. Some parents are in the room. Others meet the surrogate before or after, or join by video.
Usually one embryo is transferred. The number is agreed at matching and written into the agreement, not decided on transfer day.
When is pregnancy confirmed and when does the clinic release her to an OB?
The surrogate takes a blood pregnancy test 9 to 11 days after transfer. The test measures beta hCG, the hormone a developing pregnancy produces. A home urine test is less reliable at this stage, and many clinics ask surrogates to wait for the blood test.
If the first result is positive, the clinic repeats the test to check that the level is rising as expected. An early ultrasound then confirms the pregnancy is in the uterus and, at a later scan, shows a heartbeat. Once the clinic is satisfied the pregnancy is progressing normally, it releases her to her own obstetrician for routine prenatal care. The clinic gives her instructions for stopping her medications.
If the test is negative, the clinic reviews the cycle, the surrogate stops her medications, and the next transfer is usually scheduled within 2 to 3 months. The match stays in place.
Who pays for which part of the IVF process?
You pay for IVF, but not through PLS.
- To your fertility clinic, directly: IVF, egg retrieval, embryo creation, PGT-A, embryo storage, the surrogate's clinic screening, and the transfer.
- To the pharmacy, directly: the surrogate's medications.
- Through independent escrow: the surrogate's compensation and milestone payments, local monitoring at her nearby clinic, and her travel to your clinic.
- To PLS: the program fee, plus the egg donation match fee if PLS matches your donor.
Clinic fees vary widely, which is why PLS budgets them separately from the program fee and third-party costs. Ask your clinic for a written quote for each transfer, including medications and monitoring. See IVF costs in surrogacy.
What does ASRM say about how many embryos to transfer?
ASRM recommends single embryo transfer for gestational carriers. A second embryo raises the chance of twins much more than it raises the chance of having a baby, and twins carry higher risks for the surrogate and the babies, including preterm birth.
In practice, most surrogates state in their criteria whether they would ever accept a double transfer, and many clinics will not perform one into a gestational carrier. At PLS, the agreed number is settled at matching and written into the agreement. For the full comparison, see single vs double embryo transfer.
Sources
- ASRM (American Society for Reproductive Medicine), committee opinions on gestational carriers and on the number of embryos to transfer. https://www.asrm.org
- SART (Society for Assisted Reproductive Technology). https://www.sart.org
- CDC (Centers for Disease Control and Prevention), Assisted Reproductive Technology reporting.