The IVF Process for Surrogacy: What to Expect

In vitro fertilization — IVF — is the medical process that makes gestational surrogacy possible. It's how the embryo is created, and it's how that embryo gets transferred into the surrogate's uterus. If you're new to surrogacy, understanding IVF is one of the most important things you can do to feel prepared for what's ahead.

Here's a straightforward look at how the IVF process works in the context of surrogacy, step by step.

Step 1: Ovarian Stimulation and Egg Retrieval

The first step happens on the intended mother's side (or with an egg donor, if donor eggs are being used). The goal is to produce multiple mature eggs in a single cycle, rather than the one egg that would naturally mature each month.

This involves a series of hormone injections — typically administered daily for about 10 to 14 days — that stimulate the ovaries to produce multiple follicles. The fertility clinic monitors progress with regular blood tests and ultrasounds to track follicle growth and hormone levels.

When the follicles are mature, a trigger shot is administered, and the egg retrieval is scheduled 34 to 36 hours later. The retrieval itself is a minor procedure performed under sedation — the doctor uses a thin needle guided by ultrasound to collect the eggs from the ovaries. It usually takes about 20 to 30 minutes, and most women recover within a day or two.

The number of eggs retrieved varies widely — anywhere from a handful to 20 or more, depending on the individual's age, ovarian reserve, and response to medication.

Step 2: Fertilization and Embryo Development

Once the eggs are retrieved, they're brought to the laboratory where they're fertilized with sperm — either from the intended father or a sperm donor. Fertilization can happen through standard insemination (placing the sperm and eggs together in a dish) or through ICSI (intracytoplasmic sperm injection), where a single sperm is injected directly into each mature egg. ICSI is commonly used when there are concerns about sperm quality or quantity.

Over the next five to seven days, the fertilized eggs develop into embryos. The clinic monitors their growth, looking for embryos that reach the blastocyst stage — the point at which the embryo has about 100 cells and is ready for transfer or freezing.

Not every egg will fertilize, and not every fertilized egg will develop into a viable blastocyst. This attrition is normal and expected, though it can be emotionally difficult for intended parents who are watching the numbers drop with each update from the clinic.

Step 3: Genetic Testing (Optional but Common)

Many intended parents choose to have their embryos genetically tested before transfer. This is called PGT — preimplantation genetic testing. There are different types: PGT-A screens for chromosomal abnormalities (like Down syndrome), while PGT-M tests for specific genetic conditions that run in the family.

Genetic testing requires the embryos to be biopsied (a few cells are removed from the outer layer of the blastocyst) and sent to a lab for analysis. Results typically take one to two weeks. During this time, the embryos are frozen.

PGT adds cost to the IVF process but provides valuable information. It can improve transfer success rates by identifying the healthiest embryos and reduce the risk of miscarriage caused by chromosomal abnormalities.

Step 4: Preparing the Surrogate's Body

While the embryo creation process is happening on the intended parents' side, the surrogate's body is being prepared for the transfer. This is where the surrogate's medical protocol begins.

The surrogate takes hormone medications — primarily estrogen and progesterone — to build up her uterine lining so it's ready to receive the embryo. This process is closely monitored by the IVF clinic with blood tests and ultrasounds. The clinic is looking for a lining that's thick enough (typically 7mm or more) with the right hormonal environment for implantation.

This preparation phase typically takes three to four weeks. If the surrogate's body doesn't respond as expected — if the lining isn't thickening adequately, for example — the clinic may adjust the medication dosage or restart the cycle. It's a process that requires patience, because the clinic won't proceed with the transfer until conditions are optimal.

The medications are administered through injections, and yes — the shots are a real part of the deal. Most surrogates say they're uncomfortable but manageable, and they get easier with practice. Some surrogates have their partner help with the injections; others prefer to do them on their own.

Step 5: Embryo Transfer

The embryo transfer is the pivotal moment of the IVF process. It's the procedure where the doctor places the embryo into the surrogate's uterus using a thin, flexible catheter guided by ultrasound.

The transfer itself is usually quick — about 10 to 15 minutes — and most surrogates describe it as painless or similar to a pap smear. No anesthesia is typically needed. The surrogate lies still for a short time afterward, and then she's free to go home, usually with instructions to take it easy for the next 24 to 48 hours.

In most surrogacy journeys, a single embryo is transferred. Single embryo transfer (SET) is now the standard of care because it significantly reduces the risks associated with multiple pregnancies (twins, triplets) for both the surrogate and the babies. The intended parents and the surrogate will have discussed embryo transfer preferences — including the number of embryos — during the match meeting and in the legal contract.

Step 6: The Two-Week Wait

After the transfer, there's nothing to do but wait. The two-week wait (sometimes called the TWW) is the stretch between the embryo transfer and the blood test that confirms whether the embryo implanted and the surrogate is pregnant.

This is universally described as one of the hardest parts of the surrogacy journey — for the surrogate and for the intended parents. You're hopeful, you're anxious, and every small sensation becomes something to overanalyze. The surrogate continues her medication protocol during this time, and the clinic will schedule a blood test (a beta hCG test) about 10 to 14 days after the transfer.

If the test is positive, congratulations — the surrogacy pregnancy has begun. The clinic will monitor hCG levels over the following days to confirm the pregnancy is progressing, and an early ultrasound (usually around 6 to 7 weeks) will confirm the heartbeat.

If the test is negative, it means the embryo didn't implant. It's disappointing, and it's okay to feel that. But failed transfers are a normal part of IVF — they don't mean anything is wrong with the surrogate or the embryos. The team will regroup, review the cycle, and plan the next attempt.

What Intended Parents and Surrogates Should Know

For intended parents: The IVF process involves variables you can't control. Not every egg will fertilize. Not every embryo will be viable. Not every transfer will result in a pregnancy. The emotional toll of these uncertainties is real, and it's worth having support — from your agency, from a therapist, from your partner — as you navigate them.

For surrogates: Your role in the IVF process centers on the medication protocol and the transfer. The injections aren't fun, the waiting is hard, and the pressure of carrying someone else's hope can feel heavy. But you're not doing this alone. Your agency and your medical team are monitoring everything, and the intended parents are rooting for you every step of the way.

The IVF process is both a medical procedure and an emotional journey. Understanding how it works helps you approach it with realistic expectations — and that makes the whole surrogacy experience better for everyone involved.