The Ins and Outs of the IVF Process

You’ve been pregnant before, but surrogacy and in vitro fertilization (IVF) is new to you.  It’s totally normal to be a little anxious about what you are signing up for medically.  Here’s what you can expect from the process:

Medications

IVF includes a bunch of medications the doctors use to prepare your body to receive an embryo and later to sustain the pregnancy until your body recognizes the embryo and begins to produce the needed hormones on its own.  Typically a surrogate begins medications about three to four weeks before a scheduled embryo transfer.  The exact medications and your schedule are determined by the reproductive endocrinologist (RE, or fertility doctor) your intended parents chose.  The RE, who may work in a different state, makes this determination based on your medical screening results.  This same RE performs the embryo transfer.

So, what are these meds?  It depends on the doctor and surrogate, but some of the medications you might be expected to take are:

• Estrogen – taken to build the uterine lining.  Most commonly in pill form (Estrace).
• Lupron – taken to suppress ovulation.  Subcutaneous injection.
• Progesterone – taken to help mimic pregnancy and sustain early pregnancy.  Most commonly by intramuscular injection (Progesterone in Oil, or PIO), but can also be a suppository or patch.
• Birth control pills – taken to regulate the menstrual cycle.
• Steroids (like Medrol or Prednisone) – taken to suppress the immune system.  Pill.
• Baby aspirin – taken as a blood thinner.
• Antibiotics (like Doxycycline) – taken to help fight infection before an embryo transfer.  Pill.
• Prenatal vitamins, Folate & DHA – taken to aid overall health like with other pregnancies.  Pills.

The most common side effects are mood swings, which often disappear after the embryo transfer.  Other side effects (depending on your particular protocol) could include bloating, cramping, headaches, hot flashes, and nausea.  For most surrogates, the toughest parts of the medication protocol are (1) keeping track of everything, and (2) the Progesterone in Oil injections.  Please read our related blog posts on organization and PiO injections for useful tips!

Monitoring

After starting medications but before the embryo transfer, you will have monitoring appointments with nurses at an IVF clinic near your home.  The monitoring clinic staff collect blood samples to check your hormone levels and complete ultrasounds to evaluate your uterine pattern.  These appointments are crucial to ensuring that you are responding to the medications appropriately and will be ready for an embryo transfer.  Based on the results, the RE may adjust your protocol.  You will continue monitoring appointments after the embryo transfer and these nurses will do the blood test for a positive pregnancy.

Embryo Transfer

In some ways the embryo transfer is the easiest part of the IVF process.  You and your intended parents, if they are able to attend, will arrive at the fertility clinic in the morning.  You’ll be asked to arrive with a full bladder, which helps improve the odds of embryo implantation in the uterus.  You will not be placed under anesthesia but should not experience any significant pain.  (The worst part is the full bladder!)  The embryologist loads the embryo into a special catheter and the doctor uses an ultrasound wand to guide the catheter into the uterus.  Once positioned appropriately, the embryo is pushed out of the catheter and left to implant in the uterus.  The embryologist will examine the catheter afterwards to ensure no embryo was left inside by accident.  If the clinic’s COVID protocols allow it, your IPs and spouse/companion will be in the room with you during the procedure.  The whole procedure lasts about 15-20 minutes.

You may be asked to lay flat for a short period of time, but most doctors do not prescribe any bed rest following the transfer.  Depending on the clinic, you may be free to travel home the following day.  Finally, depending on the doctor’s recommendation and your and your intended parents’ feelings, you may undergo acupuncture before and/or after the transfer.

Finishing Medications and Transfer to OB

You may want to know—when do I finally finish with these shots?!  As with most pieces of this surrogacy journey, that depends.  The date for discontinuing medications relates more to how your body is responding and how quickly your body is producing enough of its own hormones to sustain the pregnancy than it does to the calendar.  That said, most surrogates will wean off of the hormones between weeks ten and twelve over the course of a few days.  (But remember that you are already two weeks pregnant at transfer based on how doctors do their calculations.)  At that point, you also are done with monitoring appointments at the IVF clinic and return to the normal care of your own OB and standard prenatal vitamins.