Embryo transfer is one of the most pivotal moments in the surrogacy process—a hopeful leap from preparation to potential pregnancy. In the context of gestational surrogacy, this step marks the medical attempt to achieve a successful pregnancy using an embryo created via in vitro fertilization (IVF).
For both intended parents and surrogates, the embryo transfer carries deep emotional significance. Medically, it requires precision, coordination, and a strong foundation of trust and communication between all parties.
What is Embryo Transfer in Surrogacy?
Embryo transfer is the process of placing an embryo into a gestational carrier’s uterus with the goal of establishing a pregnancy. It is the final step in the in vitro (IVF) process, following fertilization of the egg by the sperm in a lab.
In gestational surrogacy:
- IVF plays a central role. Intended parents (or donors) provide the genetic material—eggs and sperm—which are fertilized to create embryos.
- The surrogate is not genetically related to the embryo. She carries the pregnancy but shares no DNA with the baby.
- Embryos can come from:
- The intended mother’s eggs and the intended father’s sperm
- Donor eggs or sperm
- Embryo donation (previously created embryos from another couple)
- The intended mother’s eggs and the intended father’s sperm
Timeline of Embryo Transfer During the Surrogacy Journey
A step-by-step guide to how a surrogate gets pregnant:
Medical Screening of the Surrogate
Before any embryo transfer, the gestational surrogate undergoes thorough medical evaluation to ensure she is physically able to carry a pregnancy. This includes:
- Blood work and hormone testing
- Uterine evaluation (e.g., saline sonogram)
- Infectious disease screening
- Review of medical history and previous pregnancies
Synchronization of Menstrual Cycles
If a fresh embryo transfer is planned (using newly created embryos), the surrogate’s cycle must be synchronized with the egg donor or intended mother. This alignment ensures the uterine lining is ready at the right time.
- Birth control or Lupron is often used to regulate and align cycles
- Regular monitoring helps the fertility clinic time everything precisely
Hormonal Preparation
Regardless of embryo source, the surrogate begins a regimen of hormone treatments:
- Estrogen thickens the uterine lining
- Progesterone prepares the uterus to accept the embryo
Medications are administered via injections, pills, or patches—sometimes a combination of all three.
Embryo Creation (IVF)
In the lab, eggs are fertilized with sperm to create embryos. This can be done using:
- ICSI (intracytoplasmic sperm injection), especially if male fertility factors are present
- Embryos are cultured for several days, usually until the blastocyst stage (day 5–6)
Frozen vs. Fresh Embryo Transfer
Most clinics now recommend frozen embryo transfer (FET) because:
- It allows time for comprehensive genetic testing
- The surrogate’s body can be better prepared
- It offers more scheduling flexibility
Fresh transfers are less common and require cycle coordination between the egg provider and the surrogate.
Transfer Procedure and Recovery
On the big day, the embryo is thawed (if frozen) and transferred into the surrogate’s uterus using a thin catheter. The procedure is typically:
- Performed under ultrasound guidance
- Painless or mildly uncomfortable
- Done without sedation in a clinic setting
Afterward, surrogates rest for 20–30 minutes and can usually resume light activity that day.
Two-Week Wait for Pregnancy Test
After the transfer, there’s a two-week wait before a blood test (beta hCG) can confirm pregnancy. This period is often emotionally intense.
What to Expect During the Embryo Transfer Procedure
A clear understanding of the process can ease nerves for both the surrogate and intended parents.
- Procedure length: About 15–30 minutes
- Pain level: Most surrogates describe it as similar to a Pap smear
- Before the transfer: Surrogates may be asked to arrive with a full bladder for better ultrasound visibility
- After the transfer: Bed rest isn’t always required, but light activity is encouraged
Surrogates receive continuous support from their agency, fertility team, and often, the intended parents.
Success Rates and Factors that Affect Embryo Transfer Outcomes
Success rates with IVF vary by clinic and circumstances. On average, frozen embryo transfers have an average 50–60% success rate, while fresh embryo transfers have an average 40–50% success rate.
These rates depend on embryo quality, surrogate health, and fertility clinic practices.
Embryo Quality
High-quality embryos (graded based on cell development and appearance) have a higher chance of implantation.
Embryos that undergo PGT-A (Preimplantation Genetic Testing for Aneuploidy) may offer improved outcomes by identifying chromosomally normal embryos.
Surrogate’s Health
A surrogate with these qualifications has a significantly better chance of a successful transfer.
- A history of healthy pregnancies
- No chronic illnesses
- A stable uterine environment
Number of Embryos Transferred
Most clinics transfer one embryo to minimize the risk of multiples. In some cases, two may be transferred, though this carries risks for both surrogate and babies.
Use of PGT-A (Genetic Testing)
PGT-A can:
- Reduce miscarriage risk
- Increase the chances of a successful pregnancy
- Add cost to the process but may reduce the number of attempts needed
Fresh vs. Frozen Embryo Success Comparison
- Frozen transfers allow for better uterine preparation and timing
- Fresh transfers may work well if cycles are aligned, but are logistically complex
Legal Considerations Around Embryo Transfer in Surrogacy
Embryo transfer in a surrogacy arrangement cannot legally proceed until all parties have signed a formal surrogacy contract. This document outlines the roles, rights, and responsibilities of both the intended parents and the surrogate. It includes important details like financial compensation, medical decisions, number of embryo transfer attempts, and what should happen in the case of a miscarriage or failed transfer.
Consent and custody agreements must be established before the embryo transfer takes place. If an embryo transfer fails, the contract will typically outline how the parties should proceed. This may include how many attempts are agreed upon, whether the surrogate wishes to continue, and how any additional costs or emotional considerations will be handled.
Emotional and Psychological Aspects for Surrogates and Intended Parents
The emotional experience of embryo transfer is significant for both surrogates and intended parents. For surrogates, it can be an exciting and meaningful step, but it may also bring up anxiety or emotional vulnerability. Intended parents also go through a rollercoaster of emotions during this phase. The transfer represents hope and progress, but it also carries uncertainty.
Costs Associated With Embryo Transfer in Surrogacy
The IVF process itself—retrieving eggs, fertilizing them, and creating embryos—can cost thousands of dollars. Additional fees may apply for freezing, storage, and thawing embryos, especially if multiple transfers are needed.
Surrogates may receive additional compensation specifically for undergoing a transfer, even if it does not result in pregnancy. There are also costs related to medication, such as estrogen and progesterone, which prepare the surrogate’s body for transfer and implantation.
Frequently Asked Questions (FAQs)
Answers to your most pressing questions:
Can embryo transfer be done more than once?
Yes, many surrogacy journeys involve multiple transfers. It’s common for a first attempt to be unsuccessful, and contracts often allow for more than one cycle.
Is the embryo always genetically related to the parents?
Not always. Embryos can be created using donor eggs, donor sperm, or even donated embryos. The intended parents may or may not share a genetic connection with the baby.
How many embryos are typically transferred?
Most clinics recommend transferring one embryo at a time to reduce the risk of multiples. In some cases, two embryos may be transferred, but this is less common.
Can a surrogate choose to stop after a failed transfer?
Yes. Surrogates have the right to withdraw from the process at any point. If a transfer fails, the surrogate and intended parents will revisit the contract and decide how to proceed.
What if the surrogate becomes pregnant with multiples?
This situation is addressed in the surrogacy agreement ahead of time. The medical team and both parties will follow agreed-upon protocols, which may include decisions about selective reduction in rare cases.
Who can be in the room during transfer, and how can intended parents be involved remotely?
Typically, clinics allow one support person during the transfer. If the intended parents can’t be present, many are included virtually through a video call or recorded messages of support.
How do surrogates cope emotionally if the transfer fails?
Surrogates may experience grief or guilt after an unsuccessful transfer, even though it’s no one’s fault. Counseling, peer support, and clear communication with the intended parents can help them process the outcome.
What is PGT testing and is it worth it?
Preimplantation Genetic Testing (PGT) screens embryos for chromosomal abnormalities before transfer. It may improve success rates but adds cost and doesn’t guarantee implantation.
How do I choose a clinic that supports surrogate wellbeing?
Look for a clinic that works regularly with surrogates, offers emotional support, and values patient-centered care. A good fit includes respectful communication and experience in third-party reproduction.
What happens after transfer if there’s a miscarriage?
The legal contract outlines how this is handled, including follow-up care and next steps. Emotional support and medical guidance are key during this time.
How many transfers does it usually take before pregnancy?
While some surrogates get pregnant after one transfer, it’s not uncommon for it to take two or three attempts. Patience and planning help everyone stay grounded during this phase.
Choose Surrogacy By Faith
Embryo transfer is more than a medical procedure—it’s a moment filled with possibility, emotion, and immense trust. Whether it leads to pregnancy the first time or after multiple attempts, it’s a significant step forward in the shared journey of surrogacy. If you’re interested in becoming a surrogate or pursuing parenthood through surrogacy, fill out our surrogate form or intended parent form today. We’ll be with you through this important part of the journey!