How Exactly Does the Egg Retrieval Process Work in IVF?

If you have to create a fresh embryo for your transfer cycle for surrogacy, you may wonder exactly how an egg cell is obtained. While it’s fairly obvious how a sperm sample is gathered for the in vitro fertilization process, harvesting an egg is more complicated.

Whether you are asking this question because your own egg will be harvested for a transfer cycle, or you will be using a donor egg for your fresh embryo, it’s important to understand every procedure of the surrogacy process. Remember, your reproductive endocrinologist can best explain what this process will look like for you.

Every egg retrieval may look slightly different based on the circumstances of the surrogacy and egg donor involved but, medically speaking, there are a few universal steps involved.

1. Stimulate the Ovaries.

A woman’s ovaries naturally produce one egg each menstrual cycle. However, because the egg harvesting process is so invasive, fertility specialists want to harvest more than one egg during each procedure and maximize chances of a successful pregnancy. In order to do that, a woman must take fertility medication to put her ovaries into hyper-drive, so that multiple eggs can be harvested at once.

There are a few drugs that women can take to stimulate ovaries — known as “follicle stimulating hormone” — but one of the most common is Lupron. In fact, this is the drug that prospective surrogates often must take, as well, even if they are just a gestational carrier.

At the same time that her ovaries are undergoing stimulation, a woman must also take other drugs to suppress ovulation and cause final maturation of the eggs. Once the eggs are ready, a fertility specialist will trigger ovulation and final maturation with the hormone hCG.

2. Monitor Follicle (Egg Structure) Size.

Before ovulation can occur, a fertility specialist will monitor the ovarian stimulation process. Each fertility clinic has its own regulations for the number of eggs needed and their desired size before the retrieval procedure can occur. Specialists will also monitor statistics like blood hormone levels, estrogen levels and estradiol levels.

In general, the ovarian stimulating process takes about 8-10 days.

3. Stimulate Ovulation with hCG.

Once the eggs are deemed ready for harvest, a woman is given an hCG injection. This stimulates ovulation and induces the final egg maturation. The actual egg retrieval process will be completed about 35 hours after the injection and right before the woman’s body begins to release the eggs.

4. Retrieve the Eggs.

A woman must be placed under anesthesia to harvest her eggs. Because the procedure is invasive, the anesthesia prevents her from feeling pain and discomfort.

Once she is asleep, medical professionals pass a needle through the top of the vagina to get to the ovary and the follicles. The needle sucks the eggs from the follicle wall and out of the ovary, and the surrounding fluid follows shortly after. The eggs are then taken to the in vitro fertilization lab where the eggs are identified, rinsed, and placed in small culture dishes. From there, the eggs are protected in incubators until they are ready for the in vitro fertilization process and eventual embryo transfer.

Typically, medical professionals will retrieve an average of 8-12 eggs during each procedure, which takes about 10 minutes. A woman will likely experience mild to moderate cramping after.

What’s Next — IVF

Typically, harvested eggs are put together with sperm about four hours after retrieval, but each clinic’s procedures vary. After a certain amount of time, the eggs are checked for fertilization and, if they have successfully been fertilized, they are cultured and monitored until they are ready to be transferred into the uterus.

If the in vitro fertilization process is occurring for surrogacy, the surrogate will be taking fertility medication to sync up her cycle with that of the egg donor or intended mother. Then, when the embryos are ready, she will undergo the transfer at the intended parents’ fertility clinic. She can remain awake during the procedure, which is fairly quick and painless. For surrogacy with a frozen embryo that has already been created, egg harvesting is not necessary, although a surrogate will still take preparatory medication.

Of course, every egg retrieval process is unique, and it’s important that you speak with your medical professional for more information on the procedures awaiting you. If you’re not sure whether you will require a fresh embryo in your surrogacy process, we encourage you to speak with a surrogacy clinic.

For more information on the surrogacy process in general, please contact our surrogacy specialists at 1-800-875-2229(BABY).

Which is More Successful: A Fresh or Frozen Embryo Transfer?

One of the biggest questions that intended parents have when they’re preparing for a surrogate journey is what kind of embryo transfers to use. There is a lot of information out there touting the benefits of fresh vs. frozen transfers and, when you know you can only afford a few transfers, it can be stressful to determine whether to put all your eggs in one basket, so to say.

If you’re deciding whether to use a fresh or frozen transfer in surrogacy, there’s one important thing to know: Because everyone’s surrogacy situation is different, you won’t be able to determine the best path for you based on information you find online. Only your doctor can describe the benefits of each medical path in your particular case and help you choose the procedure that’s right.

However, as you start your research, there are a few important things you should know.

What New Studies Reveal

Conventional medical advice stated that fresh embryos were preferred over frozen embryos. In the earlier decades of in vitro fertilization, doctors hypothesized that implanting a fresh embryo was more “natural” than the thawing of a frozen embryo, suggesting that a fresh embryo would be more likely to result in a successful pregnancy because of its higher quality.

However, new studies have revealed this isn’t always the case. Scientists have discovered there is relatively no difference between the success of frozen embryo transfers and fresh cycles resulting in a live birth. In a 2016 study, more than 1,000 women underwent a fresh embryo transfer, and almost 300 underwent a frozen embryo transfer. Researchers studied the results and found that the live births resulting from fresh cycles occurred in 70.4 percent of the women, while frozen cycles were successful in 65.6 percent of women who underwent this procedure.

Today, there’s no real evidence that one process over the other will determine the success of the transfer. Instead, there a few other important details that come into play.

What Really Determines the Success of an Embryo Transfer

Whether an intended parent uses a frozen or fresh embryo transfer, there is really one detail that predicts the likelihood of a pregnancy: the health and age of the eggs at time of harvest.

Before an embryo is transferred into the uterus of a surrogate, it is evaluated by medical professionals through pre-implantation genetic screening. This screening determines whether an egg is healthy enough for transfer. Usually, when medical professionals evaluate several embryos, they select the highest quality ones for transfer.

One of the biggest factors in an embryo’s quality is the egg and sperm cells involved. Whether an embryo is fresh or frozen doesn’t substantially play a role in the quality of the embryo, in contrast to what many believe. An egg cell can be just as healthy when thawed as it is when harvested fresh. What really matters is the age of the egg cell when it is harvested — not when it is thawed.

For example, women who harvest their eggs earlier in their life (like at the peak of their fertility in their 20s) and freeze them will typically have healthier embryos than a woman who creates a fresh embryo from her eggs in her early 40s. This is because, in the frozen egg or embryo, the eggs do not age; instead, they retain their quality until they are thawed. A fresh cycle with an older woman has a lower chance for harvest of high quality eggs — and, therefore, a higher quality embryo.

Determining Which Path is Best for You

Most intended mothers who start the in vitro fertilization process before pursuing surrogacy will have frozen embryos remaining. As long as those embryos remain high quality, there is typically no reason for her to create a fresh embryo for transfer to her surrogate’s uterus.

However, it’s worth noting that, if a woman creates frozen embryos later in life (with lower quality eggs), it may be a smarter move to create a fresh cycle with a donor egg. Women who retrieve eggs later in life typically have smaller chances of a live birth, and using a healthier egg from a younger donor can greatly increase the chances of success in surrogacy.

Similarly, intended parents who have not yet created an embryo before pursuing surrogacy (for example, single intended parents) will have typically have no other option than using a fresh embryo transfer, unless they wish to use a donor embryo.

Ultimately, if you are deciding between a fresh and frozen embryo transfer for your surrogacy, it’s important that you speak with your doctor first. They can evaluate your personal circumstances and recommend to you the path that offers the best chances at success.

Remember, the choice of “fresh” vs. “frozen” likely won’t be the determining factor in the success of your surrogacy. All of the other factors involved — the quality of your embryo, the health of the surrogate, etc. — play important roles in bringing a child into the world for you.

If you have further questions about the medical process of surrogacy, or would like to receive a referral to a trusted local fertility clinic, you can always contact our surrogacy specialists at 1-800-875-BABY(2229).


3 Services Your Fertility Clinic Will Provide in Surrogacy

One of the most important professionals involved in a surrogacy process is a fertility clinic. While surrogacy agencies like American Surrogacy can complete every other step of the surrogacy process, intended parents and surrogates will need to select and work with a fertility clinic to complete the medical aspect of their surrogacy journey.

Know this: The terms “fertility clinic” and “surrogacy clinic” are interchangeable.  Many surrogacy clinics are also fertility clinics, assisting intended parents with many different assisted reproductive technologies. As surrogacy has become more popular, more general fertility clinics have expanded their services to include gestational surrogacy embryo transfers.

But, what other services do fertility clinics provide in surrogacy journeys? After all, it’s important to know exactly what to expect from a clinic in order to choose the one that is best for your surrogacy goals.

In general, there are three main services fertility clinics provide in surrogacy today:

1. Pre-Surrogacy Screening

Before a surrogate or an intended parent can pursue the surrogacy process, they must be cleared by several professionals. Each surrogacy professional and fertility clinic has its own requirements but, here at American Surrogacy, all surrogacy clients must undergo screening by a mental health professional and a physician to ensure they are mentally and physically ready for the challenges of the surrogacy process.

Most intended parents will have undergone medical screening prior to choosing surrogacy, if they have already created their embryos. If they have not, they will need to undergo this testing to create their embryos. Similarly, their surrogate must undergo medical testing to ensure she can carry a healthy baby to term.

Some fertility clinics also have psychologists on staff that can complete this mental health screening prior to any medical steps taking place. If your fertility clinic does not offer these services, your surrogacy specialist at American Surrogacy can help connect you to a trusted professional and coordinate necessary screening before moving forward with your surrogacy journey.

2. Egg Harvesting and Embryo Creation

In most cases, intended parents who choose to pursue surrogacy have already created their embryos for earlier infertility treatments. When it comes time for an embryo transfer to their surrogate, the embryos are ready — only the surrogate must take medical steps to prepare for the transfer.

However, if intended parents have not yet created embryos, they can do so at a fertility clinic of their choosing. Intended parents who are using their own egg and sperm will work closely with their medical professional to undergo the harvesting procedure and in vitro fertilization process. Intended parents who are in need of a donor gamete can work with their fertility clinic to obtain a donation. Many fertility clinics have connections with particular gamete banks or can help coordinate the donation process with a known egg or sperm donor.

Once the gametes are gathered, your fertility clinic will prepare for and complete the in vitro fertilization process. Sperm and egg cells will be combined in a laboratory under medical supervision, and resulting embryos are evaluated for quality through pre-implantation genetic screening. Only the best quality embryos will be used for embryo transfer.

IVF is the most-used assisted reproductive technology out there. For many fertility clinics, it’s the most common technique they offer. While there may be slight changes in the IVF process when surrogacy is involved, you can trust that your fertility clinic will be able to complete this step efficiently.

3. Embryo Transfer and Confirmation of Pregnancy

Once the embryos are ready for transfer (whether they are part of a fresh or frozen cycle), the fertility clinic will prepare the surrogate for the embryo transfer, too. She will usually be required to take certain fertility medications for a few weeks prior to and after transfer to establish and maintain a healthy pregnancy.

The embryo transfer itself is a fairly quick and routine procedure. A surrogate will typically be required to travel to the intended parents’ clinic for the transfer. A catheter will be inserted into her cervix, through which one or two high-quality embryos will be transferred. She may be required to rest for at least 48 hours after transfer to increase the chance of a successful implantation.

A week or two after the embryo transfer is complete, the surrogate will return to the fertility clinic for the pregnancy test. While she may have taken at-home pregnancy tests to monitor her hCG levels, the medical test at the clinic will officially confirm any pregnancy. If a pregnancy is confirmed, the surrogate will be released to her own obstetrician to receive prenatal care. If a pregnancy is not confirmed, the fertility clinic will work with both parties to schedule another embryo transfer, if possible.

Because your fertility clinic will play such a key role in your medical process of surrogacy, it’s critical that you choose a trusted medical professional to guide you through these steps. If you have not yet selected a fertility clinic, our specialists can always provide referrals to local clinics when you contact our agency at 1-800-875-BABY(2229).

Remember, every fertility clinic is different, as is every intended parent’s and surrogate’s journey through surrogacy. Your own process may vary from what’s included here, and all surrogacy clients should speak with their doctor for more information about what their process will look like.

The Truth About the Medication You’ll Take as a Surrogate

When women are considering becoming surrogates, there are many questions in their minds. However, two of the biggest often are, “What medication will I need to take? Do I have to give myself shots?”

Like women undergoing fertility treatments, all surrogates must take certain medications to prepare themselves for the in vitro fertilization process. However, not all women have the same medication experience. Some women can breeze through their medication schedule, while others experience side effects that interfere with their everyday life.

If you’re thinking about becoming a surrogate, you might have heard horror stories about these negative side effects and the shots you have to take. It’s important you learn the truth about surrogacy medication before beginning this process, as it may or may not affect your final decision.

Every Surrogate’s Medication Schedule is Different

First, know this: Every surrogacy journey is unique, and so is every surrogate’s prescribed medication schedule. What you hear from others may not apply to your own surrogacy. Only your surrogacy and medical professionals will know what your surrogacy journey will involve.

To answer one of your biggest questions, yes, you likely will need to take self-injected medication. Most commonly, these shots are Lupron shots. Lupron is a medication that inhibits the secretion of hormones that control your menstrual cycle. It is critical to allowing your reproductive endocrinologist complete control over your cycle in order to prepare it for the embryo transfer. Lupron is usually taken about 14 days after you start taking birth control, and you will discontinue the shots in the days before your embryo transfer.

Some of the worst shots you may have heard about are progesterone in oil injections, which are administered via a large needle and in lots of liquid. However, many surrogates have developed ways to alleviate any discomfort from these shots. You may consider icing the site before injection, massaging the area after injection, and using a heating pad. As scary as the needle can be, the pain afterwards is more like that of a bruise than anything else. You may also take progesterone through gels or pills; your medical professional will determine which process is best for you.

Other medications you may take include doxycycline, baby aspirin, prenatal vitamins, estrogen and more. Again, only your reproductive endocrinologist can inform you of what medication you will actually take to prepare for your embryo transfer. Your medical professional will discuss this schedule in detail with you and make sure you have the tools in place to maintain the correct doses at the correct time of day.

Every Surrogate Has Different Reactions and Side Effects

You may have also heard about the side effects of surrogate medication. Like all medication, the medicines you take to become a surrogate may have some side effects — but, again, their severity will depend upon your own body and your tolerance for those medications.

Some surrogates only experience minor side effects (like bloating and soreness), while others experience much more intense effects. Whatever the extent of your personal side effects, remember that your reproductive endocrinologist will always answer any questions you have and adjust your medication schedule to what is best for you.

There are many medications involved in surrogacy, so don’t be surprised if you experience side effects pre-transfer. In the grand scheme of things, these side effects often aren’t a deal-breaker (very comparable to PMS symptoms), and what you are doing will help bring a child into the world. When they look back on it, many surrogates consider any discomfort well worth it to help reach their surrogacy goals.

You May Need the Help of Others

Surrogate medication protocols can be complicated — and you aren’t expected to embark on this journey on your own. It’s obvious that your surrogacy professional and your reproductive endocrinologist will be intimately involved in your medication schedule, but you should also be open to including other people to make the journey a bit easier.

During your medication protocol, you will be required to take certain medications at certain times. It can be incredibly helpful to include your partner or another loved one in your schedule. They can give you any shots you feel uncomfortable doing yourself, or they can provide childcare and other practical assistance during times when your side effects are particularly bad.

It is a good idea to include your partner (if applicable) in your discussions with your reproductive endocrinologist. That way, they can understand your medication protocol, how to administer it and what serious side effects to look out for.

It’s normal to have questions about what kind of medication you’ll need to take as a surrogate. To learn more about this process (and the general process of surrogacy), please reach out to our surrogacy specialists at 1-800-875-BABY(2229).

Benefits for Baby: Delayed Cord Clamping and Skin-to-Skin Contact

How a baby is delivered is one of the most important choices a woman can make for her pregnancy. When both a surrogate and an intended parent are involved, these conversations are even more important. You’ll want to make sure the delivery process is one that both parties are comfortable with and does what is best for the baby.

One of the growing trends in modern deliveries is delayed cord clamping, in which the umbilical cord continues to provide blood and nutrients to a baby up to five minutes after he or she is born. But, when skin-to-skin contact between the baby, the surrogate and the intended parents is so important, this choice may initially seem to complicate things a bit.

Whether you are considering delayed cord clamping or want to learn more, you can find some useful information below.

Why Do Parents Choose to Delay Cord Clamping?

In the majority of births, medical professionals cut the umbilical cord shortly after the baby is delivered. This is often done to allow easier access to the baby for immediate cleaning, medical care and other services.

However, there’s a growing awareness about the potential risks of immediate cord clamping — and the benefits of delaying cord clamping.

The umbilical cord connects the baby to the placenta, the vital organ that provides nutrients while the baby is in the womb. When the baby is born, the placenta is still functioning as a blood circulatory organ. This means that about 1/3 of the baby’s blood is still in the placenta at the time of his or her birth. When the umbilical cord is immediately cut, that blood remains in the placenta (which is why people can donate or store placentas after birth). However, when medical professionals choose to delay cord clamping, all of that blood is able to return to the baby.

During this transfer — called “placental transfusion” — the umbilical cord provides the baby oxygen, nutrients, red blood cells, stem cells, immune cells and blood volume. If a cord is cut before these nutrients can be delivered, the baby is at greater risk for iron deficiency during the first six months of their life. This deficiency is in turn linked with neurodevelopmental delay.

To minimize these risks, and to provide the most benefits possible to their baby, more parents today are choosing to delay cord clamping upon the delivery of their child. If you are interested in this process, we encourage you to speak with your OBGYN to learn more.

How Will Delayed Cord Clamping Affect a Surrogacy Birth?

When delayed cord clamping first was studied, it was believed that a baby needed to be held at the height of the placenta in order for blood to continue being pumped and for maximum benefits to be had. Understandably, this put off some parents from this path, as it prevented the important skin-to-skin contact between mother and baby after birth — not to mention the logistical issues of trying to hold a slippery newborn baby at placenta height after birth.

However, a new study reveals that there is no difference in what position a baby is held at during delayed cord clamping. This means that integral skin-to-skin contact is still possible during this process, which many parents should be thrilled to hear.

Skin-to-skin contact can be a bit complicated in surrogacy births. A baby must first confirm their senses by being placed on the surrogate’s skin, and then be physically transferred to the intended parents. One can see where the logistics of traditional delayed cord clamping might make that impossible. But, due to the new knowledge that a baby does not have to be held at placental height, these steps are still achievable in a surrogacy birth.

How Do I Decide Whether This is Right for Me?

As with any medical decision surrounding a baby’s birth, it’s important to speak with the obstetrician and the hospital staff overseeing the delivery. But, when you pursue delayed cord clamping with surrogacy, there is another party that must be involved: your surrogacy partner.

Both intended parents and their surrogate should be on the same page about the decision to delay cord clamping. Although there are very few risks associated with delayed cord clamping, it is still a decision regarding the surrogate’s body — so she should have just as much input as an intended parent does. Proper understanding of the pros and cons of this process is crucial before any decisions should be made.

If you are unsure of how to bring up the idea of delayed cord clamping to your surrogacy partner, remember that our surrogacy specialists can help. Your specialist can mediate this conversation and help you create a surrogacy birth plan that meets the needs of both surrogate and intended parents. Contact us today for more assistance.

7 Lucky Surrogate Traditions for Your Transfer Day

The embryo transfer process can be one of the most exciting moments for you as a surrogate — but it can also be extremely nerve-wracking. All of your intended parents’ hopes and dreams will ride on the success of the embryo implanting, most of which is up to your doctor and your body.

While the likelihood of an embryo implanting is mostly out of your control, surrogates like you have developed a few fun transfer day traditions to bring luck and good vibes to a day that’s equal parts exciting and anxiety-inducing. Whether or not these traditions are proven to increase the chance of a successful embryo transfer, they can be great ways to channel your nervous energy and connect with other surrogates.

1. Lucky Socks

One of the biggest traditions that surrogates have on transfer day is wearing lucky socks during the embryo transfer procedure. Socks are usually the only item of clothing you can keep on during the medical procedure, and there’s an old Chinese saying that warm feet increase the chance of a warm and welcoming uterus.

2. “Sticky Thoughts”

Telling someone “sticky thoughts” is the surrogate’s way of saying good luck. This phrase comes from the idea that the stickier and thicker the uterus lining is, the more likely an embryo is to implant.

3. Pineapple

Before the embryo transfer procedure, many surrogates eat different food designed to increase the likelihood of implantation. One of these is pineapple, whether it’s the core or the surrounding fruit. Pineapple contains bromelain, which has strong anti-inflammatory properties. Therefore, it can be seen as a benefit for fertility in possibly preventing implantation issues for women.

Natural fertility experts caution against ingesting pineapple too early in your ovulation and after the transfer process. However, many surrogates heartily enjoy pineapple in the days leading up to their medical procedure.

4. French Fries

Many surrogates also eat French fries after transfer. It’s unclear how this tradition came about but, with a fresh transfer, doctors usually recommend an increase in sodium to reduce the chance of ovarian hyperstimulation syndrome in egg donors. The word of beneficial salt in French fries has seemed to spread to gestational surrogates, even though they are not subject to OHSS through fresh egg harvesting. But you’ll rarely find a surrogate who will turn down French fries, no matter how much benefit they actually have in the implantation process!

5. Laughing After Transfer

Here’s an interesting one: A 2012 study in the journal of Fertility and Sterility stated that women who laugh shortly after an embryo transfer showed higher rates of successful implantation. For this reason, some surrogates decide to giggle it up right after transfer, like by watching a comedy when they’re often required to rest anyway. Laughter reduces stress, which can affect your body in many ways. It only makes sense that reducing this stress would increase the likelihood of an embryo implanting into a woman’s uterus.

6. Wearing Green

Green is a color that represents fertility, which is why you’ll see many surrogates wearing green lucky socks, painting their toes green, or just wearing green in general in the days leading up to their transfer day. Other colors like orange and yellow also represent fertility in other cultures.

7. Symbols of Turtles

Similarly, a turtle also represents fertility in many cultures, including Chinese, Polynesian and African cultures. In other cultures, it’s a symbol of good luck. Some surrogates decide to wear a turtle charm or symbol during their embryo transfer process to take advantage of those good vibes.

Whether or not you are superstitious, these traditions can be a fun way to prepare for the embryo transfer process and connect to the larger community of surrogates out there. For more surrogate-specific tips and topics, check out surrogate forums like SurroMoms Online and All About Surrogacy.

3 Things to Know About Surrogacy Insurance

Insurance can be a tricky thing to navigate during any pregnancy — and surrogacy further complicates the issue. Whether you’re a surrogate or intended parent, you’re not alone if you’re wondering exactly how surrogacy insurance works.

Fortunately, the specialists at American Surrogacy are familiar with the intricacies of surrogacy insurance and can help answer your questions when you contact us at 1-800-875-2229(BABY). In the meantime, here are three things you need to know about insurance coverage for surrogate pregnancies.

1. Coverage varies from company to company.

As surrogacy has become increasingly common, insurance companies have become more selective regarding the types of pregnancies they will cover. Whether a surrogate’s pregnancy will be covered by her health insurance today depends entirely on her individual policy.

As part of our surrogate screening process, American Surrogacy will conduct an insurance review for every prospective surrogate who joins our agency. If her insurance includes a surrogacy exclusion (as many policies today do), the intended parents she is matched with may need to purchase a supplemental insurance policy to cover the costs of her pregnancy.

It’s important to note that if you are a surrogate, your pregnancy costs will always be covered for you, regardless of your insurance situation.

2. In vitro fertilization costs may be covered.

Even in cases where a surrogate’s medical expenses cannot be covered by insurance, some insurance companies will cover infertility treatments up to a certain amount. This means that for some intended parents, insurance will cover the costs of the in vitro fertilization (IVF) process to create embryos.

Intended parents should check with their insurance company to learn whether IVF treatments may be covered by their plan. In some states, this coverage is mandated — but only for employers with certain plans and of certain sizes.

If you live in a state where infertility coverage is not mandated, or if your state’s mandate doesn’t apply to your specific situation, whether IVF will be covered by your insurance depends entirely on your individual policy.

3. A supplemental plan may be necessary.

Because many insurance plans today do not cover surrogate pregnancies, it is common for intended parents to purchase a supplemental surrogacy insurance policy. Companies like ART Risk Financial and New Life Agency offer surrogacy insurance plans that can be purchased to cover a surrogate’s medical costs.

While these additional surrogacy insurance costs can be expensive, they can also offer great peace of mind throughout the medical process and pregnancy — both for surrogates and intended parents. Hopeful parents should carefully research surrogacy insurance (as well as other surrogacy financing options) so they can be fully prepared for the costs ahead.

For more information about surrogacy insurance, contact your insurance representative or a financial advisor. You can also learn more about how our program addresses surrogacy insurance issues by calling 1-800-875-2229(BABY) or contacting us online.

The Truth About Multiple-Embryo Transfers

It’s an important conversation that every prospective surrogate and intended parent should have with their medical professional: How many embryos should I be comfortable with in a single transfer?

Ideally, this conversation should take place well before an embryo transfer — even before someone starts the surrogacy process at all. However, new research from FertilityIQ estimates that 1/5 of all patients undergoing infertility treatments are only educated about the facts of a multi-embryo transfer immediately before the procedure itself.

Clearly, both intended parents and surrogates need to advocate for themselves while preparing for this step of the surrogacy process.

At American Surrogacy, our specialists will help connect you with an appropriate medical professional early on in the process. This way, you can learn about the pros and cons of transferring multiple embryos to make the best decision for you.

Rather than solely relying on one doctor’s recommendation, it’s important that intended parents and surrogates do their own research to learn about this topic from several resources. To help you start that process, we’ve listed some of the basic information you need to know in this article.

The Basics and Risks of the Transfer Process

In every in vitro fertilization process, intended parents will need to decide how many embryos they want to transfer to the mother’s (or surrogate’s) uterus. Usually, this decision will be influenced by several factors, like:

A fertility doctor should speak at length with intended parents about this decision, as it’s one that has many different repercussions for all involved. Unfortunately, not all doctors take this approach — instead recommending one path over another, after which intended parents often go with the suggested embryo transfer number.

While each medical situation is unique, it’s important to note that transferring more than one embryo comes with well-documented risks. Carrying multiples increases medical complications for both mothers and children by almost five times. These medical complications, like early birth, can cost parents more money and cause more emotional distress than a single birth resulting from a single-embryo transfer.

Still, doctors may recommend multiple embryo transfers in older women to increase their chances of pregnancy, despite these risks. No matter what the situation, all intended parents should be fully educated about both options long before the transfer takes place.

So, Which is Better: A Single- or Multiple-Embryo Transfer?

It would appear that single-embryo transfer is the safer path to take, right? It may be, but many American intended parents today aren’t following this path.

As a whole, intended parents in the U.S. complete far more multiple-embryo transfers compared to single-embryo transfers than other countries — in fact, more than twice as often as intended parents in Australia, based on FertilityIQ’s research. This is due to several factors.

In the U.S., the cost of an IVF process is much more expensive than the cost of those in countries where the healthcare system is paid for or greatly subsidized by the government. Therefore, intended parents often transfer more than one embryo their first time to reduce the chance that they need to pay for more than one transfer process.

Research also shows that there is no consistent education offered to intended parents among fertility clinics. The amount and accuracy of information will vary based on the doctor being used — which could be a possible reason why so many intended parents choose to do a multiple-embryo transfer early in the process.

The discussion about how many embryos to transfer in the surrogacy process is an even more complicated one. After all, the risks of a multiple-embryo transfer will not be carried by the intended parents but by the surrogate — which should impact the intended parents’ desire to transfer multiple embryos in the first place.

The American Society for Reproductive Medicine usually only advises one healthy embryo be transferred in women up to age 38, because “in patients of any age, transfer of a euploid embryo has the most favorable prognosis and should be limited to one.” Therefore, many surrogates and intended parents will determine during their legal contract phase that their embryo transfer will be limited to one for each transfer process. If it is decided that multiple embryos will be transferred, the contract should also address the financial protections for the possibility of carrying multiples and any subsequent complications.

If intended parents or a surrogate are considering a multiple-embryo transfer during surrogacy, we recommend you speak in detail with your surrogacy specialist and your fertility doctor for more information about the risks and benefits of doing so. The surrogacy specialists at American Surrogacy are always available to discuss your personal surrogacy situation if you call them at 1-800-875-2229(BABY) today.

Can You Choose the Gender of Your Baby with Surrogacy?

Often, when intended parents consider in vitro fertilization and surrogacy, they wonder, “Can you choose the gender of your baby?”

With celebrities like Chrissy Teigen and John Legend openly speaking about their own gender selection of their daughter, the question of choosing a boy or girl through the IVF process has historically been a bit ethically complicated. Medically, however, the answer is straightforward — those pursuing IVF can choose the gender of their baby.

Those pursuing in vitro fertilization will learn that there are many steps to this medical process, especially if it will be followed up with a surrogate pregnancy, and how to choose your baby’s gender as a part of this is equally as complicated.

In short, the IVF process itself doesn’t automatically allow for the creation of an embryo of a certain gender, so to say, but rather lends itself to gender selection before the embryo is transferred.

Why Gender “Selection” Isn’t What You Think

While intended parents may theoretically have the ability to “choose” the gender of their baby with IVF, the selection is a bit more complicated than just telling their doctor “boy” or “girl.”

Before an embryo can be cleared for transfer into a uterus (whether that’s an intended mother’s or a surrogate’s), most fertility clinics will complete preimplantation genetic screening. This screening takes a detailed look at an embryo’s chromosomal makeup to determine whether it is healthy enough for transfer and in-utero development. As part of this screening, medical professionals are also able to identify the sex of the embryo.

Intended parents should not prioritize the sex of an embryo in choosing an embryo to implant. Instead, a fertility professional will examine the results of the screening to determine which embryos appear to be the healthiest. From there, intended parents may be able to choose gender of their baby if they have two equally healthy embryos of different sexes.

The likelihood of this happening can be small; one doctor estimates that only about 15 to 20 percent of IVF cases result in equally healthy embryos of each sex. Of these, only about half of intended parents choose a specific gender.

Keep in mind: Most fertility doctors will encourage intended parents to transfer the embryo(s) of higher quality, regardless of its sex.

Ethical Considerations of Choosing the Gender of Your Baby

Being able to choose the gender of your baby, while only available to those who complete the IVF process, is more common than it used to be. In response, choosing baby genders has become a hot-button topic for many people.

However, even in these situations, gender selection is more a matter of personal preference than discrimination against one sex or the other. For example, intended parents who select a certain gender most often do so to bring a sense of balance to an existing family — like if they already have a boy and want a girl, or vice versa.

Some critics do argue about the “slippery slope” of choosing sex during the IVF process, claiming it will lead to genetic modification and other “unnatural” changes to the reproduction process. Unfortunately, there have always been critics of any medically assisted pregnancy — and these critics often offer the same arguments.

In response to this, it’s important to remember that embryo health and safety is the most important factor in selecting a viable embryo. Doctors will always encourage intended parents to do what is the most likely to result in a successful implantation, which usually involves choosing the healthier embryo (no matter which sex) and refraining from additional medical procedures that could make it more vulnerable to miscarriage.

If you are interested in whether it is possible to choose baby gender in your IVF process, discuss the topic with your doctor. They may or may not allow for sex selection when transferring embryos. If they do, they can explain what their specific requirements are for a healthy embryo and to what degree your own preferences will make a difference.

What Happens After a Miscarriage in Surrogacy

It’s a situation no intended parent or surrogate wants to experience: a miscarriage. While fertility clinics and fertility doctors take every step to make sure an embryo and a surrogate are healthy before the transfer and implantation of the embryo, miscarriages do sometimes occur.

Miscarriages are still a rather taboo topic, but that doesn’t mean they don’t happen. They’re more common than you may think; between 10 and 25 percent of known pregnancies actually end in miscarriage. Rarely is a miscarriage someone’s “fault,” as it’s usually the result of an abnormal embryo that would not have survived to term anyway.

Experiencing a miscarriage during the surrogacy process can be even more devastating because of the time and effort put into creating an embryo and the past failures an intended parent may have had with their own fertility. A miscarriage can seem like an impossible setback, but know that your surrogacy specialist and fertility doctor will be with you as you cope with this loss and decide what to do next.

Intended Parents

For many intended parents, a miscarriage during surrogacy is a reminder of their own past miscarriages or inability to get pregnant. It is heartbreaking to see your dreams fail again, but it’s important to understand the vast scope of the surrogacy process and stay positive.

There is no dramatic difference in miscarriage rates for those who conceive an embryo via in-vitro fertilization. A miscarriage during surrogacy is a natural thing, although that will likely not come as any condolence to you in your grieving process.

If your surrogacy results in a miscarriage, it’s important to take the time you need to grieve (your surrogate will also need time to physically recover before another embryo transfer can take place). This is also a good time for you and your surrogate to reevaluate your thoughts before moving forward; it’s important that both of you are still committed and comfortable continuing the surrogacy process at a time that’s best for both of you. When you’re ready, your fertility clinic will begin the necessary steps for another implantation cycle.

Remember, miscarriage is a common occurrence, and it’s no one’s fault. Your fertility clinic will have usually prepared you for the possibility of a miscarriage, and American Surrogacy will always give you the support and counseling you need to get through this difficult time. We know that it takes time to heal from a difficult loss like this, which is why you and your surrogate have the right to decide together when to start the transfer process again.


If you experience a miscarriage as a surrogate, it’s common to feel like you’ve failed your intended parents. This is completely untrue; a miscarriage is not your fault but instead a natural phenomenon you have no control over. Still, this can be difficult to accept, especially because it’s your body that has expelled the pregnancy.

A miscarriage will not affect your ability to become pregnant again. Your surrogacy contract will state how many transfers you will complete for the intended parents, so it’s likely that you will have another embryo transferred whenever you are physically and emotionally ready. Depending on how far along your pregnancy was, this recovery period may take longer or shorter than you expect. However, it’s important that your emotional recovery is complete before you move forward with another embryo transfer.

It’s normal to feel a range of emotions after a miscarriage, even if the embryo was not genetically related to you. We can always provide you trained counseling to help you cope with these emotions and prepare for your next embryo transfer, whenever you’re ready. Usually, within the first three transfers you complete with your intended parents, one embryo will result in a successful pregnancy and birth — so, while it may be tempting to give up after this disappointment, remember that it’s highly likely you’ll find success in your subsequent transfers.

Remember, surrogacy is a marathon — not a sprint. It’s a long process that will come with many emotional ups and downs, which is why American Surrogacy’s specialists will be there for you every step of the way. Miscarriage is always a difficult event to process but know that it’s not the end of the line. A successful surrogacy is possible, and we’ll help you complete it.