Choosing to become a gestational Surrogate is an incredible choice to make to help others, and it also comes with plenty of questions. One of the most common questions is: What medications do Surrogates have to take, and what will the process actually feel like?
In gestational surrogacy, medications help prepare the uterus for embryo transfer and, when needed, support the early stages of pregnancy. Although the thought of hormone treatments and daily injections can feel overwhelming at first, understanding the process can make it easier to know what to expect.
The good news is that your medication protocol should not be a mystery. Your fertility clinic will prescribe your medications, monitor your response, and explain any adjustments. Your agency can also help you navigate the practical side of your journey, including coordination, communication, and financial arrangements.
Here is what you need to know about surrogacy medications, the typical medication timeline, possible side effects, and how to prepare for treatment with confidence.
In gestational surrogacy, an embryo created using an egg and sperm from the Intended Parents or donors is transferred into the Surrogate's uterus. The Surrogate carries the pregnancy but is not genetically related to the baby through her own egg.
Before the transfer, the fertility clinic needs to ensure that the Surrogate’s uterine lining is ready for the embryo to implant. Depending on the treatment plan, medications may help regulate the menstrual cycle, build the uterine lining, and provide the hormones needed to support early pregnancy.
Many Surrogates undergo a frozen embryo transfer, commonly called an FET. In a medicated FET cycle, estrogen and progesterone are frequently used to prepare the uterus and coordinate the timing of the transfer.
However, not every Surrogate follows the same protocol. In rare instances, some clinics use a natural or modified natural cycle when appropriate, relying partly on the body's own hormonal cycle. Your medical history, cycle characteristics, clinic protocol, and response to treatment all influence the plan.
The goal is to prepare for transfer safely and appropriately—not to give every Surrogate the same medications regardless of individual needs.
Your clinic will provide a specific medication list and instructions. The following are common examples of medications used during embryo transfer preparation.
Estradiol is a form of estrogen that helps the endometrium, or uterine lining, grow and develop before embryo transfer.
Depending on the protocol, it may be prescribed as an oral tablet (Estrace), a skin patch (Vivelle), or an injection (Estradiol Valerate). Estradiol patches are popular in some treatment plans because they deliver medication through the skin, and injections are also popular because they administer the medication intramuscularly. These methods bypass the stomach for those who are more sensitive to oral hormones.
Your clinic may adjust the dose or duration based on bloodwork and ultrasound findings. If your uterine lining needs more time to develop, your transfer may be postponed while your physician reassesses the plan.
Possible side effects include headaches, breast tenderness, nausea, bloating, or mood changes. Your clinic should review your medical history and explain which symptoms require prompt attention.
Progesterone prepares the uterine lining for implantation and helps support early pregnancy. It is an important part of many medicated embryo transfer protocols.
Progesterone in oil, commonly called PIO, is administered as an intramuscular injection, usually into a large muscle in the buttock. The solution can be in a variety of oils such as peanut, sesame, or ethyl oleate. Depending on the treatment plan, your clinic may prescribe vaginal progesterone such as Endometrin or Crinone instead of, or in addition to, injections. Sometimes oral progesterone lozenges or oral crinone pills are given.
Some Surrogates find PIO injections uncomfortable because the medication is injected into muscle and has an oil-based formulation. Soreness, bruising, or tenderness at the injection site can occur. The nice thing about the injections and suppositories is they do bypass the stomach for those more prone to nausea from oral medications, or with morning sickness in the first trimester.
If the injection method is difficult for you, you can ask your clinic whether another approved approach is appropriate. Many clinics will strongly recommend sticking with the shots because they keep progesterone levels very steady. Never change the medication or route of administration on your own.
Some medicated transfer protocols include medication to temporarily suppress or regulate the natural menstrual cycle. Examples may include a gonadotropin-releasing hormone agonist, such as leuprolide, or birth control pills used for scheduling.
These medications are not required in every cycle. Your clinic will determine whether cycle suppression is appropriate based on your treatment plan. These methods may be used when a Surrogate has previously ovulated through the estrogen medications, to further suppress ovulation.
Your clinic may also recommend prenatal vitamins or prescribe additional medications for a specific medical reason. Some other common medications include:
Other treatments should not be assumed to be necessary for every Surrogate.
For a helpful overview of the reproductive process, read the American Society for Reproductive Medicine's patient education resources on third-party reproduction.
One of the most helpful ways to understand FET medications is to look at the process chronologically. Exact dates vary by clinic, protocol, and individual response, so use the timeline below as a general guide rather than a personal medication calendar.
Before starting a new medication protocol, your clinic may schedule blood tests and an ultrasound to assess your baseline hormone levels and reproductive health.
If your physician recommends cycle suppression, that medication may be started at this stage. Your clinic will explain when to begin, how to take each medication, and what to do if you miss a dose.
Estrogen, often in the form of injection, estradiol tablets or patches, may be introduced to help the uterine lining develop.
Over the following days or weeks, the clinic checks how your body responds. Blood tests may measure hormone levels, while a transvaginal ultrasound measures the uterine lining and assesses its appearance.
If the lining is not ready, your physician may adjust the medication plan or allow more time for development. A delay does not automatically mean the cycle has failed.
Once your clinic determines that the uterine lining is ready, progesterone is introduced according to the embryo's developmental stage and the transfer protocol.
This step is particularly time-sensitive. Progesterone exposure must be coordinated with the planned embryo transfer, so follow the clinic's instructions carefully.
Your clinic will explain how to administer the medication, how to maintain the schedule, and whom to contact if a dose is missed or an injection cannot be completed.
During an embryo transfer, the fertility specialist places the embryo into the uterus through the cervix using a thin catheter. The procedure itself is generally brief and does not involve surgery.
You will usually continue the prescribed medications according to your clinic's instructions. Do not stop estrogen or progesterone because you experience spotting, suspect that a transfer has not worked, or feel well enough to discontinue treatment.
A blood pregnancy test, often called a beta-hCG test, is scheduled after the transfer at the time specified by your clinic.
If the test is positive, your physician may continue estrogen and progesterone for several more weeks, depending on your protocol. Many medicated cycles continue hormonal support into the first trimester before the clinic directs a gradual or scheduled discontinuation.
If the test is negative, your clinic will explain when to stop medication and discuss next steps.
For a broader view of the process, read Hatch's guide to the Surrogate journey and timeline.
It is reasonable to want reassurance that your medication doses are appropriate. Monitoring helps the fertility team assess how your body is responding and whether the planned transfer can proceed.
Depending on your protocol, monitoring may include:
A dose adjustment is not necessarily a reason to worry. It can be a normal part of individualized fertility care.
If you are unsure why a medication has been prescribed or why your instructions have changed, ask your physician to explain the reason in plain language. You should understand what you are taking and know whom to contact with questions between appointments.
The ASRM patient guide to embryo-transfer preparation explains how hormonal preparation, blood tests, and ultrasound monitoring can be used in reproductive treatment.
Not every surrogacy medication is an injection.. Some are taken orally or applied as patches, while others may be administered by injection or vaginally.
For Surrogates prescribed intramuscular progesterone, learning the proper technique can make the routine more manageable.
Consider these practical tips:
You may also want to set a daily reminder and keep your medication supplies organized. Having a written calendar can make it easier to follow the schedule during a busy day.
Hormonal medications affect people differently. Some Surrogates experience only mild symptoms, while others notice changes that may interfere with their usual routines.
Possible side effects include:
These symptoms do not necessarily mean that the medication is causing harm, but you should not dismiss symptoms that are severe, persistent, or unusual for you.
Can You Still Work and Care for Your Family?
Many people can continue their usual activities during embryo transfer preparation, but how you feel will depend on your individual response, medication regimen, and medical circumstances.
Planning ahead may help. Keep water and snacks available if your clinic says they are appropriate, prioritize rest when needed, and use reminders to avoid missing doses. If fatigue, nausea, headaches, or mood changes begin affecting your daily life, tell your clinic rather than simply pushing through.
Hormonal changes can also feel emotionally challenging. A supportive conversation with your care team, agency coordinator, partner, or trusted friend may help you feel less alone.
When Should You Contact Your Doctor?
Ask your clinic for written instructions describing which symptoms warrant a call and which require emergency care.
Seek urgent medical attention for warning signs such as chest pain, sudden shortness of breath, coughing up blood, sudden severe headache, new vision or speech changes, or significant one-sided leg swelling or pain. These symptoms can indicate a serious complication and should not wait for a routine appointment.
For more information about medication risks and warning signs, consult MedlinePlus' estradiol patch medication guide.
Medication costs are an important part of planning a surrogacy journey. The exact arrangement depends on the agreement, fertility clinic, insurance coverage, and surrogacy program.
In most arrangements, Intended Parents are responsible for eligible fertility-treatment costs, including medications used for the embryo transfer. These costs may be paid through an escrow arrangement, a program package, or another agreed payment method.
Before treatment begins, confirm:
Do not assume that a regular health insurance plan covers fertility medication simply because it covers other prescriptions. Coverage varies, and exclusions may apply.
Sometimes there may be lower-cost options, but the safest approach is to ask the fertility clinic and the responsible payer before making changes.
Your clinic may be able to identify an approved pharmacy, discuss available formulations, or coordinate with the pharmacy about pricing and availability. Never substitute medication, change your dose, or purchase medication from an unverified source to save money.
If you are working with Hatch as an Intended Parent, ask your coordinator to clarify how your program handles eligible medication expenses. Hatch’s Peace of Mind Program offers different package options with specified coverage for fertility medications and other expenses. Coverage varies by package, so review the exact agreement and confirm how any exclusions or additional costs are handled.
Some fertility medications require advance planning, and certain products may have specific storage or shipping requirements. It’s a good idea to never let your medication supply run too low or cut it close on refill timing to avoid the risk of running out or missing a dosage.
If a pharmacy tells you that a prescription is unavailable or a shipment may be late, contact your clinic and coordinator immediately. They can help determine whether an approved alternative pharmacy, prescription transfer, or treatment adjustment is appropriate.
Keep medications stored according to the pharmacy's instructions, especially if refrigeration or temperature controls are required. Do not assume that a delayed shipment gives you permission to change the schedule.
An embryo transfer may be postponed if the uterine lining is not ready, hormone levels need further assessment, medication is unavailable, or another medical concern requires attention.
Your physician may recommend additional monitoring, more time on the current regimen, a different protocol, or another approach based on the findings. If a transfer does not result in pregnancy, your clinic will explain when to discontinue medication and what options may be considered next.
A second transfer does not automatically mean higher medication doses or an immediate new cycle. The team may review the previous cycle, the embryo and transfer circumstances, and your response to treatment before recommending next steps.
Before beginning a cycle, ask who will explain the options, and how quickly you can expect follow-up.
How long do Surrogates take fertility medication?
The timeline varies by protocol. Preparation may take 4-6 weeks before transfer, and hormonal support may continue after transfer if pregnancy occurs until 10-12 weeks of pregnancy. Your clinic will provide the exact start and stop dates for your treatment.
Do all Surrogates have to take progesterone shots?
No, but many do and it’s good to be prepared for this possibility. Progesterone is commonly used in medicated transfer cycles, but the route may vary. Some protocols use intramuscular injections, vaginal formulations, or a combination. Some natural-cycle approaches differ, but these are less common for gestational surrogacy. Your fertility specialist will determine the appropriate regimen.
Are surrogacy medications safe?
Like taking oral birth control, all hormonal medications have potential side effects and risks. Fertility specialists consider medical history, treatment needs, and monitoring results when prescribing them. Report any concerning symptoms and ask your doctor to explain the benefits and risks of your specific medications.
Will the clinic change my dose?
They may. Your physician can adjust the dose or timing based on blood tests, ultrasound findings, side effects, and your clinical circumstances. Changes should always come with clear instructions from the treating team.
What if I miss a dose?
Contact your fertility clinic for instructions as soon as possible. The correct response depends on which medication you missed and how close you are to the transfer. Do not double a dose or independently change the schedule unless your medical team instructs you to do so, and be sure to alert your agency contact as well.
Can I stop taking medication if my pregnancy test is negative?
Follow your clinic's instructions. After a negative test, the physician will tell you when to stop your medications and explain what happens next. Do not discontinue medication early based only on symptoms or a home pregnancy test.
Who can explain my medication protocol?
Your fertility specialist or clinic team is responsible for medical instructions and treatment decisions. Your agency coordinator can help with communication, scheduling, and practical questions about the journey. Before treatment begins, make sure you know whom to contact for urgent concerns and whom to contact for routine questions.
Understanding surrogacy medications can help you feel more prepared for embryo transfer, but you should never have to figure out a complex medication protocol on your own.
Ask questions, keep your instructions organized, report side effects, and confirm who is responsible for medical decisions and financial arrangements. Your health and understanding matter throughout the process.
If you are considering becoming a Surrogate, Hatch offers resources to help you understand the journey, including its Surrogate requirements and qualifications and how to become a Surrogate.
With the right information and a responsive care team, you can approach the medication process knowing what to expect and where to turn for support.