If you're thinking about becoming a Surrogate, you probably have questions about what happens after you're matched with Intended Parents. One of the biggest milestones is the embryo transfer. You may be wondering what the procedure feels like, how to prepare, what happens if the first transfer doesn't work, or how many attempts you might need. Understanding the process can help you feel more confident as you begin your journey. If you're just starting to explore your options, learning about how to become a Surrogate can help you understand the steps involved before reaching the embryo transfer stage.
An embryo transfer is a procedure in which a fertility doctor places an embryo into your uterus, with the goal of achieving a pregnancy. In gestational surrogacy, the embryo is created through in vitro fertilization (IVF), a process in which an egg and sperm are combined in a laboratory. The egg and sperm may come from the Intended Parents, an egg donor, or a sperm donor. The embryo is then transferred into your uterus so you can carry the pregnancy for the Intended Parents. Because a gestational Surrogate does not use her own egg, she is not genetically related to the baby.
If you're new to the process, our guide to how IVF works in gestational surrogacy explains how embryos are created and how the transfer fits into the larger surrogacy journey.
Before your transfer, your fertility clinic will make sure your body is ready for pregnancy. This includes preparing the lining of your uterus, called the endometrium, where the embryo will attach and grow. Depending on your treatment plan, you may take medications such as estrogen and progesterone to help prepare the lining. These are commonly administered through intramuscular injections, but may also be taken as vaginal suppositories, pills, patches, or lozenges depending on your clinic’s protocol. Your clinic will use ultrasounds and blood tests to monitor your progress and determine when the timing is right. Some clinics may also recommend a mock cycle, or practice cycle, to see how your body responds to medication, although not every Surrogate needs one.
Sometimes, a transfer needs to be delayed because the uterine lining needs more time to develop or your doctor wants to review a test result. Although waiting can be frustrating, a delay doesn't mean you've done anything wrong or that your surrogacy journey is over. Your doctor will explain what needs to happen before moving forward, and your agency can help you understand how the delay may affect scheduling.
The good news is that an embryo transfer is usually a quick procedure that doesn't require surgery or general anesthesia. Your clinic will explain how to prepare for your appointment, which may include arriving with a full bladder or following specific medication instructions. During the procedure, your doctor uses a thin, flexible tube called a catheter to place the embryo into your uterus through the cervix, often with the help of an ultrasound.
Afterward, your clinic will explain which medications to continue, what activities are appropriate, and when to return for a pregnancy test. A blood test is often scheduled about 9–14 days after transfer, although timing varies by clinic. Try not to read too much into how you feel during the waiting period, since symptoms or a lack of symptoms can't reliably tell you whether the transfer worked. Many symptoms are from the hormonal medications regardless of pregnancy outcome. Follow your clinic's instructions and don't stop prescribed medication unless your medical team tells you to.
A single-embryo transfer means one embryo is placed into your uterus, while a double-embryo transfer means two embryos are placed during the same procedure. Although transferring two embryos may increase the chance of pregnancy during that particular transfer in some circumstances, it also increases the chance of twins.
For gestational surrogacy, fertility specialists generally recommend transferring one embryo at a time when appropriate. Organizations such as the American Society for Reproductive Medicine emphasize reducing multiple pregnancies because they carry additional risks. Twin pregnancies can be healthy, but they are more likely to involve complications such as high blood pressure, preeclampsia, premature birth, and low birth weight. Transferring one embryo greatly reduces the chance of twins, although identical twins can still occur if the embryo splits.
Your fertility doctor should explain the recommended transfer plan and the benefits and risks of each option. As a Surrogate, you should have the opportunity to ask questions and understand the medical considerations before treatment.
You may hear your fertility team discuss egg donor age, embryo quality, and genetic testing. These factors can help doctors assess the likelihood of an embryo developing into a pregnancy, but none can guarantee an outcome. The age of the person providing the egg affects the likelihood of certain chromosome abnormalities in an embryo. As egg age increases, that likelihood generally increases as well, although age alone cannot predict whether a particular embryo will result in a pregnancy or live birth.
You may also hear about PGT-A, which stands for preimplantation genetic testing for aneuploidy. This test examines sampled cells from an embryo for an unusual number of chromosomes. The results may help Intended Parents and fertility specialists decide which embryo to transfer, but PGT-A has limitations and cannot guarantee implantation, pregnancy, or the birth of a healthy baby.
Before transfer, you'll also complete medical screening to help determine whether pregnancy is a safe option for you. This may include reviewing your medical and pregnancy history, evaluating your uterus, and completing recommended blood tests and infectious-disease screening. Egg donors and other genetic contributors may undergo additional screening as well. If you have questions about what testing has been completed, ask your clinic to explain the results and whether anything else is needed before transfer. It's always okay to ask questions about your medical care.
It's understandable to worry about an unsuccessful transfer. Even when everything appears to be going well, an embryo doesn't always implant. If the first transfer doesn't result in a pregnancy, your clinic will review the results and discuss possible next steps. Your doctor may consider the embryo, uterine lining, timing, and other medical factors, although sometimes there isn't a clear explanation for why a transfer was unsuccessful. A failed transfer doesn't automatically mean another attempt will fail.
Some Surrogates achieve a pregnancy after the first transfer, while others need more than one attempt. The number of transfers needed varies depending on embryo quality, egg age, genetic testing results, and individual medical circumstances. Each transfer offers another opportunity for pregnancy if another suitable embryo is available and the medical team recommends proceeding. Your clinic can explain what the available information means for your specific situation. For a closer look at fertility outcomes and the factors that may affect the chances of success, explore Hatch's surrogacy success rates guide.
This is an important question to discuss before signing your surrogacy agreement. Your agreement may outline anticipated transfer attempts and how additional treatment will be handled. It is common for a contract to include up to three transfers, with either party able to choose to terminate the contract after an unsuccessful transfer. However, participating in a surrogacy arrangement does not mean giving up your right to make decisions about your own medical care. Before signing, ask your independent attorney to explain what your agreement says about additional attempts, medical recommendations, and your options if you don't want to continue treatment.
Responsibility for medical bills and other expenses depend upon your contract, insurance coverage, and applicable law. Typically these expenses are covered by the Intended Parents. Before treatment begins, make sure you understand who pays for fertility medications, appointments, transfer procedures, and additional attempts. Ask how expenses are handled if a transfer is canceled or delayed, and have your independent attorney review the financial arrangements. Getting clear answers in advance can help prevent confusion later.
Fertility clinic success rates can be confusing because different clinics may report different outcomes. A positive pregnancy test, an ongoing pregnancy, and a live birth are not the same thing, so it's important to understand what the numbers actually measure. When reviewing success rates, ask whether the figures represent positive pregnancy tests or live births, whether they're calculated per transfer or across multiple attempts, how recent the results are, and how many treatment cycles are included.
You can also explore the CDC's ART success-rate information to learn more about fertility treatment outcomes, or read Hatch's article on IVF and surrogacy success rates. Understanding what the numbers represent can help you ask better questions and make more informed decisions. Remember that overall statistics cannot predict the outcome of an individual transfer, so your doctor can help you understand what the numbers mean for your particular situation.
A surrogacy journey involves several people, including you, the Intended Parents, your fertility clinic, your agency, and your attorneys. Knowing who to contact when you have questions can make the experience feel less overwhelming. Before treatment begins, ask your agency who will support you if your coordinator is unavailable, communication breaks down, or a transfer is delayed or unsuccessful. You should also know how to contact your fertility clinic directly if you have medical questions or concerns.
Your agency can help coordinate communication, but you deserve clear information about your own care. If you're unsure about your agreement, medical decisions, or financial protections, your independent attorney can explain your options. You should never feel that you have to navigate an unexpected situation alone.
You don't need to know everything about fertility treatment before becoming a Surrogate. Your medical team and support team are there to help you understand the process, and asking a few questions can help you feel more prepared.
Ask your fertility clinic what medications you'll need, what could cause a delay, and who to contact if you have concerns. Ask your agency what support is available if a transfer fails or is canceled, how expenses are handled when treatment is delayed, and who you can reach if your coordinator is unavailable. Ask your attorney what your agreement says about additional transfer attempts, what happens if you don't want to continue treatment, and who is responsible for medical bills and other expenses.
Take the time to understand the answers before agreeing to move forward. You deserve to feel informed and comfortable with the decisions ahead.
Embryo transfer is an important milestone, but it's only one part of the surrogacy journey. Learning what to expect, understanding your treatment plan, and asking questions can help you feel more prepared. It's completely normal to feel excited and nervous at the same time, and you don't need to have all the answers before getting started.
If you're ready to explore the next steps, learn more about the process of becoming a Surrogate and what the journey may look like for you. Most importantly, remember that your health, questions, and comfort matter throughout the process. You deserve a surrogacy experience built on honest communication, thoughtful medical care, and support at every step.