Surrogacy Meds and What to Expect

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Surrogacy Meds and What to Expect

Many women exploring the process of surrogacy have questions about it and may feel uncertainty when it comes to medications. And it makes sense to seek more information about what medications are used and what effects they will have on your body and your life! As a three-time surrogate, I’ll dive into the world of surrogacy meds, cover their importance to the process, and discuss common and potential side effects.

What is the Medication Protocol for Surrogacy?

It’s important to note that every fertility specialist has a preferred medication protocol. If you are somewhat familiar with meds because you have a friend who has gone through IVF or surrogacy, keep in mind that while most medication protocols for the process are similar, they are rarely identical. As a surrogate, the clinic you will work with is determined by where the intended parents have chosen to create and store their embryos. Generally, the doctor who created their embryos will perform the embryo transfer and provide your care leading up to transfer and for the first few months of pregnancy. If the fertility clinic isn’t local to you, a nearby monitoring clinic will be chosen and your bloodwork and ultrasounds will be performed locally and then sent to the fertility doctor for review.

Why are Birth Control Pills Used in Surrogacy? What is Lupron?

Once a surrogate has been medically cleared, birth control pills lead the way in the medication lineup! This one baffles many new surrogates and probably stands as the most questioned medication prescribed. It may seem counterintuitive to take a medication designed to prevent pregnancy to get pregnant but there is a good reason! While the pills may help ensure that a surrogate doesn’t wind up accidentally pregnant prior to transfer, the primary purpose of the pills is to reduce ovarian activity (stay quiet, ovaries! This isn’t your show!) and more precisely regulate the menstrual cycle. This allows the fertility doctor to determine an optimal day for embryo transfer. Surrogates are given explicit instructions on exactly what cycle day to start and stop the pills. Sometimes, birth control pills are not enough to prevent premature ovulation. In this case, a medication called Lupron, AKA leuprolide, is prescribed to further reduce ovarian activity. This medication is taken daily via subcutaneous injection (which means a short needle is used) and typically started two weeks after beginning birth control. Like any medication, rare side effects exist, but the most common side effects of Lupron are hot flashes and headaches, which are alleviated with good hydration. Weight gain is a less common side effect and highlights the importance of starting the process with a healthy BMI. Many surrogates do not experience any side effects, which was my personal experience with this medication.

Why are Estrogen and Progesterone taken in Surrogacy? What are the Side Effects?

Estradiol, AKA the hormone estrogen, and progesterone are sort of the main events of the uterine preparation show. Estradiol is started after a prescribed amount of time on birth control and Lupron (if being used) to do the important work of thickening the endometrium, the lining of the uterus. Estradiol can be prescribed in a variety of forms, and each doctor has a preferred protocol. The most common way to take estradiol is via intramuscular injection every three days, which involves the use of a long needle injected into the gluteal muscles. This method provides a long-lasting, steady, and slow release of the hormone. Oral tablets, vaginal suppositories, and transdermal patches are also sometimes prescribed in tandem. Fatigue and weight gain are common side effects of estrogen supplementation.

Approximately five days before embryo transfer, a surrogate starts progesterone to fluff up the thickened endometrium and make it receptive to an embryo. This hormone nourishes the embryo after transfer by stimulating glands in the endometrium to secrete nutrients until later in pregnancy when the placenta takes over. The most common method for progesterone is daily intramuscular injection. Suppositories and oral tablets are also prescribed. Progesterone is the hormone responsible for early-pregnancy shortness of breath, bloating, sleepiness, and constipation, and these are common side effects of supplementation as well. Estrogen and progesterone supplementation is continued until 8-12 weeks of pregnancy when the placenta is fully formed and able to take over the job of hormone production.

Other commonly prescribed medications include low-dose aspirin to mitigate the risk of blood clots, low-dose prednisone before and just after transfer to improve the probability of implantation, and a short course of the antibiotic Doxycycline to reduce inflammation and ensure no underlying infection is present. Side effects from these meds are rare or extremely minimal due to the low dosages used for this purpose.

Feeling nervous about the potential side effects of meds is natural and completely understandable! However, these medications are a vital aspect of a successful surrogacy outcome so it’s important for potential surrogates to be comfortable with this part of the process before proceeding. Like most things, more knowledge, better understanding, and excellent support can overcome fear and anxiety. If you have questions about any aspect of surrogacy, our friendly team at Stronger Together Surrogacy would love to chat with you! After all, we are Stronger Together.