You asked – here’s a sample surrogacy medication timeline

If you’re thinking about becoming a surrogate or you’re an intended parent curious about the medical process, you might be wondering – what exactly does the surrogacy medication timeline look like? 

It’s a niche (yet incredibly important) aspect of the surrogacy process, and knowing exactly what happens when can help bring peace of mind, whether you’re just starting a surrogacy journey, or you’re still in the research phase. 

Pinnacle Surrogacy, a leading US-wide surrogacy agency, knows how important it is to have clarity on this part of the journey. Each of their coordinators has previously been a surrogate themselves, meaning you’re in truly experienced hands with each and every question.  

Take a look at our library of content created in partnership with Pinnacle Surrogacy – from demystifying surrogacy agreements, to our week in the life of a surrogate, where we lift the lid on the gestational carrier process, there’s so much helpful info here.

A sample surrogacy medication timeline, unpacked

Today, with their team’s help, we’ve broken down a sample surrogacy medication timeline that a surrogate might follow, including when each med is taken, how they’re administered, and why they’re used.

Let’s go!

Step 1 – Starting birth control pills

When: Usually around the first day of the surrogate’s cycle

What: One birth control pill daily

How: Taken orally

Why: Birth control pills help synchronize the surrogate’s cycle with the intended mother’s or the egg donor’s cycle. They also ensure the surrogate’s uterine lining is at the right stage when medication protocols begin!

Step 2 – Introducing lupron injections

When: About 2-3 weeks after starting birth control pills

What: Lupron (Leuprolide) injections, starting at 20 IU daily

How: Injected subcutaneously (just under the skin)

Why: Lupron suppresses natural ovulation to keep the surrogate’s cycle controlled. This ensures the uterus is at the ideal stage for embryo transfer.

Over the next two weeks, the surrogate continues Lupron injections while stopping birth control pills. The dosage may be adjusted, often decreasing to 10 IU per day closer to the next stage.

Step 3 – Adding estrace (estrogen)

When: About 1-2 weeks after starting Lupron

What: Estrace (oral estrogen) twice daily

How: Taken by mouth, one tablet in the morning and one at night

Why: Estrogen is crucial for thickening the uterine lining, which helps create an ideal environment for embryo implantation.

At this point, monitoring appointments will check hormone levels and uterine lining thickness. Adjustments to medication dosages may be made based on these results!

Step 4 – First estradiol valerate injection

When: Around the same time as starting Estrace

What: Estradiol Valerate injection (0.2 mL)

How: Injected intramuscularly (into the muscle)

Why: This form of estrogen supports the uterine lining as it prepares for embryo transfer. Unlike the oral version, it provides a slow and steady release into the system.

Step 5 – Reducing lupron, continuing estrogen

As the cycle progresses, the Lupron dosage is lowered, usually to 10 IU per day, before stopping altogether. Estrace continues to be taken twice daily.

Step 6 – Preparing for embryo transfer

When: Around the third week of medication (exact timing depends on the monitoring results)

What:

• Estrace (continuing)
• Estradiol Valerate injections (continuing)
• Progesterone (introduced at this stage)

How:

• Estrace remains oral
• Estradiol Valerate remains intramuscular
• Progesterone is typically given as an intramuscular injection or vaginal suppository

Why: Progesterone is essential for maintaining early pregnancy. It supports the uterine lining, making it receptive for the embryo.

Step 7 – Embryo transfer day

The surrogate continues all prescribed medications as directed. The embryo transfer is performed at the fertility clinic, and after the procedure, the surrogate rests before returning home.

Post-transfer medications

What continues:

• Estrace (estrogen)
• Progesterone (injections or suppositories)
• Prenatal vitamins
• Folgard (folic acid)

These medications help support implantation and early pregnancy development.

Pregnancy test and beyond

About 10-14 days after the embryo transfer, a blood test (HCG Beta) confirms whether implantation was successful. If the test is positive, the surrogate will continue estrogen and progesterone for several weeks. 

More hormone monitoring may be needed to ensure stable levels, depending on the situation.

If pregnancy progresses as expected, medications are usually tapered off around the 10-12 week mark, when the placenta takes over hormone production.

Got more specific questions about meds? Have a read of our guide to the most common fertility drugs right now, created in collab with leading global provider FastIVF.

Your top surrogacy medical process FAQs answered

1. Do all surrogates follow the same medication timeline? No, medication protocols vary depending on the fertility clinic, the surrogate’s individual response, and the needs of the intended parents’ embryo(s).
   
2. Are the injections painful? Subcutaneous injections (like Lupron) use a small needle and are generally well tolerated. Intramuscular injections (like progesterone and estradiol valerate) require a larger needle, but techniques like warming the oil before injecting or using a numbing cream can help ease discomfort.
   
3. How long do surrogates need to take medications? Typically, medications continue until around 10-12 weeks of pregnancy. After that, the placenta takes over hormone production.
   
4. What happens if a surrogate has side effects? Some mild side effects like bloating, headaches, or breast tenderness are common. If a surrogate experiences anything unusual or severe, the fertility clinic should be contacted immediately.
   
5. Do intended parents need to know the medication schedule? While surrogates manage their medication schedules with their medical team, some intended parents like to stay informed. It helps them understand the surrogate’s commitment and the medical aspects of the journey.

The bottom line

Understanding the surrogacy medication timeline can help you feel more prepared and in control, whether you’re considering becoming a surrogate or looking into surrogacy as an intended parent to build your family!

Want to learn more, or start your journey? Reach out to the Pinnacle Surrogacy team today – they’re here to support you through every step.