If there’s one thing that’s for certain, it’s that there are a heck of a lot of medications used when treating infertility. But what about for surrogacy? Given that gestational surrogates are healthy, generally fertile women, it might seem surprising at first thought that serving as a gestational surrogate would require the use of a lot drugs, but in fact it does.
Though each reproductive endocrinologist or fertility center has its own unique medication protocol, they will all include three basic things:
- A way to control the gestational surrogate’s natural cycle (birth control pills and/or Lupron)
- A way to grow the uterine lining (some form of estrogen)
- A way to thicken the uterine lining and nourish the embryo (some form of progesterone)
In more specific detail, these are various drugs a gestational surrogate may use:
Birth Control Pills
When planning for a fresh embryo transfer cycle, the doctor will synchronize the gestational carrier’s menstrual cycle with the intended mother’s (or the egg donor’s, if donor eggs are being used). This is so the surrogate mother’s uterus is ready to receive the embryos once the eggs have been retrieved and fertilized in the lab. The easiest way to synchronize the cycles is with the use of birth control pills.
Many (though not all) fertility specialists use Lupron to shut down a gestational carrier’s natural menstrual cycle. The main reason for this is so that she does not ovulate herself, which would cause the transfer cycle to be cancelled. Lupron is said to create a state of “chemical menopause” and is administered either through daily subcutaneous shots in the belly, or through one large intramuscular injection in the hip that’s effects last for six weeks.
Because the gestational carrier is in chemical menopause, she will need medication to begin building up her uterine lining. There are many different forms of estrogen that may be used – injectable (intramuscular, usually in the hip), oral, or transdermal (skin) patches. Some reproductive endocrinologists prefer to use a combination of methods, such as oral plus patches.
Just like estrogen, the surrogate’s natural production of progesterone has been halted by the use of Lupron, so progesterone is given just before the embryo transfer until near the end of the first trimester. Progesterone thickens and grows the uterine lining so it can nourish the embryo and fetus until the placenta takes over that role. Progesterone is commonly given by intermuscular injection (in the hip), but can also be administered through vaginal suppositories.
This antibiotic (or another similar one) is often used just prior to the embryo transfer to eliminate any bacteria in the uterus or vaginal canal that might affect how the embryo will implant.
Some, but not all, fertility doctors prescribe a dose of Valium just prior to and just after the embryo transfer. It’s thought to keep the uterine muscle smooth and relaxed and thus, increase the odds of implantation.
This mild steroid is sometimes used to prevent or minimize any inflammation in the uterus, thus helping the embryo implant in the uterine lining.
A dose of baby aspirin each day is prescribed by some doctors as a way of thinning the blood. This is thought to provide better circulation to the uterus and developing placenta, thus helping the embryo grow.
Medical protocols change over time as research advances and new treatments are developed. And of course your fertility specialist should look at your gestational carrier as an individual to come up with a medical plan that will maximize her chances of getting and staying pregnant. If she has had problems or concerns with her fertility drug protocol in the past, she shouldn’t hesitate to bring it up – there is often considerable flexibility in the ways the cycle medications can be managed.
Her blood levels of estrogen and progesterone will be tested throughout the early days and possibly weeks of the pregnancy, so adjustments can be made as necessary to ensure the best chances for a sustained and successful pregnancy.
Although it seems like a lot of medications for one person to take, your gestational carrier will be weaned off her fertility drugs before the end of her first trimester, as her body takes over providing everything the baby needs. You can both look at it this way – it’s a short, yet understandably intense time, but it leads up to what you’re both looking forward to- an enjoyable, healthy pregnancy and the birth of your baby!