Medical note: This page is educational only and is not medical advice. Eligibility, medications, testing and follow-up depend on the fertility clinic and the individual's health history.
Medical screening and counseling
ASRM recommends a complete medical evaluation before a gestational carrier is accepted, including preconception counseling, medical history, physical examination, infectious-disease screening and review of relevant pregnancy history. Psychological evaluation and counseling are also part of recommended screening.
Uterine evaluation
ASRM highly recommends evaluation of the uterine cavity, for example with a saline-infusion sonogram or another appropriate modality chosen by the treating clinic.
Legal clearance before treatment
ASRM recommends that the legal agreement and legal-clearance documentation be completed before treatment begins. The fertility clinic and attorneys should confirm the exact sequencing for the specific journey.
Cycle preparation
The clinic may use hormonal medication to prepare and synchronize the endometrium for embryo transfer. The exact protocol can differ substantially by clinic and patient and may include estrogen, progesterone or other medications, with ultrasound and blood-test monitoring as appropriate.
Embryo transfer
Embryo transfer is performed by the fertility clinic using its own protocol. ASRM strongly recommends single-embryo transfer in gestational-carrier cycles because multiple gestation increases obstetric risk.
Pregnancy confirmation and follow-up
After transfer, the clinic determines the timing of pregnancy testing, repeat laboratory testing and early ultrasound. There is no single schedule that should be treated as universal. Once the clinic considers the pregnancy ready for routine obstetric care, care may transition to an OB or maternal-fetal-medicine team depending on the circumstances.
Medical autonomy
ASRM's ethics guidance states that the gestational carrier remains the source of consent for her own medical care throughout embryo transfer, pregnancy, labor, delivery and aftercare.
Questions to ask the fertility clinic
- Which screening tests and records do you require?
- How will the uterine cavity be evaluated?
- What medication protocol do you expect to use?
- When is legal clearance required?
- What embryo-transfer policy do you follow?
- How and when do you transition care to the obstetric provider?
Related guides
Surrogate requirements · BMI requirements · Surrogacy risks · Legal considerations