Medical Process of Surrogacy: A Complete Guide for Intended Parents in 2026

1. What Surrogacy Is from a Medical Perspective
2. Stage 1. Medical Screening: Comprehensive Evaluation Under Strict Standards
3. Stage 2. Embryo Creation: IVF, ICSI, PGT-A and PGT-M
4. Stage 3. Endometrial Preparation: Synchronization Is Everything
5. Stage 4. Embryo Transfer: The Critical 20 Minutes
6. Stage 5. Confirmation and Early Pregnancy Monitoring
7. Stage 6. Prenatal Care and Monitoring 

Surrogacy is not a choice among several options, but often the only path to the birth of a genetically related child. Recurrent pregnancy loss, hysterectomy, severe systemic diseases, or diagnoses in which carrying a pregnancy poses a direct threat to the mother’s life are precisely the situations in which families begin to understand how this method works from the inside. Let us examine it in more detail: from the first screening to hospital discharge.

What Surrogacy Is from a Medical Perspective

In gestational surrogacy, the surrogate mother (gestational carrier) carries a child without any genetic connection to it – the embryo is created from the material of the intended parents and/or donors and transferred into a prepared uterus. This fundamental distinction makes the method legally protected and predictable. It is available to married couples, single parents, and same-sex families – provided that the program is conducted in a country with clear legal regulation.

It is important to understand: the surrogate mother is not the biological mother of the child in either a genetic or legal sense. She provides the uterus – and only that. This is not a metaphor, but a medical and legal fact established in the legislation of countries where surrogacy is legal.

Stage 1. Medical Screening: Comprehensive Evaluation Under Strict Standards

No reliable, legally operating surrogacy program begins without a full-scale medical assessment of all participants. This screening determines the prognosis and conditions under which the program will proceed: whether donor oocytes will be required, or whether the intended mother’s oocytes are of sufficient quality to create healthy embryos; whether donor sperm is needed, or whether a short course of andrological treatment can improve sperm quality from the intended father. All of these factors also influence the overall cost of the reproductive program.

The surrogate mother undergoes a full gynecological evaluation, including pelvic ultrasound, assessment of uterine anatomy, and hysteroscopy to exclude polyps, adhesions, and other intrauterine pathologies. In parallel, infectious disease screening is performed according to U.S. Food and Drug Administration protocols: HIV, hepatitis B and C, syphilis, and TORCH infections. The first stage is completed with psychological testing, which evaluates motivation, emotional stability, and readiness for the program without psychological harm. A candidate who is medically perfect but fails psychological screening is not admitted to the program.

Intended parents undergo genetic carrier screening for hereditary diseases, while the reproductive endocrinologist develops an individualized protocol based on the combined results of all diagnostics.

Below is a complete checklist of examinations performed for all participants in accordance with international protocols:

Screening is the foundation of the entire program. The more thoroughly it is performed at the start, the fewer unexpected complications arise during the process, and the higher the overall chance of success.

Stage 2. Embryo Creation: IVF, ICSI, PGT-A and PGT-M

The central component of the medical surrogacy process is in vitro fertilization (IVF). A reproductive specialist performs ovarian stimulation in a donor or the intended mother, followed by follicular puncture (egg retrieval) and fertilization using the ICSI (intracytoplasmic sperm injection) method, in which a single sperm is injected directly into an egg. This significantly increases the likelihood of fertilization even in cases of reduced sperm quality. The resulting embryos are cultured under laboratory conditions until the blastocyst stage – day 5-6 of development – when their structure and viability can be assessed with much greater accuracy.

If the intended mother’s own oocytes are not suitable for medical reasons, donor eggs are used in the program. Donors are selected according to strict criteria, including phenotype matching, blood group compatibility, and overall health status.

The key standard in 2026 is PGT-A (preimplantation genetic testing for aneuploidy). Before transfer, each embryo is tested for chromosomal abnormalities, and only chromosomally normal blastocysts are eligible for transfer. According to data from the Society for Assisted Reproductive Technology, this reduces the risk of miscarriage by an average of 40–50% and significantly increases the chance of success on the first attempt. In leading clinics, implantation rates of PGT-A-tested embryos reach 60–70%.

In certain cases, when one or both intended parents are carriers of single-gene disorders (such as cystic fibrosis, spinal muscular atrophy, Huntington’s disease, and others), PGT-M (preimplantation genetic testing for monogenic diseases) is applied. Unlike PGT-A, which evaluates chromosome number, PGT-M analyzes specific mutations in the embryo’s genome. This allows the exclusion of hereditary diseases before pregnancy occurs – without the need for invasive prenatal diagnostics or complex decision-making during gestation.

In 2026, the combination of PGT-A and PGT-M is considered the most comprehensive available system for genetic protection of embryos.

Stage 3. Endometrial Preparation: Synchronization Is Everything

In parallel with laboratory work on embryos, the surrogate mother receives a course of hormonal therapy to prepare the endometrium for embryo implantation. Estrogens and progesterone – administered as injections, vaginal gels, or transdermal patches – are introduced sequentially to build an optimal endometrial environment.

The goal is to achieve a thickness of 8-12 mm with a triple-line structure visible on ultrasound. The physician performs a series of control ultrasounds to precisely determine the “implantation window” – a short period of maximal uterine receptivity when embryo transfer has the highest chance of success. Timing at this stage is critical: even a high-quality embryo will not implant in an inadequately prepared endometrium. For this reason, the quality of monitoring directly determines the outcome of the entire program.

Stage 4. Embryo Transfer: The Critical 20 Minutes

Embryo transfer is an outpatient procedure lasting approximately 15-20 minutes, performed under continuous ultrasound guidance. No anesthesia is required; sensations are comparable to a routine gynecological examination.

The modern SET protocol (Single Embryo Transfer) involves transferring only one embryo at a time. This eliminates the risks associated with multiple pregnancies, reduces obstetric burden on the surrogate mother, and improves neonatal outcomes across all key parameters. Remaining high-quality blastocysts are cryopreserved and stored for potential future transfer if needed.

Stage 5. Confirmation and Early Pregnancy Monitoring

On days 10-12 after transfer, the surrogate mother undergoes a blood test for hCG (human chorionic gonadotropin). A rising hormone level is the first objective indicator of successful implantation.

At 6-7 weeks of gestation, an ultrasound is performed to confirm fetal heartbeat. At this stage, most intended parents – often located in another country – receive a video recording and a medical report. Hormonal support continues until the 12th week, when the placenta takes over progesterone production.

Stage 6. Prenatal Care and Monitoring 

Pregnancy is managed according to a high-risk obstetric monitoring protocol. Each trimester includes extended screening: ultrasound with Doppler assessment and biochemical markers. At 9–10 weeks, non-invasive prenatal testing (NIPT) is performed for chromosomal abnormalities, along with standard screening at 12, 22, and 30 weeks of pregnancy. All medical reports are promptly shared with the intended parents.

The process concludes with the birth of a healthy child in the country chosen by the parents. If you want everything to proceed smoothly and under a fixed-price contract, you can contact a program manager via the website and request a free personalized plan tailored to your situation.