How Long Does the Surrogacy Process Take?
“How long does the surrogacy process take?” is a question we get from everyone—both surrogates and intended parents want to know. The best guess I can give you in 18-24 months, but keep in mind that it can take much longer—even several years in some circumstances.
So what goes into that 18-24 month timeframe? You can expect the following phases in a surrogacy journey:
· Making a batch of embryos at the IVF clinic
· Screening of the surrogate (background check, screening interview, psychological screening, and medical screening)
· Legal Contracts
· Embryo Transfer
· Pregnancy
· Delivery
· Postpartum recovery for the surrogate
As you can see, that’s a lot of steps to get through, and the journey isn’t over when the baby is born. The 18-month timeframe assumes that sufficient PGS normal embryos are formed with the first in vitro fertilization attempt and that it takes only one embryo transfer to get pregnant. While this is the scenario we all hope for, some intended parents and surrogates run into obstacles that make the process longer?
What are some reasons that the process can take longer?
Well, one frequent reason is that making sufficient embryos is more difficult for the intended parents. This can be because the intended mother has a poor ovarian reserve and must go through repeated egg retrieval cycles. Or, similarly, the intended father may have poor sperm quality, and repeated fertilization attempts (with associated egg retrieval cycles) are required. Or maybe one of the intended parents is a carrier for a serious genetic disease, and the resulting embryos must be screened to be sure they are free from this disease; in such a situation we know that a significant number of embryos will have to be discarded so more egg retrievals may be required. In addition, when intended parents are using an egg donor, the process of finding a suitable egg donor and scheduling an egg retrieval cycle with her can be lengthy, especially if the intended parents are picky (and, by the way, it’s 100% OK to be picky about your egg donor so don’t let that dissuade you from finding the right egg donor for you!). If the egg donor has a summer internship and cannot cycle for a few more months, you may just have to wait it out.
Another reason that the process can take longer is that the surrogate is asked to undergo additional screening by the reproductive endocrinologist. Perhaps there is a question raised by the surrogate’s standard screening, or by her obstetrical history with her own pregnancies. Or maybe the intended parents have a limited number of embryos and cannot make more. This would happen, for example, if the intended mother had her eggs retrieved before undergoing chemotherapy for cancer, or perhaps the intended mother’s age makes it impossible to make more viable embryos. Whatever the reason, the reproductive endocrinologist (that’s the IVF doctor) may want to make sure that everything is perfect with the surrogate’s body before the embryo transfer, because there’s no opportunity for a do-ever.
Or perhaps something came up on the medical screening that needs to be corrected before the embryos transfer. The surrogate may have had several spontaneous pregnancies without a problem, but now the IVF doctor finds a uterine polyp and wants to remove it.
Another reason for delays in the process is that the surrogate’s body doesn’t respond to the medications as expected. For example, her uterine lining may not develop a nice, thick triple stripe appearance. It may take several attempts at adjusting medications to get the lining just right. Or perhaps the surrogate just doesn’t get her menstrual cycle when expected and everyone just has to wait that out.
Repeated failed embryo transfers can also make your surrogacy journey longer. Each FET cycle can easily be three months or more. Similarly, a miscarriage can add to the process, because the surrogate’s body must return to baseline before more embryo transfers can be attempted. (Side note: having PGS tested embryos can make things easier for everyone with fewer failed transfers and miscarriages).
For intended parents, having to rematch with another surrogate can also extend your timeline. Perhaps your IVF doctor recommends a different surrogate or your first surrogate had awful reactions to the medications and feels she cannot do it again. Less commonly, surrogates may request a rematch if the intended parents are unable to move things along quickly enough (such as if they need to make more embryos but are having difficulty selecting an egg donor.
Also, insurance issues can impact the time frame. Perhaps more embryos are needed, but the intended parents need to wait for open enrollment at work to sign up for IVF friendly health insurance. Or maybe the surrogate will need an Affordable Care Act (ACA) marketplace plan, and everyone has to wait for yearly open enrollment to get her insurance coverage in place.
And, oh yeah, cannot forget about COVID-19. Many egg retrieval and embryo transfer cycles were canceled at the beginning of the pandemic. Everything was just put on hold for several months at IVF clinics. No one can promise that another shutdown won’t happen.
I know it’s frustrating. I know it’s hard. I know it just plain sucks, but there are a lot of steps in the surrogacy process and it’s best to have realistic expectations to get through this lengthy (but immensely satisfying) journey.