When a pregnancy is conceived naturally, the body produces a variety of hormones to help prepare the uterus for conception, maintain the pregnancy, and help the embryo grow and develop. To achieve a successful surrogate pregnancy, this process needs to be recreated in the surrogate’s body using supplemental hormones and other medications.

Throughout your surrogacy experience, you will likely be prescribed a variety of medications to coordinate and control your cycle and ensure your uterus is ready for the embryo transfer at the exact right time. These medications help maximize the chances of a successful pregnancy.

The exact course of medication that you will need to take during the surrogacy process will vary based on a number of factors, including your individual needs, a clinic’s protocol,  and the circumstances of your surrogacy. Remember to always take all medications as directed by your doctor and discuss any questions you have about your course of treatment with your doctor or pharmacist.

Doxycycline

Doxycycline is an antibiotic that fights bacteria in the body. You (and your partner, if applicable) may each be prescribed this pre-cycle antibiotic early in your surrogacy journey to treat any possible low-grade pelvic infection that may exist. Doxycycline is an added precaution that ensures you are healthy and ready for the surrogacy cycle. It may also act as an anti-rejection tactic to ensure your body accepts the embryo when it is implanted.

Doxycycline is generally taken as an oral tablet. It may be administered for a brief period before the embryo transfer and again after the transfer. Most women will not experience side effects with doxycycline, but this may vary by individual.

Lupron

Lupron prevents your natural cycle from interfering with the surrogacy process by inhibiting the secretion of hormones that control your cycle. Lupron temporarily “shuts down” the ovaries to prevent premature ovulation, giving your reproductive endocrinologist complete control over your cycle. Lupron is usually used in conjunction with birth control pills to synchronize your cycle with the intended mother’s or egg donor’s cycle prior to the embryo transfer. You will usually begin taking Lupron about 14 days after starting birth control, and your dosage will likely decrease when your menstrual cycle starts. You will discontinue Lupron completely in the days before the egg retrieval is performed for the intended mother or egg donor.

Lupron is usually self-administered by injection using a ½ inch needle. Lupron is generally well-tolerated, but some side effects of Lupron may include headache, fatigue, and hot flashes.

Estrogen

Estrogen is a hormone naturally produced by the ovaries to thicken the uterine lining and help maintain an early pregnancy. You will take estrogen early in your cycle in the form of birth control pills to help coordinate with the intended mother’s or egg donor’s cycle. You will also begin taking estrogen replacements about halfway through your use of Lupron and will continue through the 12th week of pregnancy when the placenta takes over hormone production. These hormone supplements help replace the natural hormones that were suppressed while on Lupron so that you can maintain any pregnancy that occurs.

Estrogen may be administered by oral tablet, suppository, injection or a patch applied to the skin on the abdomen. Side effects may vary depending on the form of the estrogen supplements. Women who use the patch may experience skin redness, irritation, nausea, or fluid retention. Estrogen administered by an oral tablet or suppository may cause bloating, nausea, or breast tenderness. Weight changes, headache, stomach upset, and cramping are other possible side effects.

Progesterone

Progesterone is the hormone produced by the ovaries after ovulation. Once the uterine lining reaches the ideal thickness, you will begin taking progesterone replacements to further prepare the uterus for embryo implantation. This hormone signals the uterus to begin producing the proper nutrients to support the embryo. You will start taking progesterone in the days prior to the embryo transfer and continue until the 12th week of pregnancy to help maintain a stable pregnancy.

Progesterone may be administered through suppositories, gels, or pills, but it is usually administered by intramuscular injections. These injections use a larger needle than is used for the Lupron injections and generally need to be administered by a nurse or at home by a spouse or partner. Side effects of progesterone may include bloating, irritability, and tenderness of the injection site, breast tenderness, vaginal discharge, and dizziness.

Aspirin

You may need to take a daily low-dose aspirin to assist with cycle stimulation. Aspirin has been suggested to improve implantation rates and pregnancy in women undergoing in vitro fertilization and is generally used during the first 12 weeks of pregnancy.

Aspirin is taken as an oral tablet. Aspirin’s side effects are usually minor but may include upset stomach, heartburn or easy bruising.

Tetracycline

Tetracycline is an antibiotic taken a few days prior to the embryo transfer to prevent infection and subsequent rejection of the embryo. Tetracycline is taken as an oral tablet, and side effects may include minor stomach upset and sensitivity to the sun.

Medrol

Medrol is a low-dose steroid that is used to suppress the autoimmune system and increase the chance of successful embryo implantation. Medrol is taken as an oral tablet. Most women will not experience side effects from taking Medrol.

Prenatal Vitamins

Finally, your doctor will likely have you take prenatal vitamins before the transfer and throughout your pregnancy. These vitamins ensure that you and the baby are getting the proper nutrients and encourage healthy growth and development for the baby. Prenatal vitamins can be taken orally. While taking prenatal vitamins, you may experience mild constipation, diarrhea, nausea or upset stomach.

Remember that every woman is different. Not every surrogate will take the same dose of the same medication at the same time during the surrogacy process. Your exact course of treatment will vary depending on your individual needs. Always listen to your body and follow your medical professional’s instructions to keep yourself and the baby healthy and to ensure a successful surrogate pregnancy.