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A Surrogate’s Journey: GC Alicia Talks Pre-Transfer and Monitoring

Written by Alicia Gruber, a proud mom, Milspouse, 2x gestational surrogate, and active surrogacy educator and advocate.

If you’re new to surrogacy, you probably have a lot of questions. I know I did! The first thing to know is that there is so much more to surrogacy than just stuffing an embryo up there and hoping for the best. It’s all about the preparation. And monitoring. LOTS of monitoring.

Leading up to your IVF transfer, be prepared for an abundance of ultrasounds, blood draws, daily injections, traveling, plus email and phone communications.

The amount of energy, blood, tears and love that go into making a healthy embryo a healthy baby is unexpected by most. 

The chain of events leading up to transfer date varies from clinic to clinic. The story typically begins with the start of your monthly bff – Aunt Flow. Under normal circumstances, most women dread getting their period. As a surrogate, you look forward to it because that means you are actually starting the big parts of the journey. Ironically, it is very common to have a late period due to being in such anticipation of it. Annoying right?

For my clinic, (Pacific Fertility Center – LA) I start injections of Estradiol (estrogen) every three days starting the day after my period day number one. Estradiol helps support natural estrogen by assisting in thickening the lining to be ready for implantation.

Transfers at PFC are typically done 19-21 days after the start of your period. About one week before the transfer is the first of many appointments called monitoring appointments. These appointments are at satellite clinics near your home that report results back to your primary fertility clinic. 

At the first monitoring session, they will draw blood to check a few different hormone levels. First, they check HCG to make sure you aren’t currently pregnant, trust me it happens. Second, they check progesterone. Ideally, less than .9ng/mL (nanograms per milliliter) is preferred to confirm your body is in pre-ovulation. The last blood test may vary based on your specific med schedule. In my situation, they test my estradiol levels. Every case is different so my primary RE reviews the results to make sure the number is what they are looking for to move forward. 

Next stop on the monitoring appointment tour is the ultrasound! Because the ultrasound tech needs a good look at your uterus, they are going to use a vaginal wand instead of a handheld device. If you’ve never had a trans-vaginal ultrasound not to worry. It is far less uncomfortable than the normal pap smear with the metal tool that looks and feels like a cold duckbill. 

There are two main things they want to confirm during this ultrasound: the thickness of your lining and that it is “triple-striped”.  The thicker your lining, the better the chances are the baby will implant comfortably. Lining should be at least 6mm, but ideally 7-9mm for the best chances of supporting a successful pregnancy. 

Now we get to the striping. This is the term people know the least about. The term triple-striped is referring to the structure of the uterine lining. A tri-laminar lining is the most receptive. A tech will see three lines stacked on top of each other. For the untrained eye, I can almost guarantee you no matter how much you squint and cock your head to the side, you won’t be able to see stripes from circles on the monitor. I have been through three monitoring appointments and still don’t know up from down until there’s a baby in there. 

Some techs will tell you what they are looking at, others won’t. They will all send your results to your main fertility clinic who then will let you know how to proceed. The waiting for the results is dreadful! Try and keep busy to keep your mind off of it. Having already been through the med screening, I am sure you have learned by now it won’t be the last time you play the game of ‘hurry up and wait’.

Surrogacy is full of new terms and medical procedures, but don’t let the big picture discourage you. Take one appointment at a time, ask as many questions as you can think of and enjoy the journey with your IP’s! You are making a family and there is no greater gift than that.

Be sure to follow @FamilyInceptions on Facebook and Instagram and @GuberAlicia on Instagram to follow along with Alicia’s surrogacy journey!

Interested in learning more about surrogacy from real surrogates and intended parents? Join one of our Facebook groups and join the conversation.


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Eloise Drane
Eloise Drane, Founder

"I believe that we are all placed on this earth for a purpose. Each one of us has a specific calling in this world and although it is different for everyone, we are here to serve one another. My purpose is to help women who wish to become surrogates and egg donors and the hopeful parents who wish to partner with them. I feel very lucky to be living my purpose."