Course / Medicated vs. Unmedicated Frozen Transfers
1. Natural Cycle (NC-FET)
A natural FET relies on the woman’s (or surrogate’s) own hormonal cycle to prepare the uterine lining for embryo implantation.
No—or minimal—medication is used beyond luteal phase support (typically progesterone).
Process Overview:
Ovulation is tracked via ultrasound and bloodwork (LH surge or follicular monitoring).
The embryo transfer is timed precisely based on ovulation (the release of the egg).
Progesterone may be added to support the luteal phase.
Advantages:
Mimics the body’s natural physiology.
Fewer medications and lower cost.
Reduced exposure to synthetic hormones.
May be psychologically appealing to those preferring minimal intervention.
Challenges:
Requires accurate cycle tracking and frequent monitoring.
Risk of cycle cancellation if ovulation timing is missed.
Not suitable for women/surrogates with irregular or anovulatory cycles.
2. Medicated or “Artificial” Cycle (AC-FET)
An artificial cycle FET uses medication to control and synchronize the uterine lining without relying on the body’s natural ovulation.
This is the most commonly used method for gestational carriers and in surrogacy programs.
Process Overview:
Estrogen therapy (oral, patch, or injection) thickens the uterine lining.
Once optimal lining thickness (≥7–8 mm) is achieved, progesterone supplementation begins.
The embryo transfer is scheduled in alignment with the hormonal “day” equivalent to implantation timing.
Advantages:
Predictable and programmable, ideal for surrogacy coordination.
Suitable for women/surrogates with irregular cycles or PCOS.
Eliminates risk of unexpected ovulation.
Greater scheduling flexibility for both clinic and surrogate.
Challenges:
Involves more medication and monitoring.
Some may experience hormone-related side effects (bloating, mood swings, headaches).
The decision depends on the patient or surrogate’s health profile, hormonal regularity, and the logistics of treatment coordination.
Key clinical considerations include:
Menstrual regularity: Are cycles predictable and ovulatory?
Hormone balance: Is there evidence of luteal phase defect or poor ovulation?
Endometrial response: Does the uterine lining reach optimal thickness naturally?
Logistics: Can daily monitoring and precise timing be coordinated easily?
Medical conditions: PCOS, endometriosis, or thyroid issues often favor medicated cycles.
Surrogacy protocol: For gestational carriers, artificial cycles are standard due to control and synchronization reliability.
At Surrogacy4All, fertility specialists review medical history, lab data, and surrogate readiness to determine which approach maximizes implantation potential while maintaining safety and comfort.
✅ Natural cycles may work best for women with regular ovulation and low intervention preferences.
✅ Medicated cycles are preferred in surrogacy, PCOS, or irregular cycles due to control and predictability.
✅ Endometrial receptivity analysis (ERA) can fine-tune progesterone start timing for either method.
✅ Always monitor lining thickness, hormone levels, and endometrial pattern before confirming transfer readiness.
✅ Success rates are comparable between both methods when properly managed.
FET cycles often bring emotional stress, especially during waiting periods.
Even though the surrogate or intended mother may not be undergoing stimulation, the anticipation of transfer success can heighten anxiety.
Clinically proven methods for anxiety reduction:
Mindfulness and relaxation therapy – lowers cortisol, improves hormonal balance.
Acupuncture – promotes blood flow and relaxation.
Sleep hygiene and gentle exercise – regulate stress hormones.
Counseling or support groups – recommended for both surrogates and intended parents.
At Surrogacy4All, psychological wellbeing is integrated into every treatment plan, recognizing that emotional balance supports physiological success.
Some patients ask whether adding additional treatments — hormonal boosters, supplements, or therapies — can enhance FET success.
Evidence shows:
More medication doesn’t always mean better results.
What matters is precision and synchronization, not treatment intensity.
Adding estrogen beyond necessary levels or introducing untested supplements can, in some cases, reduce uterine receptivity.
The best approach is a customized protocol, guided by measurable markers like:
Endometrial thickness
Hormone profiles
Embryo development stage and quality
At Surrogacy4All, fertility teams emphasize evidence-based personalization, not over-treatment
Both natural and medicated FET cycles can achieve excellent outcomes when properly executed.
| FET Type | Pregnancy Rate | Live Birth Rate | Notes |
|---|---|---|---|
| Natural Cycle FET | 50–65% | 45–60% | Best for ovulatory women, fewer medications |
| Medicated (Artificial) FET | 55–70% | 50–65% | Preferred in surrogacy; highly controlled conditions |
Key determinants of success include:
Embryo quality (especially PGT-A-tested blastocysts)
Uterine environment
Clinical skill during transfer
Surrogate or patient health
For women with Polycystic Ovary Syndrome (PCOS), hormonal imbalances can disrupt endometrial development and ovulation.
Acupuncture benefits include:
Stabilizing LH and FSH balance
Improving blood flow to the uterus
Supporting ovulation and endometrial response
Reducing anxiety and cortisol during treatment
Integrating acupuncture within a controlled FET protocol (usually medicated) can enhance physiological readiness and emotional stability.
Even though FET involves previously created embryos, addressing male factor infertility during the IVF phase is critical.
Acupuncture for male partners has shown benefits such as:
Improved sperm motility and morphology
Reduced oxidative stress and DNA fragmentation
Enhanced sperm quality before fertilization, which may improve embryo viability
While this occurs prior to embryo freezing, it remains a valuable adjunct in optimizing overall cycle success.
Endometriosis can impair implantation through inflammation and altered uterine environment.
Acupuncture in endometriosis patients may:
Reduce pelvic inflammation and pain
Regulate immune response and uterine contractility
Improve blood flow and endometrial receptivity
Lower stress levels during hormonal treatment
When integrated into a medicated FET cycle, acupuncture can complement medical management and help create an optimal uterine environment.
✅ For gestational carriers, medicated FET cycles are the safest, most controllable approach.
✅ Always confirm endometrial thickness ≥7mm and a triple-line pattern before scheduling transfer.
✅ Use ERA testing if prior transfers failed to fine-tune progesterone timing.
✅ Encourage relaxation practices, including acupuncture or guided meditation.
✅ Remember: Synchrony, not stimulation, determines FET success.
Our job is to listen, to connect the dots between your needs, and to determine how we can best help you have your baby. If you’re asking how much does it cost for a surrogate, we’ll walk you through every step of the process to ensure there are no surprises.
To make an appointment with one of our counselors or physicians, please call (212) 661-7673 or email info@surrogacy4all.com. We look forward to hearing from you.
Surrogacy4All is a unique international surrogacy service targeted at providing state of the art IVF and surrogacy services to Intended Parents irrespective of age, sex or color, at the lowest possible cost in the world.
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