What Hormones Are Used in Surrogacy and How Do They Affect You? — A Doctor’s Insight

By Dr. Naman Arya, MD, MPH, MSHCM

Reproductive Endocrinology and Infertility Division at Surrogacy4All.

Introduction

As a physician specializing in reproductive health, one of the most common concerns I hear from potential surrogates is about hormone treatments, what they are, how they work, and how they might affect their body and emotions. It’s a great question, and the more informed you are, the better equipped you’ll be to take this journey with confidence.

In this blog, I’ll Walk you through the types of hormones commonly used in surrogacy, their purpose, their side effects, and how they fit into the overall IVF process. We’ll follow the latest guidance from the American Society for Reproductive Medicine (ASRM) and U.S. Food and Drug Administration (FDA) protocols, and include real surrogate experiences for a grounded, relatable perspective.

1. Why Are Hormones Necessary in Surrogacy?

In gestational surrogacy, the surrogate carries a baby that is not biologically hers. Because the embryo is created using the intended parents’ or donors’ egg and sperm, the surrogate’s body must be carefully prepared to accept and nurture this embryo.

Hormone therapy helps to:

• Suppress natural ovulation
• >Build and maintain the uterine lining
• Create an optimal environment for embryo implantation

2. Common Hormones Used in Surrogacy

A. Lupron (Leuprolide Acetate)

Purpose: Suppresses the body’s natural menstrual cycle to allow full control over timing.
How It’s Administered: Subcutaneous injection

Possible Side Effects:

• Hot flashes
• Mood swings
• Headaches
• Temporary menopause-like symptoms

Doctor’s Note: Lupron use is temporary and stops before embryo transfer. It’s used to prevent premature ovulation and ensure synchrony with the embryo transfer schedule.

B. Estrogen (Estradiol)

Purpose: Thickens the uterine lining to make it receptive to the embryo
Forms: Oral tablets, transdermal patches, or intramuscular injections

Side Effects:

• Nausea
• Breast tenderness
• Water retention
• Mood changes

Duration: Often started 10–14 days before embryo transfer and continued until 10–12 weeks of pregnancy

Real Surrogate Experience — Tanya, 31, New Jersey: “The estrogen patches were easy to use, and I just kept a chart to remember when to switch them out. I did have some mood swings, but staying active helped me balance things out.”

C. Progesterone

Purpose: Supports the uterine lining and maintains early pregnancy
Forms: Intramuscular injections, vaginal gels or suppositories

Side Effects:

• Fatigue
• Bloating
• Soreness at injection sites
• Emotional sensitivity

Doctor’s Insight: This is the most crucial hormone post-transfer. It mimics what the body naturally produces in a regular pregnancy to support the embryo.
Duration: Usually continued until around the 10th–12th week of pregnancy

D. Doxycycline or Medrol (Optional)

While not hormones, some clinics prescribe these medications as part of pre-transfer prep.
⦁ Doxycycline: An antibiotic to prevent infection
⦁ Medrol (Methylprednisolone): A steroid used briefly to reduce inflammation and support implantation

Side Effects: Minimal and short-term; include digestive upset or changes in appetite

3. Emotional and Psychological Effects of Hormones

Hormones influence not just your body, but your mood and energy levels. Many surrogates report following feelings:

⦁ More emotional or tearful
⦁ Anxious or mentally foggy
⦁ Irritated or overwhelmed

Why This Happens: Hormones are powerful chemical messengers. When administered at levels much higher than normal, they can impact the brain’s mood-regulating centers.

How to Cope:

⦁ Communicate with your care team
⦁ Prioritize sleep and nutrition
⦁ Practice gentle exercise like walking or yoga
⦁ Consider talking with a therapist or support group

Real Surrogate Experience — Jessica, 36, Texas: “I was surprised how emotional I got during the hormone phase. My agency connected me with a counselor who helped me ride the wave and keep perspective.”

4. Monitoring and Adjustments

Throughout your cycle, your hormone levels and uterine lining will be monitored via blood tests and ultrasounds. Your fertility doctor may adjust dosages or switch medications depending on how your body responds.

Monitoring Ensures:

⦁ Adequate endometrial thickness (typically 7–12mm for embryo transfer)
⦁ Proper hormone levels (especially progesterone post-transfer)
⦁ Early detection of side effects or complications

Tip: Keep a written or digital log of medication schedules, symptoms, and how you’re feeling. This helps your care team optimize your protocol.

5. After Embryo Transfer: What Happens to Hormones?

Once the embryo has been implanted, the goal is to sustain early pregnancy. The placenta will eventually take over hormone production, but until then, your body relies on supplementation.

Transition Period:

⦁ From weeks 6–12 of pregnancy, your body begins producing its own estrogen and progesterone
⦁ Hormone support is gradually tapered off under doctor supervision

Doctor’s Insight: Stopping hormone treatment too early can lead to pregnancy loss, which is why strict adherence to the protocol is vital.

6. Are There Long-Term Effects of Hormone Use?

Most women tolerate fertility hormones well, and long-term risks are minimal when used responsibly.

FDA and ASRM Findings:

⦁ No evidence links short-term hormone use in surrogacy to cancer or permanent hormonal disruption
⦁ Some may experience lingering fatigue or temporary menstrual changes post-treatment

Doctor’s Recommendation: Always report unusual symptoms after treatment ends. Follow-up visits help ensure a smooth recovery.

7. Final Thoughts: Empowerment Through Educatio

Understanding how hormones work and what to expect is empowering. While there can be challenges, most surrogates find the hormone phase manageable with the right support.

If you’re considering surrogacy, know that you won’t go through this process alone. As your physician, I’m here to guide, monitor, and support you every step of the way.

Real Surrogate Story — Asha, 33, Illinois: “The injections were tough at first, but I just reminded myself why I was doing it. Seeing the look on the intended parents’ faces when they heard the heartbeat made it all worth it.”