I am feeling extremely honored to say that I have had a few emails recently from surrogates very early in the process, or ladies who are considering applying to be a surrogate. Quite of few of those have asked me if I could share some more details with them about how the embryo transfer actually works. I will share with you how things went for me this time. I think it goes without saying that each clinic, each doctor, each nurse has their own way of doing things. So please take this as a personal experience, not a manual for how yours will go.
You probably already have the gist of it from my previous posts. The "tenative transfer date" is usually included on your med calendar. This calendar shows you the planned medical protocol.
Everything is subject to change. Always. You will never know for certain the date and time of the actual transfer until the last minute. There have been plenty of examples of surrogates on the table, knees in the air, still not sure if the transfer would be taking place that day. In fact, I was one of those with my first transfer. For us, it was a matter of logistics. Other times it has to do with embryo quality, or reaching the intended parents to get final approval (if they aren't attending the transfer).
So, you follow your calendar and take all of your medications. You will probably have at least one appointment at a local monitoring clinic (This might be your regular OB, but many of them don't do outside monitoring. My first time, I went to a large hospital's fertility center. This time I am going to a smaller, specialized fertility center in a nearby city). They will do a vaginal ultrasound to check how your uterine lining looks, as well as making sure your ovaries do not look like you're about to ovulate (NOT what you want to happen). They might do blood work, also. My first surrogacy, I had 3 of these checks leading up to the transfer date. In my current journey, I only had one. They might adjust your medications if it seems necessary. After your last monitoring appointment, the clinic where your transfer is taking place will let you know if you are "go" for the planned transfer. Plans will be made for your travel, etc as necessary. It is typical that you will be heading out with a date, but not a specific time. The time is often not scheduled until the day before.
You will have received instructions from your nurse on how to prepare for your transfer. In my experience, transfers were in the morning. I was permitted to eat as normal, but drinking has parameters. I was given a specific time which was my last chance to urinate. From that time until transfer, I needed to drink exactly 1 liter of water, and could not use the restroom until after the transfer. This gives the doctor and nurses an ideal view of the uterus as they use ultrasound to assist in the procedure.
I was also given 1 Valium (only with one of my transfers) and told what time to take it while we were in the waiting room. This is because it relaxes the muscles of and around the uterus, and helps with transfer success. When it's time, the nurse takes you to the room. You undress from the waist down and cover with a sheet. You are put on the table just like you were having a regular women's or prenatal exam. The nurse performs a quick look on the ultrasound to just be sure your bladder is ideally full and she can see what they need to see. Once you are ready, they will bring in the intended parents (if they are coming, and weren't already in the room). The doctor will come place the speculum, same as when you are having a pap. The entire procedure feels much like a pap, and only lasts a few moments longer. Instead of scraping the cervix as in a pap, the doctor will place a catheter through it and into the uterus. They will do a practice run first, making sure they can reach where they want to with no trouble. Then the embryologist will come in. The microscopic embryo is transferred to the doctors catheter tool. He goes back through the catheter, and the embryo is dropped off. You will likely be able to see all of this happening on the screen via ultrasound. I was able to see clearly where the catheter was going and a tiny white dot where the embryo was placed. The doctor will keep everything in place for just a moment as the embryologist goes to a microscope and verifies that the embryo(s) was, in fact, removed from the tool. In that quick moment - you just might have gotten pregnant! The speculum is removed and you can put your feet down, but you'll have to stay lying down for a little bit. Protocols vary a lot. On my recent transfer, a timer was set for 5 minutes. I was allowed to get up and walk to the bathroom right away. I have heard of other ladies have to wait upwards of 30-45 minutes. This is NOT fun (especially the more pregnancies you have already had!) but you will feel SO relieved when you can go pee!
Again, protocols vary quite largely. Some doctors insist on strict bed rest for 24-48 hours. Some just say "Take it easy." My first transfer I was told to be a couch potato for the rest of that day, and have someone else carry my luggage when I flew home the next day. This time, the doctor would have been perfectly ok with me flying home the same day. The intended mother, though, requested we stay a few days before flying home. We were fortunate we could work out the time away to oblige. For the first 24 hours I was restricted from swimming pools or baths, and repeatedly lifting over 25 pounds. Tampons are also a no-no, as well as drinking alcohol, smoking, etc of course - because you now consider yourself pregnant! You are also on 'pelvic rest' at this time. The length of restriction varies by doctor and patient. You may have already been told to abstain from sexual activity prior to the transfer, but you definitely will afterward. This means anything that induces an orgasm is off limits, because the contraction of the uterus could interfere with implantation. This and other restrictions will last until a time determined by your doctor. Sometimes it is until your beta blood test. Sometimes it is longer - until your ultrasound. Sometimes it is extended because you may have some bleeding. There isn't an amount of time I can tell you is the same for everyone.
Two Week Wait:
The standard time between the transfer and your first blood test is around 12 days. Those who have been through it dread the "Two Week Wait". It is so hard to keep your mind off of that test! Once you reach that point, it's just a blood draw.
They will check for hcg hormone indicating pregnancy, as well as your estrogen and progesterone levels. If the test is positive, it is possible they will send you for at least one repeat test. This is to make sure the hcg levels are increasing, indicating the embryo is developing. If anything was high/low, your hormone medications may be adjusted. You will remain under the supervision of the RE (reproductive endocrinologist - doctor who performed the transfer) until roughly 10-12 weeks. At that point you are 'released'. You are weaned off of medication. That doctor is no longer involved in your care at all. You will begin seeing your OB, etc for regular prenatal care. You are not considered high risk simply because you've had an embryo transfer and/or are a surrogate. Unless other complications arise, you can now enjoy a (anything but!) normal pregnancy. Congratulations!