What if My Surrogate’s Embryo Transfer Doesn’t Work?
So, your surrogate had her beta test and it came back negative. What happens next?
Well, first you cry, maybe throw some (preferably soft) things, hug the cat, snuggle the dog. Take care of yourself (and the same advice goes for your surrogate, too). And after that, you try again with another embryo transfer.
Surrogacy contracts commonly provide for three embryos transfer attempts before you call it quits with your match. But there’s a lot of variation here, so be sure to check your contract or talk to your surrogacy lawyer.
If there are more frozen embryos ready, you can generally move on to the next embryo transfer as soon as your surrogate’s body is ready. Your reproductive endocrinologist (“RE”) can help you figure out the timing, but think a couple of months. This also gives your surrogate’s body a break from feeling like a pincushion (as intended mothers know, all those injections can take a toll on your body). You may also have scheduling issues with regards to your surrogate having transfer blackout dates so that can impact your scheduling too.
If your embryos are not PGS tested, now is the time to think about whether you want to do that in preparation for your next transfer. Have this talk with your IVF doctor.
Your doctor may or may not want to change things around for the next embryo transfer. Maybe your surrogate’s lining wasn’t optimal, so your doctor might like to make some medication protocol changes. Maybe an additional test like an endometrial receptivity test (ERA) is called for. Or your doctor may just chalk it up to “bad luck” and recommend doing the exact same medication protocol in preparation for your next embryo transfer. We’ve seen all of these options used for surrogacy.
So when everything is ready, you give embryo transfer another go. Hopefully with better results the next time around. Sometimes, however, it’s not that easy.
Perhaps the intended parents have run out of embryos and need to make more. Unless you are using frozen eggs, this can take several months. Then you have to add in the time it takes for PGS testing on these embryos, which means the surrogate won’t be able to start meds until the PGS test results come back. Another delay factor is that the intended mother may need to undergo several rounds of egg retrievals in the IVF process to make a big enough batch of embryos to justify spending the money on PGS testing. So now, you’ve got some additional potential delays before you can get to the next embryo transfer.
While PGS testing itself can be completed relatively quickly, if the intended parents need PGD testing to screen for a specific disease (like cystic fibrosis) this can take longer. So add in some extra waiting if PGD is needed.
If the intended parents need to use a donor to make more embryos, the process can take longer because you now have to search for a donor and schedule the donation cycle. It takes some parents a considerable time period to find a donor. Some intended parents just have a hard time selecting an egg donor, for personal reasons. And when you’re working with an egg donor, her body’s menstrual cycle and her personal schedule for work and school need to be accommodated, too. If you are working with a known sperm donor, his availability has to be taken into account. This can create lengthy delays before the embryos can be made.
The good news is that anonymously donated frozen eggs (or sperm) are quicker alternatives. With a frozen donor egg cycle, you can have 5 day blastocysts ready 6 days after purchasing the eggs—it doesn’t get any faster than that. This is a decision that the intended parents need to make—as a surrogate, you don’t really get a say in it.
What you do have a say in, as a surrogate, is deciding how long you are willing to wait. Generally, we recommend that this be thought through before a match is finalized, so everyone can have fair expectations of the process. Contracts can then specify what exactly is going to happen if the intended parents need to make more embryos. In some cases, a monthly hold fee can paid to the surrogate to compensate her for waiting. In other cases, everyone will decide they will part ways if the first (or second) embryo transfer doesn’t work because the intended parents and surrogate’s expectations of the future timeline are not in sync.
Sometimes the IVF doctor will recommend a change in surrogates. This rarely happens after one failed embryo transfer, but we have seen it following two failed transfers. Most contracts provide for this possibility and everyone can then go on their way to rematch with someone else. And after three failed embryo transfers, rematching is the most common solution. And, as a surrogate, you may be ready to rematch right away, or you may need some time in between matches—either way it’s your choice and you agency shouldn’t push you to move forward before you are ready.
One other thing I want to mention is that intended parents can experience a wide variety of feelings after a failed transfer, including feelings of hopelessness, which may cause them to with distance themselves from their surrogate. Please understand that many intended parents have been through years of failed fertility treatment, and went into surrogacy hoping that finally something would work. Along with this history, intended parents have spent substantial money on fertility treatment and still don’t have a baby. Therefore, I recommend that surrogates not take this personally when the intended parents emotionally pull back. Don’t assume they are blaming you. But please reach out to your agency to help you navigate your relationship with your intended parents at this difficult time.
I know that I have given you a lot of depressing information. I want to leave you on a positive note. It often takes 2 or 3 embryo transfers to get a viable pregnancy. So don’t let a failed embryo transfer leave you thinking “it’s never going to work”. As surrogacy professionals, we often see success come on the second or third try. And the surrobabies are definitely worth the wait.