If there’s one part of the surrogacy journey that makes people nervous before they’ve even applied, it’s the medications. The word “injections” tends to do a lot of heavy lifting in that worry, and it’s completely understandable.
Most gestational surrogates take medications before an embryo transfer to prepare the uterus and support an early pregnancy. Depending on the fertility clinic’s protocol, this may include estrogen, progesterone and, in some cases, medications such as Lupron. While some protocols involve injections, others rely on tablets, patches or vaginal medications.
Here’s the reassuring part: for most surrogates the medications are predictable and temporary, and thousands of women go through them every year, including plenty who were genuinely needle-shy to start with. This guide is a plain-English overview of the kinds of medications you may come across, what they’re generally used for, and how surrogates often describe the experience, so the whole thing feels less unknown before you begin.
A quick but important note. NewGen Families is a surrogate matching agency, not a medical provider or fertility clinic. Nothing here is medical advice, a protocol, or a substitute for professional guidance. Every surrogate’s medication plan is prescribed and managed by the intended parents’ IVF clinic and their medical team, and your own instructions always take precedence over anything you read online, including this article. If you have a medical question, your clinic is the right place to ask.
What medications do surrogates take?
Most gestational surrogates go through what’s called a frozen embryo transfer, or FET. The embryo already exists, frozen and waiting, so the medications generally aren’t about creating eggs. Instead, they’re typically used to help prepare the body to receive the embryo and to support an early pregnancy.
Clinics design their own protocols, so no two are identical, but the medications a surrogate encounters often fall into three broad categories.
Suppression medications
Before anything else, a clinic usually wants the cycle to be predictable and on a controlled schedule. This stage can involve short-term birth control pills to line up the timing, and sometimes a medication like Lupron (leuprolide), a small injection that temporarily quiets the body’s natural hormones so the clinic can prepare the lining deliberately. Not every protocol includes this stage; some clinics use lighter or “natural cycle” approaches, particularly for surrogates with regular cycles.
Estrogen
Estrogen (often estradiol) is commonly used to help thicken the uterine lining in preparation for the embryo. Depending on the clinic, it may come as oral tablets (such as Estrace), skin patches, or an injection (such as Delestrogen). Surrogates typically take it for a couple of weeks, with monitoring appointments along the way.
Progesterone
Progesterone helps signal the body to support a pregnancy, and it’s the medication surrogates tend to ask about most. It usually begins a few days before transfer and, in a pregnancy, often continues into the first trimester until the placenta takes over. Common forms include progesterone in oil (PIO), an intramuscular injection, and vaginal suppositories or gels such as Endometrin or Crinone. Some clinics use one, some use a combination.
Surrogacy Medications at a Glance
| Medication | Why it’s used | How it’s taken | Typical timing |
|---|---|---|---|
| Birth control | Cycle scheduling | Tablet | Before treatment |
| Lupron | Hormone suppression | Small injection | Before estrogen |
| Estrogen | Build uterine lining | Tablet, patch or injection | Before transfer |
| Progesterone | Support implantation | Injection or vaginal medication | Before and after transfer |
Do surrogates have to do injections?
This is the question behind the question for a lot of women, so here’s an honest, general answer: it depends entirely on the clinic’s protocol, but many surrogates do at least some injections.
Two things tend to reassure people.
Many of the injections are small
Medications like Lupron are often given as a subcutaneous injection, meaning a short, fine needle into the fatty tissue just under the skin, similar to what people with diabetes use. Surrogates commonly describe these as a quick pinch and little more.
Protocols have evolved
Fertility medicine keeps changing, and some clinics now rely on vaginal progesterone or lighter-medication cycles that involve fewer injections. If needles are a real worry for you, it’s a very reasonable thing to raise early, and your NewGen coordinator can help you talk it through with the people who’ll actually be setting your plan: the clinic.
Progesterone in oil: what surrogates often say about it
Progesterone in oil, or PIO, is the injection with the big reputation, so it’s worth taking some of the mystery out of it, keeping in mind that whether you use it at all, and exactly how, is entirely up to the clinic.
Why it has a reputation
Unlike the small subcutaneous shots, PIO is an intramuscular injection, and the medication sits in a thick oil, which is why it tends to be given slowly and why people talk about it. It’s commonly a once-a-day injection during the relevant window.
How surrogates tend to describe it
The most common thing experienced surrogates say is that the anticipation was worse than the reality. Many feel anxious for the first few days and then settle into a routine within about a week, often with a partner or friend helping. Some soreness, small knots, or mild bruising at the site is frequently mentioned as normal, and clinics generally advise getting in touch if anything feels more significant than that.
Support is part of it
Your clinic will show you exactly how to manage your medications, and there’s a lot of practical wisdom floating around the surrogate community about making injections more comfortable, from warming techniques to injection timing. Rather than treating any of that as instructions from us, the best move is always to ask your clinic what’s right for your specific medication, and to lean on your NewGen support team, many of whom have been through these cycles themselves, for encouragement along the way.
Common side effects of surrogacy medications
Because these medications work with pregnancy-related hormones, the side effects surrogates report often feel similar to early pregnancy. Everyone is different, but commonly mentioned effects include:
- Bloating and mild fluid retention
- Breast tenderness
- Mood shifts
- Fatigue
- Headaches
- Hot flushes, more often associated with the suppression stage
- Soreness, bruising, or small knots at an injection site
Most surrogates describe these as mild and temporary, easing as the early weeks pass. Your clinic and your NewGen support team have heard it all before, so it’s always worth mentioning anything you’re feeling.
When something doesn’t feel right
Side effects are one thing; symptoms that feel wrong are another. Clinics generally want to hear from you promptly about things like significant or spreading redness, hives or itching at an injection site, or prolonged pain, and about anything that simply worries you. For any medical emergency, seek emergency care first. This is general information, not a checklist; your clinic’s guidance is what counts.
How long do surrogates take medication?
As a rough, general picture:
- Suppression and lining preparation often span a few weeks before transfer.
- Progesterone commonly starts a few days before transfer and, in a pregnancy, may continue through the first trimester until the placenta takes over hormone production.
So for most surrogates the medication phase isn’t open-ended. It tends to be more intensive in the weeks around transfer and then eases within the first trimester, though the exact length is always set by the clinic.
Needle Anxiety: Tips for Surrogates Nervous About Injections
If needles make you anxious, you’re in good company, and it doesn’t mean surrogacy isn’t for you. Plenty of surrogates start out needle-shy and look back surprised at how routine it became. None of the tips below are medical instructions; they’re the kind of practical, everyday things surrogates and their support networks often find helpful. Anything to do with your actual medication or technique is always a conversation for your clinic.
Ask for a proper demonstration first
Clinics will usually walk you through everything, in person or over video, before you do anything on your own. Seeing it done, asking your questions, and knowing you can call if you’re unsure takes a lot of the fear out of the first time.
Recruit a helper
Many surrogates enlist a partner, friend, or family member to help with the intramuscular injections, and plenty of partners become quietly expert at it. Having someone in your corner turns it from a solo ordeal into a shared two-minute routine.
Build a calming ritual around it
Surrogates often find it easier when the injection sits inside a comforting routine: the same time each evening, a favorite show on, a playlist, a treat afterward. Slow breathing beforehand helps too. When your body learns what to expect, the anxiety tends to settle.
Distract and reframe
Looking away, chatting, counting, or scrolling something funny in the moment can genuinely help. So can reframing what the shot is for: many surrogates say that focusing on the reason behind it, a family waiting on the other side, made each one meaningfully easier to do.
Ask your clinic about comfort options
It’s completely fine to tell your clinic that needles worry you and to ask what might make things more comfortable. They’ve supported many people through exactly this, and comfort measures are their call to make, not something to piece together from the internet.
Lean on people who’ve done it
The thing that reassures surrogates most is often talking to someone who’s been there. Our Surrogate Support Team has been through these cycles themselves and knows precisely how the nerves feel, so no worry is ever too small to bring to us.
The mindset that seems to carry people through is a simple one: within a week or two, the injections become just another part of the day, and the meaning behind them makes them easier to face. You’re never doing it alone.
Who pays for surrogacy medications?
Here’s a genuinely reassuring one: surrogates don’t. The intended parents cover the cost of the medications required for the journey through the escrow and benefits structure, and NewGen surrogates also receive compensation that recognizes the injectable medications specifically. You shouldn’t be out of pocket for a prescription tied to your surrogacy.
For how this fits the wider compensation picture, see our guide to surrogate pay and compensation and our overview of how the surrogacy process works.
The takeaway
The medications are the part almost everyone dreads beforehand and very few list as the hardest part afterward. For most surrogates they’re structured, temporary, and fully covered, and they come with a whole team who understand them, including a clinic guiding every step and a support network who’ve been there.
If you’re weighing up whether surrogacy is right for you, the medications don’t have to be the thing that holds you back. You can take our eligibility quiz or read our full timeline of the surrogacy journey to see how everything fits together, and always bring the medical questions to the professionals who’ll be looking after you.
[CTA: See if you’re eligible / Chat with our Surrogate Support Team]
Frequently asked questions
What medications do surrogates take?
Most surrogates go through a frozen embryo transfer protocol that can involve suppression medications (sometimes including birth control and a medication like Lupron), estrogen to help prepare the uterine lining, and progesterone to support early pregnancy. The exact medications and doses are always determined by the intended parents’ IVF clinic. This is general information, not medical advice.
Do all surrogates have to do injections?
Not necessarily. Many protocols include at least some injections, but the type and number vary by clinic, and some now use vaginal progesterone or lighter-medication cycles with fewer needles. It’s a fair thing to ask about early, and your clinic sets the plan.
Are progesterone in oil injections painful?
They have a big reputation, but many surrogates find the anticipation worse than the reality and settle into a routine within a week or so. Some soreness is commonly mentioned as normal. Your clinic will guide you on technique and comfort.
How long do surrogates take medication?
As a general picture, suppression and lining preparation often run a few weeks before transfer, and progesterone commonly starts a few days before transfer and may continue through the first trimester in a pregnancy. The clinic sets the actual timeline.
Can you be a surrogate if you’re nervous about needles?
Absolutely. Many surrogates start out needle-shy. Clinics will always provide guidance and demonstrations, and a support network helps. Whether a particular protocol suits you is a conversation for your medical team.
Who pays for surrogacy medications?
The intended parents, always. Surrogates should never be out of pocket for prescribed medications associated with their journey.
Is this article medical advice?
No. NewGen Families is a surrogacy agency, not a medical or fertility provider. This article is general educational information only. Always follow the guidance of the IVF clinic and medical professionals responsible for your care.
