Introduction
For most intended parents pursuing surrogacy, in vitro fertilisation (IVF), is where the medical journey begins. It is the process through which embryos are created: eggs and sperm are combined in a laboratory, fertilised embryos are developed over several days, and one is then transferred to the uterus of the gestational carrier.
Understanding IVF is not about becoming a medical expert. It is about knowing what is happening at each stage, what you will be asked to do, what the realistic timelines look like, and what factors genuinely influence your chances of success. That understanding helps intended parents prepare practically and emotionally for a process that is, by its nature, unpredictable.
This guide walks through the IVF process from consultation to embryo transfer, explains what happens in the laboratory between retrieval and transfer, and sets out the key variables that affect outcomes; including age, embryo quality, and the significance of genetic screening. It also explains how IVF fits into the surrogacy journey specifically, and where the process differs from IVF pursued for a self-carried pregnancy.
What IVF Actually Is
IVF stands for in vitro fertilisation; "in vitro" meaning outside the body, in a controlled laboratory environment.
In a natural conception, a single egg is released each month, travels down the fallopian tube, and may or may not be fertilised by a sperm cell. In IVF, hormone medications are used to stimulate the ovaries to produce multiple eggs in a single cycle. Those eggs are retrieved, fertilised in the laboratory, and the resulting embryos are cultured and assessed before one is selected for transfer.
For intended parents pursuing surrogacy, the process is fundamentally the same, with one important difference. The embryo transfer does not take place in the intended mother's uterus, but in the uterus of the gestational carrier. The intended parents create the embryo; the gestational carrier carries the pregnancy. In cases where donor eggs are used, the egg retrieval takes place with the donor rather than the intended mother, but the fertilisation and transfer process is otherwise identical.
Stage One: Initial Assessment and Treatment Planning
Before any treatment begins, both intended parents undergo a comprehensive assessment. For the intended mother (or egg donor), this includes:
- Hormone testing, including AMH (anti-Müllerian hormone) to assess ovarian reserve
- An antral follicle count via ultrasound to evaluate the number of follicles available for stimulation
- Uterine assessment (relevant for self-carried cycles; less so for surrogacy)
- General health screening
For the intended father or sperm donor, a semen analysis assesses sperm count, motility, and morphology.
These results inform the treatment protocol; the type and dose of medications used to stimulate the ovaries, the approach to fertilisation (standard IVF or ICSI), and whether genetic testing of embryos is recommended before transfer.
At this stage, your fertility specialist will also discuss the question of fresh versus frozen embryo transfer; a distinction we return to below, as it has significant implications for surrogacy journeys specifically.
Stage Two: Ovarian Stimulation
Ovarian stimulation is the phase most people associate with IVF; daily hormone injections over approximately eight to twelve days, designed to encourage the ovaries to develop multiple mature follicles simultaneously.
In a natural cycle, only one follicle typically reaches maturity. Stimulation overrides this, producing a cohort of follicles that can yield multiple eggs, increasing the number available for fertilisation and, ultimately, the number of embryos available for transfer or freezing.
Throughout stimulation, the response is closely monitored through regular blood tests and ultrasound scans. This monitoring allows the clinical team to adjust medication doses, assess the risk of ovarian hyperstimulation syndrome (OHSS), and determine the optimal timing for the next step.
When the lead follicles have reached the appropriate size, typically 18mm or above, a trigger injection is administered. This final injection completes the maturation of the eggs and initiates the process leading to ovulation. Egg retrieval is timed precisely: 34 to 36 hours after the trigger shot.
What this means for surrogacy: The stimulation phase involves the intended mother or egg donor, not the gestational carrier. In surrogacy journeys where donor eggs are used, the intended parents are not directly involved in this phase medically, though they will be closely following progress at their clinic.
Stage Three: Egg Retrieval
Egg retrieval is a short surgical procedure, typically performed under intravenous sedation so the patient is comfortable and unaware throughout.
Using transvaginal ultrasound guidance, a fine needle is passed through the vaginal wall into each ovarian follicle to aspirate the fluid. An embryologist in an adjacent laboratory examines that fluid immediately to identify and collect the mature eggs. The procedure typically takes 20 to 30 minutes; recovery in clinic usually adds another hour or two.
The number of eggs retrieved varies significantly depending on ovarian reserve, age, and response to stimulation. Not all retrieved eggs will be mature, and not all mature eggs will fertilise successfully, which is why producing a larger cohort at retrieval improves the odds of having viable embryos to transfer or freeze.
Stage Four: Fertilisation and Embryo Culture
Once eggs have been retrieved, fertilisation takes place in the laboratory. There are two approaches:
Standard insemination involves placing approximately 50,000 to 100,000 motile sperm alongside each egg in a culture dish and allowing fertilisation to occur naturally; selected for cases where sperm parameters are within normal range.
ICSI (intracytoplasmic sperm injection) involves a single sperm being injected directly into each egg under a microscope. ICSI is used when sperm count or motility is low, when previous fertilisation has been poor, or in certain donor egg protocols.
Fertilised eggs, now embryos, are cultured in a carefully controlled laboratory environment over the following three to five days. Most clinics aim to culture embryos to the blastocyst stage (day five or six), at which point the embryo has developed sufficiently for both transfer and genetic testing, if required. Blastocysts that reach this stage have already demonstrated a capacity for sustained development, which is why blastocyst-stage transfer is now the standard in most programmes.
Stage Five: Genetic Testing (Optional but Increasingly Common)
Before transfer, embryos can undergo preimplantation genetic testing (PGT); a biopsy of a small number of cells from the outer layer of the blastocyst, which are then analysed for chromosomal abnormalities.
PGT-A (preimplantation genetic testing for aneuploidies) identifies embryos with the correct number of chromosomes. Chromosomal abnormalities are the leading cause of failed implantation and early pregnancy loss, and their prevalence increases with egg age. Transferring a chromosomally normal embryo significantly improves the probability of a successful outcome per transfer and reduces the risk of miscarriage.
PGT is not required, and many successful transfers take place without it. But for intended parents who have experienced recurrent IVF failure, those using eggs from donors over 35, or those who want to maximise the efficiency of each transfer; particularly in the context of a surrogacy programme, it is worth discussing with your fertility specialist.
Stage Six: Embryo Transfer
For surrogacy journeys, embryo transfer takes place in the gestational carrier, not the intended mother.
In the weeks before transfer, the gestational carrier's uterine lining is prepared using oestrogen medication to achieve the appropriate thickness and receptivity. Progesterone is then introduced to replicate the conditions of the luteal phase of the natural cycle, creating an environment ready to receive the embryo.
The transfer itself is a straightforward, minimally invasive procedure. A thin catheter is passed through the cervix into the uterus, and the embryo is deposited with a small amount of fluid into the uterine cavity. It typically takes around 15 minutes and does not require anaesthesia.
Whether a fresh or frozen embryo is transferred has implications for surrogacy specifically. In a fresh transfer, the gestational carrier's cycle must be synchronised with the egg retrieval cycle; logistically complex in international programmes where the intended parents and gestational carrier may be in different countries. Frozen embryo transfer (FET) allows the embryo to be cryopreserved after the retrieval cycle and transferred in a separate, carefully timed cycle. This is the standard approach in most international surrogacy programmes, including those coordinated by New Leaf Fertility Partners.
Approximately nine to fourteen days after transfer, a blood test confirms whether implantation has occurred.
What Affects IVF Success?
IVF success is not straightforwardly predictable, but the factors that influence it are well understood. The most significant are:
Egg age and quality
This is the single most powerful variable. Egg quality declines with age, and with it the proportion of chromosomally normal embryos produced. For intended mothers using their own eggs, live birth rates per transfer are broadly in the range of 40 to 50 percent under 35, falling to around 25 to 26 percent at 38 to 40, and further beyond 40. For intended parents using donor eggs, where the donor is typically younger, success rates are substantially higher and remain more consistent regardless of the recipient's age.
Embryo quality
Not all fertilised embryos develop to the blastocyst stage, and not all blastocysts are chromosomally normal. An embryo that looks morphologically good under the microscope may still carry chromosomal abnormalities that prevent implantation, which is why PGT-A testing can add meaningful information beyond visual grading alone.
Sperm quality
Sperm count, motility, and morphology all influence fertilisation rates. ICSI can compensate for many sperm quality issues, but severely compromised sperm may still affect embryo development.
Uterine environment
For surrogacy journeys, the health and receptivity of the gestational carrier's uterine lining is critical. This is why the preparation protocol before transfer, and the monitoring of endometrial thickness, is taken seriously.
Number of transfers
IVF success is cumulative, not binary. Many intended parents who do not succeed on a first transfer go on to achieve a successful pregnancy on a subsequent attempt. This is one reason why unlimited embryo transfers, as included in our Guarantee Premium Program, represent a meaningful financial and psychological protection. The cost of additional transfers will not become a factor in how long you try.
The Emotional Dimension
IVF is physically manageable for most people, but emotionally demanding for almost everyone. Research has found that the psychological stress of IVF can be comparable to that experienced during serious illness; an important acknowledgement for intended parents to have going in, not as a deterrent, but as permission to take the emotional aspect seriously.
The two-week wait between embryo transfer and pregnancy test is often described as the hardest part of the process. So is the experience of a failed transfer, or of embryos not surviving to the blastocyst stage. These outcomes are common and do not indicate that future attempts will also fail; but they are losses, and they register that way.
IVF in the Context of Your Surrogacy Journey
For intended parents pursuing surrogacy with New Leaf Fertility Partners, IVF takes place at one of our partner fertility clinics in Accra. All packages include medical and IVF treatment costs, embryo transfers, and surrogate compensation, with no hidden fees.
The pre-birth parental order process under Ghana's Registration of Births and Deaths Act, 2020 (Act 1027) requires that an application be submitted within 12 weeks of embryo transfer; which means the legal and medical timelines of your journey are directly connected.
If you are at the stage of understanding what IVF involves and whether surrogacy in Ghana is the right pathway for you, we would be glad to walk you through the process in more detail at an initial consultation.
