The Clinical Way, or the Natural Way?

Medicated or Unmedicated Cycle's?

One of the most confusing parts of surrogacy we hear from prospective surrogates is a simple question — will I have to be on medications?

The honest answer is: *it depends.
And more importantly, you usually have options.

In gestational surrogacy, there are two primary clinical paths used to prepare a surrogate’s body for embryo transfer: a medicated (sometimes called “programmed”) cycle, and an unmedicated or natural (or modified natural) cycle. Both are used safely and successfully every day. Neither is inherently “better” — but they are different, and those differences matter.

A medicated cycle uses estrogen and progesterone to prepare the uterus on a set schedule. This approach gives clinics predictability and control over timing, which can be helpful when coordinating many moving parts. For some surrogates, this path feels straightforward and manageable — especially because it reduces the need to drop everything at a moment’s notice for monitoring or to travel quickly for transfer. For others, the idea of daily injections or extended hormone use feels overwhelming — and that reaction is completely valid.

An unmedicated or natural cycle works with your body’s own rhythm. Ovulation is carefully monitored, and the embryo transfer is timed accordingly. This approach avoids suppressing the surrogate’s natural cycle and can reduce or eliminate the need for hormone injections. However, it often requires significant flexibility in scheduling, frequent monitoring, and the ability to respond quickly — something that not everyone has the time or capacity to manage.

What’s important — and reassuring — is that clinical data from frozen embryo transfer (FET) research shows that natural or modified natural cycles often have pregnancy and live birth rates comparable to, and in some studies slightly higher than, fully medicated cycles in women who ovulate regularly. Miscarriage rates are similar, and in some cohorts, slightly lower with natural cycles.

In surrogacy, individualized care truly matters. Gestational carriers are healthy, capable women doing something extraordinary — and their health deserves to be centered at every step. While large studies specifically comparing medicated versus natural cycles only in surrogates are limited, broader obstetric data shows that surrogate pregnancies carry unique physiological considerations. That’s why protocol choice should never be automatic, and should always be talked through in detail between the surrogate, the intended parents, and the clinic.

At Vermont Surrogacy Network, we believe surrogates should be informed, supported, and heard. Some clinics offer both paths. Some clinics only offer medicated cycles. Some surrogates feel perfectly comfortable with medications; others strongly prefer a natural approach. None of these preferences make someone a better or worse surrogate.

What matters is transparency, education, and alignment — between the surrogate, the clinic, and the intended parents.

There is no universal “right” way to prepare for a surrogacy transfer.
But there is a right way to walk through the decision: with evidence, compassion, and respect for the woman carrying the pregnancy.

And that is the standard we work to uphold every day.

*Even "unmedicated" cycles still require progesterone shots to get the pregnancy moving in the right direction.