WHEN DO YOU GET YOUR PERIOD AFTER A D&C OR MISCARRIAGE? PREVIOUS ITEM NEXT ITEM The time following a miscarriage or D&C (dilation and curettage) can be both physically and emotionally challenging, and many surrogates wonder when their menstrual cycle will return following either a miscarriage or D&C. Attuning yourself to your body’s health and response over the next several weeks helps you understand how you are recovering and what your next steps in surrogacy will be. Doctors will generally monitor your blood hormone levels to ensure that your human chorionic gonadotropin (hCG) levels return to zero on their own. Your body will typically experience a slow bleed for up to a week following the miscarriage or procedure. The cessation of the bleeding is generally an indication that the hCG levels have returned to zero. HOW SOON AFTER MISCARRIAGE OR D&C DO YOU GET YOUR PERIOD? Your first period will generally return within four weeks of your hCG levels returning to zero. However, it is not uncommon for some women to experience prolonged return to ovulation and menses, which can last up to eight weeks. For many women, ovulation will not occur during your first cycle, as the body is still recovering. In most cases, your IVF doctor will want to wait for your body to experience one or two cycles before starting medications for a repeat medical cycle and embryo transfer. Your cervix will remain soft and open during this time and may make intercourse painful. EXTENDED BLEEDING In the cases of a natural miscarriage especially, you’ll want to pay special attention to how long your initial bleed lasts and how frequently you experience a recurrence of bleeding. In these cases, it is possible that some tissue may have been retained in the uterus and is preventing your body from healing. If you continue to experience light spotting over an extended time , it could be possible that your body is having trouble returning to regular hormone levels. You will want to speak with your doctor if you experience any case of extended bleeding. PROLONGED ABSENCE OF MENSES A prolonged return of menstruation is not normal. While it can take up to eight weeks for your body to properly recover and return to having regular cycles, some women will experience an even longer delay. This is typically experienced after a D&C as opposed to a natural miscarriage and may indicate the presence of new scar tissue or fibroids inside of the uterus. If you have not experienced a menstrual bleed by 10 weeks following the miscarriage or procedure, it is important that you notify your doctor. At Growing Generations, we are here for you every step of the way. Contact Growing Generations to learn more.

WHY WOULD A WOMAN BECOME A SURROGATE? PREVIOUS ITEM NEXT ITEM It’s a question we hear often, and it’s not surprising either. Our surrogates are motivated to become surrogates for a great many reasons, but nearly all of them tell us, they become surrogates out of altruistic origins. They want to give the gift of family to someone who is unable to do this for themselves. They often feel as though if they are able to help someone, they should. The goal of this journey is building your family and giving you a child. Every single Growing Generations surrogate is a mother, and in some cases done growing her own family. This means she has already gone through pregnancy and birth, and she understands just how special babies are and how important family is. Gestational surrogates, sometimes called gestational carriers, bear no genetic link to the child they are carrying. This lack of biological connection also contributes to a lack of an emotional maternal link to the child. Dr. Kim Bergman explains, “Surrogates see themselves as basically babysitting your baby, inside their body. They are crystal clear that the baby they are carrying is not theirs and can’t wait to see you holding your baby at the end of the journey”. As the process moves forward, a sense of pride, self-worth, and accomplishment begins to grow in these women. They are intensely proud of the choices they've made to help you grow your family. Surrogates also realize that surrogacy can be financially helpful to their families. Many use the compensation from the surrogacy to start their own business, go back to school, put a down payment on a home, or pay off debt. This compensation opens doors for them that may have otherwise remained closed. As a result, these women are often as grateful to you as you are to them. When you pair the desire to help others, pride, lack of genetic and emotional connection to your child, and financial compensation, it becomes easy to understand how surrogates quite easily and naturally send your baby home with you at the end of the journey. Surrogates respect family and life, they’re on your team by choice, and they want to work with you towards your goal of having a family. In over 20 years of operation, Growing Generations has never had a surrogate change her mind, talk about changing her mind, or need to be talked out of changing her mind, never, not once. This is due in part because of our extremely thorough psychological and medical screening process and because the women who become surrogates are serious about helping someone else have a family.

SURROGATE GLUCOSE TEST DURING PREGNANCY PREVIOUS ITEM NEXT ITEM All pregnant women are tested for gestational diabetes during their pregnancy, and it is no cause for alarm. Even if they’ve had no prior issues with blood sugar levels in their day-to-day life or in previous pregnancies, they will still have a glucose test during pregnancy as a surrogate. While being a surrogate does not raise the odds of developing gestational diabetes, factors such as excessive weight, age, and carrying multiples may contribute to a more significant insulin resistance and the development of this condition. GESTATIONAL DIABETES TEST Glucose tolerance tests monitor the body’s ability to turn sugar into energy. During pregnancy, the additional hormones can confuse the pancreas, rendering it unable to break down glucose properly. When this happens, blood glucose rises and, on occasion, the woman will develop gestational diabetes. Unlike type 2 diabetes, gestational diabetes is purely hormonal. If a diagnosis of gestational diabetes is given, it is not the result of your surrogate’s food and exercise choices. This is not a diagnosis that could have been avoided with different behaviors. GLUCOSE TOLERANCE TEST RESULTS Learning that your surrogate’s initial glucose tolerance test came back elevated is a conversation that no intended parent hopes to have during their journey. Your initial reaction will likely be surprise, which then ignites questions and concerns: “ She’s never had THAT in her history ! What does this mean for the pregnancy? What did she do to ‘fail’ this test when she’s never failed it before?” Let’s start by establishing a baseline. Having an elevated one-hour glucose test result is not a “failure.” If the test result is elevated (a “fail”), then there is nothing that could have been done differently by your surrogate to “pass.”. Also, many women will have elevated levels in a one-hour standard test and go on to pass a three-hour screening and have no problems. However, an elevated result on a one-hour glucose screening can also be the first indicator that your surrogate has developed gestational diabetes. In either event, it’s important to note that this test result is not the result of any action or inaction on the part of your surrogate. Understand that your surrogate is likely having an emotional reaction to these results as well. Despite not being able to control the results, she likely feels guilty and perhaps even a bit scared. The kindest thing that you can do for her is to reassure her that she hasn’t lost your trust and that you’re in this together . WHAT DOES IT MEAN FOR THE BABY? If left unidentified or untreated, gestational diabetes can affect the baby. Here's how: With a buildup of sugar in the bloodstream, a pancreas will work harder than it should, often to no avail. This means that the glucose buildup can, and often will, cross the placenta and work its way into the developing baby’s blood. That will cause the newborn’s pancreas to work overtime and create more energy than it needs. As a result, that fetus will store the extra energy as fat. This can lead to a variety of complications, including high birth weight, damage to the shoulders as they exit the birth canal, and an increased risk of obesity or type 2 diabetes later in life. GESTATIONAL DIABETES TREATMENT In most cases, gestational diabetes can be managed by closely monitoring diet and adding a bit of additional exercise. Your surrogate will be asked to monitor her glucose levels with a home testing kit and keep a strict log of her food intake and sugar levels, but she may not need to change much about her lifestyle. Women who are unable to control their blood sugar levels, even with strict adherence to diet and exercise, may be asked to begin taking oral medication or injected insulin. For most women, gestational diabetes will go away once the child is born. The American Diabetes Association advises women who develop gestational diabetes to have a 2-hour glucose tolerance test at 6 weeks postpartum in order to ensure that the diabetes has cleared up. UNDERSTANDING GESTATIONAL DIABETES DURING SURROGACY It’s important to understand what gestational diabetes is (a hormone-driven resistance to insulin) and what it is not (poor dietary choices or the inability to follow a diet). Your surrogate will likely feel some level of guilt in the case of a gestational diabetes diagnosis, even though it was induced by pregnancy. This is a great time to show her that you support her and will stand by her side moving forward. Growing Generations is always here to answer your questions as intended parents and support you throughout your family-building journey.

ABOUT US THE GOLD STANDARD Growing Generations is the gold standard surrogacy agency, known for delivering the most premium service in the fertility space. For nearly three decades, we have been at the forefront of making parenthood a reality for those who aspire to leave a legacy. Our team customizes a service approach for every surrogacy journey, supporting each one of our clients with personalized attention and care no matter what the challenges to family-building may be AT GROWING GENERATIONS At Growing Generations, our mission goes beyond creating paths to parenthood— IT’S ABOUT MAKING SURE THE JOURNEY TO GET THERE IS THE FULFILLING AND ENRICHING EXPERIENCE IT DESERVES TO BE. LEADERSHIP TEO MARTINEZ CEO GROWING GENERATIONS Teo earned his undergraduate degree from the University of California, Los Angeles and his MBA at Pepperdine University, Malibu. He began his career with Growing Generations in 1998, when surrogacy and egg donation were still in their infancy. Having worked in every department at GG, today Teo oversees the company’s strategic development and the delivery of GG’s renowned customer care and satisfaction. A husband, father of two, and one of six children himself, he loves that he gets to help people create families. Teo is filled with gratitude to be part of so many miracles, victories, and heartwarming success stories. In addition to being part of these extraordinary journeys, he believes he has the best co-workers in the world and feels privileged to go to work with them each day. ERICA HORTON PRESIDENT GROWING GENERATIONS Erica began her career at Growing Generations as a college intern in 2003. Like most people at the time, she had no direct experience with the fertility world, but she was immediately intrigued when she read an internship listing titled “marketing intern needed for gay surrogacy agency” (we have always helped all prospective parents but back in the early days you had to say it explicitly). As a queer woman and someone with a gay father, she already had a passion for LGBTQ+ people and families. She had a general idea of what surrogacy was but had never thought of the two coming together in such an intentional way. She at once knew she had to be a part of what Growing Generations was doing. When she reflects back, she says “I can vividly recall the moment I saw the internship posting, the moment I received a call for an interview, and the day of my interview-down to the clothes I was wearing and the excitement I felt.” ​ ​ Her role in the company has expanded significantly since 2003, and now—as President—she oversees all departments that manage care for intended parents, surrogates, and donors. She is proud to have been part of establishing Growing Generations as one of the most experienced and reputable agencies in the world. She believes our start working intentionally with the underserved LGBTQ community required us to break barriers and forge paths where none existed before and that still is one of our core strengths today. Erica served on Family Equality’s Board of Directors for 9 years and served as Board Chair for 2 of those years. She has two children: Gavin, born in 2009 and Jack, born in 2012. Both boys were conceived with the help of a sperm donor. Erica is passionate about ALL people realizing their dream to have a family. Outside of work Erica loves spending time with her boys and her partner, Dan; together they love the beach, being in the ocean, riding bikes, traveling, cooking, and trying new foods. KIM BERGMAN, PhD SENIOR PARTNER, GROWING GENERATIONS Kim Bergman, PhD, a licensed psychologist since 1990, has specialized in the area of gay and lesbian parenting, parenting by choice and third party assisted reproduction for over two decades. Dr. Bergman has created a comprehensive psychological screening, support and monitoring process for intended parents, surrogates and donors. She is a member of the American Society for Reproductive Medicine (serving as a founder and past Chair of the LGBTQ Special Interest Group, past Chair of the Corporate Member Council, and a member of the Executive Committee of the Mental Health Professional Group, having served as a past Chair), the American Psychological Association, the Los Angeles County Psychological Association, the Lesbian and Gay Psychotherapy Association, and the Gay and Lesbian Medical Association. She is on the national Emeritus board of the Family Equality. Dr. Bergman writes, teaches and speaks extensively on parenting by choice. Along with co-authors, she published “Gay Men Who Become Fathers via Surrogacy: The Transition to Parenthood” (Journal of GLBT Family Studies, April 2010) and “Gay Fathers by Surrogacy: Prejudice, Parenting, and Well-being of Female and Male Children” (Psychology of Sexual Orientation and Gender Diversity, June 2019). Dr. Bergman is the author of, Your Future Family: The Essential Guide to Assisted Reproduction (Conari Press 2019) and You Began as a Wish (Independent Press 2019) and along with co-editor Bill Petok, Psychological and Medical Perspectives on Fertility Care and Sexual Health (Elsevier, 2021). Dr. Bergman created her own family using third party assisted reproduction and she lives with her wife of over four decades. She has two adult daughters. STUART BELL SENIOR PARTNER, GROWING GENERATIONS Stuart has been a Partner at Growing Generations since 2001. Prior to joining Growing Generations, he spent over a decade in executive level positions in both profit and not-for-profit companies. As a writer with a strong emphasis on gay rights issues, his work has appeared in numerous publications over the past 30+ years. He is the author of Prayer Warriors, a memoir published in 1999 by Alyson publications. In February 2008, Stuart and his husband welcomed their son into the world who was conceived through Growing Generations’ surrogacy and egg donation programs. He is active as a donor and volunteer with local and national organizations including Human Rights Campaign, Family Equality Council, LA Gay & Lesbian Center and Youth Emerging Stronger. He served for 10 years on the board of the American Fertility Association (now a program of Family Equality), four of those as co-chair. He is the founder and Co-Chair of The Del Shores Foundation, a non-profit which amplifies and nurtures the voices of LGBTQ+ writers who live in Southern states. A native of Tennessee, Stuart holds a degree in Communications from Middle Tennessee State University and has lived in Los Angeles since 1992.

EGG DONATION & BIRTH CONTROL PREVIOUS ITEM NEXT ITEM Most of our egg donors come to us on some form of birth control. This is normal and expected and most times has no impact on your donation journey. However, certain methods of birth control can cause your donation journey to slow down. Here’s a look at what those birth control methods include and why they’ll cause us to hit “pause” on your journey. DEPO-PROVERA. More commonly referred to as “the shot”, Depo-Provera delays the egg donation process for a period of six months. If you are on the shot, we will ask you to discontinue use and contact us again in six months. The first six months following discontinuation have been shown to lead to a lower fertility return. We want to make sure there is ample time for all of the medication to exit your system before attempting to stimulate your body to produce a large number of eggs. You will need to have regular and normal menstrual cycles before we’re able to move forward. NORPLANT/IMPLANON. Commonly called implants. Some clinics may require the implant to be removed prior to starting the donation process. HORMONAL IUD. There are two types of intrauterine device used to prevent pregnancy. The first, Paraguard or other copper based products, may be left in place during the entire donation process. The second option is a hormone based IUD, commonly the Mirena. Some clinics may require the hormonal IUD to be removed prior to starting the donation process. If you have additional concerns about your method of birth control and how it will impact your donation you should speak with your admissions specialist. If you are interested in becoming an egg donor with Growing Generations apply here .

THE CONTRACTING PHASE PREVIOUS ITEM NEXT ITEM Once you have confirmed the match with your surrogate, you will move into the contracting phase of your journey. During this time, you will be working with lawyers who are very well versed in fertility and reproductive law in the United States to draft and execute your surrogacy agreement. Many states require a legal contract between the surrogate and the intended parents. This contract, commonly known as the surrogacy agreement, will be catered to suit the laws of the states/countries that are included as well as any specific requests you and your surrogate have agreed upon. The main purpose of the contract is to specify and clarify the outcomes of any issues that may arise during the course of the pregnancy. Examples include: What will happen to the child should something happen to the intended parents before the baby is born What would happen if the baby were diagnosed with a genetic illness while in utero. How many fetuses is the surrogate willing to carry The contract is designed to protect all parties and prevent potential disputes. Most IVF clinics will stipulate that a surrogacy agreement be in place before any medical procedures begin. Later on in your journey, you will need to manage more legal paperwork to establish parental rights. Final parental establishment for the intended parents is acquired via a court order declaring the parental rights and obligations of the intended parents. At this point, you will be identified as the sole legal parents. The court order will also include directions for the department of Vital Records to issue a birth certificate for the child, upon which will be placed the names of the intended parents. This is usually done before the end of the third trimester, though this may vary from state to state.

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BEST AIRLINES FOR INTERNATIONAL NEWBORNS PREVIOUS ITEM NEXT ITEM When it comes to your newborns first flight, we understand that you’re bound to be a little anxious! Especially for parents whose journey home includes an overseas flight, it is important to consider which airlines are able to make your trip home as comfortable as possible. We’ve done a bit of web crawling for you, and here’s what we’ve learned about international vs US domestic carriers. According to travel expert blogs and articles published on The Huffington Post and Travelsort.com, your best bet is always to book with an international carrier as opposed to an American based carrier. American based carriers have had to focus on cutting their costs to guard their profits over recent years, and don’t have the capital to offer as many amenities as their international counterparts. While most airlines will still allow passengers with small children to pre-board, often times ahead of even first class passengers, many airlines also offer additional considerations to help make your flight more enjoyable. Many International airlines are still able to offer perks and convenience features to parents of newborns including bassinets for sleeping, free on board diapers, wipes, and formula, as well as complimentary formula warming. Only a handful of American based carriers can brag these features, and most can’t guarantee these features will be available ahead of time. Many of the same carriers were applauded time and time again for their attention to your smallest passenger. These airlines include: Singapore Airlines, Japan Airlines, Cathay Pacific, Etihad, Virgin Atlantic, Emirate, Lufthansa and British Airways. When pricing and booking your tickets to the USA for the birth of your child, keep in mind that you’ll be traveling home with a newborn and look into what each airline offers. When in doubt if certain features or amenities will be available on your flight or in your cabin (will you be flying coach or first class), it’s always best to call ahead and ask.

YEAST INFECTIONS IN SURROGATE PREGNANCY PREVIOUS ITEM NEXT ITEM Yeast infections are common and impact millions of women every year. Even so, many women will experience their first yeast infection, or potentially her first outbreak of several yeast infections, in her surrogate pregnancy . WHY ARE YEAST INFECTIONS MORE COMMON IN SURROGATE PREGNANCY? According to the American Pregnancy Association , the second trimester of pregnancy represents the time in a woman’s life where she is most likely to experience a yeast infection. So why is there an increased likelihood of a yeast infection in surrogacy if you never experienced one during your own pregnancies? The link could be because several potential causes of a yeast infection occur all at once as a woman prepares to become a surrogate. For example, some common causes of yeast infections include: Hormonal changes related to pregnancy Starting hormone therapy treatments (including birth control pills, estrogen, or progesterone treatments) Taking antibiotics or steroids (a common component of your pre-transfer medical protocol ) An increase of sugar in the diet (sweets are a common craving for pregnant women) An influx of vaginal intercourse (potentially before or after doctor ordered pelvic rest) Blood or semen in the vagina Often characterized by an increase and change in appearance of your normal vaginal discharge and a persistent, insatiable itch, yeast infections are caused when the levels of yeast and acid in the vagina are out of balance. Both elements are present in your body normally, so the presence of bacteria is not the problem; it is the unbalance that presents the issue. YEAST INFECTION TREATMENT DURING SURROGATE PREGNANCY While yeast infections have no major risks or implications to the pregnancy, they can still be uncomfortable and problematic for you, especially if left untreated. Yeast infections during pregnancy can be difficult to control, so it’s best to get early treatment. Additionally, and unlike traditional pregnancies, yeast infections in IVF pregnancies and surrogacy may require a different form of treatment than your standard over the counter creams. This is because many IVF doctors do not want the creams or their plastic applicators introduced to your vagina in the early stages of your pregnancy. While some doctors may be OK with the creams with hand application only, other doctors may choose to call in a prescription to treat the infection orally. We understand that it can feel embarrassing and invasive to tell your nurse about a potential yeast infection before simply self-treating with over the counter medications, but in the case of surrogacy, you should absolutely mention symptoms to your nurse, even if this is a multi-occurrence infection. Treatment is key, because if it is left untreated, the yeast infection can be transferred to the child you are carrying during birth, leading to a condition of the mouth called thrush. Once you begin treatment you can expect to experience relief from the symptoms within 10 to 14 days, although most treatments will begin to offer relief from many of the symptoms within 48 hours. STEPS TO PREVENTING YEAST INFECTIONS DURING PREGNANCY If you find that you are experiencing repeated yeast infections during your journey, you may opt to introduce the following natural prevention measures in order to try and stave off any future infections. Wear loose clothing Wear cotton underwear Always wipe from front to back after using the restroom Limit sugar intake, as vaginal yeast feeds on sugar If you have additional questions or concerns, try to focus on feeling comfortable mentioning this to your nurse or case specialist. Sending an email to approach the subject may offer you a bit more comfort than mentioning it in a call, but understand that both your case specialist and your nurse manage these sorts of issues every day, and they’re nothing to be embarrassed by. Growing Generations is a premier surrogacy agency that provides intended parents, surrogates, and egg donors with exceptionaly attentive service. If you are interested in becoming a surrogate, contact us online or complete our surrogate application .

UNDERSTANDING EMBRYO STAGES & DEVELOPMENT WITH IVF PREVIOUS ITEM NEXT ITEM Did you know your surrogate is already “pregnant” before an embryo transfer even happens? It can be hard to comprehend, but that it is the reality of IVF pregnancies. Keep reading to learn more about embryo stages and development during the IVF process. GESTATIONAL AGE In a traditional pregnancy, gestational age is determined based on the day of ovulation. Fertilization and implantation of the embryo typically occurs about two weeks later. In the case of IVF, and specifically gestational surrogacy, pregnancy works a bit differently. The eggs that will eventually become embryos are not allowed to travel from the ovary into the uterus to await fertilization. Instead, the eggs are retrieved, either from an intended mother or egg donor , directly from the ovary before they are released. This happens two weeks into a woman’s typical 28-day menstrual cycle. We talk more about this process in our related blog post . GROWTH & EVALUATION Those eggs are then fertilized outside of the body and allowed to begin growing. A reproductive endocrinologist closely monitors the cell multiplication over the next several days, tracking the stages of embryo development at the IVF lab. In the case of a planned fresh embryo transfer, the eggs will then be transferred into an awaiting uterus on either day 3, 5, or 6 of external development. In the case of a planned frozen embryo transfer, the embryos are typically frozen, thawed and transferred on day 5 of development. In the meantime, the recipient of the embryo will be on a hormone therapy regimen that will cause their body to mirror where it would be in a non medicated cycle. This process allows doctors to create the ideal environment for the embryos to implant and grow before moving forward with the transfer. EMBRYO TRANSFER With this in mind, the embryo recipient walks into the fertility clinic on transfer day 2 weeks “pregnant” before the transfer even occurs. During the transfer, the doctor will migrate the embryo or embryos into the awaiting uterus. At the conclusion of the transfer, the recipient is said to be 2 weeks plus the age of the embryo pregnant. If a 5-day blastocyst was transferred, the recipient will walk out of the clinic 2 weeks and 5 days pregnant. PREGNANCY STAGE The term “pregnant” is relative to whether the embryos actually implant and continue to develop. A pregnancy test, which will consist of a blood test, will generally be done 10 to 12 days after the embryo transfer. If the result of the pregnancy test is positive, your surrogate will be somewhere between 4 weeks 3 days to 5 weeks pregnant. Around the 10-week mark, your surrogate will be released to the care of an obstetrician and the pregnancy will follow the course of a traditional pregnancy. To learn more about surrogacy and IVF pregnancy, contact Growing Generations online. If you are considering growing your family with surrogacy, apply today .