India was, for many years, one of the world's most significant destinations for surrogacy — both for Indian couples and for international couples seeking gestational surrogates. The combination of relatively low costs, available surrogates, and a legal framework that, while imperfect, permitted surrogacy arrangements that were more restricted in other countries made India a global surrogacy hub.
That landscape has changed significantly. The Surrogacy (Regulation) Act 2021 and the Assisted Reproductive Technology (Regulation) Act 2021 — which together form the current regulatory framework for assisted reproduction in India — have fundamentally restructured what surrogacy is legally available, who can access it, and under what conditions.
Understanding what has changed, what remains possible, and what the implications are for couples who may be considering surrogacy as part of their path to parenthood is essential for anyone navigating this terrain.
This article provides that understanding — clearly, specifically, and with the honest acknowledgment that the regulatory landscape is complex and has continued to evolve since the Acts were passed.
What Changed: The Commercial Surrogacy Prohibition
The most significant change introduced by the Surrogacy (Regulation) Act 2021 is the prohibition of commercial surrogacy in India.
Commercial surrogacy — in which a woman is paid a fee to carry a pregnancy for another person or couple — is no longer legally permitted in India. This prohibition is absolute. A surrogate cannot receive payment for her services beyond medical expenses and insurance coverage. Any arrangement in which a surrogate receives financial compensation beyond these specific permitted categories is illegal under the Act.
The rationale for this prohibition — articulated in the legislative debates and the accompanying explanatory materials — is the protection of women from exploitation. Commercial surrogacy, in its less regulated historical forms, created conditions in which economically vulnerable women carried significant physical risks for financially motivated reasons in arrangements that were not always genuinely consensual or adequately protective of their health and rights. The legislative intent of the prohibition is to eliminate this exploitation.
The consequence — which has been debated extensively since the Act was passed — is that the practical availability of surrogacy in India has been substantially reduced. Women who previously served as gestational surrogates for financial reasons can no longer legally do so. The pool of available surrogates has contracted significantly.
What Remains Possible: Altruistic Surrogacy
The Surrogacy (Regulation) Act 2021 permits altruistic surrogacy — a specific, legally defined form of surrogacy in which a close female relative of the intending couple agrees to carry a pregnancy voluntarily, without financial compensation.
The specific requirements for legal altruistic surrogacy under the current framework are detailed and must be met completely for the arrangement to be legally valid.
The surrogate must be a close female relative of the intending couple. The Act specifies that the surrogate must be a "close relative" — though the precise definition of close relative in this context has been the subject of subsequent regulatory clarification. Sisters, sisters-in-law, and other closely related women within the family structure are generally considered within the definition. The surrogate must be willing and must not be coerced.
The surrogate must be a married woman with at least one child of her own. This requirement ensures that the surrogate has prior experience of pregnancy and childbirth, has already demonstrated fertility, and has her own biological child — meaning the surrogacy arrangement does not put her in the position of potentially being left without biological children of her own.
The surrogate must be between 25 and 35 years of age.
The surrogate can only serve as a surrogate once in her lifetime.
The arrangement must be genuinely altruistic — no payment beyond approved medical expenses and insurance. The insurance must cover the surrogate for the duration of the pregnancy and post-delivery period.
Both the intending couple and the surrogate must receive independent medical and legal counseling before the arrangement proceeds.
The arrangement must be approved by the appropriate authority — the state-level Surrogacy Board — before it proceeds.
These requirements significantly narrow the practical availability of surrogacy. The requirement that the surrogate be a close relative is particularly restrictive — because it eliminates the possibility of using a non-related surrogate, even one who is genuinely willing, and because close female relatives of the right age who meet all the clinical and personal criteria are not always available.
Who Can Access Surrogacy Under the Current Law
The Act also specifies who is eligible to access surrogacy — the intending couple or individual for whom the surrogate carries the pregnancy.
Eligible intending couples under the Act must be:
A couple married for at least five years. The wife must be between 23 and 50 years of age. The husband must be between 26 and 55 years of age.
The wife must have a medical condition necessitating surrogacy — the Act specifically requires a medical indication for surrogacy. This means that surrogacy is not available as a matter of preference or convenience but only where a clinically established medical reason makes it necessary. The medical conditions that constitute valid indications include: absence of the uterus (congenital or surgical), uterine abnormalities that make pregnancy medically unsafe or impossible, repeated IVF failure attributable to uterine factors, and other specific medical conditions preventing pregnancy.
Single women may access surrogacy under specific conditions — widows between 35 and 45 years of age, and divorced women in the same age range.
Same-sex couples and unmarried heterosexual couples are not included within the eligible categories under the current law.
Foreign nationals and non-resident Indians (NRIs) are not eligible for surrogacy under the current regulatory framework.
These eligibility restrictions mean that the couples who can legally access surrogacy in India under the current law are significantly fewer than before the Act was passed.
The Medical Indication Requirement — What It Means in Practice
The requirement for a medical indication is perhaps the most practically significant limitation on access to surrogacy under the current framework. Surrogacy is not available simply because a couple wants to use it — it requires a clinically established reason why the intending mother cannot carry a pregnancy herself.
The medical conditions that clearly meet this requirement include:
Absence of uterus — whether congenital (Mayer-Rokitansky-Küster-Hauser syndrome, in which the uterus is absent from birth) or surgical (after hysterectomy for cancer, fibroids, or other conditions). This is the clearest and most unambiguous medical indication.
Uterine abnormalities incompatible with pregnancy — severe Asherman syndrome with complete obliteration of the uterine cavity, or uterine abnormalities of a degree that makes pregnancy medically dangerous.
Repeated IVF failure attributed to uterine factors — where thorough investigation has established that the reason for repeated IVF failure is an irreparable uterine condition. This is a more complex category — the clinical evidence establishing the uterine basis of the failures must be specific, documented, and evaluated by an appropriate medical board.
Medical conditions making pregnancy dangerous — severe cardiac disease, specific autoimmune conditions, or other systemic conditions where carrying a pregnancy poses a substantial risk to the intending mother's life.
For couples who are considering surrogacy as a path — particularly those who have experienced repeated IVF failure — the first clinical question is whether a medical indication within the Act's scope is present. This is an assessment that must be made by a qualified fertility specialist in conjunction with the appropriate Medical Board under the regulatory framework.
The Regulatory Process: What Approval Involves
For couples who meet the eligibility criteria and have established a medical indication and an eligible altruistic surrogate, the regulatory approval process involves multiple steps that must be completed before any clinical procedure can proceed.
Surrogacy Board approval. The state-level Surrogacy Board — established under the Act — must approve the surrogacy arrangement before it begins. The application to the Board includes documentation of the intending couple's eligibility, the surrogate's eligibility and medical fitness, the established medical indication, the counseling certificates for both parties, and the legal agreements governing the arrangement.
Registration of the ART clinic. The ART clinic performing the surrogacy procedure must be registered under the ART Regulation Act 2021. Clinics that are not registered cannot legally perform surrogacy procedures.
Genetic parentage. The surrogacy arrangement must use the gametes of the intending couple — the eggs of the intending mother and the sperm of the intending father — wherever medically possible. The use of donor gametes in a surrogacy arrangement is subject to additional regulatory requirements.
Legal agreements. A formal surrogacy agreement, reviewed by independent legal counsel for both parties, must be in place before any medical procedure begins.
The complexity of this approval process — and the practical difficulty of finding an eligible relative surrogate, obtaining Board approval, and completing all legal requirements — means that surrogacy under the current framework is not a quick or straightforward path. Couples who are considering it should plan for a timeline of months from the beginning of the process to the clinical procedure.
What Has Been Challenged and What May Change
The Surrogacy (Regulation) Act 2021 has been the subject of judicial challenge in the Indian courts, and several aspects of the regulatory framework have been subject to ongoing litigation and modification since the Act was passed.
Notably, the requirement that the surrogate be a married woman was challenged in the Supreme Court of India, which issued an interim order in 2023 permitting unmarried women to serve as surrogates as well — representing a modification of the original Act's requirement. This and other judicial developments indicate that the regulatory framework is not static — it continues to evolve through judicial interpretation and administrative clarification.
Additionally, amendments to the Act regarding the use of donor gametes in surrogacy arrangements — which were initially restricted in ways that proved clinically problematic — have been the subject of ongoing regulatory attention.
Given this evolving landscape, couples who are considering surrogacy in India should seek current, specific legal advice from a lawyer qualified in family and ART law at the time they are making decisions — because the specific regulatory requirements may have changed from what is described here.
This article reflects the framework as established by the Surrogacy (Regulation) Act 2021 and subsequent amendments and judicial decisions available at the time of writing. It is not legal advice.
The Practical Landscape: What Surrogacy in India Looks Like in Practice
For Indian couples who meet the eligibility criteria, have a clear medical indication, and have an eligible relative who is willing to serve as a surrogate, altruistic surrogacy remains a legally available and clinically viable path to parenthood.
The clinical procedure involves the standard IVF process for the intending couple — stimulation, egg retrieval, fertilization, embryo development — followed by preparation of the surrogate's uterus and transfer of the intending couple's embryo to the surrogate. The pregnancy is then carried by the surrogate, who receives the medical care and monitoring that any pregnant woman requires, with additional legal protections and insurance coverage as required by the Act.
The clinical success rates of surrogacy — once a suitable surrogate has been identified and the regulatory requirements met — are comparable to those of frozen embryo transfer cycles in standard IVF patients, with the success rate primarily determined by the quality of the embryo being transferred.
For couples for whom the clinical indications are clear and for whom a willing eligible surrogate exists within the family, the remaining legal process — while complex — is navigable with the support of a registered ART clinic and qualified legal counsel.
What Metro IVF Offers for Couples Considering Surrogacy
At Metro IVF in Ambikapur, couples who are exploring surrogacy as part of their path to parenthood receive a complete clinical assessment of whether the medical indication for surrogacy is present and documented, an explanation of the current regulatory framework and its requirements, a referral to qualified legal counsel for the surrogacy agreement and Board approval process, and the clinical management of the IVF procedure that produces the embryo for transfer to the surrogate.
Dr. Soni is honest about the complexity of the current surrogacy framework — both the clinical complexity and the legal complexity — and about the practical challenges of finding an eligible relative surrogate who meets all the statutory requirements. Couples who are considering surrogacy are given the complete picture of what is involved before they begin the process, so that the decisions they make are genuinely informed.
Where surrogacy is not available or is not practically feasible for a specific couple — because no eligible relative surrogate exists, because the regulatory requirements cannot be met, or because the clinical indication is not clearly established — alternative paths are discussed specifically and honestly.
Your Next Step
If you are considering surrogacy as a path to parenthood — whether because of a clear medical indication, because IVF has not worked, or because you are exploring all available options — a consultation with Dr. Ashish Soni at Metro IVF in Ambikapur will give you the most complete and current clinical assessment of whether surrogacy is available and appropriate for your specific situation, and what the process of pursuing it involves.
The regulatory landscape is complex. The clinical and legal requirements are specific. The right guidance — at the right time — makes the difference between a process that is navigable and one that is not.
Metro IVF Test Tube Baby Center Ambikapur, Chhattisgarh metrofertility.in Led by Dr. Ashish Soni — North India's First Fertility Super Specialist
Surrogacy in India has changed — but it has not disappeared. Book your consultation with Dr. Ashish Soni at Metro IVF to understand what is possible for your specific situation.