Published: 6 November 2026
Medically reviewed by Dr. Pranay Shah, MS (Obs. & Gyn.), Founder, Director & Chief Fertility and IVF Specialist, Wellspring IVF & Women’s Hospital, Ahmedabad
Last medically reviewed: 6 November 2026
In short: the surrogacy process in India follows a fixed legal order. A District Medical Board first certifies that the intending couple has a medical reason for surrogacy. The Appropriate Authority then issues eligibility certificates for the couple and the surrogate. The surrogate is insured, a Magistrate issues an order on the child’s parentage and custody, and a certificate of essentiality is granted. Only after all of this can IVF and embryo transfer begin. Only altruistic surrogacy is legal; commercial surrogacy is banned.
This guide walks through each step as it works under the Surrogacy (Regulation) Act 2021 and the Surrogacy (Regulation) Rules 2022, including the 2024 amendment on donor gametes. It is written for couples who have already been told that carrying a pregnancy is not possible or not safe, and who want to know what actually happens next.
Step 1: A medical indication, certified by the District Medical Board
Surrogacy in India is a medical treatment, not a choice of convenience. The intending woman must have a condition that makes pregnancy impossible or unsafe. The rules list situations such as an absent or abnormal uterus, repeated failure of IVF despite good embryos, recurrent pregnancy loss, or an illness that would make pregnancy life-threatening.
Your fertility specialist documents the history and investigations, and the District Medical Board examines the case and issues the certificate of medical indication. Without this certificate nothing else can proceed. If you are still exploring whether surrogacy is right for you, our page on altruistic surrogacy in Ahmedabad explains which conditions usually qualify.
Step 2: The intending couple’s eligibility certificate
The Appropriate Authority of the district issues a certificate of eligibility to the intending couple. The main conditions are:
- A legally married Indian couple, with the wife aged 23 to 50 and the husband aged 26 to 55 on the date of certification.
- No surviving child, biological, adopted or through surrogacy. There is a narrow exception when an existing child is mentally or physically challenged or has a life-threatening disorder.
- An Indian widow or divorcee aged 35 to 45 may also apply as an intending woman.
Couples in which both spouses hold OCI cards have a separate route under the amended Rules. The full legal detail is in our article on who is legally eligible for surrogacy in India.
Step 3: A willing surrogate and her eligibility certificate
The surrogate must be an ever-married woman with a child of her own, aged 25 to 35, who has not been a surrogate before; a woman can act as a surrogate only once in her lifetime. She needs a certificate of medical and psychological fitness, and the Appropriate Authority issues her eligibility certificate.
No clinic, agent or advertisement may recruit or pay a surrogate. Brokering, advertising for surrogates and paying beyond permitted expenses are offences under the Act. Our guide to what altruistic surrogacy allows and prohibits explains where the legal line sits.
Step 4: Insurance cover for the surrogate
The intending couple must buy general health insurance for the surrogate, from an insurer recognised by IRDAI, for a period of 36 months. It covers complications arising from pregnancy and delivery. Proof of this insurance is part of the essentiality file.
Step 5: An order of parentage and custody from a Magistrate
Before treatment, the intending couple applies to a Magistrate’s court for an order on the parentage and custody of the child to be born. This is one of the most important protections in the Act: the child’s legal parents are settled before pregnancy begins, not argued over after birth.
Step 6: The certificate of essentiality
The Appropriate Authority issues the certificate of essentiality once it has the medical indication, the Magistrate’s order and proof of insurance. With this certificate and both eligibility certificates in hand, a registered surrogacy clinic may begin treatment.
Always check that the clinic itself is registered. You can follow our step-by-step method to check a surrogacy clinic’s registration on the national registry.
Step 7: Consent, IVF and embryo transfer
The surrogate signs written informed consent in a language she understands, after counselling about the risks. She may withdraw consent before the embryo is transferred.
The medical steps then follow an ordinary IVF cycle: ovarian stimulation and egg collection for the intending woman (or her eggs are used if already frozen), fertilisation in the laboratory, and culture of the embryos. The surrogate’s uterus is prepared with hormones, and normally a single embryo is transferred; the rules allow more only in special circumstances. A surrogate may undergo a limited number of transfer attempts.
Donor gametes: since the February 2024 amendment, one donor gamete (egg or sperm) may be used if the District Medical Board certifies a medical condition in the husband or wife that requires it. At least one gamete must come from the intending couple. A single woman must use her own eggs with donor sperm.
Sex selection is illegal. No embryo may be selected for its sex, and a clinic that offers it is committing an offence under both the Surrogacy Act and the PCPNDT Act 1994.
Step 8: Pregnancy, birth and the child’s legal status
The surrogate receives full antenatal care, paid as a medical expense by the intending couple. At birth the child is deemed to be the biological child of the intending couple, with all the rights of a child born naturally. The intending parents cannot refuse to take the child, whatever the child’s sex or health. The birth certificate is issued in the intending parents’ names.
What surrogacy can and cannot cost
Because only altruistic surrogacy is allowed, the cost to the couple is made up of medical charges (IVF, embryo transfer, antenatal care, delivery), the surrogate’s insurance, legal and certification costs, and permitted expenses. There is no fee for the surrogate herself. When you compare clinics, ask for a written breakdown of each of these heads. Our IVF package prices show how the IVF part is usually charged.
Where Wellspring fits in
Wellspring IVF & Women’s Hospital in Satellite, Ahmedabad is a registered surrogacy clinic (Reg. No. GJ-01/AHD/27/2026). Dr. Pranay Shah reviews the medical indication, prepares the documentation the District Medical Board needs, and runs the IVF and embryo transfer once the certificates are issued. We do not recruit or pay surrogates, and we do not offer commercial surrogacy. To discuss your case, see our surrogacy treatment page.
Medical indications the rules accept, in more detail
The Surrogacy (Regulation) Rules 2022 list the medical conditions for which the District Medical Board may certify that gestational surrogacy is needed. In plain language, they fall into four groups:
- No uterus, or a uterus that cannot carry a pregnancy. This includes a uterus that is absent from birth (as in MRKH syndrome), a uterus removed for cancer or another illness, and an abnormal uterus such as a very small, unicornuate or T-shaped uterus, severe scarring inside the cavity (intrauterine adhesions) or a persistently thin endometrium that does not respond to treatment.
- Repeated IVF failure despite several attempts with good-quality embryos, when no other cause can be corrected.
- Recurrent pregnancy loss without a treatable cause.
- A medical illness that makes pregnancy impossible or life-threatening, for example severe heart, kidney or lung disease, or a condition in which pregnancy would put the mother’s life at serious risk.
Each case is judged individually. A specialist’s report that clearly documents the diagnosis, the treatment already tried and why pregnancy is unsafe makes the Board’s review faster and simpler.
The process at a glance
| Step | Who decides or issues it | What it confirms |
|---|---|---|
| 1. Medical indication | District Medical Board | Surrogacy is medically needed |
| 2. Couple’s eligibility | Appropriate Authority | Age, marriage and no surviving child |
| 3. Surrogate’s eligibility | Appropriate Authority | Age, marital status, own child, fitness, first surrogacy |
| 4. Insurance | IRDAI-recognised insurer | 36 months of cover for the surrogate |
| 5. Parentage and custody | Magistrate’s court | The intending parents are the child’s legal parents |
| 6. Essentiality certificate | Appropriate Authority | All legal conditions are met |
| 7. IVF and embryo transfer | Registered surrogacy clinic | Treatment with written informed consent |
| 8. Pregnancy and birth | Obstetric team | Care of the surrogate; birth registered to the intending parents |
Documents you will usually be asked for
Requirements vary slightly between districts, so treat this as a starting list and confirm it with your clinic and the local Appropriate Authority.
From the intending couple
- Proof of identity and age for both spouses, such as Aadhaar or passport.
- Marriage certificate or other legal proof of marriage.
- Medical records that support the indication: scan and surgery reports, histopathology, previous IVF cycle records and, where relevant, a physician’s report on the medical illness.
- An affidavit stating that the couple has no surviving child, or documents on the exception for a child with a serious disability or illness.
From the surrogate
- Proof of identity and age.
- Proof that she is or has been married, and the birth certificate of her own child.
- Certificates of medical and psychological fitness.
- Her written informed consent, signed after counselling.
What the surrogate’s medical care involves
Before transfer, the surrogate has a full medical assessment: a general examination, blood tests for anaemia, blood group and infections, an ultrasound of the uterus and, where needed, other investigations. Her uterus is then prepared with oestrogen and progesterone, and the embryo is transferred under ultrasound guidance, a short procedure that does not need anaesthesia.
Once she is pregnant she receives standard antenatal care: regular check-ups, the routine scans and screening tests of pregnancy, nutrition and supplements, and planned delivery in a hospital with a neonatal unit. Her care continues after delivery. All of these are medical expenses that the intending couple pays for, and the 36-month insurance protects her if complications occur during or after pregnancy.
If you are an intending woman (widow or divorcee)
An Indian widow or divorcee aged 35 to 45 follows the same sequence of certificates. The main medical difference is the source of the embryos: she must use her own eggs, fertilised with donor sperm from a registered ART bank. If her own eggs are not usable, surrogacy is not currently permitted for her, and the specialist will discuss other options such as adoption.
Common mistakes that delay or endanger the process
- Paying an agent or “coordinator” to find a surrogate. This is illegal, and arrangements made this way can collapse at the certification stage.
- Starting treatment at an unregistered clinic. Only a clinic registered under the Surrogacy Act may carry out surrogacy procedures.
- Incomplete medical records. Missing surgery notes or previous cycle reports are the most common reason the Medical Board asks for more information.
- Assuming another country’s rules apply. Surrogacy for foreign nationals is not permitted in India, and arrangements abroad have their own legal and citizenship issues for the child.
- Promising the surrogate money. Beyond medical costs, insurance and permitted expenses, any payment is an offence for both the couple and anyone who arranges it.
Questions to ask a surrogacy clinic
- What is your registration number under the Surrogacy (Regulation) Act, and may I see the certificate?
- Will you prepare the medical report and documents for the District Medical Board?
- Who will perform the egg collection and the embryo transfer?
- How many embryos will you transfer, and why?
- Can you give me a written estimate that separates IVF charges, antenatal care, delivery, insurance and legal costs?
- Where will the surrogate deliver, and is there a neonatal unit on site?
Frequently asked questions
How long does the surrogacy process take in India?
There is no fixed legal timeline. The certificates from the District Medical Board, the Appropriate Authority and the Magistrate usually take several weeks to a few months, depending on the district. The medical part then follows the normal course of an IVF cycle and a full-term pregnancy.
Can we pay the surrogate mother in India?
No. Commercial surrogacy is banned under the Surrogacy (Regulation) Act 2021. The surrogate may receive only her medical expenses, insurance cover and other expenses allowed by the rules. Any other payment is a criminal offence.
Can donor eggs or sperm be used in surrogacy?
Since the February 2024 amendment to the Surrogacy Rules, a couple may use one donor gamete if the District Medical Board certifies that the husband or wife has a medical condition that requires it. At least one gamete must still come from the intending couple. A single woman must use her own eggs with donor sperm.
Who is the legal parent of a child born through surrogacy?
The child is deemed to be the biological child of the intending couple or intending woman, with all the rights of a natural child. The Magistrate’s order on parentage and custody is obtained before the embryo transfer, not after birth.
Can the surrogate change her mind?
Yes. The surrogate gives written informed consent and may withdraw it before the embryo is transferred to her womb. After transfer, the rules on continuing or ending the pregnancy follow the Act and the Medical Termination of Pregnancy law.
Does the surrogate have to be a close relative?
No. The Surrogacy (Regulation) Act 2021 as passed requires a willing woman who meets the legal conditions: ever married, with a child of her own, aged 25 to 35, a surrogate only once in her lifetime, and medically and psychologically fit. She does not have to be a relative, but she cannot be recruited or paid beyond permitted expenses.
Is surrogacy allowed for single men, unmarried couples or foreign nationals in India?
No. The Act allows surrogacy only for a legally married Indian man and woman who meet the age and medical conditions, or for an Indian widow or divorcee aged 35 to 45. Single men, unmarried or same-sex couples and foreign nationals are not eligible under the current law.
Which conditions qualify a woman for surrogacy?
The rules accept an absent or abnormal uterus, a uterus removed for illness, repeated IVF failure despite good embryos, recurrent pregnancy loss without a treatable cause, and a medical illness that makes pregnancy impossible or life-threatening. The District Medical Board certifies the indication for each case.
Sources
- The Surrogacy (Regulation) Act, 2021 (Act No. 47 of 2021), Government of India.
- The Surrogacy (Regulation) Rules, 2022 (G.S.R. 460(E)) and the Surrogacy (Regulation) Amendment Rules, 2024 (G.S.R. 119(E)), Ministry of Health and Family Welfare.
- The Pre-Conception and Pre-Natal Diagnostic Techniques (Prohibition of Sex Selection) Act, 1994.
This article explains the law in general terms and is not legal advice. Rules are amended from time to time; the clinic will confirm the current requirements for your case.
