When people ask me how is surrogacy done, they usually want two things at once: a clear map of the steps and a sense of what it really feels like to walk that road. Surrogacy is not just a medical protocol. It is a long relationship between intended parents, a surrogate, medical teams, and lawyers, all wrapped around the fragile hope of a baby.
If you are reading this because you are thinking about becoming a parent through surrogacy, or becoming a surrogate yourself, you are already holding a complicated mix of excitement, fear, and questions. That is normal. The goal here is to unpack the process from start to finish, with special attention to how surrogacy works in India, where laws have changed dramatically in the last few years.
What surrogacy actually is (and what it is not)
Surrogacy means a woman carries a pregnancy with the intention that the child will be raised by someone else, usually called the intended parents.
There are two basic medical models.
Traditional surrogacy uses the surrogate’s own egg. She is genetically related to the baby. Fertilisation can be through IUI (intrauterine insemination) or other techniques. This model is now rare and often heavily restricted because of legal and emotional complications.
Gestational surrogacy uses IVF. Embryos are created using the intended mother’s eggs or donor eggs, and the intended father’s sperm or donor sperm. The surrogate has no genetic link to the baby; she is a gestational carrier. When most people ask how does surrogacy work today, they are talking about this gestational model.
In India, only gestational surrogacy in India is permitted. Traditional surrogacy is not allowed under current law.
The big picture: stages of a surrogacy journey
Before we zoom in on the medical details, it helps to see the whole arc. Think of the surrogacy process as a chain of overlapping stages.
Here is a simple snapshot from a practical, lived point of view:
- Clarifying whether surrogacy is right for you and in which country or state it is legally possible. Matching with a surrogate and building an early relationship. Undergoing medical and psychological screening for everyone involved. Completing the IVF cycle, embryo transfer and confirming pregnancy. Navigating pregnancy, delivery, and final legal parentage steps.
On paper those five lines look tidy. In real life the edges blur. Legal and psychological screening may continue through the matching phase. Medical issues can send you back to the planning stage. Some intended parents arrive with frozen embryos already created; others are just starting fertility testing.
Still, this framework gives you a mental shelf to place each part of the story.
Step by step: how surrogacy typically works
1. Deciding whether surrogacy is the right path
People reach surrogacy from many directions: repeated IVF failures, medical conditions that make pregnancy unsafe, single parenthood by choice, or as a same sex couple. The first task is not paperwork; it is emotional honesty.
In my work with intended parents, the early questions look like these:
Are we ready to separate genetic parenthood from pregnancy itself
Is it more important that the child shares DNA, or that we minimise medical risk and emotional strain
Can we realistically manage the financial, legal, and time commitments required
You can talk these through with a fertility specialist, a counsellor familiar with third party reproduction, and if relevant, a spiritual or community advisor. People often underestimate how much unresolved grief about infertility can complicate a surrogacy journey. Making some space to process that grief first almost always pays off.
In India, intended parents must also ask a more specific question: are we legally eligible at all under the current surrogacy laws in India. Foreigners, unmarried heterosexual couples, and most single men, for example, cannot pursue surrogacy there under current rules.
2. Choosing where and how to pursue surrogacy
The next decision is jurisdiction and model. Surrogacy is regulated at various levels: national, state, and sometimes even city level. The same family could be fully protected in one place and completely blocked in another.
In broad strokes:
Some countries and states allow compensated surrogacy with strict regulations. Intended parents may pay the surrogate a fee for her time and effort, within legal limits.
Others allow only altruistic surrogacy, where the surrogate receives reimbursement for medical and pregnancy related expenses, but no profit.
Some ban surrogacy altogether, or allow it only for very narrow groups.
The surrogacy process in India falls firmly into the altruistic category, at least on paper. The Surrogacy (Regulation) Act 2021, often called the surrogacy regulation bill while it moved through Parliament, created a nationwide framework:
Surrogacy in India is limited to Indian citizens or Overseas Citizens of India under specific conditions. Commercial arrangements are prohibited. Only altruistic surrogacy in India is allowed, meaning no payment beyond approved medical expenses and insurance.
The intended parents generally must be a married heterosexual Indian couple who have been married for at least several years and who can show medical need for surrogacy. A limited pathway exists for certain single women, such as widows or divorced women within a defined age band. The fine print is detailed and keeps evolving, so you should always check the latest rules, not rely on hearsay.
Foreigners who once looked to a surrogate in India for comparatively lower costs are now barred by law. Many have shifted to other jurisdictions.
3. Matching with a surrogate
Matching is both practical and deeply personal. It used to be common in India to work with a surrogate from a low income background, sometimes with limited understanding of her legal rights. The current law has tried, imperfectly, to tighten protections.
On a practical level, matching involves aligning:
Medical criteria such as age, prior pregnancies, BMI, overall health, and proximity to the IVF clinic.
Legal criteria such as nationality, marital status, number of previous surrogacies, and compliance with local eligibility rules.
Emotional compatibility such as expectations about communication, involvement in appointments, understanding of selective reduction or termination decisions, and long term contact after birth.
In altruistic surrogacy in India, the original law heavily emphasised a “close relative” as surrogate, though later clarifications have softened this somewhat to allow a broader circle of willing women under regulated conditions. In many Indian cases, a sister, cousin, or sister in law may carry the pregnancy. That choice may reduce financial exploitation but increase family complexity. If the surrogate is family, clear boundaries and professional counselling are even more important.
Outside India, matching often happens through agencies or independent platforms. Experienced surrogates may have strong preferences about the type of intended parents they want to help. Their autonomy here is crucial.
4. Screening and legal groundwork
Before any medical treatment, good programs insist on comprehensive screening for everyone.
For intended parents, this usually means fertility testing if embryos are not yet created, infectious disease screening such as HIV, hepatitis, syphilis and counselling about genetic carrier testing. For the surrogate, it means medical evaluation, gynaecological examination, bloodwork, uterine assessment (often via ultrasound or hysteroscopy), and a review of previous pregnancies and deliveries.
Psychological screening matters just as much. A surrogate needs to show she understands the process, the risks, and the emotional impact of carrying and then handing over a baby. Intended parents need space to explore realistic expectations, especially regarding control. Surrogacy is not a remote controlled pregnancy; the woman carrying the baby remains a human being with her own body and life.
At this stage, lawyers draft the surrogacy agreement. In many countries, it covers:
Decision making in routine and emergency medical situations.
Agreed approach to multiple embryo transfer, pregnancy reduction, or termination for medical reasons.
Financial arrangements, including expense reimbursement, insurance cover, and what happens in case of bed rest or complications.
Plans for birth registration, parental rights, and any post birth contact.
In India, contracts are shaped within the rigid framework of the Surrogacy (Regulation) Act. The law tries to standardise much of what used to be left to private negotiation. For example, it emphasises that the child born through surrogacy is the biological child of the intending couple, with no parental rights for the surrogate. Institutional ethics committees and government boards are now required to approve each case.
A practical note from experience: do not skip dedicated independent legal representation for the surrogate, even in an altruistic arrangement. She should have her own lawyer, not simply sign something drafted for the intended parents.
The medical side: IVF, embryo transfer and pregnancy
Once the legal and psychological ground is solid, attention turns to the medical protocol. This is the part many people think of first when they ask how surrogacy work, but it is really the middle layer of the process.
Creating embryos
If embryos are not already frozen, the intended mother or an egg donor undergoes ovarian stimulation. Fertility medications encourage the ovaries to produce multiple mature eggs. Doctors monitor progress through blood tests and ultrasounds over about 10 to 14 days, then collect the eggs through a short procedure using a needle guided by ultrasound.
The eggs are fertilised in the lab with sperm from the intended father or a donor. The resulting embryos grow in culture for several days. Many clinics now aim for blastocyst stage, around day five, which allows better selection. Embryos may be frozen while legal and logistical details are finalised. They can also be tested for certain genetic conditions when medically indicated.
Preparing the surrogate’s uterus
The surrogate’s cycle is planned so that her uterine lining is ready to receive an embryo. Typically, this involves hormonal medications that thicken and stabilise the endometrium, sometimes synchronised with the embryo’s developmental stage. Clinics monitor via ultrasound and bloodwork.
Unlike the egg provider, the surrogate does not undergo egg retrieval. Her body’s main job is to provide a stable, healthy environment for implantation and growth.
Embryo transfer
Embryo transfer is usually quick and relatively painless. One or sometimes two embryos are placed into the surrogate’s uterus through a thin catheter passed through the cervix. Many programs globally, and the newer Indian regulations as well, encourage single embryo transfer to reduce the risk of twins or higher order multiples, which carry higher risk for both baby and surrogate.
After transfer, there is a waiting period of roughly two weeks before a blood test checks for pregnancy. Anyone who has been through IVF knows this “two week wait” can feel longer than the entire rest of the journey combined.
Pregnancy is confirmed through rising hormone levels and ultrasound. From that point, the surrogate’s care looks much like any pregnancy, but layered with extra monitoring and communication.
Daily life during a surrogacy pregnancy
Once the initial excitement settles, there are months of ordinary days. This is where the character of the relationship between intended parents and surrogate really shows.
Some intended parents attend key appointments in person or via video. Others prefer regular text updates. Cultural differences also play a role. In some Indian arrangements, especially in the older commercial era, surrogates lived in hostels with limited contact with intended parents. The surrogacy regulation bill aimed to dismantle many of those exploitative setups. Today, more Indian programs support the surrogate living at home with her family, which is healthier when proper support and monitoring are in place.
During pregnancy, conversations cover:
Lifestyle: diet, physical activity, travel.
Medical decisions: screening tests, vaccines, response to complications.
Emotional boundaries: how often to communicate, what language to use around the baby, whether the surrogate’s own children are told and how.
From experience, the most successful journeys are the ones where everyone is treated as an adult partner, not a service provider or a silent guest. Simple rituals help: sharing ultrasound photos, sending recordings of the intended parents’ voices for the baby to hear, or writing a letter of gratitude that the surrogate can keep.
It is also the time to revisit legal and logistical planning: where the birth will occur, how the handover will happen, who will be in the delivery room, and how the baby will be registered.
Birth, handover and legal parentage
Birth is the emotional peak of the process, but on the ground it is a mix of hospital routines and legal paperwork. The goal is to make the practical steps as boringly predictable as possible so that everyone can focus on the human moment.
In many jurisdictions, pre birth or post birth court orders clarify who the legal parents are. In some, the intended parents’ names go directly on the birth certificate; in others, the surrogate is recorded first and then parental rights are transferred through an adoption like process.
In India, the law states that the child is the biological child of the intending couple, and the surrogate has no parental rights. However, in practice, hospitals and registries still need clear documentation from the appropriate authorities. Intended parents should work with lawyers who understand local implementation, not just the statute’s wording.
The handover itself can be gentle or rushed, depending on culture, hospital policies, and planning. I usually encourage intended parents and surrogates to talk well in advance about what feels right. Some surrogates want immediate skin-to-skin contact with the baby before saying goodbye. Others prefer that the intended parents be the first to hold the child.
There is no single “correct” script, only what honours the physical recovery of the surrogate, the health of the baby, and the emotional needs of everyone involved.
The Indian context: law, ethics and practice
Surrogacy in India has travelled a long road, from a booming international industry to a tightly regulated, domestically oriented system.
For years, India was a global hub. Lower costs, skilled IVF clinics, and minimal initial regulation attracted intended parents from many countries. At the same time, investigative reports highlighted serious ethical concerns: poor women acting as surrogates without independent legal advice, inadequate health care, and orphaned or abandoned babies when intended parents backed out.
The surrogacy regulation bill, eventually enacted as ivf in india the Surrogacy (Regulation) Act 2021, was a hard pivot. Its core principles are:
Only altruistic surrogacy in India is permitted. No commercial fee can be paid to the surrogate, though her medical expenses, insurance and some pregnancy related costs may be covered.
Surrogacy is allowed only for intended couples or single women who meet strict eligibility criteria, including age bands and proof of medical need such as infertility or conditions making pregnancy dangerous.
Only gestational surrogacy in India is legal. The surrogate cannot contribute her own egg.
Foreign intended parents are excluded. The law applies only to Indian citizens and certain categories like Overseas Citizens of India, subject to additional rules.
Clinics and surrogacy agencies must register with government authorities. Each surrogacy arrangement requires approval from specialised boards that review medical and legal compliance.
Critics argue that the law may have swung too far, making surrogacy inaccessible to many who need it and driving some arrangements underground. Supporters say it was necessary to stop blatant commercialisation.
For families considering a surrogate in India, this means you cannot simply “book a package” anymore. You must:
Be absolutely sure you are eligible.
Work only with registered ART and surrogacy clinics.
Expect layers of paperwork and time for approvals.
Accept that compensation is limited to expenses, not a salary, which changes who is able and willing to be a surrogate.
The reality on the ground is still evolving. Court challenges and clarifications continue. Anyone serious about the surrogacy process in India should consult both a fertility specialist and a lawyer who are up to date with current interpretations, not just the text of the Act as passed.
Emotional realities for intended parents and surrogates
Legal and medical clarity does not erase the emotional weight of surrogacy. If anything, when the logistics finally settle, feelings rush in.
Intended parents often describe a strange mixture of gratitude and distance. They may feel intensely connected to the baby but oddly disconnected from the pregnancy, especially if they live far from the surrogate. Some worry that not carrying the baby will affect bonding. In practice, by the time you are waking up for night feeds, the path by which the child arrived tends to matter less than the relentless immediacy of parenting. Still, it can help to acknowledge those worries openly.
Surrogates can feel a spectrum of emotions too. Many I have met describe a profound pride in helping create a family, along with physical exhaustion and sometimes a sense of anticlimax. They recover from childbirth while returning to their own routines without a newborn in the house. That transition deserves active support from family, community, and mental health professionals if needed.
In family based altruistic surrogacy, such as a sister carrying for her sibling, emotions weave through existing relationships. If there have been unspoken tensions about money, status, or fertility, pregnancy tends to bring them to the surface. That is another reason why counselling should be viewed as an essential part of how surrogacy work, not a luxury.
One practical way to prepare is to sit with a short, honest checklist before starting.
- How will we handle it if the first or second embryo transfer fails and we feel discouraged at different times What kind of communication rhythm with the surrogate will feel respectful rather than intrusive Are we prepared for the possibility of complications, including bed rest or emergency delivery How will we talk about surrogacy with our child in age appropriate ways over the years What do we each need, practically and emotionally, in the weeks right after birth
If you can answer these questions together, or at least agree to keep revisiting them, you are already building the skills that parenting itself will demand.
Looking ahead
Surrogacy sits at the intersection of science, law, economics and love. That is why no two journeys feel the same, even when the medical steps look identical on a chart.
Whether you are exploring how does surrogacy work in your own country, or specifically trying to understand the surrogacy laws in India and the impact of the surrogacy regulation bill, the core remains constant. A woman decides to carry a baby for someone else. Everyone involved agrees, ahead of time, how to protect her health, her autonomy, the child’s best interests, and the intended parents’ role.
If you take nothing else from this long overview, let it be this: treat surrogacy as a relationship, not just a transaction. Choose professionals who respect that, stay curious and honest with each other, and keep room for the unexpected. The process is rarely smooth from start to finish, but for many families and surrogates, it remains one of the most meaningful collaborations of their lives.