Surrogacy touches some of the most intimate parts of life: fertility, health, family, money, and law. When you add a complex legal framework like the one around surrogacy in India, it can feel overwhelming. I have seen couples walk into clinics hopeful and leave confused, not because they lack courage, but because the rules and process are genuinely complicated.
If you are trying to understand how surrogacy works in India today, what a surrogate\'s role really is, and what the law allows, it helps to slow down and walk through things step by step. That is what we will do here, with an eye on the real experience behind the forms and medical jargon.
How surrogacy in India works today
Surrogacy in India used to be a booming commercial industry that attracted intended parents from across the world. That landscape no longer exists. After several court cases, public debates, and reports of exploitation, India moved to a strictly regulated, altruistic-only model.
Under current law, only altruistic surrogacy in India is permitted. This means:
- No commercial payment to the surrogate, only medical expenses and prescribed allowances. Only Indian heterosexual married couples (and in some cases single women) meeting specific conditions can pursue surrogacy. Only gestational surrogacy in India is allowed, not traditional surrogacy.
Gestational surrogacy means the surrogate carries an embryo that has no genetic link to her. The embryo is created using IVF, usually from the intended parents' gametes, or from donor sperm or eggs where allowed by the law and accompanying ART regulations.
So when people ask, "how does surrogacy work" or "how is surrogacy done" in India today, the honest answer is: carefully, within a narrow legal corridor, with a heavy emphasis on paperwork, eligibility checks, and oversight.
A quick timeline of surrogacy laws in India
To understand why the rules look the way they do, a little context helps.
For many years, India had clinics offering commercial surrogacy with very limited regulation. Foreign couples, Indian NRIs, and domestic couples all came for treatment. Surrogates were often from vulnerable economic backgrounds, and although some reports described life-changing income, others highlighted poor medical follow-up, unclear contracts, and abandoned children in complicated legal cases.
Public concern grew, and the government began to restrict the practice step by step. The surrogacy regulation bill went through several drafts over the years. The end result is the Surrogacy (Regulation) Act, 2021, supported by detailed rules. In parallel, the Assisted Reproductive Technology (Regulation) Act also came into force to regulate IVF, egg and sperm donation, and related services.
The key shift is this: surrogacy is now presented as a last-resort medical solution for specific Indian couples, not as a fertility marketplace.
When you talk to clinics or lawyers, they often still refer informally to the "surrogacy regulation bill", but practically speaking, you are dealing with the full Act and its rules.
Who can opt for surrogacy in India?
Before we dive into the surrogate herself, it is important to know who is even allowed to seek a surrogate in India. This is one of the biggest shocks for many people who walk into a clinic expecting the old system.
The broad outline, at the time of writing, is:
- Only Indian heterosexual married couples can use surrogacy, and both spouses must be Indian citizens. There are age limits for both partners (typically mid-twenties minimum and mid-forties to early fifties as an upper limit, depending on gender). The couple must prove medical infertility or a specific medical condition that makes pregnancy risky or impossible. In some versions of the rules, single women (widows or divorcees) meeting certain criteria may also be eligible; however, this area has seen frequent clarifications and sometimes confusion at the implementation level.
Same-sex couples, unmarried couples, foreign nationals, and many NRIs currently face significant legal barriers or outright exclusion from surrogacy in India.
Clinics that respect the law will usually insist on showing you the text of the latest notifications and may even advise a separate legal opinion if your situation is not straightforward. That is a positive sign. If a clinic waves away your questions with "ho jayega, don't worry", be cautious.
Basic legal eligibility for a surrogate in India
Now to the heart of your question: who can be a surrogate, and how is she chosen?
The law sets out a fairly specific template of who can act as a surrogate in India. Clinics and surrogacy boards interpret and implement this, sometimes with small local variations. Typically, a woman must:
- Be a close relative of the intended couple, as defined by the rules (this is one of the most debated and practically difficult requirements). Be married and have at least one living biological child of her own. Fall within a specified age bracket, usually in her mid-twenties to mid-thirties. Act as a surrogate only once in her lifetime. Have a certificate of medical and psychological fitness for surrogacy.
Altruistic surrogacy in India builds on the idea that surrogacy should be an act of compassion within an existing family network, not a job or income source. That is the theory. In practice, families encounter situations where no close relative is medically fit or willing to carry a pregnancy. They then face hard decisions between continuing fertility treatment without surrogacy, looking for legal alternatives outside India, or sometimes trying to stretch the rules in risky ways.
From the surrogate's point of view, it is also a serious commitment. Pregnancy itself carries risks. When you add hormonal treatments, IVF procedures, and the emotional weight of carrying someone else's child, it becomes a complex medical and psychological journey.
Medical screening of the surrogate
Medical screening is much more than a blood test and a quick ultrasound. Good clinics treat the surrogate's health as central, not secondary to the intended parents' dream.
Typically, a surrogate in India will go through:
Thorough medical history and physical exam. Doctors ask about previous pregnancies, miscarriages, C-sections, chronic illnesses, surgeries, and medication. A woman who has had a complicated first delivery, severe preeclampsia, or gestational diabetes may be ruled out for her own safety.
Blood tests and infection screening. This often includes blood group, hemoglobin levels, kidney and liver function, thyroid function, tests for HIV, hepatitis B and C, syphilis, and other infections. The goal is to protect both the surrogate and the future baby.
Reproductive system evaluation. Pelvic ultrasounds Click here! help assess the uterus, ovaries, and any structural issues such as fibroids. The doctor may look at the endometrial lining, ovarian reserve (though eggs are not used from the surrogate in gestational surrogacy), and any signs of previous scarring.
Cardiac and other systemic checks. In women over 30 or those with risk factors, a cardiology opinion, ECG, or additional tests can be advised. Some clinics insist on a fitness certificate from a physician who is not directly involved in the IVF process, to avoid conflict of interest.
Lifestyle and support assessment. This is rarely written in big letters on any form, but experienced doctors quietly pay attention to factors like nutrition, living environment, access to clean water and transport, and the level of practical help she has at home. A medically fit woman with zero practical support may struggle more in late pregnancy bed rest than someone with modest health but strong family help.
The best clinics are conservative in their final decision. Many intended parents initially feel frustrated when potential surrogates are rejected after screening. Over time, most come to appreciate that rigorous medical screening prevents bigger heartbreak later.
Psychological and social evaluation
Good mental health care often makes the difference between a bearable journey and a traumatic one. Yet, psychological screening is one of the most underestimated parts of the surrogacy process in India.
A psychologist or trained counselor should ideally meet the surrogate alone and then with her spouse and, in some cases, with key family members. The conversation usually explores:
Her understanding of surrogacy. Does she truly grasp that the baby is not legally or genetically hers, and that she will not be raising this child?
Her motivations. In an altruistic context, money cannot be the primary driver, at least not officially. Even within families though, financial expectations, emotional debts, or even pressure from elders can appear. The counselor looks for signals of coercion.
Her emotional resilience and history. Prior experiences with depression, anxiety, trauma, or loss can influence how she copes. Pregnancy involves hormonal shifts that can intensify emotional states.
Spousal and family support. A husband who agrees on paper but resents the pregnancy can create enormous stress. In some households, in-laws have more practical power than the surrogate herself; their buy-in matters.
Capacity for decision-making. The surrogate should be able to understand consent forms, ask questions, and make informed decisions, not merely sign where told.
Where screening is done well, it is common for a psychologist to say no to a potential surrogate who is medically fit but emotionally unprepared. That "no" protects everyone: the surrogate, the couple, and the future child.
How is surrogacy done: step by step through the process in India
There are many variations in how clinics organize the journey. However, the main stages of the surrogacy process in India usually follow a recognizable arc.
Here is a simple roadmap to orient yourself:
Medical evaluation of intended parents and exploration of alternatives like more IVF cycles, adoption, or child-free living. Legal consultation to check eligibility under surrogacy laws in India and clarify documentation needs. Identification and initial screening of a potential surrogate in the family, followed by formal medical and psychological evaluation. Approvals from the appropriate surrogacy boards, including certificates of eligibility for the couple and fitness for the surrogate. IVF cycle planning, embryo creation, legal agreements, embryo transfer, and if successful, pregnancy care and delivery arrangements.Each of these steps can take weeks or months, and families often underestimate the time needed for documentation and government approvals. It is not unusual for the whole journey, from first serious consultation to taking the baby home, to stretch from 12 to 24 months.
Let us look a little closer at some of these stages.
The legal paperwork and approvals
Under the current framework, both the intended couple and the surrogate must obtain specific certificates from designated authorities, often at the district or state level. These may include:
Certificate of essentiality for the couple. This document confirms that the couple has a genuine medical indication for surrogacy and no other medically reasonable option to have a biological child. A specialist's opinion and medical reports are typically required.
Certificate of eligibility for the couple. This covers aspects like citizenship, marital status, age, and absence of surviving biological or adopted children, except in special cases like severe disability in an existing child.
Certificate of eligibility for the surrogate. This confirms her age, marital status, relationship to the couple where required, number of times she has acted as surrogate, and medical fitness.
These certificates rely on inputs from doctors, but they are ultimately legal documents. Even a minor inconsistency between what is written in a medical record and what is stated in an affidavit can cause delays or, in worst cases, rejections.
Families often find this part more stressful than the medical injections and scans, largely because they have less control over timelines. My usual advice: start the paperwork as early as possible, keep multiple photocopies and digital scans, and maintain a simple tracking sheet of what has been applied for and what is pending.
IVF, embryo transfer, and pregnancy care
Once approvals are in place, the medical aspects of how surrogacy works look very similar to any IVF program, except for the fact that the intended mother does not carry the pregnancy.
Ovarian stimulation and egg retrieval. The intended mother (or an egg donor, if used) takes hormonal injections to produce multiple eggs. Once ready, eggs are retrieved with a minor procedure under anesthesia.
Fertilization and embryo culture. Eggs and sperm (from the intended father or donor) are combined in the lab to create embryos. Embryos are usually cultured for a few days before transfer or freezing.
Endometrial preparation for the surrogate. The surrogate's menstrual cycle is synchronized and her uterine lining prepared with hormones so that it is receptive at the time of embryo transfer.
Embryo transfer. One or sometimes two embryos are placed into the surrogate's uterus through a thin catheter. This procedure is usually painless and does not require anesthesia.
Pregnancy testing and follow-up. About two weeks after transfer, a blood test confirms whether implantation occurred. If pregnant, the surrogate moves into routine antenatal care, with extra monitoring typical in IVF pregnancies.
Many intended parents underestimate how emotionally intense it feels when the surrogate goes for scans and appointments. You may want to attend every visit and watch every ultrasound. Yet, respecting her comfort, privacy, and health is also crucial. Some families work out a middle path: the couple joins key milestone visits, like the first heartbeat scan or anomaly scan, while the surrogate attends routine checks with a companion she chooses.
The role of the surrogate beyond "carrying the baby"
Legally and medically, a surrogate's role looks simple: she carries a pregnancy and delivers the child. In real life, her impact ripples much further.
Physical and emotional labor
Pregnancy is demanding even when a woman is carrying her own baby. When she carries for someone else, the emotional equation shifts.
Many surrogates describe a strong sense of duty or responsibility. They feel deeply accountable to the intended parents for every symptom or scare, even when it is unrelated to anything they did. A borderline blood pressure reading or a minor bleed in the first trimester can send everyone into a panic, and the surrogate absorbs a lot of that anxiety.
In conversations I have witnessed, some surrogates speak of subtle guilt if they need bed rest and cannot manage usual household duties. Others worry about their own children, who may feel neglected while their mother is more closely monitored and sometimes temporarily moved nearer the clinic.
Supporting a surrogate well goes beyond paying medical bills. It includes:
Creating safe communication channels so she can report symptoms early without fear of blame.
Respecting her need for rest, food she can tolerate, and mental space.
Being honest with her about risks and outcomes, rather than hiding bad news.
Listening to her needs during labor and respecting her choices within medical safety limits.
Navigating attachment and separation
One of the biggest myths is that surrogates "give away their baby". In gestational surrogacy in India, the baby is genetically the child of the intended parents or donors, not the surrogate. Still, nine months of feeling kicks, nurturing life, and facing labor create bonds.
Good counseling before and throughout pregnancy prepares a surrogate to view herself as a caregiver who is holding space for this baby until the parents can take over. She is often encouraged to build a positive emotional connection during pregnancy, talking and singing to the baby, while also reinforcing that the child belongs to the intended parents.
The day of birth can still be emotionally complex. I have seen surrogates who felt deep joy watching the parents hold their child, and others who felt a quiet emptiness for a few weeks afterward, even though they never saw the baby as theirs. Both responses are normal.
After delivery, regular check-ins, even brief phone calls, can reassure her that the baby is thriving and that her effort had a real, ongoing impact. Where both families are comfortable, occasional updates or photos can be deeply meaningful.
The surrogate's rights and boundaries
Despite the altruistic framing, a surrogate is not a passive vessel. She retains rights over her body and medical decisions. This includes:
Right to informed consent for procedures like C-sections, inductions, or early delivery decisions.
Right to privacy in medical records, within the boundaries of what must be shared for the child's care and legal processes.
Right to refuse unreasonable demands that are not medically necessary, such as strict, culturally biased diet rules or excessive physical restrictions unrelated to her health.
In practice, many surrogates come from less privileged backgrounds or occupy a lower status in family hierarchies. This can make it harder for them to assert boundaries, especially when the intended parents are older relatives. The clinic and legal counsel have a responsibility to protect not just the letter of the law but the spirit of fairness and autonomy.
Ethical and practical questions families often ask
Surrogacy in India raises a long list of "what if" questions. Here are a few that come up repeatedly in real consultations.
What if the pregnancy results in twins?
Multiple pregnancy carries higher risks for both surrogate and babies. The law, clinic policy, and the signed surrogacy agreement usually specify how many embryos will be transferred and under what circumstances selective reduction might be considered. These are hard conversations that should happen well before embryo transfer, not in the middle of a crisis.
What if prenatal testing reveals a serious abnormality?
Most surrogacy agreements include clauses on how to handle major anomalies. Abortion laws, medical ethics, and everyone's beliefs intersect here. The surrogate's consent remains central, as she undergoes any procedure. Yet the intended parents bear the long-term responsibility for raising the child if the pregnancy continues. Talking through hypothetical scenarios calmly in advance does not guarantee peace, but it provides a shared map when you are under stress later.
What if the relationship between surrogate and intended parents breaks down?
Occasionally, money disputes, family politics, or misunderstandings fracture trust. In some cases, an intermediary, such as a counselor or a senior doctor, helps repair the relationship. Where that fails, legal agreements and court orders become the main tools to protect the child's interests and ensure the surrogate's safety. Choosing transparency, documenting every agreement, and setting realistic expectations from the start reduce the chances of this outcome.
What happens after birth with registration and parentage?
Under surrogacy laws in India, the intended parents are recognized as the legal parents of the child, subject to compliance with the Act and proper documentation. Birth certificates typically list them, not the surrogate. However, the exact process of obtaining the birth certificate, discharge summaries, and any court orders varies by state. Plan for several days of paperwork after delivery, even when everyone is cooperating.
Weighing surrogacy against other paths
For many couples, surrogacy is not the first stop on the road, but one of the last. By the time they ask how surrogacy works, they have often done multiple IVF cycles, surgery, or years of fertility treatment. They are exhausted.
At that point, people sometimes ask for a simple verdict: is surrogacy in India a good idea or a bad one?
The honest answer is that it is a demanding but sometimes necessary option, embedded in a restrictive legal framework. Compared to adoption, it offers a genetic link that some families deeply desire. Compared to continuing risky pregnancies in a woman with serious health conditions, it can be safer. On the other hand, it brings heavy legal oversight, emotional complexity for the surrogate, and, for many people, outright ineligibility due to the tight laws.
Anyone considering surrogacy in India today should:
First, check legal eligibility clearly, preferably with a lawyer who works on reproductive law, not only with the clinic staff.
Second, explore whether your family can realistically identify a potential surrogate who fits age, health, and relationship criteria and is genuinely willing.
Third, secure psychological support for everyone involved, including your own marriage or partnership, because fertility journeys can strain even strong relationships.
Fourth, think about finances beyond direct medical expenses: travel, time off work, support for the surrogate's lost income, and contingencies.
Fifth, reflect honestly on your own values: how you feel about prenatal testing, disability, potential complications, and the possibility that despite all this effort, a pregnancy might still fail.
Surrogacy is not a shortcut. It is simply a different kind of long road. For those who walk it, a well-chosen, well-supported surrogate becomes not a footnote but a central figure in their family story. Understanding her eligibility, the scrutiny she undergoes, and the depth of her role helps everyone move forward with more respect, clarity, and care.