Surrogacy in India has undergone a dramatic transformation following the Surrogacy (Regulation) Act 2021, shifting from a commercial industry to a strictly regulated altruistic model available only to married Indian couples. For intended parents facing infertility, this comprehensive guide explains the current legal framework, eligibility requirements, complete cost breakdown, and step-by-step process for pursuing surrogacy in India in 2026.

India remains an attractive destination for surrogacy despite restrictive regulations, with total costs ranging from ₹15-35 lakhs (approximately USD 18,000-42,000) compared to $100,000-150,000+ in Western countries. However, only legally recognized Indian and Indian-origin married couples can access surrogacy services under current law.

Key Facts About Surrogacy in India (2026):

• Legal Status: Only altruistic (non-commercial) surrogacy permitted

• Eligible Couples: Indian citizens, NRI, OCI married for minimum 5 years

• Ineligible Groups: Foreigners, single individuals, same-sex couples, divorced/widowed persons (with exceptions)

• Surrogate Requirements: Must be married woman aged 25-35 with at least one biological child

• Cost Range: ₹15-35 lakhs (approximately USD 18,000-42,000)

• Success Rate: 50-70% depending on clinic and medical conditions

• Timeline: 18-24 months from initial consultation to baby delivery

• Mandatory Approvals: District Medical Board and Court approval required

• Insurance Coverage: 36 months post-delivery insurance mandatory for surrogate

• Compensation: Only medical expenses allowed (no commercial compensation)

• Legal Certificates: Eligibility certificate, Essentiality certificate, Court order for parentage required

Part 1: Understanding Surrogacy and Eligibility Criteria

What is Surrogacy?

Surrogacy is an assisted reproductive technology where a woman (surrogate mother) becomes pregnant and delivers a child for intended parents who cannot conceive naturally. The child is biologically related to the intended parents (uses their egg and sperm), but the surrogate carries the pregnancy and delivers the child.

Types of Surrogacy:

Genetic Surrogacy (Full Surrogacy):

• Egg from intended mother + sperm from intended father

• Surrogate carries the pregnancy only

• Biologically the child of intended parents

• Most common type in India

Traditional Surrogacy:

• Uses surrogate's own egg

• Biologically related to surrogate

• Prohibited under Indian law since 2021

• Previously used in commercial surrogacy

Gestational Surrogacy:

• Surrogate has no genetic relation to child

• Only carries pregnancy

• Legal form under current Indian law

• Recommended by Indian fertility authorities

Medical Indications for Surrogacy

Surrogacy is recommended when intended parents have specific medical conditions preventing natural conception or pregnancy:

Uterine Conditions:

• Absent uterus (Müllerian Agenesis or MRKH syndrome—born without uterus)

• Uterus surgically removed (hysterectomy for medical reasons)

• Severe uterine damage (tuberculosis, asherman's syndrome, severe adhesions)

• Repeated implantation failure despite good quality embryos

• Severely compromised uterine structure limiting pregnancy safety

Medical Conditions Making Pregnancy Dangerous:

• Severe cardiac disease with pregnancy contraindication

• Uncontrolled diabetes or hypertension

• Severe kidney disease or liver disease

• Autoimmune disorders with pregnancy risk

• Cancer survivors with uterine compromise

• HIV or hepatitis with transmission risk to fetus

Reproductive History Issues:

• Repeated IVF failures despite good embryos (poor implantation)

• Recurrent pregnancy losses (miscarriage)

• Recurrent ectopic pregnancies

• Severe endometriosis limiting conception

• Unexplained infertility after full investigation

Age-Related Infertility:

• Advanced maternal age with poor egg quality

• Prolonged infertility despite treatment

• High risk of genetic abnormalities in natural pregnancy

District Medical Board must issue medical indication certificate confirming surrogacy medical necessity.

Eligibility Criteria for Intended Parents (2026)

Strict legal requirements determine who can pursue surrogacy in India:

Citizenship and Legal Status:

✓ Must be Indian citizens, NRI (Non-Resident Indian), or OCI (Overseas Citizen of India)
✓ Foreign nationals with Indian origin may qualify under specific circumstances
✓ Must reside in India during medical procedures
✓ Must be legally married

Marital Status and Duration:

✓ Legally married for minimum 5 consecutive years
✓ Only heterosexual marriages recognized
✓ Marriage must be valid under Indian law
✓ Divorce or separation disqualifies intended parents
✓ Widowed persons generally not eligible (exceptions apply)

Age Requirements:

Category	Minimum Age	Maximum Age
Intended Wife (Female)	23 years	50 years
Intended Husband (Male)	26 years	55 years
Combined Age Limit	—	Not specified

Infertility Requirement:

✓ At least one partner (wife or husband) must have proven infertility
✓ Infertility documented by registered medical practitioner
✓ Must have undergone unsuccessful treatment for infertility
✓ Medical report confirming infertility required

Child Status Requirement (Most Restrictive):

✓ Couple must NOT have surviving children (biological, adopted, or surrogate)
✓ Exception: If surviving child is mentally or physically disabled OR suffers from life-threatening disorder, couple may pursue additional children through surrogacy
✓ "Surviving child" includes children born to either partner from previous relationships
✓ This is one of the most restrictive eligibility criteria

Example of Child Status Rule:

• Couple with one healthy biological child = NOT eligible

• Couple with one disabled child + desire second child = MAY be eligible

• First-time parents seeking first child = Eligible (if all other criteria met)

Ineligible Groups Under Current Law:

❌ Unmarried individuals (single men or women)
❌ Same-sex couples (married or unmarried)
❌ Divorced or separated individuals
❌ Widowed individuals (except under specific exceptions)
❌ Couples married less than 5 years
❌ Foreign nationals (even of Indian descent in most cases)
❌ Couples with surviving healthy children
❌ Couples with only one partner infertile (other partner must also be infertile)
❌ Persons with history of child abuse or criminal convictions

Eligibility Criteria for Surrogate Mother (2026)

Surrogate mothers must meet very specific and restrictive criteria:

Personal Status Requirements:

✓ Must be a married woman (not single, divorced, or widowed)
✓ Marriage must be legally valid
✓ Spouse/family consent required for surrogacy participation
✓ Must be between 25-35 years of age (strictly enforced)
✓ Must have at least one living biological child of her own
✓ Must have given birth naturally (vaginal or cesarean delivery)

Medical and Genetic Requirements:

✓ Must pass comprehensive medical examination
✓ Must pass psychological/psychiatric evaluation
✓ Must provide certificate of medical fitness
✓ Must provide certificate of psychological fitness
✓ Cannot have any infectious diseases (HIV, hepatitis, tuberculosis)
✓ Cannot have genetic disorders
✓ Cannot have mental illness or psychological disorders
✓ Must have normal reproductive health
✓ Cannot have had more than two previous pregnancies (to limit risk)

Legal and Surrogacy-Specific Requirements:

✓ Cannot be close genetic relative of intended parents (to avoid complications)
✓ Can only serve as surrogate ONCE in lifetime (federal law)
✓ Cannot have been surrogate mother previously (even for different couple)
✓ Must provide written informed consent
✓ Must understand terms of surrogacy agreement
✓ Cannot use her own eggs (genetic surrogacy only—recipient's eggs used)
✓ Must have eligibility certificate from District Medical Board
✓ Must complete mandatory counseling sessions

Compensation Limitations:

❌ Cannot receive monetary compensation beyond medical expenses
❌ Cannot be paid for "time off work"
❌ Cannot receive "surrogate fees" (commercial surrogacy banned)
✓ Can receive:

• All medical expenses (prenatal, delivery, postnatal)

• Living expenses during pregnancy (nutritional support)

• Travel allowances for medical appointments

• Health insurance coverage for 36 months post-delivery

• Maternity clothing and comfort items

• Counseling and support services

Surrogate Profile (Typical in India):

In practice, surrogates are often economically disadvantaged women willing to help infertile couples. Many surrogates are from lower-income families, rural areas, or are widows supporting families. Clinics must ensure informed consent and that surrogates understand all implications.

Medical Indication Certificate

District Medical Board Issues Certificate When:

✓ Medical report confirms intended mother's infertility or health condition
✓ Surrogacy medically necessary for couple to have biological child
✓ Couple meets eligibility criteria (age, marital status, no surviving children)
✓ Proof of 5-year marriage provided
✓ Both partners undergo medical and psychological evaluation
✓ Couple confirms understanding of surrogacy process and implications

This certificate is mandatory before any medical procedure can begin.

Part 2: Current Surrogacy Laws in India (2026)

The Surrogacy (Regulation) Act 2021

Overview:

The Surrogacy (Regulation) Act 2021, passed by Indian Parliament and effective from January 2022, fundamentally transformed surrogacy in India. This law completely banned commercial surrogacy and established altruistic surrogacy as the only legal form, with strict regulations protecting all parties.[2]

Key Legislative Changes:

Aspect	Before 2021	After 2021 (Current)
Commercial Surrogacy	Legal and prevalent	Banned nationwide
Surrogate Compensation	High fees paid (₹3-10 lakhs+)	Only medical/living expenses
Eligible Couples	Anyone including foreigners	Only Indian/NRI/OCI married couples
Foreign Nationals	Could pursue surrogacy	Banned except OCI/NRI
Same-Sex Couples	Not addressed	Explicitly banned
Single Individuals	Not addressed	Explicitly banned
Surrogate Selection	Could be anyone	Must be close relative only
Surrogate Genetic Role	Could use surrogate's egg	Cannot use surrogate's egg
Multiple Surrogacies	Surrogates could repeat	Limited to once in lifetime
Insurance	Not mandated	36-month mandatory coverage
Court Approval	Required but variable	Mandatory with court order for parentage
District Medical Board	Not required	Mandatory approvals for all procedures

Purpose of the Act:

✓ Protect women from exploitation in commercial surrogacy
✓ Ensure ethical medical practices in surrogacy
✓ Regulate surrogacy procedures and prevent abuse
✓ Establish clear legal framework
✓ Ensure transparent and documented process
✓ Protect interests of surrogate mother and child
✓ Prevent surrogacy for non-medical reasons
✓ Ensure proper psychological counseling
✓ Establish parental rights and responsibilities

Regulatory Bodies and Oversight

District Medical Board (DMB):

Composition:

• Chief District Medical Officer (Chair)

• Chief Obstetrician and Gynecologist

• Pediatrician

• Social Worker

• Ayurveda/Yoga/Unani/Siddha representative (if available)

Responsibilities:

• Issue medical indication certificate to couples

• Approve surrogacy arrangements

• Ensure medical protocols followed

• Monitor surrogate health throughout pregnancy

• Inspect fertility clinics for compliance

• Maintain records of all surrogacy procedures

• Investigate complaints or violations

• Issue certificates of essentiality

National Surrogacy Board:

• Oversees implementation nationally

• Creates guidelines and protocols

• Handles complaints and disputes

• Ensures consistency across states

• Reviews medical and ethical standards

Fertility Clinics (ICMR-Accredited):

• Must be registered with Medical Council

• Follow ICMR guidelines on Assisted Reproductive Technology

• Maintain proper documentation

• Conduct medical and psychological evaluations

• Provide counseling services

• Maintain confidentiality and privacy

• Report to District Medical Board

• Keep records for statutory period

Penalties and Legal Consequences

For Intended Parents Violating Law:

• Fine up to ₹10 lakhs

• Imprisonment up to 10 years

• Criminal prosecution for commercial surrogacy

• Loss of child custody in egregious cases

For Surrogate Mothers:

• Generally protected from prosecution

• Cannot be prosecuted for accepting compensation

• Protected under victim provisions if exploited

For Medical Professionals:

• Fine up to ₹10 lakhs

• Imprisonment up to 10 years

• Removal from medical register

• License cancellation

• Civil liability for damages

• Professional conduct violation proceedings

For Agencies/Intermediaries:

• Fine up to ₹10 lakhs per violation

• Imprisonment up to 10 years

• Business closure orders

• Confiscation of assets

• Criminal prosecution

State-Level Variations

While the national law is uniform, some states have additional regulations:

States with Stricter Requirements:

• Karnataka: Additional state-level registration

• Maharashtra: Additional counseling requirements

• Delhi: Additional documentation requirements

States with Extended Timelines:

• Bihar: Longer court approval timelines

• Uttar Pradesh: Additional bureaucratic procedures

Recommended States for Surrogacy (Better Infrastructure):

• Delhi NCR (Gurugram, Delhi, Noida)

• Maharashtra (Mumbai, Pune)

• Karnataka (Bangalore)

• Tamil Nadu (Chennai)

• Rajasthan (Jaipur)

These states have:

• Well-established fertility clinics

• Experienced District Medical Boards

• Faster legal processing

• Better legal support infrastructure

• More surrogate availability (with strict screening)

Part 3: Complete Cost Breakdown for Surrogacy in India (2026)

Overall Cost Range

Total Surrogacy Cost in India: ₹15-35 Lakhs (USD 18,000-42,000)

Cost varies based on:

• City and clinic location

• Medical complexity

• Additional procedures needed

• Insurance requirements

• Legal jurisdiction

• Surrogate selection method

• Success factors

Cost Component	Low Range	High Range	Percentage
Surrogate Compensation	3,00,000	5,00,000	20-25%
Medical Procedures (IVF/Eggs)	2,00,000	4,00,000	15-20%
Medical Monitoring	2,00,000	4,00,000	15-20%
Delivery	1,00,000	2,00,000	8-10%
Insurance (36 months)	1,00,000	2,00,000	8-10%
Legal Fees	75,000	2,25,000	5-15%
Clinic/Agency Fees	1,50,000	3,75,000	10-15%
Counseling/Support	37,500	1,50,000	3-5%
Miscellaneous	1,00,000	1,50,000	5-10%
TOTAL	15,00,000	35,00,000	100%

Table 1: Surrogacy Cost Breakdown in India 2026

Detailed Cost Components

1. Surrogate Mother Compensation (₹3-5 Lakhs): 20-25% of Total

This is the only "compensation" allowed under altruistic surrogacy law:

Includes:

• Prenatal care during 9-month pregnancy

• Vitamins, supplements, and nutritional support (₹8,000-10,000/month)

• Maternity clothing and comfort items

• Travel allowance to medical appointments (₹3,000-5,000/month)

• Post-delivery care for 8 weeks

• Health insurance premium contribution

Specific Breakdown:

• Base medical care: ₹1,50,000

• Nutritional support (9 months): ₹90,000

• Travel allowance (9 months): ₹45,000

• Maternity clothing: ₹25,000

• Post-delivery care: ₹50,000

• Miscellaneous: ₹40,000

• Total: ₹3,00,000-5,00,000

Does NOT include (legally banned):

• Surrogate "fees" or compensation for service

• Payment for "time off work"

• Emotional distress compensation

• Lifestyle disruption fees

• Convenience payments

• Risk premium payments

2. Egg Retrieval and Preparation (₹1,50,000-2,50,000): 10-15% of Total

Includes:

• Hormone stimulation medications (₹30,000-60,000)

• Follicle stimulation and monitoring (₹50,000-75,000)

• Egg retrieval procedure (₹40,000-60,000)

• Egg preparation and cleaning

• Sperm preparation

• In-vitro fertilization (IVF) procedure

• Embryo culture and development

Details:

• Follicle-stimulating hormone (FSH) injections: ₹25,000-50,000

• Ultrasound monitoring (8-10 scans): ₹15,000-30,000

• Egg retrieval under anesthesia: ₹40,000-60,000

• Laboratory charges: ₹25,000-40,000

3. Embryo Transfer (₹75,000-1,50,000): 5-10% of Total

Includes:

• Endometrial preparation of surrogate

• Hormone protocols for implantation

• Embryo transfer procedure

• Post-transfer monitoring

• Implantation support medications

Specific Costs:

• Progesterone and estrogen medications: ₹25,000-40,000

• Endometrial evaluation and preparation: ₹20,000-40,000

• Transfer procedure: ₹30,000-50,000

• Monitoring and support: ₹20,000-30,000

4. Medical Monitoring During Pregnancy (₹2,00,000-4,00,000): 15-20% of Total

Includes:

• Routine obstetric visits (monthly checkups)

• Ultrasound scans (6-8 during pregnancy)

• Blood tests and screening (first trimester, second trimester, third trimester)

• Specialized testing if high-risk pregnancy

• Gestational diabetes testing

• Prenatal screening for fetal abnormalities

• Doppler studies and monitoring

Detailed Breakdown:

• Prenatal visits (10-12 visits): ₹60,000-80,000

• Routine ultrasounds (6-8 scans): ₹60,000-80,000

• Blood tests and labs: ₹40,000-60,000

• Specialized tests (if needed): ₹30,000-80,000

• High-risk monitoring (if applicable): ₹10,000-80,000

• Total: ₹2,00,000-4,00,000

5. Delivery and Childbirth (₹1,00,000-2,00,000): 8-10% of Total

Vaginal Delivery:

• Hospital room and nursing care: ₹40,000-60,000

• Obstetric fees: ₹20,000-30,000

• Anesthesia: ₹5,000-10,000

• Medications and IV fluids: ₹10,000-15,000

• Laboratory and imaging: ₹10,000-15,000

• Total: ₹85,000-1,30,000

Cesarean Section Delivery (15-20% of surrogacies):

• Hospital room and nursing: ₹50,000-80,000

• Surgical team fees: ₹30,000-50,000

• Anesthesia: ₹10,000-15,000

• Medications and supplies: ₹15,000-25,000

• Post-operative care: ₹15,000-30,000

• Total: ₹1,20,000-2,00,000

6. Neonatal Care (If Needed) (₹50,000-2,00,000): Variable

Normal Newborn Care:

• Birth weight screening: ₹2,000

• Vaccination: ₹5,000

• Basic screening tests: ₹3,000

• Total: ₹10,000

NICU Admission (If Complications):

• NICU daily charges: ₹5,000-20,000/day

• Ventilator support (if needed): ₹3,000-10,000/day

• Medications: ₹10,000-50,000

• Special monitoring: ₹20,000-100,000

• Average NICU stay: 3-7 days

• Total (if needed): ₹50,000-2,00,000

7. Insurance Coverage (₹1,00,000-2,00,000): 8-10% of Total

Mandatory 36-Month Coverage Includes:

• Pregnancy and childbirth complications

• Post-delivery complications (infection, hemorrhage, thrombosis)

• Obstetric conditions (gestational diabetes, preeclampsia)

• Anesthesia-related complications

• Emergency care and hospitalization

• Medical procedures related to surrogacy complications

Cost Breakdown:

• Policy premium: ₹1,00,000-1,50,000

• Medical service provider coordination: ₹25,000-50,000

• Total: ₹1,00,000-2,00,000

Note: Required by law. Intended parents must arrange and pay.

8. Legal Fees (₹75,000-2,25,000): 5-15% of Total

Includes:

Initial Legal Work (₹25,000-50,000):

• Initial consultation and case assessment

• Document preparation and review

• Eligibility certificate application

• Government approval applications

• Correspondence with District Medical Board

Contract/Agreement Drafting (₹25,000-75,000):

• Surrogacy agreement drafting

• Terms and conditions documentation

• Rights and responsibilities agreement

• Medical procedure authorization

• Compensation agreement (for medical expenses)

• Notarization of agreements (required)

Court Proceedings (₹25,000-1,00,000):

• District Magistrate filing fees

• Summons and court notices

• Hearing preparation

• Advocate fees for court appearances

• Order drafting and processing

• Parentage declaration order

Post-Delivery (₹15,000-50,000):

• Birth certificate registration

• Parentage certificate filing

• Custody confirmation order

• Passport application assistance

• Post-delivery legal documentation

Total Legal Fees: ₹75,000-2,25,000 (varies significantly by jurisdiction and complexity)

9. Fertility Clinic/Agency Fees (₹1,50,000-3,75,000): 10-15% of Total

Includes:

• Clinic consultation fees (₹2,000-5,000/visit)

• Case management and coordination

• Surrogate identification and screening

• Medical record management

• Staff support and counseling

• Coordination with District Medical Board

• Quality assurance and monitoring

• Documentation and record-keeping

• Post-delivery support

By Tier of Clinic:

Tier-1 Clinics (Premium, Metro Cities):

• Fees: ₹2,50,000-3,75,000

• Success rates: 60-70%

• Advanced technology and infrastructure

• Experienced staff with international training

• Examples: Delhi, Mumbai, Bangalore premium clinics

Tier-2 Clinics (Mid-level, Metropolitan):

• Fees: ₹2,00,000-2,75,000

• Success rates: 50-60%

• Good infrastructure and experience

• Accredited by ICMR

• Examples: Gurugram, Pune, Jaipur clinics

Tier-3 Clinics (Smaller Cities):

• Fees: ₹1,50,000-2,00,000

• Success rates: 45-55%

• Basic infrastructure and services

• ICMR accredited

• Examples: Smaller city clinics

10. Counseling and Psychological Support (₹37,500-1,50,000): 3-5% of Total

Includes:

• Psychological evaluation and testing

• Mental health counseling for couple (3-5 sessions)

• Psychological assessment of surrogate

• Counseling for surrogate and family (3-5 sessions)

• Pre-surrogacy counseling and education

• Coping strategy development

• Stress management training

• Post-delivery support and counseling

• Follow-up counseling

Cost Breakdown:

• Initial psychological evaluation: ₹5,000-10,000

• Counseling sessions (per session): ₹2,000-5,000 × 5-10 sessions

• Couple counseling: ₹10,000-30,000

• Surrogate counseling: ₹7,500-30,000

• Total: ₹37,500-1,50,000

Cost Variations by Location

Delhi/NCR Region: ₹18-25 Lakhs

• Premium clinics with advanced technology

• Experienced medical teams

• Higher surrogate availability (competition for best candidates)

• Faster legal processing

• Success rates: 65-72%

• Examples: South Delhi, Gurugram, Noida clinics

Mumbai: ₹18-28 Lakhs

• Most expensive region

• Premium clinics with international standards

• Highly qualified medical staff

• Success rates: 60-70%

• Longer waiting lists

Bangalore: ₹15-22 Lakhs

• Good balance of quality and cost

• Established fertility clinic infrastructure

• Success rates: 55-65%

• Moderate waiting times

Pune: ₹14-20 Lakhs

• Competitive pricing

• Good clinic options

• Success rates: 50-60%

Hyderabad: ₹12-18 Lakhs

• More affordable option

• Growing clinic infrastructure

• Success rates: 50-58%

Kolkata/Jaipur: ₹8-15 Lakhs

• Most economical options

• Basic to mid-level infrastructure

• Success rates: 45-55%

• Longer travel/coordination required

Payment Structure and Options

Typical Payment Schedule:

At Registration (₹2-3 Lakhs):

• Consultation fees and initial evaluation

• Application and documentation

• Initial clinic/agency fees

• Percentage of legal fees

Before Medical Procedures (₹3-5 Lakhs):

• Egg retrieval and IVF procedures

• Medications and hormones

• Laboratory tests and imaging

• Surrogate medical evaluation

During Pregnancy (₹3-5 Lakhs):

• Monthly clinic visits

• Surrogate compensation and support

• Regular monitoring and tests

• Medications and supplies

• Insurance premiums

At Delivery (₹3-5 Lakhs):

• Hospital and childbirth costs

• Post-delivery care

• Legal finalization costs

• Remaining surrogacy compensation

Post-Delivery (₹1-3 Lakhs):

• Neonatal care (if needed)

• Insurance coverage (ongoing)

• Legal documentation and birth certificate

• Final clinic and legal fees

Payment Methods

Direct Payment to Clinics:

• Upfront payment with contract

• Installment plans (common: 3-4 payments)

• Bank transfer to clinic account

• Some clinics accept credit cards

Insurance Payment:

• Insurance company pays medical providers directly

• Couple reimburses insurance premium

• Coordination between clinic and insurance

Surrogate Compensation:

• Typically paid to surrogate directly

• Some clinics hold in escrow until delivery

• Transparent accounting required by law

Legal Fees Payment:

• Usually paid to lawyer directly

• Can be installment or lump sum

• Court fees paid separately

Hidden Costs to Anticipate

Additional Expenses Not Always Included:

• Multiple IVF attempts (if first attempt unsuccessful): ₹1.5-2.5 lakhs per additional attempt

• Failed pregnancy requiring re-transfer: ₹50,000-1 lakh

• Genetic testing (PGD/PGS if recommended): ₹50,000-1 lakh

• Recurrent pregnancy loss management: ₹50,000-1.5 lakhs

• NICU admission (if complications): ₹50,000-2 lakhs

• Extended surrogate hospitalization: ₹10,000-20,000/day extra

• Repeated legal procedures (if complications): ₹25,000-75,000 extra

• Additional travel and accommodation (if not local): ₹50,000-2 lakhs

• Medical complications requiring extended care: Highly variable

• Psychological counseling beyond included sessions: ₹2,000-5,000/session

• Post-delivery legal issues (parentage disputes): ₹1-5 lakhs

Cost Overrun Scenarios:

• Couple travels to clinic: ₹50,000-1.5 lakhs (flight + accommodation + meals)

• Multiple IVF cycles needed: ₹1.5-2.5 lakhs × (number of cycles - 1)

• NICU admission: ₹50,000-2+ lakhs

• Surrogate complications requiring extended care: ₹1-3 lakhs

• Legal disputes or complications: ₹50,000-1.5 lakhs

Part 4: Step-by-Step Surrogacy Process in India (2026)

Phase 1: Eligibility Assessment and Consultation (Weeks 1-4)

Step 1: Choose a Fertility Clinic

Selection Criteria:

• ICMR-accredited fertility clinic

• Registered with Medical Council of India

• Positive reputation and reviews

• Transparent cost structure

• District Medical Board presence/coordination

• Surrogate screening infrastructure

• Legal support coordination

• Success rate statistics

Initial Consultation (₹2,000-5,000):

• Meet fertility specialist

• Medical history review

• Discussion of medical indications

• Overview of surrogacy process

• Cost explanation and payment structure

• Questions and concerns addressed

• Take-home information materials

Step 2: Medical Evaluation of Intended Parents

Wife's Medical Evaluation:

• Detailed infertility history

• Physical examination

• Pelvic ultrasound

• Blood tests (hormone levels, infections screening)

• HSG (hysterosalpingography) or other uterine assessment

• Assessment of uterine and ovarian health

• Age and ovarian reserve testing (AMH)

Husband's Medical Evaluation:

• Semen analysis and quality assessment

• General physical examination

• Blood tests (infections, genetic screening)

• Assessment of sperm count, motility, and morphology

• Genetic testing if indicated

Expected Results Timeline: 1-2 weeks

Step 3: Psychological Evaluation

For Intended Couple:

• Individual psychological assessment

• Understanding of surrogacy implications

• Mental health history review

• Motivation assessment

• Relationship stability evaluation

• Coping mechanisms evaluation

• Post-delivery psychological readiness

Expected Timeline: 1 week

Step 4: Documentation Collection

Required Documents:

• Marriage certificate (original and copy)

• Age proof (passport, birth certificate, Aadhaar)

• Residential proof (electricity bill, rent agreement)

• Income proof (income tax returns, salary slips)

• Infertility medical report from registered doctor

• Medical records from all prior fertility treatments

• Passport (for NRI applicants)

• OCI certificate (if applicable)

• Caste certificate (if required by state)

• Any legal custody orders (if applicable)

Document Verification: 1 week

Step 5: Medical Indication Certificate Application

Application to District Medical Board:

• Submit application with required documents

• Medical report confirming infertility

• Psychological evaluation report

• Both partners' medical certificates

• Proof of 5-year marriage

• Proof of no surviving children

• Identity and residence verification

District Medical Board Review: 2-4 weeks

Medical Indication Certificate Issued: Mandatory before proceeding

Phase 2: Surrogate Selection and Matching (Weeks 5-16)

Step 1: Surrogate Identification Pool

Clinic maintains pool of pre-screened surrogates who meet legal requirements:

• Married women aged 25-35

• Have at least one living biological child

• Passed medical screening

• Passed psychological evaluation

• Provided informed consent

• No prior surrogacy experience

Step 2: Surrogate Medical Screening

Comprehensive Medical Evaluation:

• Complete physical examination

• Reproductive health assessment

• Uterine ultrasound and cavity assessment

• Blood tests (complete blood count, chemistry, serology)

• Infectious disease screening (HIV, hepatitis B/C, syphilis, tuberculosis)

• Genetic screening (selected conditions)

• Pap smear or cervical assessment

• Previous obstetric and gynecological history review

Medical Assessment Results: Suitable for surrogacy confirmation

Step 3: Surrogate Psychological Evaluation

Psychological Assessment Includes:

• Mental health history

• Motivation and understanding of surrogacy

• Family support and consent verification

• Capacity to carry pregnancy for others

• Coping mechanisms for pregnancy-related challenges

• Understanding of parentage being separate from intended parents

• Ability to surrender child after delivery

• Financial situation and independence

• Marital relationship stability

Surrogate Eligibility Certificate Issued: After approval

Step 4: Couple-Surrogate Matching

Matching Process (Ethical Framework):

• Clinic facilitates introduction

• Couple and surrogate meet (optional but recommended)

• Discussion of expectations and concerns

• Understanding of legal agreements

• Exchange of basic information

• Signing of mutual consent agreement

Clause Notes:

• Couple cannot choose surrogate based on superficial criteria (appearance, caste, religion)

• Must respect surrogate's choices and autonomy

• Clinic ensures ethical matching

• Cannot exploit economically vulnerable surrogates

Step 5: Surrogacy Agreement Preparation

Legal Documents Drafted:

• Surrogacy agreement specifying:

  • Rights and responsibilities of all parties

  • Medical procedures and timeline

  • Compensation structure (medical expenses only)

  • Insurance coverage details

  • Confidentiality clauses

  • Dispute resolution mechanisms

  • Parental rights and custody

  • Contingency plans (if miscarriage, stillbirth)

  • Genetic material usage rights

• Medical protocols and procedure authorizations

• Informed consent documentation

All Documents Require:

• Notarization

• Signatures of all parties

• Witness signatures (2 witnesses)

• Legal certification

Step 6: District Medical Board Approval

Submission to DMB:

• Completed surrogacy agreement

• Medical reports of surrogate and couple

• Psychological evaluations

• Medical indication certificate

• Eligibility certificates

• Insurance coverage proof

• Clinic compliance documentation

DMB Review and Approval: 2-4 weeks

Surrogacy Arrangement Approval Certificate: Issued when all criteria met

Phase 3: Medical Procedures (IVF and Embryo Transfer)

Step 1: Intended Mother's Ovarian Stimulation (10-14 days)

Hormone Injections (FSH and LH):

• Self-injected daily for 10-14 days

• Stimulates multiple follicles in ovaries

• Medication protocol varies based on ovarian reserve

• Blood tests every 2-3 days to monitor hormone levels

• Ultrasounds every 2-3 days to monitor follicle growth

Cost: ₹50,000-80,000
Side Effects: Mild bloating, headache, mood changes (temporary)

Step 2: Trigger Shot and Egg Retrieval (36 hours after trigger)

Trigger Injection (hCG):

• Final injection to trigger egg maturation

• Timed to allow 36-hour maturation before retrieval

• Essential step for egg quality

Egg Retrieval Procedure:

• Ultrasound-guided aspiration under anesthesia

• 15-20 minute procedure

• 8-15 eggs typically retrieved (varies by ovarian reserve)

• Recovered eggs assessed for quality

• Mild cramping and discomfort post-procedure

Cost: ₹40,000-60,000
Recovery: Same day discharge, rest recommended

Step 3: Sperm Collection and Preparation

Sperm Sample Collection:

• Fresh sample on day of egg retrieval (preferred)

• Previously collected and frozen sample (if preferred)

• Normal fertility requirements: >40% motility, normal morphology

• Even with male factor infertility, ICSI (intracytoplasmic sperm injection) can help

Sperm Preparation:

• Wash and concentration to achieve optimal sperm quality

• Removal of seminal fluid

• Selection of best quality sperm

Step 4: In-Vitro Fertilization (IVF) - Day 1

Fertilization Process:

• Eggs incubated with prepared sperm

• Sperm penetrates egg and fertilization occurs

• Fertilized eggs (zygotes) allowed to develop overnight

Fertilization Assessment (Day 1):

• Check for signs of successful fertilization

• Expected: 50-80% of eggs fertilize

• Report to couple on number of fertilized embryos

Cost: ₹30,000-50,000 (included in IVF package)

Step 5: Embryo Culture and Development (Days 2-3 or Days 2-5)

Embryo Grading (Day 3):

• Embryos assessed for cell division and quality

• Grade A: Best quality

• Grade B: Good quality

• Grade C: Fair quality

• Grade D: Poor quality (usually not transferred)

Culture Medium:

• Embryos grown in specialized culture medium

• Temperature and gas concentration controlled

• Conditions mimic uterine environment

Blastocyst Development (Day 5-6, if preferred):

• Some programs culture to blastocyst stage (Day 5)

• Allows better embryo selection

• More discriminatory for best-quality embryos

• Associated with higher implantation rates

Cost: ₹10,000-15,000 (included in IVF package)

Step 6: Surrogate Endometrial Preparation (Parallel Timeline)

While couple undergoes IVF, surrogate starts hormone protocol:

Endometrial Preparation Protocol:

• Estrogen therapy (oral or patch) starting around Day 1-3 of cycle

• Ultrasound monitoring of endometrial thickness

• Goal: Endometrium 7-10mm thick

• Typically 10-12 days of estrogen treatment

• Then addition of progesterone for 3-5 days before transfer

• Timed to synchronize with embryo development

Cost: ₹25,000-40,000
Side Effects: Mild bloating, breast tenderness, mood changes

Step 7: Embryo Transfer (10-14 days after egg retrieval)

Preparation:

• Selection of best-quality embryo (usually 1-2 transferred)

• Surrogate should have full bladder for ultrasound guidance

• Couple present for procedure (if desired)

Transfer Procedure:

• Speculum inserted into vagina

• Catheter passed through cervix

• Embryo(s) loaded and gently transferred

• Ultrasound confirmation of placement

• 15-20 minute procedure, usually painless

• Similar to pap smear discomfort level

Post-Transfer:

• 15-30 minutes rest (not strictly necessary but recommended)

• Normal activity can resume next day

• Bed rest not required (no evidence of benefit)

• Avoid strenuous exercise and sexual intercourse for 1-2 weeks

Cost: ₹30,000-50,000

Step 8: Pregnancy Confirmation (12-14 days after transfer)

Pregnancy Test:

• Blood test for beta-hCG (human chorionic gonadotropin)

• Confirms implantation and pregnancy

• hCG typically >100 mIU/mL for positive pregnancy

Follow-up Test (48 hours later):

• Repeat beta-hCG

• Should double (or more) in 48 hours

• Indicates healthy, progressing pregnancy

Ultrasound Confirmation (14-21 days after transfer):

• Ultrasound confirms gestational sac in uterus

• Rules out ectopic pregnancy

• Shows fetal heart rate by 6-7 weeks

Success Rates (As of 2026):

• Per-transfer pregnancy rate: 45-60% (age and clinic dependent)

• Live birth rate per transfer: 40-50%

• Multiple birth rate: 25-30% (due to 2-embryo transfers)

Phase 4: Pregnancy Monitoring (9 Months)

Trimester 1 (Weeks 1-12)

Weekly/Biweekly Visits:

• Obstetric examination

• Blood pressure monitoring

• Weight assessment

• Fetal heart rate monitoring

• Ultrasound at weeks 6-7, 9-10, 12-13

Blood Tests:

• First trimester screening (weeks 11-13)

• Nuchal translucency measurement

• PAPP-A and beta-hCG measurement

• Non-invasive prenatal testing (NIPT) if desired (advanced testing)

Counseling:

• Pregnancy dos and don'ts

• Nutrition and exercise guidance

• Surrogate support and monitoring for complications

• Couple counseling regarding upcoming parenthood

Cost: ₹50,000-80,000

Trimester 2 (Weeks 13-27)

Monthly/Biweekly Visits:

• Routine obstetric care

• Fetal growth monitoring

• Gestational age assessment

• Placental position evaluation

• Amniotic fluid volume assessment

Ultrasounds:

• Detailed anatomy scan (18-20 weeks)

• Assessment of all fetal structures

• Fetal abnormality screening

• Growth assessment (20-24 weeks)

Blood Tests:

• Glucose tolerance test (24-28 weeks) for gestational diabetes screening

• Complete blood count

• Repeat infectious disease screening if indicated

Surrogate Care:

• Nutritional support continued

• Exercise and activity monitoring

• Monitoring for gestational diabetes

• Managing pregnancy-related symptoms

Cost: ₹60,000-100,000

Trimester 3 (Weeks 28-40)

Frequent Visits (2-3 weekly):

• Fetal growth monitoring

• Amniotic fluid assessment

• Fetal position assessment

• Signs of preeclampsia or other complications

• Fetal heart rate monitoring

Ultrasounds:

• Growth scan (32-34 weeks)

• Position confirmation (37+ weeks)

• Estimated fetal weight

• Placental location

Surrogate Care:

• Monitoring for preeclampsia, gestational diabetes, anemia

• NST (Non-stress test) monitoring if complications

• Counseling for delivery preparation

• Insurance documentation finalization

Cost: ₹80,000-150,000

Total Monitoring Cost: ₹2,00,000-4,00,000 (over 9 months)

Phase 5: Delivery and Postpartum (Weeks 40-42)

Pre-Delivery Preparation

Hospital Selection:

• Clinic-affiliated hospital or independent hospital with neonatal care

• Hospital must have pediatrician on staff

• Neonatal intensive care unit (NICU) if needed

• Operating room for emergency cesarean section

Delivery Plan:

• Couple and surrogate discuss delivery preferences

• Trial of labor vs. planned cesarean section

• Pain management options discussed

• Surrogate's choice respected within medical safety parameters

Legal Documentation (Pre-Delivery):

• Court proceedings initiated for parentage order

• District Magistrate summons issued

• Couple and surrogate appear before court (if required)

• Order may be finalized before or after delivery

Delivery Day:

Labor and Delivery:

• Surrogate admitted to hospital when labor begins

• Fetal monitoring throughout labor

• Progression of labor assessed

• Couple may be present during labor (if desired and permitted by surrogate)

Vaginal Delivery (80-85% of cases):

• 8-12 hours average labor duration

• Pain management options: epidural, spinal, nitrous oxide, natural

• Delivery typically lasts 1-2 hours

• Baby delivered to intended parents immediately

Cesarean Section (15-20% of cases):

• Planned cesarean for medical indications

• Emergency cesarean for labor complications

• Surgical delivery under anesthesia

• Recovery 1-2 days in hospital

Postpartum Care:

For Surrogate (48-72 hours post-delivery):

• Monitoring for hemorrhage and infection

• Pain management (medications safe if breastfeeding)

• Monitoring of uterine involution

• Care of surgical incision (if cesarean)

• Emotional support and counseling

• Hospital discharge after 48-72 hours (typically)

For Newborn:

• Vitamin K and antibiotic eye drops

• Newborn screening tests

• Hearing screening

• Breastfeeding support (if surrogate chooses to breastfeed until weaning)

• Routine vaccinations

• Blood glucose monitoring

• Jaundice monitoring

• Discharge with parents after 24-48 hours (if healthy)

For Intended Parents:

• Legal custody documentation finalized

• Birth certificate application initiated

• Parentage order confirmation

• Adoption of newborn into intended family

• Pediatric care coordination for child

• Post-delivery support and counseling

Cost: ₹1,00,000-2,00,000 (delivery only)

Phase 6: Legal Finalization (Post-Delivery)

Birth Registration and Certificate

Court Order for Parentage:

• District Magistrate issues order naming intended parents as parents

• Order issued typically within 2-4 weeks of delivery

• Court recognizes parental rights of intended couple

Birth Certificate Issuance:

• Intended parents named as parents on birth certificate

• Child's name and date of birth recorded

• Certificate issued by Registrar of Births and Deaths

• Official legal recognition of parentage

Surrogate Legal Responsibilities End:

• Surrogate has no parental rights or responsibilities after delivery

• Intended parents assume all parental rights

• Surrogate identity typically not disclosed (privacy protected)

Post-Delivery Legal Documentation:

• Surrogate must sign parentage transfer documents

• Legal release of all parental rights

• Finalization of compensation payments

• Closure of surrogacy agreement

Passport and Travel Documents

Passport Application:

• Child's birth certificate submitted with passport application

• Intended parents submit as guardians

• Passport issued in child's name

• Intended parents named as guardians

Visa and Immigration (If International Intended Parents):

• Birth certificate establishes parentage

• Court order confirms parental rights

• Passport and visa obtained for child

• Permission to travel internationally

Timeline and Cost for Legal Finalization:

• Court proceedings: 2-4 weeks

• Birth certificate issuance: 1-2 weeks

• Passport application: 2-4 weeks

• Total timeline: 4-8 weeks

• Legal costs: ₹75,000-2,25,000

Phase 7: Post-Delivery Support (Months 1-3)

Medical Followup

Surrogate Postpartum Visits:

• Week 2 after delivery: Suture removal (if cesarean) and bleeding assessment

• Week 6 after delivery: Complete postpartum examination

• 36-month insurance coverage active for complications

Newborn Pediatric Care:

• 1-week visit: Weight, feeding, jaundice assessment

• 1-month visit: Complete newborn examination, vaccinations

• 3-month visit: Growth assessment, development milestone review

• Ongoing pediatric care as needed

Psychological and Emotional Support

For Intended Parents:

• Post-delivery counseling for bonding and parenting

• Support group for parents via surrogacy (optional)

• Resources for explaining surrogacy to child

• Coping with surrogate separation (if applicable)

For Surrogate:

• Postpartum emotional support and counseling

• Monitoring for postpartum depression

• Support for returning to normal life

• Ongoing clinic support through 6 weeks postpartum

Success Measurement:

• Family established and healthy

• Surrogate recovery completed without complications

• Legal documentation complete

• All financial obligations fulfilled

• Positive outcome for all parties

Part 5: Legal Requirements and Documentation

Required Eligibility Certificates

Medical Indication Certificate

Issued By: District Medical Board
Purpose: Confirms medical necessity for surrogacy
Validity: Throughout surrogacy process
Requirements for Issuance:

• Infertility diagnosis confirmed by registered doctor

• Medical conditions precluding natural pregnancy documented

• Intended parents' age and marital status verified

• Proof of 5-year marriage provided

• No surviving children certification

• Both partners medically examined

• Both partners psychologically evaluated

• Couple's understanding of process confirmed

Surrogate Eligibility Certificate

Issued By: District Medical Board after surrogate screening
Purpose: Confirms surrogate meets all legal requirements
Validity: Specific to one surrogacy arrangement
Requirements for Issuance:

• Age verified (25-35 years)

• Married status confirmed

• At least one living biological child confirmed

• Medical examination completed and cleared

• Psychological evaluation completed and cleared

• No prior surrogacy history confirmed

• Informed consent documented

• Husband/family consent obtained (in some jurisdictions)

Essentiality Certificate (Offered by District Medical Board)

Issued By: District Medical Board (optional)
Purpose: Confirms medical indication for surrogacy
Prerequisites:

• Couple has proven infertility

• Obtained court order confirming parentage

• Obtained insurance coverage

• Medical board finds surrogacy necessary

• Couple meets all eligibility criteria

Parentage Order (Most Critical Legal Document)

Issued By: District Magistrate's Court
Purpose: Establishes legal parentage of child with intended parents
Timeline: Can be sought before delivery (pre-birth) or after
Requirements:

• Couple applies to District Magistrate

• Court reviews surrogacy documentation

• Court may summon couple and surrogate for testimony

• Court verifies medical indication and all requirements

• Court issues formal parentage order

• Named intended parents as legal parents of child

• Child has no legal relation to surrogate

This order is absolutely critical for:

• Birth certificate issuance

• Passport application

• Inheritance and succession rights

• Medical decision-making authority

• Legal guardianship rights

• Property and asset rights

Legal Agreements and Contracts

Surrogacy Agreement (Core Contract)

Parties to Agreement:

• Intended mother

• Intended father (if applicable)

• Surrogate mother

• Clinic/agency (witness and coordinator)

Mandatory Clauses:

1. Parties' Rights and Responsibilities

• Intended parents' parental rights and obligations

• Surrogate's responsibility to carry pregnancy safely

• Clinic's coordinating role

• All parties' confidentiality obligations

2. Medical and Reproduction Terms

• Description of medical procedures to be performed

• Specific IVF protocol (single vs. dual embryo transfer)

• Use of genetic material (eggs, sperm)

• Genetic testing (if any) approved

• Insurance coverage details

• Medical decision-making authority during pregnancy

• Experimental procedures (if any) permitted

• Emergency medical authority in complications

3. Financial Terms

• Total compensation amount (medical expenses only, no commercial payment)

• Payment schedule and installments

• Specific items covered (prenatal care, medications, nutrition, travel, insurance)

• Items NOT covered (e.g., lost wages, lifestyle disruption)

• Who covers cost overruns from complications

• Reimbursement procedures and documentation

4. Surrogate Obligations

• Commitment to carry pregnancy to term (with exceptions)

• Medical appointment attendance

• Medication compliance

• Abstinence from harmful substances

• Lifestyle restrictions (no smoking, limited alcohol)

• Dietary recommendations compliance

• Exercise and activity restrictions

• Sexual intercourse restrictions during sensitive periods

• Compliance with obstetric recommendations

5. Insurance and Risk Allocation

• 36-month insurance coverage requirement

• Coverage details and exclusions

• Payment responsibility if complications arise

• Life insurance coverage for surrogate (in some agreements)

• Disability coverage

• Medical decision-making if surrogate incapacitated

6. Contingencies and Risk Events

If Miscarriage or Stillbirth Occurs:

• Whether surrogacy arrangement continues

• Cost responsibility for loss

• Whether multiple attempts are included

• Attempt limits and reattempt costs

• Psychological support provided

If Fetal Abnormality Detected:

• Intended parents' right to terminate pregnancy

• Surrogate's obligations regarding abnormal fetus

• Decision-making authority

• Emotional support for surrogate if termination occurs

• Financial responsibility for complications

If Surrogate Develops Pregnancy Complications:

• Determination of necessary medical interventions

• Decision-making authority

• Cost responsibility

• Continuation of payments during complications

• Disability coverage if surrogate becomes permanently disabled

If Child is Born with Congenital Abnormality:

• Intended parents' obligation to accept child

• Surrogate's responsibility and liability (typically none)

• Legal parentage despite abnormality

• Financial responsibility for child's care

• Post-natal genetic testing and disclosure

If Intended Parent Dies During Pregnancy:

• Succession of parental rights

• Custody and guardianship determination

• Financial responsibility continuation

• Spousal rights if surviving spouse exists

• Legal parentage provisions

7. Parentage and Custody

• Intended parents confirmed as legal parents

• Surrogate surrenders all parental rights after delivery

• Custody transfer upon delivery

• Guardianship provisions

• Inheritance rights of child

• Legal name of child

• Nationality of child

8. Confidentiality and Privacy

• Surrogate's identity kept confidential

• Medical records privacy protection

• Agreed information sharing with child's pediatrician

• Public disclosure limitations (no media, social media)

• Privacy rights of surrogate protected

• Privacy rights of couple protected

• Restrictions on surrogacy discussion with others

9. Dispute Resolution

• Arbitration procedures if disagreements arise

• Mediation requirement before court action

• Legal jurisdiction for disputes

• Responsibility for legal costs

• Confidentiality of dispute proceedings

• Binding nature of arbitration decisions

10. Termination and Dissolution

• Circumstances allowing agreement termination

• Consequences of termination

• Financial obligations upon termination

• Authority to continue pregnancy if terminated

• Custody determination if terminated mid-pregnancy

All Agreements Must Be:

• Drafted by qualified legal counsel

• Notarized (authentic notary certification)

• Signed by all parties with witnesses

• Reviewed and approved by District Medical Board

• Filed with appropriate authorities

• Copies provided to all parties

• Clear and unambiguous language used

Documents Required for Application

For Intended Couple:

Identity and Residence:

• Passport (both partners)

• Birth certificate or age proof (both partners)

• Aadhaar card or state ID (both partners)

• Residential proof (electricity bill, water bill, or rent agreement)

• State/national ID document

Marriage Documentation:

• Marriage certificate (original and notarized copy)

• Marriage registration certificate from local authority

• If applicable: Divorce decree (if previously married)

Medical Documentation:

• Infertility diagnosis from registered fertility specialist

• Complete medical history documentation

• Blood tests results (infectious disease screening)

• Previous fertility treatment records

• Imaging results (ultrasound, HSG)

• Hormone test results

• Medical fitness certificate from registered doctor

Financial Documentation:

• Income tax returns (last 3 years)

• Salary slips (last 3 months)

• Bank statements (last 3-6 months)

• Property documents (if applicable)

• Employment letter (if employed)

• Business registration (if self-employed)

• Financial capacity confirmation

Psychological Documentation:

• Psychological evaluation report

• Mental health history clearance

• Marital counseling report (if applicable)

• Understanding of surrogacy process confirmation

For Surrogate:

Identity and Residence:

• Voter ID or Aadhaar card

• Birth certificate or age proof

• Residential proof

• Marriage certificate

Medical Documentation:

• Medical examination report

• Blood tests (complete health screening)

• Ultrasound of reproductive organs

• Obstetric history documentation

• Previous pregnancies and delivery records

• Genetic screening (if applicable)

• Infectious disease screening results (HIV, Hepatitis B/C, Syphilis)

Psychological Documentation:

• Psychological evaluation and clearance

• Understanding of surrogacy obligations

• Family and husband consent (if applicable)

• Mental health history clearance

Financial and Legal:

• Identification and residence verification

• Information about economic circumstances

• Understanding of compensation structure

• Understanding that child's custody goes to intended parents

• Informed consent documentation

Part 6: Important Considerations and Risks

Medical Risks for Surrogate

Pregnancy-Related Complications:

• Gestational diabetes (4-10% of surrogacies)

• Preeclampsia and hypertension (2-3% of surrogacies)

• Placental abruption or previa (1-2%)

• Gestational anemia (10-30%)

• Urinary tract infections (5-10%)

• Miscarriage (10-15%, similar to natural pregnancy)

• Ectopic pregnancy (rare, <1%)

• Multiple gestation complications (if 2 embryos transferred, 25-30% multiple births)

Delivery-Related Complications:

• Excessive bleeding/postpartum hemorrhage (2-5%)

• Amniotic fluid embolism (extremely rare, 1-40 per 100,000)

• Placental retained/incomplete (1-3%)

• Infection/endometritis post-delivery (1-2%)

• Thrombosis/blood clots (1-2%)

• Hysterectomy emergency (rare, <1%)

• Maternal mortality (extremely rare in India, <1 per 10,000)

Long-Term Risks:

• Infertility (no increased risk from surrogacy if uncomplicated)

• Psychological/emotional effects (case-dependent, varies)

• Uterine scarring (if cesarean performed, 1-2%)

• Adhesions or structural damage (rare)

• Menstrual irregularities (temporary, 5%)

Risk Mitigation:

• 36-month mandatory insurance coverage

• Rigorous medical screening before surrogacy

• Experienced obstetric care during pregnancy

• Hospital delivery with trained staff

• Emergency cesarean capability

• Neonatal intensive care if needed

• Post-delivery monitoring and support

• Legal documentation ensuring medical decision-making

Psychological and Emotional Risks

For Intended Parents:

• Attachment anxiety before delivery

• Pressure of legal/financial investment

• Anxiety about child's health/normality

• Difficulty bonding if surrogate stays involved

• Grief if pregnancy fails or child has complications

• Stress from prolonged process (18-24 months)

• Identity issues explaining surrogacy to child

• Fears about surrogate changing mind (rare but possible anxiety)

For Surrogate:

• Emotional attachment to pregnancy/baby

• Grief when surrendering child after delivery

• Difficulty separating from baby post-delivery

• Hormonal postpartum depression (5-20% of surrogates)

• Exploitation feelings if economic circumstances difficult

• Loss of purpose after delivery

• Family relationship strain

• Identity confusion from "surrogate" role

For Child:

• Identity confusion regarding biological vs. psychological parentage

• Questions about surrogate mother

• Potential psychological impact if discovered unprepared

• Genetic vs. parental identity issues (generally minimal if raised by genetic parents)

• Search for surrogate identity (after reaching adulthood)

• Mental health issues (same prevalence as general population studies show)

Psychological Support Recommendations:

• Pre-surrogacy counseling mandatory for all parties

• Ongoing counseling during process

• Post-delivery support and follow-up

• Support groups for intended parents via surrogacy

• Information for child's psychologist on surrogacy history

• Open communication with child about origins

Legal and Ethical Risks

Legal Risks:

Non-Compliance with Surrogacy Act 2021:

• Severe penalties for commercial surrogacy

• Criminal prosecution possible

• Loss of parental rights in extreme cases

• Financial penalties (₹10 lakhs fines)

• Imprisonment up to 10 years

Jurisdictional Disputes:

• Different states' varying interpretation of law

• Forum shopping for favorable jurisdiction

• Complications with inter-state surrogacy

Surrogate's Change of Mind (Extremely Rare):

• Surrogate attempting to keep child post-delivery

• Requires court intervention

• Parental order provides protection but litigation possible

• Emotional and financial costs

Unregistered Clinic Usage:

• Medical risks without oversight

• Legal consequences for couple

• Criminal exposure

• Poor medical outcomes

• Exploitation of surrogate

Improper Documentation:

• Missing or invalid agreements

• Certificates not properly obtained

• Court orders not issued

• Birth certificate complications

• Passport/travel document delays

Ethical Risks:

Exploitation of Surrogate:

• Economic vulnerability exploited

• Pressure to agree to unsafe medical procedures

• Inadequate compensation for serious risks

• Insufficient informed consent

• Lack of independent legal counsel for surrogate

Lack of Autonomy:

• Surrogate's decisions overridden by intended parents

• Medical decisions made without proper consent

• Restrictive lifestyle requirements

• Limited agency in pregnancy choices

Commodification of Surrogacy:

• Surrogate treated as "means to an end"

• Child treated as commodity

• Economic inequality between parties

• Power imbalances

Risk Mitigation Through Legal Protections:

✓ Use only ICMR-accredited clinics registered with Medical Council
✓ Ensure all documents notarized and witnessed
✓ Obtain all required certificates from District Medical Board
✓ File parentage order immediately post-delivery
✓ Ensure 36-month insurance coverage active
✓ Use qualified legal counsel with surrogacy experience
✓ Complete comprehensive psychological counseling
✓ Maintain full transparency with surrogate
✓ Ensure informed consent documented
✓ Follow all Surrogacy Act 2021 requirements exactly

Part 7: Frequently Asked Questions

Q: Can foreign nationals pursue surrogacy in India?

A: Generally no. The Surrogacy Act 2021 restricts surrogacy to Indian citizens, NRI (Non-Resident Indians), and OCI (Overseas Citizens of India). Foreign nationals, even if married to Indian citizens, are not eligible. Limited exceptions may exist for OCI cardholders of Indian origin.

Q: Can single individuals pursue surrogacy in India?

A: No. The law explicitly requires couples to be legally married. Single men, single women, and unmarried partners are not eligible, regardless of their financial capacity or motivation.

Q: Can same-sex couples pursue surrogacy in India?

A: No. The law specifies "heterosexual married couples" as eligible. Same-sex couples, whether married in other jurisdictions or not, are not eligible under current Indian law (2026).

Q: Can we choose our surrogate or must we use clinic-provided surrogates?

A: Under the new law, surrogate must be a "close relative" of the intended couple, though definitions of "close relative" vary by state. Many clinics interpret this as allowing surrogates outside immediate family, but the woman must have been screened and found suitable. You cannot hire a surrogate independently—it must be coordinated through an ICMR-accredited clinic.

Q: What if the intended mother can produce eggs but cannot carry pregnancy?

A: This is perfect candidate for gestational surrogacy. The intended mother's eggs are used with the intended father's sperm, and surrogate carries the pregnancy. Child is biologically related to intended parents. This is the standard form of legal surrogacy in India.

Q: What if the intended father has low sperm count?

A: ICSI (Intracytoplasmic Sperm Injection) can be used even with low sperm count, as long as some viable sperm are present. If completely azoospermia (no sperm), donor sperm would be required (not legal in India currently for surrogacy).

Q: How much time does the entire surrogacy process take?

A: Timeline typically 18-24 months from initial consultation to baby delivery:

• Evaluation and certification: 2-4 months

• Surrogate matching and agreement: 2-4 months

• IVF and embryo transfer: 1-2 months

• Pregnancy and monitoring: 9 months

• Delivery and legal finalization: 1-2 months

Variations occur based on clinic efficiency, legal delays, and medical factors.

Q: What is the success rate of surrogacy in India?

A: Success rates vary by clinic, age of intended mother, and quality of eggs:

• Per-transfer pregnancy rate: 45-60%

• Live birth rate per transfer: 40-50%

• Overall success (per patient starting surrogacy): 50-70%

Younger women with good egg quality have higher success rates.

Q: What if the pregnancy fails or surrogate has miscarriage?

A: This must be addressed in the surrogacy agreement:

• Does the agreement include multiple attempts?

• Is there additional cost for reattempt?

• Is compensation continued if miscarriage?

• Can the couple choose to reattempt?

Most clinics offer packages with at least one reattempt included, but confirm in advance.

Q: Can the intended parents be present during labor and delivery?

A: This depends on the surrogate's preferences and hospital policies. Many surrogates prefer their own family present. The surrogacy agreement should specify this, and the couple should discuss with surrogate directly. Some clinics facilitate this; others don't allow it.

Q: What happens if the surrogate refuses to surrender the child after delivery?

A: This is extremely rare but theoretically possible. Legal protections include:

• Parental order issued by court names intended parents as legal parents

• Surrogate has no legal claim to child

• Court enforces custody transfer to intended parents

• Surrogate would need to pursue custody litigation with very poor legal basis

• Laws specifically designed to prevent this scenario

• 36-month insurance covers legal costs if needed

Q: Can the intended mother breastfeed the child if she didn't carry the pregnancy?

A: Yes, through induced lactation:

• Hormonal protocol can induce milk production in non-pregnant women

• Typically requires preparation over 2-3 months before delivery

• Supplementation with formula often necessary

• Emotional benefits of nursing (without biological pregnancy)

• Not medically necessary but possible if desired

Q: How much can we legally pay the surrogate?

A: Only medical and living expenses—NO commercial compensation:

• Medical expenses (prenatal, delivery): ₹1.5-2.5 lakhs

• Nutritional support: ₹75,000-90,000

• Travel allowance: ₹45,000-60,000

• Maternity clothing: ₹25,000

• Counseling and support: ₹37,500-1 lakh

• Insurance: ₹1-2 lakhs

Cannot pay "surrogate fees" or "compensation for service." Law explicitly prohibits commercial surrogacy.

Q: What insurance coverage is mandatory for surrogate?

A: 36-month coverage including:

• Pregnancy-related complications

• Childbirth and delivery complications

• Post-delivery complications (up to 36 months post-delivery)

• Emergency medical care

• Hospitalization

• Surgical procedures

• Insurance must be active before surrogacy begins

Q: Can we use donor eggs instead of intended mother's eggs?

A: If the intended mother has no viable eggs (premature menopause, genetic condition, poor egg quality), donor eggs may be used. However, surrogacy law doesn't clearly address this scenario. Consult fertility specialist and legal counsel about your specific situation.

Q: Can we use frozen eggs or sperm from the intended parents?

A: Yes. Many couples freeze eggs/sperm years in advance, then pursue surrogacy later. Frozen gametes work as well as fresh for IVF and surrogacy.

Q: How is the child's birth certificate issued?

A: Process:

• Court issues parentage order naming intended parents as legal parents

• Intended parents apply for birth certificate with court order

• Registrar of Births and Deaths issues certificate

• Intended parents named as mother/father

• Surrogate not named on certificate

• Certificate constitutes full legal recognition of parentage

Q: Can intended parents travel out of India during surrogate's pregnancy?

A: Generally yes, but:

• Must maintain medical appointments (some via telemedicine possible)

• Should be available during critical monitoring periods

• Insurance may require presence during delivery

• Court may require appearance during legal proceedings

• International travel while surrogate is in labor problematic

• Arrange reliable communication with clinic

Q: What rights does the child have regarding learning about the surrogate?

A: Rights depend on laws and agreements:

• Child has right to know biological truth (psychological perspective)

• Most experts recommend age-appropriate disclosure

• May have right to non-identifying information about surrogate

• Typically not entitled to identify surrogate (privacy laws protect her)

• Genetic information may be available through clinic

• DNA testing available if child seeks biological verification (very rare)

• Psychological counseling recommended during identity exploration

Q: What if we move to another country after surrogate's delivery?

A: Process:

• Child can obtain passport and travel documents after birth certificate/parentage order

• Intended parents establish legal guardianship (clear with court order)

• Child can be taken out of India after all legalities completed

• International relocation doesn't affect legal parentage

• Some countries may question non-biological parentage in immigration context

Q: Can a divorced or widowed person pursue surrogacy?

A: Generally no under current law:

• Law requires couple to be currently married

• Divorced individuals not eligible

• Widowed individuals not eligible

• Exceptions may exist for widow with disabled child from previous marriage seeking additional child

Q: What documents do we need to travel to India for the surrogacy process?

A: Required documents:

• Passport (valid minimum 6 months)

• Visa (tourism or business visa typical)

• Medical reports from previous fertility treatment

• Proof of marriage (marriage certificate)

• Proof of income/finances

• Medical fitness certificate from home country

• Insurance documentation

Part 8: Choosing the Right Fertility Clinic and Legal Support

Questions to Ask Fertility Clinics

About Experience and Track Record:

1. How many surrogacy cases have you completed?

2. What is your success rate (live births per cycle)?

3. What is the average cost for a complete surrogacy?

4. What is included in the package and what costs extra?

5. How long is the typical timeline from consultation to baby?

6. What payment plan options do you offer?

7. Can you provide references from past parents?

8. Are you ICMR-accredited and registered with Medical Council?

About Surrogate Management:

1. How do you screen and select surrogates?

2. What medical and psychological tests are done?

3. How do you ensure surrogate's informed consent?

4. What support do you provide to surrogates?

5. How do you ensure surrogates are not exploited?

6. What is the insurance coverage for surrogate?

7. What happens if surrogate has complications?

8. How many times can your surrogates participate?

About Medical Procedures:

1. What is your embryo transfer success rate?

2. Do you transfer single or dual embryos?

3. What genetic testing is available?

4. What contingencies exist if first attempt fails?

5. How many attempts are included in package?

6. What is your approach to high-risk pregnancies?

7. What neonatal care facilities are available?

8. Who will be the attending physician?

About Legal Support:

1. Do you have in-house legal support or referrals?

2. What legal documents do you prepare?

3. How do you coordinate with District Medical Board?

4. What is your process for obtaining parentage order?

5. How long does legal finalization typically take?

6. What happens if legal complications arise?

7. Do you handle international cases (if applicable)?

8. What is the legal cost and what does it include?

About Communication and Support:

1. How often will we receive updates?

2. Who is our primary contact?

3. How accessible is the clinic for consultations?

4. What support services do you offer?

5. Do you provide counseling services?

6. What support group or community exists?

7. What post-delivery support is provided?

8. How long is clinic involvement after delivery?

Red Flags in Clinic Selection

Avoid Clinics That:

❌ Guarantee specific outcomes or success rates
❌ Have no ICMR accreditation or Medical Council registration
❌ Cannot provide surrogate screening documentation
❌ Don't have legal support or referrals
❌ Offer suspiciously low costs (likely exploiting surrogates)
❌ Don't discuss legal requirements or Surrogacy Act 2021
❌ Have poor online reviews or complaints
❌ Cannot explain the District Medical Board process
❌ Don't discuss insurance coverage in detail
❌ Pressure you to commit immediately without time to consider
❌ Cannot provide references
❌ Don't mention contingencies for failed attempts
❌ Suggest ways around legal requirements

Recommended Fertility Clinics (Examples)

Delhi/NCR Region:

• Apollo Fertility

• Fortis Fertility Centers

• Max Healthcare Fertility

• Indira IVF

• Shashwati Advanced Fertility Center

Mumbai:

• Cocoon Fertility

• Nova IVF Fertility

• Reliance Fertility

• Lilavati Hospital Fertility Clinic

Bangalore:

• Dr. Ajay Rao Fertility Center

• Nova IVF Bangalore

• Apollo Fertility Bangalore

• Babycare IVF Bangalore

Note: Clinic recommendations change; verify current accreditation and reviews before selection.

Choosing Legal Support

Look for Lawyers With:

✓ 5+ years experience with surrogacy law
✓ Knowledge of Surrogacy Act 2021 and current regulations
✓ Experience with District Medical Board processes
✓ Track record with court orders and parentage cases
✓ Coordination with fertility clinics
✓ Clear fee structure and transparent costs
✓ References from previous surrogacy clients
✓ Understanding of international cases (if applicable)
✓ Knowledge of state-specific variations
✓ Ability to explain complex legal concepts clearly

Questions for Lawyers:

1. How many surrogacy cases have you handled?

2. What is your experience with current Surrogacy Act 2021?

3. What states/jurisdictions are you licensed in?

4. What documents do you prepare?

5. How do you coordinate with clinic and District Medical Board?

6. What is your fee structure and total cost?

7. What contingencies exist if complications arise?

8. How long does legal finalization typically take?

9. Can you provide references from past clients?

10. What is your approach to protecting all parties' interests?

Recommended Approach:

1. Clinic refers qualified lawyer with surrogacy experience

2. Consult lawyer independently before hiring

3. Ensure lawyer understands all legal requirements

4. Confirm coordination with clinic

5. Review fee structure in detail

6. Obtain written fee agreement

7. Request timeline for each legal phase

8. Maintain regular communication throughout process

Part 9: Action Plan for Pursuing Surrogacy in India

Timeline and Checklist

Phase 1: Preliminary Research and Decision (Months 1-2)

Week 1-2: Research and Information Gathering

• Research surrogacy laws and Surrogacy Act 2021

• Understand eligibility criteria

• Research fertility clinics and reviews

• Research approximate costs and timelines

• Gather testimonies from other families

• Consult general fertility specialist about medical necessity

• Discuss with partner and family if applicable

Week 3-4: Emotional Preparation

• Acknowledge emotions and feelings about surrogacy

• Discuss surrogacy expectations with partner

• Consider psychological counseling/support

• Prepare for financial investment

• Prepare for 18-24 month timeline

• Research support groups for families via surrogacy

• Make decision to pursue surrogacy

Week 5-8: Initial Clinic Selection

• Identify 3-5 potential clinics

• Review accreditation and credentials

• Schedule initial consultations

• Prepare questions for clinic consultations

• Attend consultations

• Request cost quotes and timelines

• Select primary clinic

Phase 2: Medical Evaluation and Certification (Months 3-6)

Month 3: Medical Workup

• Schedule complete medical evaluation

• Submit to fertility specialist

• Undergo blood tests and imaging

• Complete psychological evaluation

• Gather prior fertility treatment records

• Obtain infertility diagnosis confirmation

• Medical examination results reviewed

Month 4-5: Legal Preparation

• Gather all required documents

• Apply for Medical Indication Certificate

• Prepare District Medical Board application

• Provide marriage documentation

• Submit to DMB for review

• Respond to any DMB information requests

• Medical Indication Certificate issued

Month 6: Financial Planning

• Finalize clinic selection and cost quote

• Secure financing (personal funds, loans, insurance)

• Open dedicated surrogacy savings account if needed

• Arrange payment schedule with clinic

• Set aside emergency funds for cost overruns

• Discuss insurance with clinic

Phase 3: Surrogate Selection (Months 7-10)

Month 7-8: Surrogate Matching

• Review clinic's pool of screened surrogates

• Clinic presents surrogate candidates

• Meet surrogate (if desired)

• Surrogate undergoes medical screening

• Surrogate undergoes psychological evaluation

• Discuss expectations and concerns

• Mutual consent obtained

• Surrogate Eligibility Certificate applied for

Month 9-10: Legal Agreement

• Lawyer prepares surrogacy agreement

• Review agreement with lawyer

• Discuss with clinic and surrogate

• Execute agreement with notarization

• Submit to District Medical Board

• Obtain DMB approval of arrangement

• Surrogacy Arrangement Approval Certificate issued

Phase 4: Medical Procedures (Months 11-13)

Month 11: Preparation

• Final medical consultations

• Hormone protocols prepared

• Surrogate begins endometrial preparation

• Insurance coverage activated and verified

• Final consent and authorization forms signed

• Medications and supplies procured

Month 12: IVF and Transfer

• Egg stimulation and monitoring

• Egg retrieval procedure

• Sperm collection and preparation

• Fertilization and embryo development

• Surrogate endometrial readiness confirmed

• Embryo transfer performed

• Pregnancy test conducted at 12-14 days

Month 13: Pregnancy Confirmation

• Beta-hCG results confirm pregnancy

• Ultrasound confirms fetal heartbeat

• Clinic and couple celebrate positive result

• Pregnancy monitoring timeline established

• Ongoing counseling and support begun

Phase 5: Pregnancy Monitoring (Months 14-22)

Months 14-16: First Trimester Monitoring

• Monthly/biweekly clinic visits

• Ultrasounds performed (6-7 weeks, 9-10 weeks, 12-13 weeks)

• First trimester screening tests

• Continue communication with surrogate

• Emotional support and counseling

• Prepare for upcoming parenthood

Months 17-19: Second Trimester Monitoring

• Monthly clinic visits

• Detailed anatomy ultrasound (18-20 weeks)

• Growth assessment ultrasounds

• Gestational diabetes screening (24-28 weeks)

• Ongoing surrogate health monitoring

• Preparation for third trimester

• Birth planning discussions

Months 20-22: Third Trimester Monitoring

• Biweekly to weekly clinic visits (as pregnancy advances)

• Growth ultrasounds and assessment

• Fetal well-being monitoring (NSTs if indicated)

• Surrogate monitoring for complications

• Hospital and delivery planning

• Court proceedings for parentage order

Phase 6: Delivery and Legal Finalization (Months 23-24)

Month 23: Pre-Delivery Preparation

• Court hearing for parentage order (if not already completed)

• Birth planning and hospital coordination

• Surrogate's readiness for delivery

• Couple's readiness for baby

• Insurance documentation finalized

• Legal documents prepared for post-delivery

• Pediatric care arranged

Month 24: Delivery

• Surrogate admitted for labor/delivery

• Baby delivered

• Initial newborn care and screening

• Parentage order signed by court

• Birth certificate application initiated

• Initial bonding period

• Surrogate postpartum care

Post-Delivery (Months 25-26):

• Birth certificate issued

• Passport application

• Final legal documentation completion

• Insurance coverage verified (36-month period begins)

• Surrogate discharged and supported

• Pediatric care begun for baby

• Counseling and support for family

• Celebration and adjustment to parenthood

Budget Tracker Template

Estimated Costs Vs. Actual Costs:

Expense Item	Estimated	Actual	Paid Date	Notes
Clinic Consultation	₹5,000	₹5,000	Jan 2026	Initial visit
Medical Evaluation	₹15,000	₹18,000	Jan 2026	Blood work + imaging
Medical Indication Cert	₹10,000	₹10,000	Feb 2026	DMB application
Surrogate Screening	₹25,000	₹25,000	Mar 2026	Medical + psychological
Legal Agreement	₹75,000	₹100,000	Apr 2026	Lawyer fees, notarization
IVF Procedures	₹200,000	₹220,000	May 2026	Egg retrieval, fertilization
Embryo Transfer	₹40,000	₹40,000	Jun 2026	Transfer procedure
Surrogate Support	₹300,000	₹325,000	Jun-Feb 2027	Monthly allowance
Pregnancy Monitoring	₹250,000	₹275,000	Jun 2026-Feb 2027	Clinic visits, ultrasounds
Insurance	₹150,000	₹150,000	May 2026	36-month coverage
Delivery	₹150,000	₹180,000	Feb 2027	Hospital, childbirth
Legal Finalization	₹75,000	₹100,000	Mar 2027	Court, birth certificate
Clinic Agency Fees	₹200,000	₹225,000	Throughout	Service coordination
Miscellaneous	₹100,000	₹150,000	Various	Unexpected costs
TOTAL	₹1,595,000	₹1,823,000	—	Approx. 18-24 months

Part 10: Important Legal Notice and Resources

Legal Disclaimer

This guide is for informational purposes only and does not constitute legal advice. Surrogacy law in India is complex and varies by state, jurisdiction, and individual circumstances. Laws are subject to change, and regulations are continuously being refined.

You should:

• Consult with a licensed attorney in your state for specific legal advice

• Work with an ICMR-accredited fertility clinic

• Understand all legal requirements before proceeding

• Ensure compliance with Surrogacy (Regulation) Act 2021

• Verify all eligibility criteria with legal counsel

• Review all agreements with independent legal review

• Maintain documentation of entire process

• Keep copies of all certificates and approvals

This guide reflects the status of surrogacy law in India as of January 2026 but may not reflect all current changes or state-specific variations.

Government and Regulatory Resources

National Level:

• National Board of Surrogacy: Oversees surrogacy regulation and handles complaints

• Ministry of Health and Family Welfare: Primary oversight agency for health-related surrogacy issues

• Indian Council of Medical Research (ICMR): Sets medical guidelines and accredits fertility clinics

• Medical Council of India: Registers medical professionals and monitors standards

State-Level District Medical Boards:

Each state has District Medical Boards responsible for:

• Issuing eligibility and essentiality certificates

• Approving surrogacy arrangements

• Monitoring compliance

• Investigating complaints

Locate your state's DMB through your state government health department.

District Magistrate's Court:

Courts issue parentage orders confirming legal parentage of child with intended parents. Approach court in jurisdiction where surrogate resides.

Recommended Organizations and Support Groups

India-Based Organizations:

• Surrogacy (Regulation) Cell, Ministry of Health: Information on regulations and compliance

• National Infertility Awareness Association: Support and information for infertility and surrogacy

• Indian Society for Assisted Reproduction: Medical standards and clinic accreditation

• All India Institute of Medical Sciences (AIIMS) Family Planning Clinics: Government fertility services

Online Support Communities:

• Fertility Forums India: Online discussions with families pursuing surrogacy

• Surrogacy Support Groups on Facebook: Communities of families via surrogacy

• WhatsApp Groups: Many cities have support groups for surrogacy families

• Reddit Communities: r/surrogacy and India-specific fertility communities

Recommended Reading and Resources

Government Publications:

• "Surrogacy (Regulation) Act 2021: Complete Text"

• "Guidelines for Accreditation of Fertility Clinics" (ICMR)

• "District Medical Board Standard Operating Procedures" (State Health Department)

Books:

• "The Surrogate: Gestational Surrogacy in India" - Available through fertility clinics

• "Legal Guide to Surrogacy in India" - Various authors

• "Psychology of Surrogacy" - Counseling resources

Websites:

• ICMR Official Website: www.icmr.gov.in (clinic accreditation search)

• Medical Council of India: www.nmc.org.in (physician verification)

• State Government Health Departments (DMB information)

• Ministry of Health and Family Welfare: https://main.mohfw.gov.in

Contact Information by Major Cities

Delhi/NCR:

• Delhi District Medical Board: Department of Obstetrics & Gynecology, AIIMS Delhi

• Registrar of Births and Deaths: Delhi Health Department

• District Magistrate Court: Delhi District Courts

Mumbai:

• Maharashtra Medical Council

• Mumbai District Medical Board: KEM Hospital

• Registrar of Births and Deaths: Mumbai Municipal Corporation

Bangalore:

• Karnataka Medical Council

• Bangalore District Medical Board: St. Martha's Hospital

• Registrar of Births and Deaths: BBMP

Conclusion and Key Takeaways

Summary of Surrogacy Process

Pursuing surrogacy in India is a complex, legally regulated, 18-24 month process requiring significant financial, emotional, and legal commitment. The Surrogacy (Regulation) Act 2021 has fundamentally transformed surrogacy from a commercial industry to an altruistic model available only to legally married Indian couples meeting strict eligibility criteria.[2]

The journey involves:

1. ✓ Medical qualification - Establishing medical necessity for surrogacy

2. ✓ Legal eligibility - Meeting strict criteria (age, marriage duration, no surviving children, citizenship)

3. ✓ Surrogate selection - Finding appropriate surrogate with proper screening

4. ✓ Financial commitment - Investing ₹15-35 lakhs over 18-24 months

5. ✓ Medical procedures - Undergoing IVF and embryo transfer

6. ✓ Pregnancy monitoring - Supporting surrogate through 9-month pregnancy

7. ✓ Delivery - Hospital childbirth with intended parents assuming parental role

8. ✓ Legal finalization - Court orders confirming parentage and birth certificate issuance

Key Success Factors

Medical Success Factors:

• Younger intended mother (better egg quality)

• Healthy surrogate with good obstetric history

• Experienced fertility clinic with high success rates

• Careful embryo selection and transfer

• Proper pregnancy monitoring and management

Legal Success Factors:

• Compliance with all Surrogacy Act 2021 requirements

• Working with ICMR-accredited clinic and qualified lawyer

• Obtaining all required certificates and approvals

• Proper documentation and agreements

• Timely filing for parentage order

• Transparent and ethical process

Psychological Success Factors:

• Proper counseling for all parties

• Clear expectations and communication

• Ethical surrogate treatment and respect

• Support systems and community

• Post-delivery emotional support

• Plan for explaining surrogacy to child

Your Action Steps

Immediate (This Month):

• Decide if surrogacy aligns with your situation

• Research fertility clinics in your area

• Verify you meet basic eligibility criteria

• Consult with fertility specialist about medical indications

• Begin psychological preparation

Short-Term (Next 1-3 Months):

• Schedule consultations with 3-5 clinics

• Meet fertility specialists and ask detailed questions

• Gather financial resources

• Consult with surrogacy lawyer

• Collect necessary documents

• Initiate medical workup

Medium-Term (Months 3-6):

• Complete full medical evaluation

• Apply for Medical Indication Certificate

• Select clinic and finalize agreement

• Begin surrogate selection process

• Prepare legal agreements

• Verify insurance and financial readiness

Long-Term (Months 6-24):

• Proceed through surrogacy process as outlined

• Maintain regular communication with clinic and surrogate

• Support surrogate through pregnancy

• Prepare for delivery and parenthood

• Complete all legal documentation

• Celebrate arrival of your child

Important Reminders

Remember:

✓ Surrogacy is legal and regulated in India when pursued through proper channels
✓ Medical necessity must be established by qualified fertility specialist
✓ Strict legal requirements exist for all parties
✓ Surrogate protection is paramount in the legal framework
✓ Transparency and informed consent protect everyone
✓ Success rates are good (50-70%) with experienced clinics
✓ Support systems are critical for all parties
✓ The child's best interests are central to legal framework
✓ Your medical and legal professionals are your guides through this journey
✓ Thousands of families have successfully built families through surrogacy in India

Document Information

Document Title: Surrogacy in India 2026: Complete Legal Guide to Costs, Laws, and Process

Version: 1.0

Date Created: January 15, 2026

Total Word Count: ~15,000 words

Document Scope: Comprehensive guide for intended parents pursuing surrogacy in India under the Surrogacy (Regulation) Act 2021

Target Audience: Indian citizens, NRI, OCI, and married couples seeking surrogacy information; families exploring this option; legal and medical professionals

Geographic Coverage: Applicable throughout India with regional variations noted

Language and Accessibility: Clear, non-technical language suitable for all education levels

Format: Professional downloadable document (DOCX and PDF compatible)

Legal Status: Informational guide only; not a substitute for legal advice or medical counsel

References

[1] Government of India. (2021). The Surrogacy (Regulation) Act, 2021. Ministry of Law and Justice, Government of India.

[2] Surrogacy (Regulation) Rules, 2022. Ministry of Health and Family Welfare, Government of India, 2022.

[3] Indian Council of Medical Research (ICMR). (2021). National Guidelines for Accreditation, Supervision and Regulation of ART Clinics in India 2021. New Delhi: ICMR.

[4] Insurance Institute of India. (2025). Maternity and Surrogacy-Related Insurance Coverage Standards. III Publications, 2025.

[5] Pullen, A., & Osinowo, C. (2024). Global Surrogacy Regulation and Comparative Law Analysis. International Journal of Reproductive Medicine, 2024.

[6] World Health Organization (WHO). (2023). Ethical Issues in Assisted Reproductive Technology. WHO Technical Report Series.

[7] National Board of Examination in Medical Sciences. (2025). Medical Indication Guidelines for Surrogacy in India. NBEMS Publications.

[8] Ministry of Health and Family Welfare. (2023). District Medical Board Implementation Handbook. Government of India.

This comprehensive guide reflects current surrogacy law, medical practices, and legal requirements in India as of January 2026. All information sourced from government agencies, ICMR guidelines, state regulations, and established medical and legal authorities.

For specific legal advice regarding your surrogacy case, consult with a licensed attorney in your jurisdiction. For medical guidance, consult with ICMR-accredited fertility specialists.

Created to help intended parents understand their legal rights, medical options, and financial obligations when pursuing ethical and legal surrogacy in India.