Surrogacy offers hope to couples and individuals who struggle with infertility or cannot carry a pregnancy themselves. India has become a destination for surrogacy due to its regulated medical practices and experienced fertility specialists.
This guide lays out the current law, who actually qualifies, what the process looks like step by step, what it costs, and where to get medically sound guidance if you're in Kerala or considering care here.
What is Surrogacy and How Does It Work?
Surrogacy is an arrangement where a woman (the surrogate) carries and delivers a child for another person or couple (the intending parents). There are two types:
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Traditional surrogacy: The surrogate's own egg is used, making her the biological mother. This is not permitted under Indian law.
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Gestational surrogacy: An embryo created from the intending couple's gametes (or, since 2024, one donor gamete in certified medical cases) is transferred into the surrogate's uterus. She carries the pregnancy but has no genetic link to the child. This is the only form of surrogacy Indian law allows.
On top of restricting the type of surrogacy, India also restricts the terms: only altruistic surrogacy is legal, the surrogate can be reimbursed for medical expenses and insurance, but cannot be paid a fee. Commercial surrogacy is a criminal offence.
Is Surrogacy Legal in India? The Surrogacy (Regulation) Act, 2021
Yes, but under conditions far stricter than most people expect. The Surrogacy (Regulation) Act, 2021 came into force in January 2022, replacing the earlier, largely unregulated era when India was known globally as a low-cost commercial surrogacy hub.
What the law bans:
- Any payment to a surrogate beyond documented medical expenses and insurance
- Surrogacy agents/intermediaries profiting from arranging surrogacy
- Surrogacy for foreign nationals (more on this below)
- A surrogate carrying more than one surrogate pregnancy in her lifetime
What the law allows:
- Gestational, altruistic surrogacy for eligible Indian couples and certain single women
- The surrogate must be a close relative of the intending couple, medically and psychologically screened and certified fit
- A registered surrogacy clinic and a District Medical Board certification are mandatory before any procedure begins
Who Is Eligible for Surrogacy in India?
The Surrogacy (Regulation) Act, 2021 lays down specific eligibility criteria for both intended parents and surrogate mothers. The table below summarises the key requirements under the current legal framework.
| Category | Key Eligibility Conditions |
|---|---|
| Intending married couple | Both Indian citizens; married 5+ years; wife aged 23–50, husband aged 26–55; no living biological, adopted, or surrogate child (except a child with a disability or life-threatening disorder); must hold a Certificate of Essentiality and Certificate of Eligibility |
| Intending single woman | Must be a widow or divorcee, aged 35–45 |
| Surrogate mother | A close relative of the intending couple; ever-married woman aged 25–35 with a child of her own; medically and psychologically certified fit; can act as a surrogate only once in her life |
A District Medical Board must certify that the intending couple/woman has a genuine medical indication for surrogacy, this isn't optional paperwork; it's the gatekeeping step that decides whether a case can proceed at all.
Can Foreign Nationals or NRIs Access Surrogacy in India?
This is where a lot of online content is either outdated or misleading, so let's be precise: foreign nationals cannot access surrogacy in India, full stop, under the 2021 Act. This provision was written specifically to end the "surrogacy tourism" era.
NRIs (Non-Resident Indians) and OCI/PIO cardholders can be eligible, but only if they hold Indian citizenship status recognised under the Act, meet all the same eligibility conditions as resident Indian couples, and secure the same District Medical Board and eligibility certifications.
Step-by-Step: How the Surrogacy Process Works in India
Surrogacy in India follows a legally regulated process designed to protect the intended parents, the surrogate, and the child. While the exact timeline may vary, the journey typically includes the following steps:
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Medical consultation and diagnosis: Confirming the medical indication (e.g., absent/abnormal uterus, recurrent implantation failure, a health condition making pregnancy dangerous).
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Certificates of Essentiality and Eligibility: Issued after District Medical Board evaluation.
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Identifying and screening the surrogate: close relative, medically and psychologically evaluated.
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Registered clinic enrolment: The treating facility must hold a valid state registration under the Act.
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Gamete retrieval and embryo creation (IVF/ICSI): Using the couple's gametes, or one donor gamete where certified.
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Legal surrogacy agreement: Executed between the surrogate and intending parents, as mandated by the Act.
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Embryo transfer and pregnancy monitoring: High-risk pregnancy protocols apply throughout.
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Delivery and parentage order: The child is legally the biological child of the intending parents from birth, but documentation and a court-recognised parentage order are still required.
Also Read: Natural Cycle IVF vs Stimulated IVF: Which Is Right for You?
Cost of Surrogacy in India: What the Money Actually Covers
Because commercial surrogacy is banned, there is no legal "surrogacy fee" package the way there was pre-2021. What intending parents actually pay for includes:
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Diagnostic work-up and fertility treatment (IVF/ICSI cycles)
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The surrogate's documented medical expenses through pregnancy and delivery
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A mandatory insurance policy for the surrogate
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Legal documentation, agreements, and certification processes
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Antenatal monitoring, delivery, and, where needed, neonatal care
Costs vary widely by case complexity, number of IVF cycles required, and whether donor gametes are involved, so any number quoted without a medical consultation should be treated as a rough estimate rather than a fixed price.
Who Typically Needs Surrogacy?
Surrogacy is medically indicated, not a preference-based choice, for conditions such as:
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Absence or malformation of the uterus (e.g., MRKH syndrome)
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Recurrent pregnancy loss or repeated failed IVF with a normal embryo
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Cardiac, renal, or other conditions where pregnancy poses serious risk to the mother
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Hysterectomy performed for a prior medical condition.
Why the Right Hospital Matters More Than the Right Agent
A lot of surrogacy content online focuses on agents and coordinators. But because Indian law places the surrogate's pregnancy under the same clinical responsibility as any other high-risk pregnancy, plus the added layer of certification and documentation, the hospital's obstetric and neonatal capability matters at least as much as its fertility unit.
A surrogate pregnancy still needs antenatal monitoring, a safe delivery plan, and NICU backup if the baby needs it, exactly like any other pregnancy.
Fertility & High-Risk Pregnancy Care at Meitra Hospital, Kozhikode
Meitra Hospital's Centre for Obstetrics and Gynaecology in Kozhikode is built around this exact combination: fertility work-up, high-risk pregnancy management, and newborn care under one roof, rather than a fertility unit operating in isolation.
A few specifics worth knowing if you're evaluating where to get your medical work-up done:
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Dr. Sandhya Pradeep, Senior Consultant, has supervised close to 9,000 deliveries and holds post-doctoral training in Obstetrics and Infertility, with particular focus on high-risk obstetrics.
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Dr. Ajitha P N and Dr. Rasheeda Beegum O lead gynaecological and obstetric care, including infertility evaluation, high-risk pregnancy management, and advanced diagnostics (colposcopy, hysteroscopy, USG-guided assessment).
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Meitra's Neonatology and NICU services, including care for extreme preterm or low-birth-weight babies and respiratory support — matter directly for surrogate pregnancies, which are often monitored as high-risk by default.
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The hospital is accredited under JCI, NABH, and NABL standards, which is relevant if you're comparing documentation and clinical-governance rigor across facilities, since the Act requires registered, compliant clinics.
To be direct about scope: Meitra's role in a surrogacy journey is the medical one, fertility diagnostics, embryo-related treatment where applicable, high-risk antenatal monitoring, delivery, and neonatal care.
The legal certification, District Medical Board approval, and surrogate agreement are separate statutory processes handled through the appropriate government authorities, and any couple exploring surrogacy should confirm current eligibility with both a fertility specialist and a legal professional before proceeding.
Why Kerala and NRI Families Trust Meitra Hospital
Meitra Hospital has built its reputation in Kozhikode on a model that's worth understanding if cost and quality are both on your mind: multi-specialty depth with transparent, second-opinion-friendly consultations, rather than a single-service clinic model.
For fertility and high-risk obstetric cases specifically, that depth means a patient with, say, a cardiac condition complicating pregnancy risk doesn't need to be referred elsewhere, Meitra's Centre for Heart & Vascular Care and Centre for Obstetrics & Gynaecology can coordinate under the same hospital.
For NRI and OCI patients who meet India's eligibility criteria for fertility treatment, Meitra's location in Kozhikode, a well-connected hub for the Gulf-NRI corridor, combined with accredited infrastructure (JCI/NABH/NABL) and experienced consultants, is a practical reason many families choose to get their medical work-up done here rather than in a metro city, often at meaningfully lower cost for comparable clinical quality.
If you're weighing your options, a direct consultation with Meitra's Obstetrics & Gynaecology team is the most reliable way to understand what applies to your specific case.
Chat with our medical assistant today to get connected with Meitra Hospital's Obstetrics & Gynaecology team.
The Emotional and Ethical Side Nobody Talks About
Most people on this topic stop at law and cost. But anyone who has sat through a genuine infertility consultation knows the emotional weight is often heavier than the paperwork.
Because Indian law requires the surrogate to be a close relative, families are also navigating a deeply personal dynamic, asking a sister, sister-in-law, or close relative to carry a pregnancy, alongside the medical process.
Good clinical care in this context isn't just about embryology and monitoring; it includes psychological evaluation and counselling for both the surrogate and the intending parents, which the Act itself mandates as part of the certification process.
Any hospital or clinic that treats this purely as a transaction is missing a legally required, and humanely necessary, part of the process.
Talk to Someone Who Can Actually Answer Your Case
Every surrogacy case depends on your specific medical history and eligibility status. Chat with our assistant today.
Medical Disclaimer: This article is for general informational purposes only and does not constitute medical or legal advice. Surrogacy eligibility, medical indications, and legal procedures vary by individual case and are governed by the Surrogacy (Regulation) Act, 2021 and related rules. Please consult a qualified fertility specialist and a legal professional to assess your specific situation before making any decisions.
