Surrogacy Treatment in India: Who Is Eligible Under the 2021 Act

Many couples come to us having read that surrogacy is “the last option” without being told whether the law actually allows it for them. In India, eligibility for surrogacy treatment is decided first by the Surrogacy (Regulation) Act, 2021 and its Rules, and only then by medical judgement. This guide walks through each eligibility test in turn: the intending couple, single women, the medical indication, the surrogate herself, and the 2024 change on donor eggs and sperm. If you already know you qualify and want the paperwork sequence, our companion article on the legal process for surrogacy in Delhi covers that separately.

Why eligibility comes before treatment

Under the 2021 Act, only altruistic gestational surrogacy is permitted. Commercial surrogacy, where a woman is paid beyond her medical expenses and insurance, is banned. The surrogate carries an embryo created from the intending parents’ gametes (or, in specific cases, with one donor gamete); she never contributes her own egg.

Because the law is strict, no clinic can simply agree to start surrogacy treatment because a couple wishes it. The appropriate authority must issue certificates confirming that the couple and the surrogate both meet the criteria, and a District Medical Board must confirm that there is a genuine medical reason. An ethical clinic will therefore assess eligibility honestly at the first consultation, before you invest time, money and emotion.

Surrogacy treatment eligibility for a married couple

The Act is framed around a legally married Indian couple. The main conditions are:

• Marriage and nationality: the couple must be legally married and Indian. The Act is framed for Indian couples, so foreign nationals and OCI cardholders should not assume they can commission surrogacy in India.
• Age of the wife: 23 to 50 years on the day the certificate of eligibility is issued.
• Age of the husband: 26 to 55 years.
• No surviving child: the couple should not have a surviving child, whether biological, adopted or born through surrogacy earlier.
• Medical indication: there must be a medical condition that makes surrogacy necessary, certified by a District Medical Board (explained below).

The exception for couples with a child

The “no surviving child” rule has one important exception. If the couple’s existing child is mentally or physically challenged, or has a life-threatening disorder or fatal illness with no permanent cure, the couple may still be considered, subject to approval by the appropriate authority and the required medical certification. This is assessed case by case.

Eligibility for single women

The Act also allows an Indian woman who is widowed or divorced and aged 35 to 45 to opt for surrogacy. Unmarried single women, single men and unmarried partners are not included in the current framework.

For single women, the gamete rule matters: she must use her own eggs, with donor sperm. If her own eggs are no longer usable, surrogacy is not available to her under the present Rules, and she should discuss other routes, such as donor-egg IVF carried in her own uterus if that is medically possible, with her specialist.

The medical indication: what the District Medical Board looks for

Surrogacy is meant for women who cannot carry a pregnancy safely or at all, not for convenience. The Rules describe the kinds of conditions that may qualify. In plain terms, these include:

• Absent uterus, either from birth (for example, Mayer-Rokitansky-Kuster-Hauser syndrome) or after a hysterectomy.
• An abnormal or badly damaged uterus, such as a uterus scarred by severe Asherman’s syndrome that has not responded to treatment, a very thin endometrium that does not respond, or major structural problems.
• Repeated IVF failure, where good-quality embryos have been transferred several times without implantation, after other causes have been investigated.
• Recurrent pregnancy loss without an explained and treatable cause.
• A medical illness that makes pregnancy life-threatening for the woman, such as some severe heart, kidney or autoimmune conditions.

Your fertility specialist prepares the medical file, but the decision is made by the District Medical Board. In practice, the Board will want to see that reasonable alternatives have been tried or ruled out. That is why a thorough female infertility evaluation, including hysteroscopy or imaging of the uterus where relevant, is often the first step even for couples who are fairly sure they need a surrogate.

Using donor eggs or donor sperm: the 2024 amendment

When the Rules first came into force, intending couples had to use their own eggs and sperm. That left many couples ineligible, because the same condition that prevents a pregnancy sometimes also affects egg quality. In March 2024, the Rules were amended.

The current position is:

• A couple may use donor eggs or donor sperm if the District Medical Board certifies that one partner has a medical condition requiring a donor gamete.
• At least one gamete must come from the intending couple. Using both donor eggs and donor sperm together is not permitted for surrogacy.
• Single women (widowed or divorced) must still use their own eggs.

Any donor eggs must come through a registered ART bank under the ART (Regulation) Act, 2021, with the donor rules that apply to all egg donation: anonymity, age limits and a once-in-a-lifetime donation.

Who can be a surrogate mother in India

The surrogate must also be certified as eligible. The key criteria are:

• She is a married woman aged 25 to 35 with a child of her own.
• She can act as a surrogate only once in her lifetime.
• She holds a certificate of medical and psychological fitness for surrogacy.
• She does not provide her own eggs; the pregnancy is gestational only.
• She gives informed written consent and can withdraw before the embryo is transferred.

The intending couple must buy insurance cover for the surrogate for 36 months, covering complications arising from pregnancy and delivery. They also bear her medical expenses. No other payment, incentive or gift is allowed; that would make the arrangement commercial and therefore illegal.

Eligibility at a glance

Situations where surrogacy treatment may not be the answer

Part of a fair eligibility assessment is recognising when surrogacy is not needed. We regularly see couples referred for surrogacy after two or three failed IVF cycles where the real problem had not been found. Before concluding that the uterus cannot carry a pregnancy, a specialist will usually want to look at:

• Embryo quality and how the embryos were cultured and selected.
• The uterine cavity, through hysteroscopy, to rule out polyps, adhesions or a septum that can be treated.
• Conditions such as hydrosalpinx, thyroid disorders or uncontrolled diabetes.
• Sperm factors that may respond to ICSI or other approaches.

Some couples who thought they needed surrogacy go on to conceive with their own pregnancy once a correctable issue is treated. Others discover that surrogacy is genuinely the right path, and they approach the District Medical Board with a much stronger, better-documented file.

Preparing for your eligibility consultation

To make the first discussion useful, bring:

1. Proof of identity, nationality and marriage (or, for single women, proof of widowhood or divorce).
2. All previous IVF and IUI records, including embryo details and transfer reports.
3. Uterine imaging, hysteroscopy or laparoscopy reports and any surgical notes.
4. Reports for any medical illness, from your physician or specialist.
5. A list of questions about timelines, costs and emotional support.

The national ART and surrogacy portal at artsurrogacy.gov.in lists registered clinics and banks and is a useful reference while you plan. Our consultants, including Dr. M. Gouri Devi, who has worked in reproductive medicine for more than five decades, can review your records and explain where you stand before any application is made. You can also read more about how we approach surrogacy within the law at Ridge IVF.

Talk to a Ridge IVF specialist

If you are wondering whether surrogacy is legally and medically open to you, a careful assessment is the right first step. Book a consultation at our Jawahar Nagar centre, the Fortis Ridge Fertility & IVF Centre in Shalimar Bagh, or our Burari centre, or call or WhatsApp +91 88001 00326. We will review your history, explain the eligibility criteria as they apply to you, and outline the next steps with honesty.

This article is for general information and is not a substitute for a personal consultation with a fertility specialist.