Medically reviewed by: Dr. Pooja Nadkarni Singh | Nimaaya Women’s Centre for Health

Medical disclaimer: This article is intended for educational purposes only. It does not replace a consultation with a fertility specialist or another treating physician. Whether surrogacy is medically appropriate depends on an individual’s reproductive history, medical condition, pregnancy risk, and eligibility under the Surrogacy (Regulation) Act 2021 laws and regulations for surrogacy in India.

Who Needs Surrogacy? 

For some women, the journey toward surrogacy begins with a simple but difficult question: “Can I safely carry a pregnancy?”

Sometimes the answer is no because the uterus is absent or has been surgically removed. In other situations, a serious medical condition can make pregnancy dangerous. There are also carefully selected cases where severe uterine problems, repeated pregnancy loss, or multiple unexplained IVF failures may lead a fertility specialist to consider a gestational carrier.

So, who needs surrogacy medically?

Surrogacy may be considered when carrying a pregnancy is biologically impossible or when pregnancy could pose a significant risk to the intended parent or baby. Medical reasons can include an absent uterus, hysterectomy, significant uterine abnormalities, certain severe medical conditions, and selected cases of repeated unsuccessful IVF or pregnancy loss. Importantly, infertility alone does not automatically mean that someone needs surrogacy. The medical indication should be evaluated and documented individually.

And here is something many people want to know from the beginning:

Needing a gestational carrier does not necessarily mean losing your genetic connection to your baby.

In gestational surrogacy, an embryo is created through IVF and transferred to the uterus of a gestational carrier. The carrier carries the pregnancy but does not provide the egg. Depending on the medical and legal circumstances, the embryo may use the intended mother’s egg and the intended father’s sperm.

But when is surrogacy actually needed? Which medical conditions can make pregnancy impossible or unsafe? And does repeated IVF failure mean it is time to consider a surrogate?

Let’s understand it step by step.

Who Needs Surrogacy? Medical Conditions at a Glance

Some of the strongest medical situations in which a gestational carrier may be considered include:

• Congenital absence of the uterus
• Acquired absence of the uterus, such as after hysterectomy
• Significant uterine abnormalities that cannot safely support pregnancy
• Irreparable intrauterine scarring
• Certain absolute medical contraindications to pregnancy
• Serious diseases that pregnancy could significantly worsen
• Selected cases of recurrent pregnancy loss associated with major uterine problems
• Selected cases of multiple unexplained IVF failures despite good-quality embryos

ASRM specifically lists absence of the uterus, significant uterine anomalies, absolute medical contraindications such as pulmonary hypertension, and serious medical conditions that may be exacerbated by pregnancy among possible indications. It also allows consideration in selected cases of multiple unexplained IVF failures despite transfer of good-quality embryos.

That distinction matters.

Surrogacy is not simply another fertility treatment that can be chosen whenever IVF does not work.

The medical reason behind the problem needs to be understood first.

What Is Gestational Surrogacy?

Gestational surrogacy is a form of assisted reproduction in which a woman carries a pregnancy for the intended parent or parents without providing the egg used to create the embryo.

The process generally involves:

1. Fertility evaluation of the intended parent or parents
2. Egg retrieval when appropriate
3. Sperm collection from the intended father or another legally permitted source
4. IVF and embryo creation
5. Preparation of the gestational carrier
6. Embryo transfer
7. Pregnancy monitoring

The gestational carrier provides the uterus and carries the pregnancy.

She does not provide the egg.

This is why a gestational carrier is not genetically related to the baby. Indian law also defines gestational surrogacy as implantation of an embryo into the surrogate’s womb where the child is not genetically related to the surrogate mother.

Gestational Surrogacy vs Traditional Surrogacy

These two terms are sometimes confused.

Gestational surrogacy

The surrogate carries an embryo created through IVF and does not provide the egg.

Traditional surrogacy

The woman carrying the pregnancy also provides her own egg.

Traditional surrogacy is substantially different because the woman carrying the pregnancy has a genetic relationship with the child.

The medical and legal framework in India is based on gestational surrogacy, not traditional surrogacy. The Surrogacy Act expressly defines gestational surrogacy around embryo implantation and the absence of a genetic relationship between the surrogate and child.

Is Surrogacy a Treatment for Infertility?

Not necessarily.

This is one of the biggest misconceptions about surrogacy.

A couple may have infertility for many reasons, but many of those reasons can be treated without using a gestational carrier.

Depending on the diagnosis, treatment may include:

• Ovulation induction
• Fertility medication
• IUI
• IVF
• ICSI
• Fertility surgery
• Donor-assisted treatment where legally and medically appropriate
• Treatment of hormonal or metabolic conditions

For example, if both fallopian tubes are blocked but the uterus is healthy, IVF may allow the woman to become pregnant and carry the baby herself.

If sperm quality is significantly reduced, ICSI may help fertilisation.

If ovulation is irregular because of PCOS, treatment may focus on restoring or supporting ovulation.

So the first question should not be:

“Do I need a surrogate?”

It should be:

“Why can’t I conceive or safely carry a pregnancy?”

Once that question is answered, the appropriate treatment becomes much clearer.

When Do Doctors Consider Surrogacy?

Doctors generally consider gestational surrogacy in three broad circumstances.

1. Pregnancy Is Biologically Impossible

The clearest example is an absent uterus.

If a person was born without a uterus or underwent hysterectomy, she cannot carry a pregnancy herself.

2. Pregnancy Is Medically Unsafe

Some serious medical conditions can make pregnancy dangerous.

In such situations, the problem is not necessarily infertility.

The person may be capable of becoming pregnant but may face an unacceptable risk if she carries the pregnancy and its affects her life.

3. A Major Uterine or Reproductive Problem Cannot Be Corrected

Some uterine conditions can be treated.

Others cannot.

When the uterus remains unable to safely support pregnancy despite appropriate medical treatment, a gestational carrier may be considered.

ASRM and ACOG both emphasise the importance of restricting gestational surrogacy to circumstances where carrying a pregnancy is biologically impossible or medically contraindicated, while recognising selected reproductive indications.

Does Your Situation Require Surrogacy? A Quick Reference

Before reading about individual medical conditions, it helps to understand one simple principle:

Medical Condition / Situation	What Happens With Pregnancy?	Is Surrogacy Usually Considered?	Can a Genetically Related Child Be Possible?	Typical First Step	What Doctors Usually Evaluate	Important Qualification
Absent uterus – MRKH syndrome	Cannot carry because there is no functional uterus	Yes – a major medical indication	Yes, potentially with own eggs + permitted sperm source	Fertility consultation + ovarian reserve assessment	Ovarian function, AMH/AFC, overall health, legal eligibility	Functioning ovaries do not automatically mean treatment is possible; individual assessment is required
Hysterectomy – uterus surgically removed	Cannot carry a pregnancy	Yes when other eligibility requirements are met	Yes, potentially if viable eggs are available	Fertility consultation + review of surgical history	Ovarian function, age, previous treatment, embryos/eggs available	Whether ovaries remain after hysterectomy is important
Severe / irreparable Asherman syndrome	May be unable to safely support implantation or pregnancy	Potentially, when significant scarring is irreversible	Yes, potentially with intended mother’s eggs	Uterine cavity evaluation, usually including hysteroscopy	Extent of adhesions, cavity restoration, previous treatment, pregnancy history	Surrogacy should not replace appropriate treatment of potentially treatable adhesions
Severe congenital uterine anomaly	Depends on anatomy; pregnancy may be possible, difficult or unsafe	Selected cases	Yes, potentially	3D ultrasound / specialist uterine evaluation	Type of anomaly, cavity shape, previous pregnancy outcomes	A uterine anomaly does not automatically mean surrogacy
Unicornuate uterus with recurrent pregnancy loss	Pregnancy may be possible but may carry significant reproductive risk	Potentially in selected cases	Yes, potentially	Uterine assessment + recurrent-loss evaluation	Anatomy, pregnancy history, associated anomalies	Specifically recognised by ASRM as an example of a potential gestational-carrier indication when associated with RPL
Septate uterus	Pregnancy may be possible; reproductive risk varies	Usually not first-line	Yes	3D ultrasound / hysteroscopy where indicated	Septum size, cavity anatomy, miscarriage history	Correctable uterine abnormalities should generally be evaluated for treatment before surrogacy
Bicornuate uterus	Pregnancy may be possible	Rarely, selected cases	Yes	Specialist uterine imaging	Uterine anatomy, obstetric history	Diagnosis alone does not establish a need for surrogacy
Severe cervical insufficiency / recurrent second-trimester losses	Pregnancy may be possible but may be difficult to sustain	Only selected cases	Yes	Maternal-fetal medicine evaluation	Previous losses, cervical history, treatability, pregnancy risk	Cerclage and other management options may be considered first; not an automatic surrogacy indication
Persistently thin / poorly responsive endometrium	Implantation may be more difficult	Not automatically; selected severe cases only	Yes, potentially	Review endometrial preparation + uterine evaluation	Endometrial thickness, cavity, adhesions, previous transfers	Do not state that <7 mm automatically requires surrogacy; evidence and clinical context matter
Severe uterine scarring after surgery/procedure	May impair implantation or pregnancy	Potentially if irreversible	Yes, potentially	Imaging / hysteroscopy	Extent and reversibility of scarring	Treatability should be assessed first
Severe fibroids distorting the uterine cavity	Pregnancy may be possible but fertility/pregnancy risks may increase	Selected cases only	Yes	Pelvic ultrasound ± MRI	Size, location, cavity distortion, symptoms	Fibroids are not an automatic indication; treatment such as myomectomy may be considered
Severe adenomyosis	Pregnancy may be possible; fertility and pregnancy outcomes can be affected	Selected cases only	Yes	Fertility specialist assessment ± imaging	Disease severity, uterine anatomy, previous IVF/pregnancy outcomes	Adenomyosis alone does not mean surrogacy is required
Recurrent pregnancy loss with irreparable uterine cause	Pregnancy may be possible but repeatedly unsuccessful or unsafe	Potentially	Yes, potentially	Comprehensive RPL evaluation	Uterine cavity, genetics, endocrine/metabolic factors, APS where indicated	The cause should be investigated before considering a gestational carrier
Recurrent pregnancy loss without identified uterine cause	Pregnancy may still be possible	Not automatically	Potentially	RPL evaluation	Genetic, uterine, endocrine and other evidence-based factors	Surrogacy should not be presented as a treatment for unexplained miscarriage by itself
Repeated unexplained IVF failure despite good-quality embryos	Ability to carry pregnancy remains uncertain	May be considered in selected cases	Yes, potentially using embryos created for the intended parents	Detailed IVF-cycle and uterine review	Embryo quality, uterine anatomy, endometrium, previous transfers	ASRM supports consideration in selected cases; no universal “3 cycles = surrogacy” rule
Repeated implantation failure with an identified uterine problem	Implantation may be compromised	Potentially, depending on severity and reversibility	Yes, potentially	Uterine evaluation	Anatomy, adhesions, endometrial factors, embryo factors	Treat the underlying problem where possible
Severe pulmonary hypertension	Pregnancy may pose very serious/life-threatening risk	Yes, potentially – major medical indication	Potentially	Cardiology/pulmonology + fertility consultation	Cardiopulmonary status, medications, pregnancy risk	ASRM specifically identifies pulmonary hypertension as an example of an absolute medical contraindication to pregnancy
Advanced cardiomyopathy / severe heart failure	Pregnancy may substantially increase cardiovascular risk	Potentially	Potentially	Cardiology clearance + fertility consultation	Cardiac function, symptoms, medications, pregnancy risk	Not every heart condition requires surrogacy
Severe congenital/structural heart disease	Risk depends heavily on severity	Selected high-risk cases	Potentially	Cardiology + maternal-fetal medicine assessment	Cardiac anatomy/function, previous pregnancy history	Individual risk assessment is essential
Advanced chronic kidney disease – Stage 4–5	Pregnancy may significantly stress kidney function and maternal health	Potentially	Potentially if viable eggs are available	Nephrology + fertility consultation	Kidney function, BP, medications, transplant status	CKD stage alone should not be used as an automatic legal/medical decision
Kidney transplant with significant graft dysfunction	Pregnancy may carry substantial maternal/fetal risk	Selected cases	Potentially	Nephrology/transplant + fertility evaluation	Graft function, medications, pregnancy risk	Specialist clearance is essential
Severe pulmonary disease	Reduced cardiopulmonary reserve may make pregnancy unsafe	Selected cases	Potentially	Pulmonology + fertility consultation	Lung function, oxygen requirement, disease severity	Mild/moderate lung disease does not automatically require surrogacy
Severe autoimmune disease with major organ involvement	Pregnancy risk depends on disease activity and affected organs	Selected high-risk cases	Potentially	Rheumatology + fertility consultation	Disease activity, organ involvement, medications	Autoimmune diagnosis alone is not an indication
Autoimmune disease requiring pregnancy-incompatible medication	Pregnancy may be unsafe if essential medication cannot be changed	Potentially	Potentially	Specialist medication review	Disease control, alternative medications, pregnancy risk	Medication changes must be medically supervised
Poorly controlled diabetes with significant end-organ damage	Pregnancy may carry substantial maternal/fetal risk	Selected severe cases	Potentially	Endocrinology + high-risk pregnancy assessment	HbA1c, renal/retinal/cardiovascular complications	Diabetes alone does not mean surrogacy
Severe pulmonary hypertension / cardiopulmonary disease	Pregnancy can be medically contraindicated	Potentially	Potentially	Cardiology/pulmonology clearance	Pulmonary pressures, cardiac function, oxygenation	Requires specialist pregnancy-risk assessment
Cancer with hysterectomy	Cannot carry after uterine removal	Potentially	Potentially if eggs/embryos are available	Oncology + fertility consultation	Cancer status, ovarian function, preserved eggs/embryos	Timing must be coordinated with oncology recommendations
Previous pelvic radiation causing severe uterine damage	Pregnancy may be unsafe or uterus may be unable to support pregnancy	Potentially	Potentially if viable eggs/embryos exist	Oncology + reproductive specialist	Uterine function, ovarian reserve, cancer status	Radiation history does not automatically mean surrogacy
Cancer treatment causing loss of ovarian function but uterus remains healthy	May be unable to produce eggs, but may still carry pregnancy	Usually not a surrogacy indication by itself	Depends on permitted reproductive options	Fertility assessment	Ovarian reserve, eggs/embryos, donor options	Donor-egg IVF and surrogacy solve different problems
Genetic disorder making pregnancy medically unsafe	Pregnancy risk depends on the condition	Potentially	Potentially	Genetic counselling + specialist assessment	Maternal disease, inheritance pattern, pregnancy risk	Genetic disease does not automatically require surrogacy
Carrier of an inherited condition but pregnancy is medically safe	Pregnancy may be possible	Usually no – surrogacy does not itself remove genetic risk	Potentially	Genetic counselling	Inheritance pattern, reproductive options	PGT or other reproductive options may address genetic risk where appropriate
Sickle cell disease with severe complications	Pregnancy may carry significant maternal risk in severe disease	Selected cases	Potentially	Hematology + high-risk pregnancy assessment	Disease severity, organ damage, crisis history	Not every patient with sickle cell disease needs surrogacy
Severe inherited/acquired thrombophilia with previous thrombosis	Pregnancy risk may be increased	Selected cases	Potentially	Hematology + maternal-fetal medicine	Thrombosis history, anticoagulation, pregnancy risk	Requires individual risk assessment
Biological inability to gestate	Intended parent cannot biologically carry a pregnancy	Potentially where legally permitted	Depends on gametes used	Fertility + legal eligibility consultation	Gamete availability, Indian legal framework	International indications cannot simply be applied to India
Low AMH alone	Uterus can usually still carry pregnancy	No automatic indication	Potentially	Ovarian reserve + fertility assessment	AMH, AFC, age, ovarian response	Low AMH primarily concerns ovarian reserve, not ability to gestate
PCOS	Pregnancy is often possible	No automatic indication	Potentially	Ovulation/fertility assessment	Ovulation, metabolic health, age, other factors	Usually treated through fertility management rather than surrogacy
Endometriosis	Pregnancy may be possible	No automatic indication	Potentially	Fertility evaluation	Disease severity, ovarian reserve, anatomy	Surrogacy is not routine treatment for endometriosis
Male-factor infertility	Intended mother can usually carry pregnancy	Usually not needed for this reason	Potentially	Male fertility assessment	Semen analysis, reproductive history	IVF/ICSI may be appropriate
Blocked fallopian tubes	Natural conception may be difficult, but uterus can usually carry pregnancy	No automatic indication	Potentially	Tubal + fertility evaluation	Tubal status, ovarian reserve, sperm factors	IVF may bypass blocked tubes
Unexplained infertility	Pregnancy may still be carried	Usually not first-line	Potentially	Standard infertility evaluation	Age, ovarian reserve, semen, ovulation, uterine factors	Surrogacy should not be used simply because infertility is unexplained
One failed IVF cycle	Pregnancy may still be safely carried	No automatic indication	Potentially	Review IVF cycle	Embryo development, transfer, uterine factors	One failed cycle is not enough to diagnose a gestational problem
Multiple failed IVF cycles with poor embryo quality	Cause may be embryo-related rather than uterine	Not automatically	Depends on embryo/gamete situation	Detailed IVF review	Age, embryo development, sperm/egg factors	Poor embryo quality does not establish that a surrogate is needed
Unexplained infertility with normal uterus	Pregnancy is usually possible	Generally not indicated solely for infertility	Potentially	Fertility evaluation	Ovulation, ovarian reserve, sperm, uterine factors	Explore evidence-based fertility treatments first

A diagnosis alone does not automatically make someone a surrogacy candidate. ASRM recommends that the medical indication be clearly documented, particularly when pregnancy is impossible or poses significant risk.

1. Uterine Conditions That May Make Pregnancy Impossible or Unsafe

The uterus is where an embryo implants and where the pregnancy develops.

So when the uterus is absent, severely damaged, or unable to support pregnancy, a gestational carrier may become an important family-building option.

Let’s look at the major situations.

Absent Uterus — Born Without One or Surgically Removed

Having no uterus is one of the clearest medical circumstances in which gestational surrogacy can be considered.

There are two broad reasons why a uterus may be absent:

• A person was born without a functioning uterus.
• The uterus was surgically removed later in life.

MRKH Syndrome — Born Without a Uterus

Mayer-Rokitansky-Küster-Hauser syndrome, commonly called MRKH syndrome, is a congenital condition involving absent or underdeveloped reproductive structures, particularly the uterus and upper vagina.

One of the first clues may be primary amenorrhea—meaning a girl does not begin menstruating during adolescence.

How Is MRKH Diagnosed?

Doctors may use:

• Pelvic ultrasound
• MRI when detailed anatomy is needed
• Hormonal and ovarian assessment
• Physical examination
• Additional investigations depending on the individual

An important point is that having MRKH does not necessarily mean the ovaries are not functioning.

Some women with MRKH have functioning ovaries and may produce eggs.

That creates an important reproductive possibility:

Your uterus may be absent, but your eggs may still be available.

If viable eggs can be retrieved, IVF may potentially be used to create embryos that can be transferred to a gestational carrier, subject to medical and legal eligibility.

Hysterectomy — When the Uterus Has Been Removed

A hysterectomy is surgery to remove the uterus.

It may be performed for conditions such as:

• Certain cancers
• Severe fibroids
• Severe bleeding
• Certain gynecological disorders
• Other serious medical conditions

After hysterectomy, carrying a pregnancy is no longer possible because there is no uterus in which an embryo can implant.

But there is an important distinction:

Hysterectomy does not always mean the ovaries have been removed.

If the ovaries remain functional, viable eggs may still be available.

This means a woman who has undergone hysterectomy may potentially have a genetically related child through IVF and gestational surrogacy.

Can You Have a Baby After Hysterectomy?

Potentially, yes.

If viable eggs are available, embryos can potentially be created through IVF and transferred to a gestational carrier.

The exact option depends on ovarian function, age, medical history, embryo availability and Indian legal requirements.

2. When the Uterus Exists But Cannot Work Properly

Sometimes the uterus is present, but a serious structural or functional problem makes pregnancy difficult or unsafe.

This is where things become more complicated.

A uterine diagnosis does not automatically mean surrogacy.

Doctors first want to know:

Can the problem be corrected?

Can the uterus recover?

Can pregnancy be carried safely after treatment?

Only when these questions have been carefully considered should a gestational carrier enter the conversation.

3. Severe Asherman Syndrome — When Scar Tissue Damages the Uterus

Asherman syndrome involves adhesions or scar tissue inside the uterine cavity.

Think of the uterus as a room where an embryo needs a healthy surface to implant.

With severe scarring, that space can become distorted or damaged.

What Can Cause Asherman Syndrome?

It can develop after procedures or events that damage the uterine lining, including certain uterine surgeries or procedures following pregnancy.

How Is Asherman Syndrome Diagnosed?

Doctors may use:

• Hysteroscopy
• Saline infusion sonography
• Ultrasound
• Other uterine imaging when appropriate

Hysteroscopy allows direct visualisation of the uterine cavity and can also allow treatment of adhesions.

Is Surrogacy Always Needed for Asherman Syndrome?

No.

Treatment is generally considered first where appropriate.

If adhesions can be removed and the uterine cavity restored sufficiently, pregnancy may still be possible.

However, if the uterine damage is severe and irreversible and the uterus cannot safely support pregnancy, gestational surrogacy may be considered.

ASRM specifically lists irreparable Asherman syndrome as an example of a significant uterine abnormality that can support gestational carrier use.

4. Congenital Uterine Anomalies — Bicornuate, Septate and Other Uterine Shapes

Some women are born with a uterus that has an unusual shape.

Examples include:

• Septate uterus
• Bicornuate uterus
• Unicornuate uterus
• Other Müllerian anomalies

But not all uterine anomalies have the same clinical significance.

Septate Uterus

A septum is a band of tissue that divides the uterine cavity.

Some septate uteri can be treated surgically.

Bicornuate Uterus

A bicornuate uterus has a distinctive two-part or heart-shaped external configuration.

Some women with a bicornuate uterus can carry pregnancies.

Unicornuate Uterus

A unicornuate uterus develops from only one side of the reproductive tract and can be associated with reproductive complications.

ASRM specifically identifies a unicornuate uterus associated with recurrent pregnancy loss as an example of a significant uterine condition where a gestational carrier may be considered.

How Are Uterine Anomalies Diagnosed?

Depending on the suspected condition, doctors may use:

• 3D ultrasound
• MRI
• Hysteroscopy
• Other reproductive imaging

Does Every Uterine Anomaly Require Surrogacy?

No.

Some anomalies can be treated.

Others may still allow pregnancy.

Surrogacy is considered when the specific anatomy makes pregnancy impossible or medically unsafe, or when a significant problem remains despite appropriate treatment.

Cervical Insufficiency and Surrogacy

Cervical insufficiency, sometimes called cervical incompetence, occurs when the cervix opens too early during pregnancy without the typical symptoms of labour.

It can contribute to second-trimester pregnancy loss or very early preterm birth.

But here is an important distinction:

Cervical insufficiency is not automatically an indication for surrogacy.

Doctors may consider treatments such as:

• Cervical cerclage
• Close pregnancy monitoring
• Appropriate management based on previous pregnancy history

If a woman has repeatedly experienced severe pregnancy complications despite appropriate management, the fertility and maternal-fetal medicine teams may discuss whether carrying another pregnancy is safe.

Surrogacy should therefore be considered only in carefully selected cases where there is a documented medical reason.

Thin Endometrium — When the Uterine Lining Does Not Respond Adequately

The endometrium is the lining inside the uterus where an embryo implants.

A thin or poorly responsive endometrium can make embryo implantation more difficult in some patients.

However, this is an area where online articles often oversimplify the situation.

A single endometrial thickness measurement does not automatically mean that a woman needs surrogacy.

Doctors may first investigate:

• Uterine scarring
• Previous procedures
• Blood-flow or structural concerns where clinically relevant
• Hormonal preparation
• Endometrial development during treatment
• Other reproductive factors

Treatment may be attempted before considering a gestational carrier.

If the endometrium remains severely compromised and the uterus cannot safely support pregnancy despite appropriate evaluation and treatment, surrogacy may be discussed in selected cases.

5. Fibroids and Adenomyosis — When Uterine Disease Affects Pregnancy

Fibroids and adenomyosis are common uterine conditions.

But neither diagnosis automatically means:

“You need a surrogate.”

The severity, location, symptoms, previous treatment and reproductive history all matter.

Uterine Fibroids and Surrogacy

Fibroids are non-cancerous growths in or around the uterus.

They can occur:

• Inside the uterine cavity
• Within the uterine wall
• On the outer surface of the uterus

Their impact on fertility depends heavily on location and size.

Which Fibroids Matter Most for Fertility?

Fibroids that distort the uterine cavity can be particularly important because they may interfere with implantation or pregnancy.

How Are Fibroids Evaluated?

Doctors may use:

• Pelvic ultrasound
• Saline infusion sonography
• Hysteroscopy
• MRI in selected cases

Does Having Fibroids Mean You Need Surrogacy?

No.

Many women with fibroids conceive and have healthy pregnancies.

Depending on the case, doctors may recommend monitoring or surgical treatment such as myomectomy.

Surrogacy may be considered only in selected situations where the uterus remains unable to safely support pregnancy or where a serious uterine problem cannot be adequately corrected.

Adenomyosis and Surrogacy

Adenomyosis occurs when tissue similar to the uterine lining grows into the muscular wall of the uterus.

It can be associated with:

• Painful periods
• Heavy menstrual bleeding
• Enlarged uterus
• Fertility difficulties
• Pregnancy complications in some patients

But again:

Adenomyosis does not automatically mean surrogacy.

The fertility team may consider:

• Severity of disease
• Age
• Previous pregnancy history
• IVF history
• Treatment response
• Ability to safely carry a pregnancy

A gestational carrier becomes relevant only when the overall medical picture supports that decision.

6. Recurrent Pregnancy Loss — When Pregnancy Does Not Continue

Experiencing a miscarriage can be emotionally difficult.

Experiencing several can leave couples wondering whether their body is capable of carrying a pregnancy.

But recurrent pregnancy loss has many possible causes.

Possible contributors include:

• Embryonic or chromosomal abnormalities
• Uterine abnormalities
• Endocrine or metabolic factors
• Genetic factors
• Other maternal or reproductive factors
• Cases where no definite cause is identified

That is why recurrent miscarriage should be investigated before considering surrogacy.

When Could Surrogacy Be Considered After Recurrent Miscarriage?

A gestational carrier may be discussed when:

• A major uterine problem has been identified;
• The problem cannot be corrected;
• Pregnancy is medically unsafe;
• Appropriate treatment has failed;
• Or the medical team believes carrying another pregnancy presents significant risk.

For example, ASRM recognises significant uterine abnormalities associated with recurrent pregnancy loss as possible indications for gestational carrier use.

The important point is:

There is no universal miscarriage number that automatically means surrogacy.

The cause matters more than the number alone.

7. Repeated IVF Failure — When Embryos Do Not Implant

Repeated IVF failure is one of the most emotionally difficult situations for intended parents.

You may have produced embryos.

You may have transferred embryos.

You may have followed every instruction.

And yet, pregnancy did not happen.

So the next question is naturally:

“Is my uterus the problem?”

Sometimes it may be.

But not always.

Why Can IVF Fail?

Possible factors include:

• Embryo chromosomal abnormalities
• Egg-related factors
• Sperm-related factors
• Embryo development
• Uterine abnormalities
• Endometrial factors
• Hormonal or metabolic factors
• Other medical conditions
• Unexplained factors

This is why one failed IVF cycle should never automatically lead to surrogacy.

When Can Surrogacy Be Considered After IVF Failure?

ASRM states that in the presence of an unidentified endometrial factor, a gestational carrier may be considered for patients with multiple unexplained IVF failures despite transfer of good-quality embryos.

Notice the wording:

multiple + unexplained + good-quality embryos

That is very different from saying:

“Three failed IVF cycles = surrogacy.”

There is no universal number of failed IVF cycles that automatically makes someone eligible.

Doctors may review:

• Embryo quality
• Embryo development
• Uterine anatomy
• Endometrial preparation
• Previous pregnancy history
• Medical conditions
• Previous IVF protocols

Only after this evaluation can the team determine whether a gestational carrier is medically reasonable.

Serious Medical Conditions That May Make Pregnancy Unsafe

Some women do not have a problem conceiving.

Their concern is different:

“Can my body safely handle pregnancy?”

Pregnancy causes major physiological changes.

Blood volume increases.

The heart works harder.

Kidney function adapts.

The respiratory system has greater demands.

For someone with severe underlying disease, these changes can sometimes create significant risks.

ACOG recommends that gestational surrogacy be restricted to situations where carrying a pregnancy is biologically impossible or medically contraindicated, while ASRM provides examples of serious medical conditions that can support gestational carrier use.

8. Severe Heart Disease — When Pregnancy May Be Medically Unsafe

Pregnancy places additional demands on the cardiovascular system.

For someone with severe heart disease, those changes may be dangerous.

Examples of serious cardiovascular conditions can include:

• Severe pulmonary hypertension
• Advanced cardiomyopathy
• Severe heart failure
• Certain serious congenital heart conditions
• Certain severe valvular diseases

ASRM specifically identifies pulmonary hypertension as an example of an absolute medical contraindication to pregnancy.

Does Every Woman With Heart Disease Need Surrogacy?

No.

Heart disease covers a very wide spectrum.

Some women with heart conditions can have pregnancies with careful specialist management.

Others may face very high or unacceptable risk.

The decision may involve:

• Cardiologist assessment
• Maternal-fetal medicine evaluation
• Fertility specialist assessment
• Review of medications
• Evaluation of cardiac function

If pregnancy is medically contraindicated, gestational surrogacy may provide a way to build a family without exposing the intended mother to the risks of pregnancy.

9. Severe Kidney Disease — Protecting Maternal Health

Pregnancy places additional physiological demands on the kidneys.

For women with advanced kidney disease, pregnancy can carry substantial risks.

These may include worsening kidney function and pregnancy complications such as hypertension and preeclampsia.

ASRM includes advanced chronic kidney disease among medical circumstances where gestational carrier use may be appropriate when pregnancy poses substantial risk.

Can a Woman With Kidney Disease Use Surrogacy?

Potentially, yes.

But the severity of kidney disease matters.

A nephrologist may need to assess:

• Kidney function
• Blood pressure
• Current treatment
• Disease progression
• Previous pregnancies
• Expected pregnancy risks

If pregnancy is considered medically unsafe, a gestational carrier may be discussed.

10. Autoimmune Disorders — Lupus, Rheumatoid Arthritis and Beyond

Autoimmune conditions are complicated because they affect people differently.

Some women with autoimmune disease have healthy pregnancies.

Others may have severe disease affecting major organs.

Another concern is medication.

Certain medicines used to control autoimmune disease may not be appropriate during pregnancy.

ASRM identifies selected serious autoimmune and inflammatory conditions among circumstances in which gestational carrier use may be considered.

When Might Surrogacy Be Considered?

It may be discussed when:

• Disease activity makes pregnancy unsafe;
• Important organs are affected;
• Pregnancy could substantially worsen the condition;
• Essential medication cannot safely be stopped or changed;
• Specialist assessment indicates that pregnancy presents unacceptable risk.

The important thing is not simply the name of the disease.

It is the severity of the disease and the actual pregnancy risk.

11. Severe Lung Disease and Pulmonary Conditions

Pregnancy changes the respiratory and cardiovascular demands placed on the body.

For women with severe pulmonary disease, those changes may be difficult to tolerate.

Examples of serious pulmonary conditions can include:

• Severe pulmonary hypertension
• Advanced interstitial lung disease
• Severe COPD
• Severe cystic fibrosis

The severity of disease, oxygen requirements, lung function and overall cardiopulmonary reserve all matter.

A pulmonary specialist and maternal-fetal medicine specialist may be involved in assessing pregnancy risk.

If pregnancy is medically contraindicated, gestational surrogacy may be considered.

12. Cancer Survivors — Can You Have a Biological Child After Treatment?

Cancer treatment can affect fertility in different ways.

Depending on the cancer and treatment, a woman may experience:

• Hysterectomy
• Pelvic radiation
• Reduced ovarian function
• Premature ovarian insufficiency
• Damage to reproductive tissues

But cancer treatment does not always mean that biological parenthood is impossible.

Fertility Preservation Before Cancer Treatment

When medically appropriate, some patients may be able to preserve:

• Eggs
• Embryos
• Other reproductive material

If the uterus is later unable to support pregnancy, preserved eggs or embryos may potentially be used with a gestational carrier.

Can Cancer Survivors Use Surrogacy?

Potentially, yes.

The decision should involve:

• Oncologist
• Fertility specialist
• Appropriate medical specialists
• Review of current health
• Review of preserved eggs or embryos
• Assessment of pregnancy safety

A history of cancer alone does not automatically mean that surrogacy is necessary.

13. Genetic Conditions — What Does Surrogacy Solve?

Genetic conditions and surrogacy are often discussed together, but they actually involve two separate questions.

Question 1: Is pregnancy safe for the mother?

Some inherited disorders can make pregnancy dangerous.

Question 2: Could the genetic condition be passed to the baby?

This is a reproductive genetics question.

Surrogacy addresses the pregnancy-carrying issue.

It does not automatically eliminate genetic risk.

Depending on the situation, the fertility team may discuss:

• Genetic counselling
• Carrier testing
• IVF
• Embryo testing where medically appropriate
• Donor gametes where legally permitted
• Gestational surrogacy when pregnancy itself is unsafe

This distinction is important.

A surrogate does not automatically prevent a genetic disorder from being inherited.

If genetic transmission is the concern, the genetic risk itself needs to be assessed.

Who Does NOT Necessarily Need Surrogacy?

This section is important because online articles can sometimes make surrogacy appear necessary for almost every difficult fertility diagnosis.

That is not medically accurate.

You may have:

• PCOS
• Low AMH
• Endometriosis
• Blocked fallopian tubes
• Male-factor infertility
• Mild or moderate fibroids
• Unexplained infertility
• Age-related fertility decline
• One unsuccessful IVF cycle

and still potentially carry a pregnancy yourself.

Depending on the cause, treatments may include medication, surgery, IUI, IVF, ICSI or other fertility options.

Does Low AMH Mean You Need Surrogacy?

No.

Low AMH primarily relates to ovarian reserve.

It does not automatically mean that the uterus cannot carry a pregnancy.

The fertility specialist may focus on ovarian response, age, embryo development and the most appropriate fertility treatment.

Does PCOS Mean You Need Surrogacy?

No.

PCOS commonly affects ovulation and fertility, but many women with PCOS can become pregnant and carry pregnancies.

Treatment depends on the individual’s ovulation, metabolic health and fertility factors.

Does Male Infertility Mean Surrogacy?

Usually not.

Male-factor infertility may be treated through methods such as ICSI when appropriate.

If the intended mother can safely carry the pregnancy, a gestational carrier is generally not required simply because sperm-related infertility exists.

Does One Failed IVF Cycle Mean Surrogacy?

No.

One unsuccessful cycle does not establish that the uterus cannot support pregnancy.

The cycle should be reviewed before changing treatment strategy.

How Do Doctors Determine Whether Surrogacy Is Medically Appropriate?

There is no single blood test that tells you:

“You need surrogacy.”

Instead, your fertility team looks at the complete medical picture. Choose the best IVF & Fertility Clinic who answers all your questions properly and doesn’t leave you confused.

Step 1: Review Your Medical History

Doctors may review:

• Previous pregnancies
• Miscarriages
• IVF cycles
• Embryo transfers
• Previous deliveries
• Uterine surgeries
• Hysterectomy
• Cancer treatment
• Chronic diseases
• Medications
• Previous pregnancy complications

Step 2: Review Your Reproductive History

The doctor may want to understand:

• How long you have been trying
• Whether pregnancy occurred previously
• Whether miscarriages occurred
• How previous IVF cycles performed
• How embryos developed
• Whether implantation occurred

Step 3: Evaluate the Uterus

Depending on the situation, doctors may use:

• Pelvic ultrasound
• 3D ultrasound
• Saline infusion sonography
• Hysteroscopy
• MRI

The goal is not simply to find an abnormality.

The goal is to determine whether the uterus can safely support pregnancy.

Step 4: Assess Ovarian Function

Depending on the case, assessment may include:

• AMH
• Antral follicle count
• Other ovarian reserve tests
• Hormonal assessment when clinically indicated

Step 5: Involve Other Specialists When Needed

If pregnancy risk comes from a medical condition, fertility specialists may work with:

• Cardiologists
• Nephrologists
• Pulmonologists
• Oncologists
• Rheumatologists
• Maternal-fetal medicine specialists
• Genetic counsellors

This multidisciplinary approach is particularly important when the reason for surrogacy is maternal health rather than infertility alone.

What Tests May Be Recommended Before Surrogacy?

There is no universal test package.

The evaluation depends on the reason surrogacy is being considered.

Reproductive evaluation may include:

• Ovarian reserve assessment
• Pelvic ultrasound
• Uterine evaluation
• Previous IVF record review
• Embryology report review
• Pregnancy history

Medical evaluation may include:

• Cardiac assessment
• Kidney function assessment
• Pulmonary evaluation
• Oncology clearance
• Autoimmune disease assessment

Genetic evaluation may include:

• Genetic counselling
• Carrier testing
• Other genetic testing when indicated
• Embryo testing when clinically appropriate

Not every patient needs every test.

Good fertility care is not about ordering every possible test. It is about ordering the tests that answer the questions that matter.

How Does Medical Surrogacy Work Step by Step?

Once a gestational carrier is considered medically appropriate, the surrogacy process generally includes several stages.

1. Initial Consultation

The fertility specialist understands why the intended mother cannot safely carry a pregnancy.

2. Medical Indication Assessment

The reason for surrogacy is documented and evaluated.

3. Reproductive Evaluation

Eggs, sperm, embryos and previous treatment are assessed.

4. Specialist Clearance

Additional specialists may assess pregnancy risk where necessary.

5. Legal Eligibility Assessment

The intended parents and proposed surrogate must satisfy the applicable legal requirements.

6. Gestational Carrier Screening

The carrier undergoes appropriate medical and psychosocial assessment.

7. IVF and Embryo Creation

Where medically and legally permitted, embryos are created through IVF.

8. Uterine Preparation

The gestational carrier’s endometrium is prepared according to the treatment protocol.

9. Embryo Transfer

An embryo is transferred into the carrier’s uterus.

10. Pregnancy Monitoring

The pregnancy is monitored through appropriate obstetric care.

11. Delivery and Postnatal Care

The gestational carrier receives appropriate maternity and postpartum care.

Legal documentation and parentage matters are handled according to the applicable Indian framework.

ACOG highlights that gestational surrogacy has medical, psychosocial, ethical and legal complexities and recommends appropriate counselling and legal guidance.

Is the Baby Genetically Related to the Surrogate?

No, not in gestational surrogacy.

This is perhaps the biggest misconception about surrogacy.

The gestational carrier provides the uterus and carries the pregnancy.

She does not provide the egg.

Indian law specifically defines gestational surrogacy as an arrangement in which the surrogate carries the child after embryo implantation and the child is not genetically related to the surrogate mother.

Can You Use Your Own Eggs With a Gestational Carrier?

Potentially, yes—but Indian law must be considered.

Medically, if viable eggs are available, IVF can potentially create embryos using those eggs.

However, India’s surrogacy regulations place specific conditions on gamete sources.

The 2023 amendment states that a couple undergoing surrogacy must have both gametes from the intending couple and that donor gametes are not permitted for such a couple. It separately states that an intending single woman who is a widow or divorcee must use her own eggs and donor sperm.

Therefore, patients should not assume that an international surrogacy pathway automatically applies in India.

Medical possibility and legal permission are two different questions.

Who Is Eligible for Surrogacy in India?

Surrogacy in India is regulated under the Surrogacy (Regulation) Act, 2021, together with its rules and regulations. The Act establishes a regulated framework for surrogacy and requires a medical indication necessitating gestational surrogacy, along with prescribed certifications and other conditions.

The law also prohibits commercial surrogacy and provides for altruistic surrogacy under specified conditions.

This means there are two separate questions:

Medical question

Do you have a medical reason that may justify gestational surrogacy?

Legal question

Do you satisfy the current statutory requirements to proceed?

You need both.

Who Qualifies for Surrogacy in India? Eligibility at a Glance

Under the statutory framework, eligibility for an intending couple includes specific requirements.

The Act provides for an eligibility certificate where the intending couple is married and falls within the specified age limits—23 to 50 years for the female partner and 26 to 55 years for the male partner on the date of certification. It also addresses the requirement concerning surviving children, with an exception for certain children with serious medical conditions as specified by law.

The surrogate mother must also satisfy statutory requirements.

The Act specifies that the surrogate must be an ever-married woman who has a child of her own and is between 25 and 35 years of age on the day of implantation. She must not provide her own gametes, and the law limits her participation in surrogacy. Medical and psychological fitness certification is also required.

A simplified overview

Requirement	General statutory framework
Medical indication	Required
Gestational surrogacy	Required
Commercial surrogacy	Prohibited
Intended couple	Must satisfy statutory eligibility requirements
Female intended parent age	23–50 years under Section 4
Male intended parent age	26–55 years under Section 4
Surrogate	Ever-married woman with a child of her own
Surrogate age	25–35 years on implantation
Surrogate’s own egg	Not permitted
Medical/psychological fitness	Required
Required certificates	Yes

Important: This is a high-level summary, not a legal eligibility determination. Court decisions have also addressed how age restrictions apply in particular cases involving surrogacy procedures or embryos created before the Act came into force.

What Is the 2023 Donor-Gamete Rule?

The use of donor gametes in Indian surrogacy requires particular attention.

The Surrogacy (Regulation) Amendment Rules, 2023 amended the relevant form under the 2022 Rules.

For a couple undergoing surrogacy, the rule states that both gametes must come from the intending couple and donor gametes are not permitted.

For an intending single woman who is a widow or divorcee, the rule states that she must use her own eggs and donor sperm.

This means the answer to:

“Can I use donor eggs in surrogacy in India?”

cannot simply be answered with a general international fertility rule.

The specific legal and medical circumstances matter.

What Is a Certificate of Essentiality in Surrogacy?

The Certificate of Essentiality is an important part of India’s statutory surrogacy process.

Under Section 4 of the Surrogacy (Regulation) Act, the intending couple must possess a Certificate of Essentiality issued by the appropriate authority after the required conditions are satisfied. These include a certificate of medical indication from a District Medical Board, a court order concerning parentage and custody of the child to be born through surrogacy, and prescribed insurance coverage for the surrogate mother.

What Does the Medical Indication Certificate Do?

The medical indication certificate establishes that there is a medical reason necessitating gestational surrogacy.

The District Medical Board is constituted under the Act and includes specified medical professionals.

This is important because:

Infertility alone should not be confused with a statutory medical indication for surrogacy.

What Other Certificates and Approvals Are Required?

The surrogacy process involves more than a fertility clinic simply approving treatment.

Depending on the case and current regulations, documentation may include:

• Medical indication certification
• Certificate of Essentiality
• Eligibility certification
• Medical and psychological fitness certification for the surrogate
• Court documentation concerning parentage and custody
• Insurance coverage for the surrogate
• Other forms and approvals required by the applicable authority

The exact process should be confirmed with the registered clinic and relevant authority because regulations and administrative procedures can change.

The Act requires a Certificate of Essentiality for the intending couple and an eligibility certificate for the surrogate, along with separate eligibility requirements for the intending couple.

Is Commercial Surrogacy Legal in India?

No.

India’s framework permits altruistic surrogacy, not commercial surrogacy.

The Act prohibits commercial surrogacy and provides restrictions intended to prevent exploitation of surrogate mothers and children born through surrogacy.

This is why the financial structure of a surrogacy arrangement should not be treated like a commercial transaction.

Medical expenses, insurance and other expenses specifically permitted by the applicable law and rules must be handled according to the statutory framework.

Surrogacy Cost in India

Another question almost every intended parent asks is:

“How much does surrogacy cost in India?”

The honest answer is that there is no single cost that applies to every case.

The total expense can depend on:

• Fertility consultation
• Medical investigations
• IVF
• Fertility medications
• Egg retrieval
• Embryology
• Embryo transfer
• Gestational carrier screening
• Pregnancy monitoring
• Specialist consultations
• Delivery-related care
• Insurance requirements
• Legal and administrative requirements
• Additional treatment if medically required

Someone who already has frozen embryos may have a very different treatment pathway from someone who needs a new IVF cycle.

Similarly, a patient with a serious medical condition may require additional specialist assessments.

Therefore, a reliable estimate should be based on the individual treatment plan, not a generic online package.

Surrogacy vs IVF, IUI and Donor Egg Treatment

It is easy to confuse these treatments because they are all part of fertility care.

But they solve different problems.

Treatment	Main purpose	Can intended mother carry pregnancy?	Common role
IUI	Helps sperm reach the uterus	Usually yes	Selected infertility cases
IVF	Creates embryos outside the body	Usually yes	Many infertility causes
ICSI	Assists fertilisation	Usually yes	Selected male-factor infertility
Donor egg IVF	Uses donor oocyte	Usually yes	Selected ovarian/egg-related cases
Embryo donation	Uses donated embryo	Usually yes	Selected family-building cases
Gestational surrogacy	Another woman carries pregnancy	No or medically unsafe	Inability or significant contraindication to gestate

The simplest way to remember the difference is:

IVF helps create the embryo.

Surrogacy determines who carries the pregnancy.

Read our Blog on: Difference Between IVF and Surrogacy

What Are the Risks and Challenges of Surrogacy?

Surrogacy can provide a path to parenthood, but it is a major medical, psychological and legal process.

Medical considerations

The gestational carrier is still undergoing a real pregnancy.

Potential risks include:

• IVF-related risks
• Pregnancy complications
• Gestational diabetes
• Hypertensive disorders
• Caesarean delivery
• Preterm birth
• Other obstetric complications

The carrier should receive appropriate independent medical care.

Psychological considerations

The process can bring many emotions.

Intended parents may experience:

• Hope
• Anxiety
• Fear
• Uncertainty
• Emotional stress

The gestational carrier may also experience emotional and practical challenges.

ACOG and ASRM emphasise counselling and psychosocial considerations in gestational surrogacy.

Legal considerations

Important issues include:

• Consent
• Parentage
• Custody
• Medical decision-making
• Documentation
• Insurance
• Legal compliance
• Rights and responsibilities of the parties

Because Indian surrogacy is regulated by statute, legal eligibility should be confirmed before beginning treatment.

How Do You Know If Surrogacy Is Right for You?

If you are researching “who needs surrogacy”, you may already have been through a difficult fertility journey.

But you do not need to decide based on one diagnosis.

Instead, ask five questions.

1. What exactly is preventing pregnancy?

Is the problem related to:

• The uterus?
• Eggs?
• Sperm?
• Embryos?
• Previous pregnancy losses?
• A serious medical condition?

2. Can the problem be treated?

If a uterine problem can be corrected, treatment may be preferable to surrogacy.

3. Can I safely carry a pregnancy?

This is one of the most important questions.

4. Would another woman carrying the pregnancy significantly reduce medical risk?

If pregnancy is impossible or medically contraindicated, a gestational carrier may become an appropriate option.

5. Am I legally eligible in India?

Medical eligibility and legal eligibility must both be established.

Final Thoughts — Surrogacy Is Not Giving Up

For many women, the word “surrogacy” can initially feel like the end of a dream.

But medically, it can mean something very different.

It can mean finding another way forward when your uterus is absent.

It can mean building a family after a hysterectomy.

It can mean protecting your health when pregnancy would be dangerous.

It can mean considering another path after a carefully investigated history of repeated pregnancy or IVF failure.

And in gestational surrogacy, the woman carrying the pregnancy is not genetically related to the baby.

So, needing a gestational carrier does not necessarily mean giving up your biological connection to your child.

At the same time, surrogacy is not the right answer for every fertility problem.

PCOS does not automatically mean surrogacy.

Low AMH does not automatically mean surrogacy.

One failed IVF cycle does not automatically mean surrogacy.

Fibroids do not automatically mean surrogacy.

The right decision begins with understanding the medical reason.

If you have been told that you cannot safely carry a pregnancy, have no uterus, have severe uterine damage, have experienced repeated pregnancy losses, or have undergone multiple unsuccessful IVF cycles, a fertility specialist at Nimaaya can help you understand whether gestational surrogacy is appropriate—and whether there are other options worth exploring first. If you are searching for a surrogacy option in Surat or in Mumbai, Nimaaya Women’s Centre for Health is the best choice for you.

Surrogacy is not giving up.

For the right patient, after the right evaluation, it can simply be another way of moving toward parenthood.

Frequently Asked Questions About Who Needs Surrogacy

Who needs surrogacy?

Surrogacy may be considered when a person cannot safely carry a pregnancy or cannot carry one because the uterus is absent or significantly compromised. Possible indications include absent uterus, hysterectomy, major uterine abnormalities, certain serious medical conditions and selected cases of multiple unexplained IVF failures. A medical indication must be evaluated individually.

Is surrogacy legal in India?

Yes. Surrogacy is regulated in India under the Surrogacy (Regulation) Act, 2021 and associated rules and regulations. The framework permits gestational surrogacy under specified conditions and prohibits commercial surrogacy. Medical indications, eligibility requirements, certificates and approvals apply.

Who can opt for surrogacy in India?

Eligibility depends on both medical and legal requirements. For an intending couple, the Act specifies requirements relating to marital status, age, surviving children and medical indication, along with prescribed certificates and approvals. The surrogate must also meet statutory requirements concerning age, marital and parental status, medical and psychological fitness, and other conditions.

What medical conditions require surrogacy?

Conditions that may support consideration include absent uterus, hysterectomy, significant uterine abnormalities, irreparable uterine scarring, certain absolute contraindications to pregnancy and serious medical conditions that pregnancy could significantly worsen. Multiple unexplained IVF failures may also support consideration in selected cases. No diagnosis automatically means surrogacy is required.

Will the baby be genetically mine if I use a surrogate?

Potentially, yes. In gestational surrogacy, the surrogate does not provide the egg. If the intended mother’s egg and intended father’s sperm are used and this is legally permitted, the embryo can be genetically related to the intended parents. Indian law defines gestational surrogacy as an arrangement where the child is not genetically related to the surrogate.

Can I do surrogacy if I have a heart condition in India?

Potentially, if the heart condition creates a significant medical risk from pregnancy and the case meets India’s legal requirements. Severe cardiovascular conditions such as pulmonary hypertension can be absolute contraindications to pregnancy. However, not every heart condition requires surrogacy. A cardiologist and fertility specialist should assess the individual risk.

How many failed IVF cycles are needed before considering surrogacy in India?

There is no universal number of failed IVF cycles that automatically means surrogacy is required. ASRM allows consideration of a gestational carrier in selected patients with multiple unexplained IVF failures despite transfer of good-quality embryos, particularly where an unidentified endometrial factor is suspected. The cause of failure should be evaluated first.

Can cancer survivors opt for surrogacy in India?

Potentially. Cancer treatment may result in hysterectomy, pelvic radiation damage or other reproductive effects that make pregnancy impossible or unsafe. If eggs or embryos were preserved, these may potentially be used depending on the patient’s medical circumstances and current Indian legal requirements. Oncology and fertility assessment are important before treatment.

Can I use donor eggs in surrogacy in India?

The answer depends on the specific legal category and current rules. The 2023 amendment states that a couple undergoing surrogacy must have both gametes from the intending couple and donor gametes are not allowed. It separately provides that an intending single woman who is a widow or divorcee must use her own eggs and donor sperm. Individual cases should therefore be reviewed under the current law and applicable authorities.

What is a Certificate of Essentiality in surrogacy?

A Certificate of Essentiality is part of India’s statutory surrogacy process. Section 4 requires the intending couple to possess a Certificate of Essentiality issued by the appropriate authority after specified conditions are satisfied. These include a medical-indication certificate from a District Medical Board, a court order concerning parentage and custody, and prescribed insurance coverage for the surrogate.

Can a woman without a uterus have a baby through surrogacy?

Yes, potentially. If the woman has functioning ovaries and viable eggs, IVF may potentially be used to create embryos that can be transferred to a gestational carrier. The absence of a uterus prevents her from carrying the pregnancy but does not necessarily prevent her from providing the egg.

Can I have a baby through surrogacy after hysterectomy?

Potentially, yes. A hysterectomy prevents carrying a pregnancy because the uterus has been removed. However, if viable eggs remain available, IVF and gestational surrogacy may potentially allow a genetically related child, subject to medical and legal eligibility.

Can Asherman syndrome be a reason for surrogacy?

Severe, irreversible Asherman syndrome can be considered a potential medical indication when uterine scarring prevents the uterus from safely supporting pregnancy and appropriate treatment has not corrected the problem. Milder or treatable disease does not automatically require surrogacy.

Do fibroids mean I need a surrogate?

No. Many women with fibroids can become pregnant and carry a pregnancy. The effect of fibroids depends on size, number, location and whether the uterine cavity is distorted. Treatment or monitoring may be appropriate. Surrogacy is considered only in selected severe cases where pregnancy remains unsafe or unsuccessful despite appropriate evaluation.

Does adenomyosis require surrogacy?

Not automatically. Adenomyosis can affect fertility and pregnancy outcomes, but many women with adenomyosis may still carry pregnancies. Treatment and individual risk assessment should come first. A gestational carrier may be discussed only when the overall medical situation supports it.

Does recurrent miscarriage mean I need surrogacy?

No. Recurrent pregnancy loss has many possible causes. Surrogacy may be considered when a significant uterine problem or other medical issue makes carrying another pregnancy unsafe or unlikely to succeed despite appropriate treatment. The underlying cause matters more than the number of miscarriages alone.

Does low AMH mean I need surrogacy?

No. Low AMH primarily relates to ovarian reserve and does not automatically indicate that the uterus cannot carry a pregnancy. Fertility treatment should be based on ovarian reserve, age, embryo potential and the individual’s overall reproductive circumstances.

Does PCOS mean I need surrogacy?

No. PCOS commonly affects ovulation and fertility, but many women with PCOS can become pregnant and carry a pregnancy. Treatment depends on the individual’s ovulation, metabolic health and other fertility factors.

Is one failed IVF cycle enough to consider surrogacy?

Usually, no. One failed IVF cycle does not establish that the uterus cannot carry a pregnancy. Doctors may review embryo development, uterine anatomy, endometrial preparation, medical history and other factors before changing the treatment approach.

Can kidney disease be a reason for surrogacy?

Yes, in selected severe cases. Advanced kidney disease can make pregnancy substantially higher risk. A nephrologist should assess kidney function, disease severity and expected pregnancy risks. If pregnancy is medically unsafe, gestational surrogacy may be considered.

Can autoimmune disease make pregnancy unsafe?

Some severe autoimmune diseases can make pregnancy high risk, particularly when major organs are affected or when essential medications are unsuitable for pregnancy. However, many women with autoimmune disease can have pregnancies with specialist care. The decision depends on the specific condition and its severity.

Is the surrogate genetically related to the baby?

No, not in gestational surrogacy. The surrogate carries an embryo but does not provide the egg. Therefore, she is not genetically related to the child.

What tests are done before surrogacy?

Testing depends on the medical reason. It may include ovarian reserve assessment, pelvic ultrasound, uterine evaluation, review of IVF records, medical fitness testing and specialist assessments. Genetic counselling or embryo testing may be considered in selected situations. There is no single test package for everyone.

How does medical surrogacy work?

The process generally involves confirming the medical indication, assessing fertility, completing medical and legal eligibility requirements, screening the gestational carrier, creating embryos through IVF, preparing the carrier’s uterus, transferring an embryo and monitoring the pregnancy. The exact process varies according to the medical and legal circumstances.

Important Legal Update for Readers

India’s surrogacy framework continues to be interpreted through legislation, rules, regulations and court decisions.

The core framework is the Surrogacy (Regulation) Act, 2021, which came into force on January 25, 2022. The India Code currently lists the Act together with the Surrogacy Rules, 2022, subsequent amendment rules and the Surrogacy Regulations, 2023.

There have also been important court decisions regarding the application of statutory age restrictions to couples who had already commenced the surrogacy process and created or cryopreserved embryos before the Act came into force. The Supreme Court addressed such retrospective application in Vijaya Kumari S. and another v. Union of India in 2025, and subsequent 2026 cases have considered related circumstances.

Therefore, patients should not treat an online eligibility table as a final legal determination.

The safest approach is to have the case assessed by a registered fertility clinic and the appropriate legal/administrative authority under the rules applicable at the time treatment is planned.