Surrogacy Can't Be Denied Saying Wife Not 'Perfect Woman': Telangana High Court Grants Relief To Woman With Chromosome Condition

The Telangana High Court granted relief to a married woman suffering from Complete Androgen Insensitivity Syndrome (CAIS) [missing uterus and ovaries], denied an eligibility certificate for surrogacy on the ground that her cytogenetic report showed a '46 XY karyotype' disqualifying her under the relevant rules. 

In doing so the court said that denying her an opportunity for surrogacy on ground of her not being a "perfect woman" in against the Surrogacy (Regulation) Act, 2021.

The State authorities had claimed that a "man" is genetically identified with "XY genotype" and woman with XX genotype and thus the couple did not fall under "definition of the couple" to issue the Certificate of Eligibility. Rejecting this the High Court directed the State authority to issue the certificate of essentiality and eligibility under the Act.

A Single Judge Bench comprising Justice Nagesh Bheemapaka held:

“The 1st petitioner, as per the writ affidavit, is having all physical features of a woman; she is not a transgender and she is fit to lead conjugal life. To her ill-luck, she is suffering from Complete Androgen Insensitivity Syndrome (CAIS). Because she is having CAIS problem and unable to give birth to a child, she opted for surrogacy. Otherwise, she would have given birth to a child in the normal method. To extend a helping hand to such a woman, the Government has enacted the Surrogacy (Regulation) Act, 2021. Denying her an opportunity to get a child by Surrogacy method on the ground that she is not a perfect woman is contrary to the letter and spirit of the 2021 Act and is nothing but denting the very purpose of the 2021 Act itself.”

The Court found that once the District Medical Board, constituted under the 2021 Act, had certified that the petitioner-wife suffered from Androgen Insensitivity Syndrome with absent uterus and ovaries, necessitating use of donor oocyte for surrogacy, the State Appropriate Authority could not refuse the certificate by relying on her chromosomal profile.

The petitioners, a married couple, had approached the Court challenging an order of the Commissioner, Health and Family Welfare, who rejected their application for issuance of a certificate of essentiality and eligibility for surrogacy. The couple had married on 24.11.2021 and the marriage was registered on 03.10.2022. The wife was stated to be suffering from CAIS, meaning she had no uterus or ovaries and could not conceive.

The District Medical Board had earlier issued a Medical Indication Certificate dated 22.10.2023, later extended on 23.08.2024, certifying her condition under Rule 14(a) of the Surrogacy (Regulation) Rules, 2022. The couple had also obtained an order from the II Additional Junior Civil Judge-cum-X Additional Metropolitan Magistrate, Kukatpally, concerning parentage and custody of the child to be born through surrogacy, and had taken the required insurance coverage in favour of the surrogate mother.

Despite this, the State Appropriate Authority rejected the application on 18.08.2025. The rejection order relied on Section 2(h) of the 2021 Act, which defines a “couple” as a legally married Indian man and woman, and on a communication from the Government of India stating that transgender persons are not covered under the Act. It further referred to the cytogenetic report showing the petitioner-wife's chromosome analysis as 46 XY karyotype and held that the application could not be considered.

Before the High Court, the petitioners argued that the authority had acted contrary to the statutory scheme. They contended that the competent District Medical Board had already issued the required medical indication certificate and that the Appropriate Authority had no jurisdiction to sit in appeal over that finding. They also argued that the wife was not a transgender person, but a woman with CAIS, and that denial of surrogacy on that basis violated both the Act and Article 21.

Accepting those submissions, the Court held that the case squarely fell within Rule 14(a) of the 2022 Rules. It noted that the petitioner-wife had all physical features of a woman, was fit to lead conjugal life, and had only opted for surrogacy because CAIS made natural conception impossible. The Court held that her chromosomal condition could not, by itself, abridge her chance to have a child through surrogacy.

The Court also relied on the Supreme Court's observations in Arun Muthivel v. Union of India, which held that Rule 14 is woman-centric and applies where a medical or congenital condition impedes a woman from becoming a mother.

Justice Bheemapaka observed that the whole scheme of the 2021 Act is to help infertile couples overcome the social taboo of childlessness, and that the Act is a beneficial piece of legislation meant to enable such women to develop a family and lead a normal married life.

Significantly, the Court noted that the petitioners satisfied the other statutory requirements as well: they were legally married, were within the prescribed age bracket, and did not have any surviving child biologically, through adoption, or through surrogacy earlier. In those circumstances, the refusal to issue the certificate on the ground of a chromosomal defect was held to be unjustified.

Accordingly, the writ petition was allowed and the State authority was directed to issue the certificate of essentiality and eligibility to the petitioners under the Surrogacy (Regulation) Act, 2021.

Case Title: Dr. M & another v. Union of India & another

Case No.: W.P. No.26921 of 2025

Appearance: Ms. P.D. Vineela for the petitioners; learned Government Pleader for Medical & Health for the respondents.

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