Assisted Reproductive Technology in India: Progress, Challenges, and the Road Ahead

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Introduction

Assisted Reproductive Technology (ART) has revolutionized infertility treatment, offering hope to millions worldwide, including India, where infertility affects a significant number of couples. Globally, the World Health Organization estimates that around 8–12% of couples experience infertility. ART has enabled many to overcome biological challenges and realize their aspirations of parenthood, marking a major advancement in reproductive medicine.

However, the rapid growth of ART has introduced complex legal, ethical, and regulatory challenges. For instance, in early 2025, Hyderabad Police uncovered a large-scale illegal surrogacy and baby-selling racket linked to a reputed IVF chain in Telangana and Andhra Pradesh. The accused allegedly operated without valid licenses, violated medical norms, and charged couples exorbitant fees for fraudulent surrogacy services. Vulnerable women were reportedly persuaded to carry pregnancies against their will, highlighting the darker side of ART misuse.

Such incidents reveal the need for a deeper understanding of ART’s legal framework, ethical considerations, and government efforts to regulate this sensitive field—topics that will be explored in this article.


Understanding ART and Its Types

  • Assisted Reproductive Technology (ART) refers to medical procedures that help individuals and couples conceive when natural conception is difficult or impossible.

  • Globally, ART has expanded reproductive options not only for infertile couples but also for single parents and LGBTQ+ individuals, though legal acceptance varies by country.

  • The evolution of ART began in the 20th century, with a major milestone being the birth of Louise Brown in 1978—the world’s first baby born through in vitro fertilisation (IVF) in the UK. This breakthrough proved fertilisation could happen outside the human body, opening new horizons in reproductive medicine.

  • Since then, ART has advanced significantly, with improvements in techniques like embryo freezing, genetic screening, and hormone treatments, increasing success rates and safety.

Main Types of Assisted Reproductive Technology (ART)

  • In Vitro Fertilisation (IVF)

    • Ovaries are stimulated to produce multiple eggs.

    • Eggs are surgically retrieved and fertilised by sperm in a laboratory outside the body.

    • Fertilised embryos are monitored and then implanted into the uterus.

    • Commonly used for blocked fallopian tubes, male infertility, unexplained infertility, and some genetic conditions.

  • Intrauterine Insemination (IUI)

    • Sperm is collected, prepared, and directly placed into the uterus near ovulation.

    • Enhances the chances of sperm meeting the egg naturally inside the reproductive tract.

    • Recommended for mild male infertility, cervical mucus issues, or unexplained infertility.

    • Often combined with ovarian stimulation for better outcomes.

  • Gamete Donation

    • Use of donor eggs or sperm when one partner is infertile or to prevent genetic diseases.

    • Donated gametes are carefully screened for diseases and genetic disorders.

    • Donor sperm or eggs are used in IVF or IUI treatments.

    • Also allows single parents and same-sex couples to have biological children.

  • Surrogacy

    • Another woman carries the pregnancy for intended parents who cannot conceive or carry safely.

    • Two types:

      • Traditional Surrogacy: Surrogate’s own egg fertilised by intended father’s sperm; surrogate is biologically related.

      • Gestational Surrogacy: Embryo from intended parents (or donors) implanted in surrogate; no genetic link to surrogate.

    • Used when pregnancy is medically risky or not possible for the intended mother.

  • ART techniques also often involve:

    • Hormonal stimulation to induce ovulation and increase egg production.

    • Cryopreservation, which is the freezing and storage of eggs, sperm, or embryos for future use.


Legal and Constitutional Framework

Assisted Reproductive Technology (Regulation) Act, 2021

Purpose:
Provides a comprehensive regulatory framework for ART clinics and banks to ensure ethical practices and protect the rights of donors, recipients, and children born through ART.

Key Provisions

  • Mandatory Registration:
    ART clinics and banks must register with the National Registry of ART.

Eligibility Criteria

  • Married Heterosexual Couples:

    • Woman aged 21–50 years

    • Man aged 21–55 years

  • Single Women:
    Permitted to use ART but not surrogacy.

  • Foreigners and NRIs:
    Allowed access under certain conditions.

Rights of Donors and Children

  • Donors must provide informed consent.

  • Children born through ART have the same legal rights as biological children.

  • Donor anonymity is maintained, but medical history must be recorded.

Prohibitions

  • Sex selection is banned under the PCPNDT Act.

  • Exploitation of donors and surrogates is prohibited.

  • Commercial surrogacy is regulated separately under the Surrogacy Act.

Oversight and Grievance Redressal

  • Establishment of National and State Boards to oversee the implementation of the Act and address grievances.

Surrogacy (Regulation) Act, 2021

Regulates surrogacy practices, permitting only altruistic surrogacy and banning commercial surrogacy.

Eligibility:

  • Indian married couples with at least five years of infertility.

  • Single women (widows/divorcees aged 35–45) can also avail of surrogacy.

Surrogate Mother:

  • Must be a close relative of the intending couple, married, and have at least one child of her own.

  • Cannot simultaneously act as a gamete donor.

Prohibitions:

  • Commercial surrogacy, exploitation of surrogate mothers, and abandonment of surrogate children are prohibited.

Constitutional Framework

  • Right to Privacy (Article 21): Protects reproductive choices, as upheld in KS Puttaswamy v. Union of India.

  • Right to Health (Article 21): Includes access to reproductive technologies.

  • Right to Procreation: Implied under the right to personal liberty, subject to legal regulations.

  • Non-Discrimination (Articles 14 & 15): Prohibits discrimination, though ART laws currently restrict access for unmarried and LGBTQ+ individuals.

Ethical & Regulatory Guidelines

  • Indian Council of Medical Research (ICMR) Guidelines (2005, 2017): Provided earlier ethical standards and protocols for ART clinics before the enactment of the 2021 Acts.

  • Pre-Conception and Pre-Natal Diagnostic Techniques (PCPNDT) Act, 1994: Prohibits sex selection to prevent misuse of ART technologies for gender bias.


Positive Outcomes of ART

Medical and Technological Benefits

  • ART techniques such as IVF, IUI, and surrogacy provide solutions for various infertility causes, enabling conception when natural methods fail.

  • Fertilisation outside the body allows for selection of healthy embryos, improving pregnancy success rates.

  • Fertility preservation technologies like egg, sperm, and embryo freezing offer options for cancer patients and those delaying parenthood.

  • Genetic screening through PGD/PGT helps detect and prevent hereditary diseases, promoting healthier pregnancies.

  • Advanced procedures like ICSI assist in overcoming severe male infertility by injecting sperm directly into eggs.

  • Continuous advancements in lab protocols and cryopreservation have increased overall success and reduced risks.

Social Benefits

  • ART supports diverse family structures by enabling single individuals, same-sex couples, and older adults to have biological children.

  • It helps reduce the stigma and emotional distress associated with infertility, promoting psychological well-being.

  • By expanding reproductive choices, ART fosters inclusivity and empowers individuals to exercise control over their family planning.

Economic Benefits

  • The ART industry creates employment opportunities for healthcare professionals, embryologists, counselors, and support staff.

  • It contributes significantly to medical tourism, especially in countries like India, attracting international patients seeking affordable fertility treatments.

  • Growth in related sectors, such as pharmaceuticals, laboratory equipment, and cryopreservation services, is driven by advancements in ART.

Public Health Benefits

  • Regulated ART services ensure safer fertility treatments, reducing risks of malpractice and health complications.

  • Standardization of protocols improves maternal and neonatal outcomes.

  • Ethical oversight protects the rights and welfare of donors, surrogates, and children born via ART.

Psychological and Emotional Benefits

  • ART provides hope and emotional relief to couples and individuals facing infertility, alleviating stress and anxiety associated with childlessness.

  • The opportunity to conceive through ART can significantly improve mental health and relationship satisfaction.

Technological Empowerment and Innovation

  • ART has driven innovations in reproductive medicine, such as cryopreservation, genetic testing, and microsurgical techniques, advancing overall healthcare.

  • These technological advancements have applications beyond fertility, including cancer fertility preservation and genetic disease research.

Educational and Research Advancement

  • ART programs contribute to medical education and training, building expertise in reproductive endocrinology, embryology, and genetics.

  • Research in ART fuels new discoveries in human reproduction, embryonic development, and genetic disorders.

Demographic and Population Management

  • ART can help address declining birth rates in some regions by enabling conception in older or medically challenged populations.

  • It supports family planning choices, allowing couples to space or limit births more effectively through assisted conception.

Ethical and Legal Framework Development

  • The rise of ART has necessitated the development of ethical guidelines and legal protections, promoting responsible medical practice.

  • These frameworks help protect vulnerable groups and ensure the rights of children born through ART are upheld.


Government Initiatives in ART

The Government of India has undertaken multiple initiatives to promote ethical, accessible, and regulated Assisted Reproductive Technology (ART) services across the country. These efforts emphasize improving governance, expanding access, fostering research, and raising public awareness.

1. National ART & Surrogacy Portal

The Ministry of Health and Family Welfare launched the National ART & Surrogacy Portal to facilitate streamlined registration and regulation of ART clinics and surrogacy centers nationwide. The portal provides:

  • Online registration and renewal for ART clinics and sperm/egg banks.

  • Access to guidelines, notifications, and updated information on ART and surrogacy.

  • Mechanisms for grievance submission and feedback from patients and stakeholders.

  • Information about insurance and welfare schemes for surrogate mothers and egg donors.

This digital platform acts as a centralized repository, enhancing transparency and accessibility in the ART sector.

2. Reconstitution of the National ART & Surrogacy Board

In November 2024, the Government reconstituted the National Assisted Reproductive Technology and Surrogacy Board. The Board is responsible for:

  • Overseeing the implementation of ART and Surrogacy regulations.

  • Ensuring ethical compliance and standardization across fertility clinics.

  • Addressing grievances and disputes related to ART services.

This initiative aims to strengthen regulatory oversight and accountability in the ART ecosystem.

3. State-Level Enforcement and Oversight

Several state governments have implemented measures to regulate ART clinics and surrogacy services:

  • Telangana initiated a high-level probe into illegal and unlicensed fertility clinics to enforce compliance with laws such as the Surrogacy (Regulation) Act and the Clinical Establishments (Registration and Regulation) Act.

  • States like Haryana, Maharashtra, and Tamil Nadu have also increased monitoring efforts to prevent malpractice and protect patient safety.

4. Research, Training, and Development Funding

The central government supports innovation and capacity building in reproductive technologies through:

  • Grants from the Department of Biotechnology (DBT) under schemes like the Small Business Innovation Research Initiative (SBIRI), fostering biotech innovation in reproductive health.

  • Funding from the Indian Council of Medical Research (ICMR) for projects focused on affordable ART solutions and clinical research.

  • Training programs designed to equip healthcare professionals with expertise in ART, expanding quality care availability.

  • Fertility preservation services, including free sperm and egg freezing for cancer patients at premier institutions such as AIIMS.

5. Public Awareness, Education, and Counseling

To promote informed decision-making and ethical ART practices, the government conducts:

  • Dissemination of information via the National ART & Surrogacy Portal.

  • Workshops, seminars, and fertility check-up camps across both rural and urban areas.

  • “Test Tube Baby” awareness campaigns in states like Tamil Nadu, Karnataka, and Uttar Pradesh to educate the public on safe and ethical ART procedures.

  • Counseling services to guide couples through ART options and procedures.

6. Subsidized Fertility Treatment Schemes

Recognizing financial barriers in fertility care, certain states offer subsidized or free ART treatments:

  • The Delhi IVF Scheme provides free IVF treatment in government hospitals for couples married for at least five years with proven infertility and an annual income below ₹5 lakhs.

  • States such as Haryana, Maharashtra, and Telangana extend financial support for infertility treatments under broader maternal health programs, including Telangana’s KCR Kit scheme, which encompasses fertility treatment assistance.

7. Proposed and Upcoming Initiatives

  • The inclusion of IVF and ART services under the Ayushman Bharat health insurance scheme is under consideration, which would significantly improve affordability and accessibility.

  • Expansion plans aim to introduce ART facilities and services in district hospitals to enhance rural access and reduce urban-rural disparities in fertility care.


Challenges 

Ethical and Social Challenges

  • Exploitation risks for surrogate mothers and egg/sperm donors, especially economically vulnerable women.

  • Complex parentage and custody issues, particularly in cases of surrogacy and gamete donation.

  • Social stigma and discrimination faced by ART users, especially single parents and LGBTQ+ individuals.

  • Concerns about commodification of human life and reproductive material.

Legal and Regulatory Challenges

  • Inconsistent enforcement of ART regulations across states and clinics.

  • Lack of uniformity in licensing, leading to illegal or unregulated fertility clinics.

  • Difficulty in protecting the rights of all parties involved, including donors, surrogates, parents, and children.

  • Challenges in cross-border surrogacy and ART arrangements.

Medical Risks and Limitations

  • Health risks to surrogate mothers and women undergoing ART treatments, including ovarian hyperstimulation syndrome.

  • Increased risk of multiple pregnancies and associated complications.

  • Variable success rates depending on age, health conditions, and clinic standards.

  • Long-term health effects on children conceived through ART remain under study.

Economic and Accessibility Challenges

  • High costs of ART procedures limit access for many couples, especially in rural and low-income groups.

  • Limited availability of ART services in rural and remote areas.

  • Inadequate insurance coverage for fertility treatments.

Psychological and Emotional Challenges

  • Emotional stress and anxiety due to uncertainty of treatment outcomes.

  • Psychological impact on children born through ART and families navigating complex relationships.

  • Pressure and societal expectations on infertile couples.


Way Forward

Strengthening Regulation and Oversight

  • Enhance uniform enforcement of ART laws and licensing across all states to eliminate illegal clinics.

  • Establish robust monitoring and grievance redressal mechanisms to protect rights of donors, surrogates, parents, and children.

  • Promote transparency in clinic operations and procedures.

Improving Accessibility and Affordability

  • Expand ART services to district and rural hospitals to reduce urban-rural disparities.

  • Include ART procedures like IVF under public health insurance schemes such as Ayushman Bharat to ease financial burdens.

  • Introduce subsidized fertility treatment programs at a national scale.

Enhancing Awareness and Education

  • Conduct widespread public awareness campaigns to reduce stigma and misinformation about ART.

  • Train healthcare professionals to provide ethical, sensitive, and informed counseling to ART users.

  • Promote fertility education as part of reproductive health programs.

Promoting Research and Innovation

  • Increase funding for research on affordable, safe, and effective ART technologies tailored to local contexts.

  • Support clinical trials and studies on long-term health effects of ART on children and parents.

  • Foster collaboration between research institutes, biotech firms, and healthcare providers.

Global Best Practices

  • Comprehensive Regulation: Countries like the UK and Australia maintain strict regulatory bodies (e.g., Human Fertilisation and Embryology Authority) overseeing ART clinics, ensuring ethical compliance, patient safety, and transparency.

  • Universal Insurance Coverage: Some European countries include ART treatments under universal health coverage, reducing economic barriers.

  • Donor and Surrogate Rights: Nations such as Canada enforce clear legal frameworks protecting the rights and health of donors and surrogates, including mandatory counseling and consent protocols.

  • Data Transparency: Countries maintain national ART registries, publishing success rates and adverse events to help patients make informed choices.

  • Public Awareness Campaigns: Regular education campaigns address myths, promote ethical ART use, and support mental health for infertile couples.

  • Cross-border ART Guidelines: International collaborations help regulate cross-border surrogacy and ART services, addressing jurisdictional and ethical issues.

Conclusion

Assisted Reproductive Technology (ART) has revolutionized the treatment of infertility, providing hope to millions worldwide. However, incidents of illegal and unethical practices in ART clinics, such as those recently uncovered in Hyderabad, underscore the critical need for strong regulatory frameworks and vigilant enforcement. Exploitative activities in the ART sector not only harm vulnerable individuals but also threaten the credibility and safety of reproductive technologies.

Globally, organizations like the World Health Organization (WHO) and the International Committee Monitoring Assisted Reproductive Technologies (ICMART) stress the importance of ethical standards, transparency, and equitable access in ART services. Additionally, NGOs such as the Fertility Network UK and the European Society of Human Reproduction and Embryology (ESHRE) work tirelessly to promote patient rights, provide counseling support, and advocate for ethical ART practices worldwide.

In India, NGOs like the Indian Society for Assisted Reproduction (ISAR) play a crucial role in raising awareness, providing training to healthcare professionals, and supporting ethical ART practices. Combined with government reforms, efforts from such organizations strengthen the ART ecosystem. Moving forward, continued public awareness, stringent oversight, and collaboration between policymakers, medical professionals, civil society, and global institutions will be vital to ensure that ART fulfills its promise as a safe and ethical solution for infertility.




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