Published Mar 08, 2026 | 5:13 PM ⚊ Updated Mar 08, 2026 | 5:13 PM
Representational image. Credit: iStock
Synopsis: A Hyderabad woman with Complete Androgen Insensitivity Syndrome (CAIS) won a landmark ruling after Telangana authorities denied her surrogacy rights citing her 46 XY karyotype. Justice Nagesh Bheemapaka held chromosomes don’t define womanhood, upheld medical certification, and ordered issuance of eligibility documents, affirming her right to motherhood and cautioning against bureaucratic overreach in reproductive rights cases.
When the petitioner, a woman from Hyderabad, aged 32, married her husband in November 2021 in a Hindu ceremony, she carried with her a secret that only a handful of doctors and close family knew: she had been born with Complete Androgen Insensitivity Syndrome, or CAIS. She had no uterus, no ovaries, and a chromosomal karyotype of 46 XY, the genetic profile conventionally associated with males.
Yet she had lived her entire life as a woman. She looked like a woman, presented as a woman, and had been legally married as a woman. CAIS, as her doctors confirmed, had rendered her body completely unresponsive to male hormones during foetal development, meaning she had grown into someone with a typical female appearance, despite her chromosomes. She simply could not carry a pregnancy.
Surrogacy, she and her husband decided, was their path to parenthood. They followed every step the law required: obtaining a Medical Indication Certificate from the District Medical Board, securing a court order on parentage and custody, and arranging insurance cover for the surrogate. Everything was in order, until it wasn’t.
In August 2025, the State Appropriate Authority in Telangana rejected the couple’s application for a Certificate of Essentiality and Eligibility, the document without which surrogacy cannot legally proceed. The reason cited: her karyotype report, which showed 46 XY chromosomes. In the authority’s reading, this meant she could not be classified as a ‘woman’ under the Surrogacy (Regulation) Act, 2021. Her application, they concluded, did not fit within the law.
To understand why the authority’s logic was flawed, it helps to understand what CAIS actually is. Complete Androgen Insensitivity Syndrome is a disorder of sex development (DSD) in which a person born with a 46 XY karyotype is entirely unresponsive to androgens, the hormones that would ordinarily trigger male anatomical development in the womb. The result is that the individual develops along a typical female pathway, with female external genitalia, though without a uterus or ovaries.
CAIS is not a new or obscure finding. It is well-documented in medical literature, recognised by endocrinologists worldwide, and is specifically addressed in the Indian surrogacy framework. The government’s own 2024 gazette notification, cited in the judgment, clarified that where either member of an intending couple suffers from a medical condition, the use of a donor gamete for surrogacy is permitted.
The District Medical Board had already confirmed this applied to the petitioner, certifying that she suffered from ‘Androgen Insensitivity Syndrome, Karyotype XY absent ovaries and absent uterus necessitating use of donor oocyte to avail the Surrogacy procedure.’
In short, the very authority the state relied upon had already examined and certified her condition, and approved it. The State Appropriate Authority’s rejection ignored that certification entirely.
The State Appropriate Authority had sought guidance from the Union government’s Ministry of Health and Family Welfare. The response it received stated that ‘transgender persons are not covered under the Surrogacy (Regulation) Act, 2021.’
On the basis of that opinion, and the 46 XY karyotype, the authority equated the petitioner with a transgender woman and closed the door on her application.
Justice Nagesh Bheemapaka, in his ruling dated 3 March 2026, found this conflation to be without legal or scientific basis. The petitioner, the court noted, is not transgender. She has all the physical characteristics of a woman. Her condition is congenital, she was born this way, and is entirely distinct from gender transition. The authority had made a category error, treating a rare medical condition as a statement about gender identity.
The court was unsparing in its assessment. “The 1st petitioner(the woman), 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),” said Justice Nagesh Bheemapaka in his judgment.
“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 also pointed out that the authority had overreached its jurisdiction. Its role under the Surrogacy (Regulation) Act is to verify that the conditions set out in Section 4 have been met, not to second-guess the Medical Indication Certificate already issued by the competent District Medical Board. By disregarding the board’s certificate and substituting its own interpretation, the authority had acted without jurisdiction.
The judgment draws heavily on a Supreme Court ruling in a comparable case, Arun Muthivel vs Union of India, where women with Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome, a condition that also results in the absence of a uterus, sought access to surrogacy.
The Supreme Court had held that Rule 14 of the 2021 Act is woman-centric and centres on the inability of the intending woman to conceive and carry a child. The provision, the apex court had noted, “is woman-centric and relates to the medical or congenital condition of a woman which impedes her from becoming a mother,” and that “the whole scheme of the Act revolves around the ‘inability’ of the woman to conceive and to give birth to a child.”
Justice Bheemapaka applied the same reasoning here. Rule 14(a) explicitly covers any illness or condition that makes it impossible for a woman to carry a pregnancy to viability. CAIS, with its associated absence of uterus and ovaries, falls squarely within that provision.
“Chromosome analysis 46 XY karyotype of the wife (first petitioner) cannot abridge her chances to beget a child through Surrogacy,” said Justice Nagesh Bheemapaka in his judgment.
The court further held that the Surrogacy Act is “a beneficial piece of legislation to help the infertile couple to get rid of the social taboo of infertility” and that it is “actually a tool for women suffering from rare disorders, to develop a family and lead a normal married life,” said Justice Nagesh Bheemapaka in his judgment. The authority’s rejection, it found, was “not justifiable”, and was set aside even “on humanitarian grounds.”
The judgment is significant for several reasons that extend well beyond this one case. It is one of the first Indian court rulings to explicitly grapple with the intersection of disorders of sex development and reproductive rights law, a space that is only going to grow as genetic testing becomes more widespread.
Estimates suggest CAIS affects approximately 1 in 20,000 live births. Many women with the condition live their entire lives without knowing they carry a 46 XY karyotype, a diagnosis typically made only when they seek help for primary amenorrhea or infertility. The ruling makes clear that such a diagnosis cannot be weaponised to deny them legal recognition as women, or access to reproductive assistance that the law explicitly provides for.
It also signals a warning to administrative authorities: bureaucratic overreach that ignores duly issued medical certifications and substitutes lay chromosomal analysis for clinical expertise will not withstand judicial scrutiny. The District Medical Board exists precisely to make these assessments. When it has done so, an authority downstream in the process cannot unilaterally reverse it by writing to a ministry.
The court directed the State Appropriate Authority to issue the Certificate of Essentiality and Eligibility to the couple forthwith. “The action of the 2nd respondent in refusing to issue Certificate of Essentiality and Eligibility in favour of petitioners by the impugned order on the ground of some Chromosome defect in the first petitioner is unwarranted,” said Justice Nagesh Bheemapaka in his judgment.
After years of navigating a system that repeatedly questioned her identity, the petitioner now has a court order affirming what she, and those who know her, always knew: she is a woman, and she has every right to become a mother.
