Indian couples travelling from cities such as Delhi, Mumbai, Chennai, Bengaluru and Hyderabad to Dubai, the United States, Colombia and Georgia for sex-selection-linked IVF and surrogacy are revealing a regulatory problem that cannot be understood only as a matter of overseas medical travel. The trend, reported by the Times of India, shows how persistent son preference, cross-border healthcare markets and restrictions on assisted reproduction in India are interacting to create a new route around domestic controls.
The reported journeys are expensive, organised and increasingly marketed as fertility packages. Overseas IVF and surrogacy services described in the report cost between ₹15 lakh and ₹1.7 crore, depending on the destination and the services included. The packages may combine IVF, surrogacy and preimplantation genetic testing for aneuploidy, or PGT-A, with the stated purpose of identifying an embryo’s sex before treatment.
India permits PGT-A for detecting chromosomal abnormalities, but does not permit its use for sex selection. The report indicates that some overseas destinations allow the test to be used for that purpose. This legal difference is central to the emerging market. Couples who cannot legally pursue sex selection in India are able to travel to jurisdictions where clinics advertise what they call “family balancing” services.
The result is not simply a case of patients choosing a cheaper or better medical facility abroad. It is a cross-border response to a domestic regulatory boundary. The treatment itself may be available in India, often at lower cost, but the specific service sought by these couples is restricted. The report therefore places India’s assisted reproductive technology framework within a wider system of international mobility, fertility clinics, agents and digital marketing.
The scale of the demand is difficult to establish conclusively from the available material, but the reported accounts point to a concentrated metropolitan pattern. Dr Deepak Gulati, who runs a fertility facility in New York, told the Times of India that at least 100 Indian couples visit his facility every month for IVF or surrogacy, and that at least half seek gender selection. He said many clients come from major Indian metros, including Delhi, Mumbai, Chennai, Bengaluru and Hyderabad.
That claim is an account from one provider rather than a national estimate. It nevertheless identifies the cities from which the market is drawing its customers: large urban centres with higher incomes, greater access to international travel and stronger exposure to private fertility services. The trend is therefore linked not only to reproductive preference but also to the geography of India’s urban professional and affluent classes.
The overseas market is being shaped by differences in price as well as law. According to the report, gender selection costs about $16,360 in Georgia, compared with $33,760 in the United States. A facility in Georgia has reportedly been opened to offer similar services at approximately half the New York price. Colombia is another lower-cost destination. An Indian client identified as Vikram S told the newspaper that a surrogacy process there took three to four months and cost about $60,000, or roughly ₹57 lakh.
Dubai occupies a different position in this network. The report says some clinics and agents encourage Indian couples to travel there for only 24 hours for the initial egg-retrieval stage, returning later for the IVF procedure. This arrangement reduces the time patients need to spend abroad while preserving the cross-border structure of the treatment. It also shows how reproductive care is being divided into stages across jurisdictions rather than delivered in one place.
This model depends on intermediaries. The Times of India reported that clinics in Dubai and Colombia declined to comment, even though their websites and Instagram accounts carried videos, reels and promotions for “family balancing” packages. Sources cited in the report said some clinics have agents in India who identify clients and negotiate deals. The promotional language reportedly includes assurances of almost 100% success rates, high-tech laboratories and customised packages.
Those claims require careful scrutiny because the supplied report does not provide independent clinical evidence for the success rates advertised by the clinics. What it does establish is the existence of a marketing ecosystem directed at Indian couples. Social media is not merely an information channel in this market. It helps convert a culturally rooted preference into a purchasable service, packaged with travel, medical procedures and legal navigation.
The underlying demand is connected to India’s continuing preference for male children. The report cites a sex ratio at birth of 929 girls for every 1,000 boys, based on the National Family Health Survey-5 for 2019-21. That figure provides the demographic context for the overseas market. Even when sex determination is prohibited domestically, the preference that drives the demand can persist and find a route through international services.
The important distinction is between medical access and reproductive choice. India has become a destination for IVF patients from abroad because treatment can cost less than $5,000, according to a Punjab-based IVF specialist quoted in the report. The same source said this was below half the cost in other parts of the world. India can therefore attract patients seeking fertility treatment while losing some cases in which the intended outcome includes sex selection.
This contradiction highlights the limits of analysing fertility tourism only through the lens of competitiveness. India may have lower-cost clinical capacity, but legal restrictions determine which services can be offered. International providers can use the price advantage of one jurisdiction, the legal permissiveness of another and the demand generated in a third. Patients and clinics operate across that network, while Indian regulation remains primarily territorial.
The report also connects the overseas movement to changes in India’s assisted reproductive technology and surrogacy framework. A Hyderabad-based fertility expert said the ART law introduced in 2022 to curb commercial surrogacy had increased the movement of some patients abroad. The doctor argued that legal complexity was driving even genuine cases outside India, with the option of selecting a male child acting as an additional incentive.
That assertion is a practitioner’s assessment, not an independently measured finding in the supplied material. It does, however, raise an institutional question: whether a framework designed to prevent exploitation and regulate reproductive services is accessible enough for patients who have legitimate medical needs. The existence of a regulatory objective does not by itself show that the rules are ineffective. But the reported movement abroad suggests that regulation can also redistribute demand, particularly when wealthy patients can absorb international travel and treatment costs.
This is where the urban dimension becomes especially clear. The couples described in the report are largely connected to metropolitan India, where private healthcare, international travel, digital marketing and high-value financial transactions are concentrated. The same cities that generate demand for advanced fertility treatment also provide the agents, doctors and consumers needed to sustain a cross-border market.
The market is consequently stratified. Couples with limited resources remain subject to domestic restrictions and domestic treatment options. Wealthier couples can travel to destinations where the desired service is available, paying from ₹15 lakh to ₹1.7 crore. The regulatory boundary therefore operates differently across income groups. It may restrict the procedure in India, but it does not have the same practical effect on all residents.
The report does not establish how many Indian couples travel abroad each year, how many procedures are completed successfully, or how many children born through these arrangements return to India. It also does not establish whether the reported clinics comply with the laws of their respective jurisdictions or whether Indian agencies are monitoring the agents and advertising channels operating domestically. These gaps matter because the available evidence is based mainly on provider accounts, practitioner comments, a client interview and the newspaper’s investigation.
What the evidence does establish is a three-part system. First, son preference sustains demand. Second, India’s legal restrictions prevent sex selection through domestic assisted reproduction. Third, overseas providers and intermediaries convert the gap between demand and domestic law into an international service market. The system is strengthened by price differences, social media promotion and the ability of metropolitan households to travel.
Some doctors cited in the report have called for a reconsideration of India’s PGT-A rules while retaining safeguards. That debate cannot be separated from the purpose of the existing restrictions. Any regulatory discussion would have to distinguish the use of genetic testing for medical reasons from its use for sex selection, while also addressing the social conditions that sustain preference for sons. The report provides no evidence that changing the testing rules alone would resolve that preference.
The larger urban policy question is whether reproductive regulation can remain effective when affluent patients, private providers and digital platforms operate across borders. India’s fertility economy is already internationally connected: foreign patients come to India for lower-cost IVF, while Indian patients leave for services unavailable at home. The regulatory challenge is therefore not only how to control clinics within the country, but also how to understand the networks that form around domestic law.
The reported rise in fertility tourism confirms that the demand for sex-selection-linked treatment has not disappeared. It has moved through a combination of international clinics, travel arrangements, agents and online promotion. What remains uncertain is its full scale and the adequacy of oversight across that chain. Those are the questions that policymakers, medical regulators and urban healthcare systems will need to examine as cross-border reproductive care expands.
