CARE Recommendations | Ethical Surrogacy Guidance and ASRM-Based Best Practices

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CARE Ethical Recommendations for Agencies

Version 1.0 — Voluntary, Non-Enforceable Best Practices

The Chinese-American Reproductive Ethics Alliance (CARE) provides guidance, education, and voluntary ethical recommendations for surrogacy and ART agencies. CARE is not a regulatory body, and membership does not require adherence to strict rules. Instead, CARE offers flexible, ASRM-aligned suggestions to help agencies strengthen professional practice and support all participants with fairness and respect.

These recommendations are designed to complement the diverse business models, cultural backgrounds, and operational structures found throughout the fertility field.

1. Guiding Principles (Grounded in ASRM Recommendations)

1.1 Autonomy & Choice

Intended parents and surrogates have the right to make fully informed decisions about their reproductive journeys. CARE supports both medically indicated and non-medical (social) surrogacy where legally permitted.

1.2 Respect & Inclusion

Agencies are encouraged to maintain culturally respectful, non-discriminatory practices that welcome diverse family structures, ethnicities, and international intended parents.

1.3 Transparency

Clear communication about fees, expectations, risks, and timelines fosters trust and aligns with ASRM’s commitment to informed consent.

1.4 Non-Exploitation

CARE supports compensation models that are fair, transparent, and compliant with local laws, ensuring the well-being of surrogates and donors.

1.5 Professional Collaboration

Agencies are encouraged to work with qualified clinics, licensed mental health professionals, and reproductive attorneys.

2. Recruiting & Screening (Voluntary Recommendations)

2.1 Surrogacy Candidate Screening

Agencies may follow ASRM’s guidance by ensuring:

appropriate medical screening conducted by clinics
psychological evaluation by licensed professionals
clear communication of expectations before matching

CARE recognizes that clinics, not agencies, determine medical eligibility.

2.2 Intended Parent Intake

Agencies may use a basic intake process covering:

reproductive goals
financial preparation
communication preferences
understanding of legal responsibilities

CARE recommends screening that is reasonable and relevant (e.g., criminal background checks), without intrusive or impractical requirements.

2.3 International Intended Parents

Agencies may provide additional education on:

U.S. parentage processes
hospital procedures
newborn documentation
state-specific surrogacy laws

This supports informed participation from families worldwide.

3. Matching Process Recommendations

3.1 Respectful Privacy

CARE recommends sharing only relevant information during matching and maintaining confidentiality around unrelated personal details.

Examples of relevant disclosures:

medical suitability
family-building expectations
termination/embryo transfer decisions

Examples of optional disclosures:

number of previously completed journeys (unless voluntarily shared or required by local laws)
Personal demographic information is not required for matching

3.2 Flexibility for Intended Parents

Family-building goals vary. CARE supports the autonomy of intended parents to decide how many matches or surrogates they may consider, provided this is managed ethically and responsibly by the agency.

There is no recommended limit as long as it is reasonable and in compliance with relevant laws, as family needs differ.

4. Legal & Compliance Recommendations

4.1 Independent Legal Counsel

CARE supports the ASRM recommendation that each party should have their own attorney, ensuring informed consent and fair representation.

4.2 Parentage

Agencies may guide intended parents to understand:

the state-specific parentage process
whether their state uses pre-birth or post-birth orders
that courts, not agencies, determine legal parentage

4.3 Financial Transparency

CARE encourages agencies to:

Clearly outline fee structures
Communicate refund or cancellation policies upfront
Consider using independent escrow accounts to manage surrogate funds

These practices strengthen trust and clarity.

5. Emotional, Cultural & Practical Support

5.1 Mental Health Support

Providing access to mental health professionals can benefit surrogates and intended parents during the process, particularly during emotionally sensitive phases.

5.2 Cultural Competency

CARE recommends agencies build cultural awareness, especially when working with:

Chinese intended parents
Chinese surrogate candidates
international families
bilingual or multilingual situations

This aligns with CARE’s mission to uplift Chinese-American and international voices within the industry.

5.3 Ongoing Communication

CARE encourages respectful, balanced, and timely communication among agencies, surrogates, and intended parents.

6. CARE’s Role and Vision

CARE’s recommendations are educational and collaborative. They are intended to:

support agencies in aligning with ASRM ethical principles
provide a culturally inclusive complement to existing professional frameworks
create space for Chinese-American and international professionals to contribute equally
strengthen transparency, respect, and quality of care in reproductive services

CARE does not impose mandatory standards or enforce agency practices.

Member agencies remain fully autonomous and free to operate according to their own business models and state laws.

Our goal is to foster a positive, inclusive, and scientifically grounded environment where agencies can collaborate, learn, and elevate professional ethics together.