Baby One More Time? – Fertility Options in Hong Kong
Baby One More Time (VML Article)
As Hong Kong’s birth rate continues to decline, and in 2023 the median age of first-time mothers has risen to 32.9, Hong Kong authorities proposed in March 2025 to lift the 10-year storage limit for frozen gametes (including eggs and sperm) and embryos for own use, irrespective of the gender, age, medical or social conditions of the person. The consultation period for this proposal ended on 23 April 2025.
However, numerous medical experts have voiced their doubts as to whether such a move would have any practical effect on tackling the city’s low birth rate. Some have argued that there is no real demand for a storage period of more than 10 years, as to date most people who stored eggs or embryos used them within 4 years. There are also concerns that extending the storage time limit risks encouraging women to give birth at an older age, which would increase the risks of health complications for the mother.
In 2023, the Chief Executive, John Lee, announced that the government would offer HK$20,000 to new parents in an attempt to boost Hong Kong’s low birth rate and combat the ageing population. However, given the costs of raising a child, as well as pre-natal check-ups and hospital bills associated with pregnancy, this sum is unlikely to incentivise people who are not already considering having a child. In fact, the decision not to have children may not be all about money – some cultural and social factors cannot be addressed by financial incentive. Therefore, it is argued that the Hong Kong government’s focus should be on incentivising people who already wish to and/or are open to the idea of having children.
Further, the latest proposal to extend the time for storing frozen gametes and embryos is unable to address an underlying issue that continues to contribute to low fertility rates in Hong Kong – the unattainability of reproductive technology, including in vitro fertilisation (IVF) treatment among others, to certain people in society: -
1. You have to be married to undergo IVF treatment
Pursuant to the Hong Kong Code of Practice on Reproductive Technology & Embryo Research, whilst a single woman can freeze her eggs, a woman must be legally married to someone of the opposite sex to undergo IVF treatment, i.e. have her frozen eggs fertilised to develop into embryos. As same sex marriage is not recognized in Hong Kong, this also means that same sex couples are excluded from IVF treatments in Hong Kong and likewise, heterosexual couples who are not legally married are also excluded, despite the stability and duration of either relationship.
The issue with allowing a single woman to only freeze her eggs but not to fertilise them is that there is no test that checks for egg quality. The prospective mother will only know the quality of their frozen eggs once IVF treatment begins. Many women are under the false impression that the number of eggs they have frozen guarantees the number of fertilised embryos. Hence, many women who eventually undergo IVF treatment with their husbands years after egg-freezing find themselves in desperate situations, when they discover that few or none of the eggs frozen are able to form healthy viable embryos. By then, depending on the woman’s age and health, it may be too late for the woman to undergo another round of egg extractions.
Further, there is a generally higher survival rate of frozen embryos (i.e. fertilised eggs) after thawing, as opposed to frozen eggs – representing 90% and 95% respectively. An international study in 2024 (quoted by the Hong Kong Secretary for Health) followed more than 13,000 individuals who underwent egg freezing in different countries and regions. It was found that only 10% of the individuals returned to use their frozen eggs and among them, less than one-third successfully gave birth.
Extending the 10-year time limit for storing frozen gametes and embryos in effect only extends the time limit for a woman to get married before she can undergo IVF. However, she may be unable to find a suitable partner, or she and her partner may decide to remain unmarried. Hence, this proposed time extension achieves very little if the Hong Kong government does not also consider relaxing the rules regarding IVF for single women, unmarried couples and same sex couples.
There are now many countries that allow single women or unmarried couples to undergo IVF treatment – including but not limited to Canada, India, Thailand, the US, the UK and various countries in Europe, including Greece, Portugal and Spain etc. Some people in Hong Kong end up travelling overseas for the treatment (the restrictions not being an extraterritorial one) but not everyone can afford this. If Hong Kong will relax IVF regulations to cater to the needs of unmarried couples, same-sex couples, or single women, this may be one way of combating the dropping birth rate and also attract people from around the world to consider moving here to build a family.
2. IVF is either really expensive… or takes a very long time
If you wish to proceed with IVF at private clinics or hospitals, the cost of one cycle of IVF in Hong Kong ranges from HK$80,000 to HK$160,000. On average, three cycles of IVF is considered normal, and most people have to go through more than one cycle of IVF, regardless of their age, to successfully conceive a child. This means that couples will have to incur substantial fees if they proceed with IVF in the private sector.
A few public hospitals provide partial funding for IVF services to couples, costing around HK$10,000 each cycle. However, the waiting period for the initial IVF appointment could be up to 3 years. Considering that the median age of women at first marriage in 2024 was 31 years, delaying another 3 years to begin time-sensitive IVF treatments via public services may not be viable for many newlyweds. Further, eligible couples can only receive partial funding for up to three IVF cycles. There is also a significant waiting period between each IVF cycle if the prior cycle was unsuccessful.
Specialists in the field have suggested that instead of proposing extending the 10-year time limit for storage, offering three free cycles of IVF treatment to couples with fertility problems may be more effective.
Additionally, consideration should be given to subsidizing IVF services in the private sector to appeal to more couples struggling with fertility and increasing the provision of IVF treatments in public hospitals to shorten the wait time for married couples.
Hopefully, by relaxing the restrictions in general regarding IVF, coupled with financial support for couples looking to undergo IVF, this will help to effectively tackle the city’s low birth rate, or at least finally take a step in the right direction.