How Can Transgender People Preserve Fertility? Egg and Sperm Freezing Policies in the Chinese Mainland and Hong Kong SAR, With Overseas IVF Options

Transgender, nonbinary and intersex people may face an important long-term decision before starting gender-affirming treatment: whether to preserve their fertility. Oestrogen, anti-androgen therapy and testosterone may reduce sperm production, suppress ovulation or affect reproductive function. Removal of the testes, ovaries or uterus can have permanent reproductive consequences.

Some people may recover sperm production or ovulation after stopping hormone treatment, but the timing and extent of recovery cannot be guaranteed. Anyone who may want a genetically related child in the future should therefore consult a fertility specialist before beginning hormone treatment or surgery involving reproductive organs.

Identify What Should Be Preserved

Fertility-preservation decisions should be based on sex assigned at birth, reproductive organs currently present and reproductive function, rather than solely on the sex marker shown on identity documents.

• A person with testes and sperm production may consider semen cryopreservation;

• A person with ovaries may consider ovarian stimulation, egg retrieval and egg freezing;

• A person with a defined partner or donor plan may consider embryo creation and freezing;

• Surgical sperm retrieval may be considered when a sample cannot be obtained conventionally;

• Reproductive-tissue preservation may be assessed in limited circumstances, although its indications are more restrictive;

• An intersex person may require chromosome, reproductive-organ, hormone and disease-risk assessments before an appropriate option can be identified.

Freezing sperm, eggs or embryos preserves a future opportunity but does not guarantee the creation of a healthy embryo or a successful pregnancy.

A Consultation Before Gender-Affirming Treatment

Chen, 28, was assigned female at birth and planned to begin testosterone treatment. Although he did not intend to have a child within the next few years, he did not want to lose the possibility of having a genetically related child.

As an unmarried patient, he found that access to elective egg freezing was restricted when consulting medical institutions in the Chinese mainland. He therefore began exploring services in the Hong Kong Special Administrative Region of China and other overseas jurisdictions.

Testing indicated a reasonable ovarian reserve. His doctor explained that ovarian stimulation might require hormone treatment to be paused or adjusted, together with ultrasound monitoring, injections and egg retrieval. These procedures may intensify gender dysphoria for some transgender patients.

The medical team should therefore use the patient’s chosen name and form of address and discuss examination methods, privacy, support-person arrangements and anaesthesia in advance. Fertility preservation should protect psychological wellbeing, privacy and gender identity as well as reproductive material.

Eligibility Restrictions in the Chinese Mainland

Access to sperm freezing is generally broader than access to egg freezing in the Chinese mainland. However, storing sperm does not automatically provide unrestricted future access to donor eggs, IVF or gestational services.

An unmarried transgender man, nonbinary person or intersex person with ovaries may encounter marriage-status and medical-indication requirements when seeking elective egg freezing. Fertility preservation before treatment for cancer or another condition that seriously threatens fertility has a more established medical pathway. Whether gender-affirming treatment is accepted as a medical indication may require individual institutional review.

A legal name or sex-marker change may also create inconsistencies among identity documents, reproductive anatomy and previous medical records. Hormone records, surgical reports, previous test results and identity-change documents should be prepared before consultation.

The Hong Kong SAR of China: Storage and Use Are Different

Reproductive technology rules in the Hong Kong Special Administrative Region of China generally restrict fertilisation and embryo-transfer procedures for people who are not parties to a marriage. Procedures for obtaining gametes are, however, an exception.

An unmarried person may therefore enquire at a licensed reproductive technology centre about sperm or egg retrieval and storage. Future fertilisation, donor-gamete treatment and embryo transfer may still be subject to marriage and treatment-eligibility requirements.

Patients should separately confirm:

• Whether sperm or eggs can be retrieved and stored;

• The storage period and renewal conditions;

• How records are updated following a legal name or sex-marker change;

• Under what conditions the gametes may later be used;

• Whether lawful transport to another jurisdiction is possible.

Permission to retrieve sperm or eggs should not be interpreted as full eligibility for IVF treatment.

Kyrgyzstan: Coordinated Assessment and Preservation

Kyrgyzstan’s reproductive-rights framework permits eligible people to store reproductive cells. Some fertility centres provide semen analysis, sperm freezing, ovarian stimulation, egg retrieval, egg freezing, embryo culture and cryopreservation.

Kyrgyzstan may be considered by transgender people wishing to coordinate assessment and reproductive-cell preservation. Before booking, confirm:

• Whether the centre accepts foreign transgender patients;

• Whether registration is based on existing anatomy or document sex;

• Whether hormone treatment must be paused or adjusted;

• Storage duration and renewal charges;

• Whether the stored material may later be used locally or transported elsewhere.

Anyone planning to use stored gametes for donor treatment, IVF or a gestational arrangement should also assess the eligibility and parentage rules of the future treatment destination.

Thailand: Developed International and Private Medical Care

Thailand has an established international fertility-care sector with egg freezing, sperm freezing and IVF laboratory services. It also recognises same-sex marriage. Its Asian location, accessibility, English-language services and private medical environment may appeal to people seeking fertility assessment and gamete preservation.

Cryopreservation and future reproductive use are nevertheless separate stages. Before treatment, confirm eligibility for foreign patients, handling of names and sex markers, storage duration, renewal fees, and the conditions governing future donor sperm, donor eggs, embryo transfer or gestational services.

Prepare a Fertility File

Useful information includes:

• Sex assigned at birth and reproductive organs currently present;

• Hormone names, doses, duration and any interruption;

• Previous gender-affirming and other surgical procedures;

• AMH, reproductive hormones, ultrasound or semen reports;

• Infectious-disease and genetic screening;

• Identity documents and records of legal name or sex-marker changes;

• Whether sperm, eggs or embryos are to be stored;

• Whether the patient, a partner or another eligible person may carry a future pregnancy;

• Intended storage period, transport plan and jurisdiction of future use.

Fertility preservation before gender-affirming treatment can protect important future choices. The Chinese mainland imposes substantial eligibility restrictions on egg freezing and subsequent assisted reproduction for unmarried people. The Hong Kong Special Administrative Region of China provides certain pathways for gamete retrieval and storage, while Kyrgyzstan and Thailand may be considered as additional overseas fertility-preservation options.

If you are exploring fertility-preservation options for transgender or gender-diverse people, please contact us for professional information and support.