Eva Cai knows she wants a child. She’s just not sure if she wants a husband.
So, in 2019 she took a train across the border from the southern Chinese city of Guangzhou to Hong Kong, where she froze her eggs in a private clinic.
Now age 31, the senior executive still hasn’t claimed them — she would need to be married to do so — but the two-hour journey gave her an option not available to most single women in China. “I did the math," she said. “I don’t want to rush into marriage with a random man."
Beijing wants more babies — and on Friday, it formally wrote into law a policy allowing women to have three children, although it’s unclear when that will take effect.
But it won’t let clinics offer egg freezing procedures and in vitro fertilization (IVF) to unmarried women like Cai, arguing they are risky procedures that could “instil unrealistic hope in women who might mistakenly postpone childbearing plans."
Single women say denying them access to reproductive procedures is discriminatory — and that freezing their eggs will allow them to get married and have children, in their own time.
Some are going abroad for the treatment, an expensive option only available to those with enough money to fund the procedure and travel.
Experts argue that giving single women access to the procedure could ease the country’s looming population crisis. Yet so far Beijing has refused to entertain the idea, fearing it could lead to women delaying motherhood indefinitely.
Making babies in China
China’s first IVF baby was born in 1988 during the one-child policy, which began in the late 1970s to slow the country’s birth rate and deliver economic gains.
In the early 2000s, as egg freezing technology improved, the National Health Commission (NHC) issued rules banning Chinese hospitals and agencies from offering assisted reproductive technology (ART), including IVF and egg freezing procedures, to “single women and couples who are not in line with the nation’s population and family planning regulations."
ART practices should only be used to help facilitate pregnancy in infertile married couples, or for women diagnosed with cancer who about to receive treatment that could affect their fertility, the NHC said.
Despite the strict controls on family planning, the use of IVF spread in China — and in 2016, more than 906,000 IVF cycles were performed there, according to a nationwide study published in February. The same year, more than 311,000 IVF children were born. Two years later, state media boasted China had the world’s biggest population of “test-tube babies."
But those babies were born only within heterosexual marriages.
Unmarried women who want to access ART must travel abroad, which means the option — including freezing their eggs — is only available to a small group of wealthy women.
“I would’ve done it already if I could afford it," said Beckie Zhu, a single Guangzhou government office worker in her early 30s, who is using a pseudonym for privacy reasons.
She worries she’ll never get married or have children, as her parents hope, but doesn’t dare ask them for the money to travel abroad because of their traditional family views.
Winnie Choi, an associate operations director at a private fertility clinic in Hong Kong, said about a third of the clinic’s egg-freezing clients come from mainland China. Demand from Chinese clients started growing in 2018, when some Hong Kong celebrities spoke publicly about freezing their eggs, she said.
“Although Hong Kong’s law prohibits unmarried women from using their eggs, it is considered a safety net so they can come back to Hong Kong to use the eggs when they get married years later," Choi said.
But doing so is pricey.
In Hong Kong, Cai paid $17,000, including an annual storage fee of nearly $1,400 to freeze her egg. But a similar trip further afield can cost much more.
Shanghai-based medical tourism agency IVF USA pairs Chinese clients with American fertility clinics, where it can cost up to $40,000 for egg treatment and storage, according to database FertilityIQ — not including travel-related expenses.
“The vast majority of our clients are senior company executives or offspring of wealthy families," said Dr. Nathan Zhang, the agency’s founder.
A demographic dilemma
At first glance, banning some women from a procedure that may allow them to become mothers seems at odds with Beijing’s push for more children.
But Beijing fears that allowing women to delay childbirth could result in fewer babies.
Facing an aging population and dwindling labor force, China in 2015 scrapped its controversial one-child policy. Leaders hoped allowing couples to have two children would help address the looming demographic crisis, which threatened growth in the world’s second-largest economy.
Yet since then, Beijing has struggled to convince couples to have more babies. In 2020, the number of newborns plummeted 18% to 12 million compared to the previous year, the fourth straight year of decline.
Experts remain split on whether loosening the rules on ART would help or hinder China’s dwindling fertility rate, one of the lowest in the world.
Huang Wenzheng, a senior researcher specializing in demographic studies at the Center for China & Globalization think tank, wrote in a paper in March that allowing ART, including egg freezing for unmarried women over 35, could help boost the Chinese population.
“They might lose the chance of ever getting pregnant without access to this technology," he wrote.
Others, like Dong Xiaoying from Diverse Family Network, concede that lifting restrictions could encourage women to delay childbearing plans, leading to lower birth rates in coming years — but that’s not a reason not to do it, she added.
Zhang, from IVF USA, said the small number of women with the financial resources and desire to freeze their eggs means any relaxation of the rules is unlikely to have any impact on the demographics of a country of 1.4 billion people.
Calls for change
It’s not just China’s fertility crisis that’s at stake — feminists say the ban highlights a double standard between men and women.
China allows single men to freeze their sperm to enable them to have babies later — exactly the same rights single women are seeking to gain. “It is clear discrimination against single women’s reproductive rights," Dong said.
In 2019, unmarried freelancer writer Zaozao Xu, who goes by Teresa in English, launched legal action — the first of its kind — against a hospital that refused her request to freeze her eggs. She says a doctor told her to get married and have children. The case is still working its way through the courts.
“Instead of flag-waving for higher birth rates and coercing women to have more children, the policymakers should resolve more deeply seated concerns that hold us back from bearing children through supportive policies," Xu said.
Last March, feminist activists presented a formal proposal to give single women the right to freeze their eggs at the annual “two sessions" summit of the country’s top legislators and advisers. But at the same meeting, Sun Wei, a fertility doctor in the eastern Shandong province, argued hospitals and clinics should be legally banned from performing the procedure on single women.
“We encourage young people to marry and reproduce at the most appropriate time," Sun saud. “The public needs to be better informed of the medical risks involved with egg-freezing technology and the success rate of fertilization by thawing frozen eggs is very low."
The NHC endorsed Sun’s view in an official notice in January, listing several medical and ethical reasons why the ban should stay, including that “egg freezing jeopardizes women’s health when extracting, freezing, thawing and planting eggs."
The process could cause ovarian hyperstimulation syndrome (OHSS), surgical haemorrhage and potential infections and give women false hope of delaying their reproduction plans, it said.
In a 2015 peer-reviewed article, Sun Xiaoxi, deputy director of The Genetics & IVF Institute at Fudan University’s Obstetrics & Gynaecology Hospital, said OHSS, bleeding and infection were all risks associated with egg freezing, but were “small probability events."
Liu Ruishuang, deputy director of the Medical Ethics and Health Law Department at Peking University, said all medical practices, from vaccinations to plastic surgery, come with certain risks, and that is no reason to limit access.
Barriers beyond Chinese rules
There are signs the government may be open to relaxing the rules — but even if it does, there will be other cultural barriers standing in the way of single women.
In the January notice, the NHC said the government was drafting new rules to regulate the administration of ART, “catering to the public’s appropriate reproduction demand and on the other hand, intensifying punishment for practices that violate laws and regulations in the commercial ART market."
Dong said the drafting of new rules “is a good thing as the drafting process includes collecting the public’s opinion, consulting with general public and experts."
She said people in China had become more accepting of diverse family structures, including single mothers, despite government policies that previously set them apart.
For example, until 2016 the children of unmarried women were often denied resident registration, known as “hukou," that determines access to education and health care.
Yet even if the rules change to allow single women to freeze their eggs, social pressures could prevent some from taking up the option.
Zhu, the government worker, says her parents filled traditional gender roles over decades of marriage and want the same for her. She doesn’t dare bring up the issue of egg-freezing with them, in case it starts an argument about her path in life.
“My mom lived her whole life as a household wife, never had a real job, which is why she insisted on me having someone to depend on," she said.
“I guess they fear there would be no one to take care of me when I get old — to them that’s harrowing."
Cai, from Guangzhou, is no closer to finding a man to marry to retrieve her eggs in Hong Kong.
She says, if she doesn’t find a partner, she may try to find a way to start family on her own — and having her eggs frozen gives her more options to do so.
“I think of it as an insurance, creating more possibilities in life, other than either staying single and never having child of my own, or marrying someone hastily for the sake of building a family."