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(Bloomberg) — A woman in Hong Kong had to travel to two different countries to attempt conceiving a baby on her own. A gay couple in the city resorted to even bigger extremes: Banned from surrogacy, they turned to the black market in mainland China to have their first child. 

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At a time Hong Kong is trying to reverse one of the world’s lowest birth rates, residents seeking to have a baby outside of traditional means are running into strict rules on fertility treatments. That’s leading some of them to go abroad for expensive — and sometimes illegal — measures to have a shot at parenthood. 

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The baby shortfall is so dire that Hong Kong’s leader handed out HK$520 million ($67 million) in so-called baby bonuses — HK$20,000 payments to have a child — in just under a year, while a local lawmaker proposed hanging baby photos in government offices to encourage family creation. Hong Kong’s birth rate per woman stands at a world-low 0.8, according to the UN Population Fund, with South Korea a close second at 0.9. (South Korea’s own calculations notched an even lower 0.72 last year.)

Like much of Asia, Hong Kong bans for-profit surrogacy and limits access to any treatments involving egg fertilization to couples that are straight, married and infertile — locking out single people and the LGBTQ community. Though IVF contributes just 4% to 5% of the city’s total births each year, the issue is emerging as both an equality and economic problem for one of the world’s financial hubs.

“Every baby counts. Every additional baby that is born is someone who’s going to contribute to the economy through their taxes, through their wages, be a part of that workforce,” said Emily Tiemann, a health policy manager at the think tank Economist Impact in New York. Lawmakers in some countries are looking to open up their fertility-treatment rules and “ultra-low birth rates are contributing to that discussion,” she said.

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In the meantime, online forums are flooded with information from Hong Kong couples and single women on alternative destinations for infertility treatments, with some licensed clinics and hospitals offering travel assistance for foreign patients. Dating app-like services have also sprouted to connect single women with sperm donors overseas. Black-market brokerages for egg donors and surrogates are doing brisk business.

Hong Kong’s rules on who can access fertility are “completely outdated,” said Winnie Chow, a co-founder of the law firm CRB who formerly served on a council that oversees Hong Kong’s IVF clinics. She said it’s a reason why some people relocate.

“There’s actually a mismatch in so many ways of recognizing what a family construct may be now in modern-day Hong Kong,” she said. “So if you talk about attracting top talent, you could just be losing a whole host of them just because of inability to recognize them as a family unit.”

Going Abroad

One Hong Kong woman, who asked not to be named for fear of legal repercussions, froze her eggs in Thailand in her late 30s, violating a Hong Kong law punishing unmarried people from doing infertility treatments overseas.

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Hong Kong imposes a 10-year limit on storing eggs, embryos and sperm before they’re disposed of, meaning single people have to find a partner by that time to access their eggs. Thailand had no such restriction at the time and had procedures at a fraction of the cost.

Four years later, the woman received devastating news: Two controversial surrogacy cases had caused uproar in Thailand and prompted the government to ban foreigners from using Thai surrogates — and barred single women from freezing their eggs or undergoing IVF. The clinic gave her options, including transporting her frozen eggs to a Cambodian clinic by motorbike or conducting off-the-books IVF if she could produce a sperm donor. She found one who didn’t meet the Thai clinic’s terms, leading her to turn to Mumbai, where another attempt failed.

Years later, she married a Hong Kong-born man and had a child at 44. Her first batch of eggs, now freely accessible to her as a married woman, are still sitting in Thailand. She said she wishes there was less stigma around being a single mother by choice.

Nixie Lam, a lawmaker who is pushing to make infertility treatments more accessible for couples and to expand its use to single women, said Hong Kong could be missing an opportunity to become an IVF hub, with world-class clinics and top-trained doctors. She said she had proposed attracting foreign patients and charging them a premium, which could help fund Hong Kong’s other baby-boosting policies.

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Lam, who spent HK$200,000 to have her first child by IVF, said cost is a major factor holding back people from fertility treatments. But people also choose to go elsewhere because of a 10-year limit on egg freezing.

“If you freeze them at 25, you have to find a husband before 35 to use the eggs,” she said. “That is a very tight schedule for any sort of life planning.”

Hong Kong lawmakers have been debating relaxing some rules, including extending the number of years a single woman can keep her eggs frozen. The legislature is drafting a measure that would offer a tax credit of up to HK$100,000 a year for infertility treatments, in a city where a just a single IVF cycle can cost more than that.

But IVF and surrogacy services would still only be available to straight couples. Hong Kong has an LGBTQ population estimated at 419,000 with a potential spending power of $20 billion, according to data compiled by investment adviser LGBT Capital. 

One gay Canadian man who lives in the city said he and his Hong Konger husband found it “impossible” to have a baby and resorted to black-market services in mainland China, where same-sex unions and surrogacy are illegal, and unmarried women cannot even freeze their eggs.

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The Canadian said they worked with an agency to find an egg donor, then a black-market surrogate and finally a woman who would pose as the mother on the birth certificate. Only one of the fathers was present for the birth to avoid suspicion or scrutiny. 

The couple had to go to court with the on-paper birth mother so she could relinquish all parental rights. The Canadian man estimates they spent up to 800,000 yuan ($110,000) to bring their son into the world, nearly depleting their savings.

They later had another child in Canada, with his sister as the surrogate. With generous government health subsidies and insurance, the second child’s birth cost around $14,000.

Chow, the lawyer, said there are “huge risks” for couples who undergo legal infertility procedures in other countries, only to find they have no legal parental rights in Hong Kong.

She said recent lawsuits in Hong Kong have begun to push the boundaries of the city’s rules. A South African lesbian couple in August won the right to be recognized as equal parents to their baby. And a landmark court ruling in 2018 allowed same-sex partners of Hong Kong-based workers to apply for dependent visas. And just last week, Hong Kong’s top court upheld rulings that affirm public-housing and inheritance rights for married same-sex couples.

Still, ultra-low fertility mark a “disaster zone” for some economies, said Tiemann from the Economist Impact think tank.

“Beyond the economy is also the impact on personal wellbeing and just allowing people to have the family that they want,” she said. “It’s just a way of having a bit more equality as well in policies.”

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