Family Relations Central to Lesbian Couples' IVF Choices in China
Reciprocal IVF Decision-Making Among Lesbian Couples in Mainland China: A Relational Approach (Hu, 2024)
Hu, X. (2024). Reciprocal IVF Decision-Making Among Lesbian Couples in Mainland China: A Relational Approach. LGBTQ+ Family: An Interdisciplinary Journal. https://doi.org/10.1080/27703371.2024.2439845
Geographic Region: China
Research Question: How do lesbian couples in mainland China make decisions about using reciprocal IVF within their sociocultural context?
Design: Qualitative study using Biographic-Narrative-Interpretive Method. Individual interviews with lesbian mothers and prospective mothers
Sample: 12 participants, 8 of whom had undergone reciprocal IVF. 4 had considered but chose other methods. All were from relatively affluent socioeconomic backgrounds. Treatments were obtained through underground clinics in China, Southeast Asia, or the United States.
Key Findings
Lesbian couples chose reciprocal IVF as a way to create biological connections between both mothers and their child, with one providing the egg and the other carrying the pregnancy. They viewed these biological ties as helping to make their relationship more stable and "family-like."
The couples needed to use underground fertility clinics in China or travel to other countries for treatment since Chinese regulations only allow fertility treatments for married heterosexual couples.
Parents and grandparents emphasized biological connections to grandchildren, which influenced couples' decisions about who would provide the egg versus carry the pregnancy. The genetic connection through reciprocal IVF helped validate relationships with extended family members, particularly helping non-gestational mothers gain acceptance from their own parents.
Some couples worried about custody issues if they separated, since the legal system (hukou) only recognizes one mother, leaving the other mother vulnerable regardless of her genetic or gestational connection to the child.
All the couples in the study used sperm donors, but donor selection and involvement was not a major focus of their decision-making compared to the mother-child biological connections.
Limitations: Sample limited to well-off, educated participants. All participants had children after China replaced its one-child policy with a two-child policy in 2016.
Applications: Consider cultural and familial influences when counseling couples about reproductive options. Understand impact of legal/institutional barriers on decision-making.
Funding Source: Not explicitly stated
Lead Author: Xuerui Hu is affiliated with the Social Research Institute, Institution of Education, University College London
Regulatory Context
The National Health Commission (NHC) oversees reproductive medicine. All assisted reproductive technology services must be approved and licensed by the NHC.
Only non-commercial (altruistic) donation is permitted. Any form of payment beyond basic compensation for time and inconvenience is strictly prohibited. Donations can only be carried out in government-authorized medical institutions—currently, fewer than 200 clinics across the country.
Donation is anonymous by law in China. Donor-conceived individuals do not have a legal right to access identifying information about their donor.
The number of offspring per donor is limited by law, though the specific cap may vary by province (commonly cited limits range from 5 to 10 families). Clinics are required to keep careful records to avoid consanguinity risks.
ART services, including donor conception, are primarily available to heterosexual, legally married couples. Single women, LGBTQ+ individuals, and unmarried couples have historically been barred from accessing donor sperm or eggs.
Donors undergo extensive medical and genetic screening. Donors must be between 22–45 years old (sperm donors) and 20–35 years old (egg donors), with no history of hereditary disease.