Introduction <p>Fertility desire among men who have sex with men (MSM) remains understudied in non-Western contexts, particularly where filial piety intersects with institutional barriers to same-sex family formation. Conceptually, fertility desire captures whether individuals want to have children as an aspirational orientation toward parenthood, rather than a concrete fertility intention or behavioral plan. This study examines how personal, relational, and cultural factors are associated with fertility desire among Chinese MSM.</p> Methods <p>Using data from an online survey of 1,115 MSM collected in Zhejiang Province, China, between October 2023 and May 2024, we applied a Mixed Graphical Model to map conditional dependencies among adverse childhood experiences (ACEs), internalized homophobia, filial piety, relational factors, and fertility desire. The outcome was measured by asking whether respondents wanted to have their own children, aligning the empirical measure with the concept of fertility desire rather than fertility intention.</p> Results <p>Fertility desire was directly associated with self-related indicators (age, health, financial status, personal willingness) and compassionate reverence—the affective dimension of filial piety. Partner-related factors (e.g., partner’s health, finances, willingness) were structurally central but not directly linked to fertility desire. Neither ACEs nor internalized homophobia showed direct associations.</p> Conclusions <p>Fertility desire among Chinese MSM is primarily shaped by immediate self-assessments and intergenerational moral obligations rather than early adversity or minority stress.</p> Policy Implications <p>Findings highlight the need for culturally sensitive reproductive counseling and social policies that recognize diverse family forms, expand access to assisted reproductive technologies, and provide legal support for sexual minority parenthood in China.</p>