@Mikael Syska At present, SQL MI only supports default outbound access which cannot guarantee a known, static outbound IP address. This means that the incoming connection on the on-prem side will be seen as arriving from an arbitrary IP address in the Azure cloud range.
We do have plans to introduce support for NAT gateways natively in SQL MI subnets much like what App Service does. Until then, you can use Azure Firewall and a NAT gateway in combination to achieve the same effect.
This is discussed in some detail at Scenarios with private endpoints to Azure SQL Managed Instance, scenario #2
I hope this information helps.
Regards
Geetha