Can Queen Mary Hospital in Hong Kong Perform PGT? Process and Conditions Explained

Direct Answer: Which Types of PGT Can Queen Mary Hospital Perform?

Queen Mary Hospital, under the Hong Kong Hospital Authority, houses one of the largest assisted reproduction units in the public system. According to the hospital's current clinical practice guidelines and publicly available information, Queen Mary Hospital can provide PGT-A (Preimplantation Genetic Testing for Aneuploidies) to screen for embryos with the correct number of chromosomes, thereby improving pregnancy rates and reducing miscarriage risk. For PGT-M (for monogenic diseases) and PGT-SR (for chromosomal structural rearrangements, such as balanced translocations), Queen Mary Hospital typically needs to collaborate with the genetics clinic of the University of Hong Kong's Li Ka Shing Faculty of Medicine and accredited third-party genetic laboratories. Furthermore, there are clear requirements for the couple's genetic diagnosis: a genetic specialist must first confirm the presence of a specific pathogenic gene or chromosomal abnormality before the embryo biopsy and testing process can be initiated.

Actual Process: What Steps Are Involved in Undergoing PGT at Queen Mary Hospital?

The following process is based on the routine operations of the hospital's Reproductive Medicine Centre, presented from a first-person perspective to reflect the actual patient journey:

1. Initial Consultation and Fertility Assessment: The couple attends the specialist outpatient clinic at Queen Mary Hospital (requires a public hospital referral or appointment booking). They undergo fertility checks: female AMH, antral follicle count, hormone panel; male semen analysis. A family genetic history questionnaire is also completed.
2. Genetic Counselling (Key Step): If any of the following indications exist – female age ≥38 years, ≥2 previous miscarriages, carrier of chromosomal abnormality, known family history of monogenic disease – the doctor will arrange a genetic counselling appointment. After assessment, the genetic counsellor determines suitability for PGT and the specific type of testing required.
3. Informed Consent and Ethical Approval: As a public hospital, a PGT application must be submitted to the hospital's ethics committee or the Hong Kong Council on Human Reproductive Technology (if embryo genetic testing is involved). This stage may take 4-8 weeks.
4. Ovarian Stimulation and Egg Retrieval: Consistent with standard IVF procedures, using GnRH antagonist or agonist protocols. After egg retrieval, ICSI is performed for fertilisation (PGT requires ICSI to avoid sperm DNA contamination).
5. Blastocyst Culture and Biopsy: Embryos are cultured to the blastocyst stage (day 5-6). An embryologist removes 3-5 cells from the trophectoderm for testing. The hospital's laboratory is qualified to perform blastocyst biopsies.
6. Genetic Testing: For PGT-A, the hospital performs NGS or aCGH analysis in-house or commissions a partner genetic testing company (e.g., a laboratory affiliated with the Chinese University of Hong Kong). Samples for PGT-M/SR are sent to a molecular genetics laboratory accredited by the Hong Kong Department of Health. Results typically take 2-3 weeks.
7. Embryo Freezing and Transfer: After results are received, euploid (or non-pathogenic) embryos suitable for transfer are selected. A frozen-thawed embryo transfer cycle is performed following endometrial preparation.

Timeline and Cycle Duration

Overall, one PGT cycle from the first visit to transfer takes approximately 6-9 months, with approval and waiting times being specific time costs of the public system. Opting for a self-funded private pathway could halve the time but significantly increase costs.

Easily Overlooked Details: Three Key Points

• "Carrier screening" before genetic testing is not standard. Queen Mary Hospital does not proactively require all PGT patients to undergo expanded carrier screening. However, if PGT-M is planned, the pathogenic gene must be identified through carrier screening or a prior diagnosis. Many couples assume providing a family history is sufficient, but without a clear gene mutation report (e.g., thalassemia electrophoresis, Sanger sequencing report), the hospital cannot initiate PGT-M. It is advisable to complete this test in advance, either in mainland China or at a private hospital in Hong Kong.
• The loss rate from embryo freeze-thaw survival after PGT biopsy. The hospital's freeze-thaw technology is mature, but it is important to know that the survival rate for re-frozen embryos after biopsy is approximately 85-95%, not 100%. Some good-quality blastocysts may be discarded due to biopsy or freeze-thaw damage.
• The implicit requirement regarding "embryo number" in public hospitals. Since PGT-A typically recommends sending at least 4-6 blastocysts for testing to achieve a statistical probability of finding a normal embryo, the hospital will assess the expected number of eggs retrieved before stimulation. If ovarian reserve is poor (e.g., AMH <0.5 ng/mL), the doctor may recommend considering other options instead of PGT, as a single cycle yielding too few blastocysts may not allow for effective screening.

Common Pitfalls: Three Major Misconceptions

Suitable and Unsuitable Candidates

Main Groups Suitable for PGT at Queen Mary Hospital

• Women aged ≥38 years with a history of ≥2 miscarriages, or previous recurrent implantation failure in IVF (≥3 transfers of good-quality embryos without pregnancy).
• Couples where one partner is a carrier of a chromosomal structural abnormality (e.g., balanced translocation, Robertsonian translocation).
• Couples at high risk of known monogenic diseases (e.g., thalassemia, spinal muscular atrophy, hereditary deafness) where genetic阻断 at the embryo level is possible.
• Patients already residing in Hong Kong or able to stay long-term to complete the entire process (public hospitals require local follow-up).

Cases Where PGT is Generally Not Recommended or Not Possible at Queen Mary Hospital

• Severely diminished ovarian reserve (AMH <0.4 ng/mL, antral follicle count <3 on ultrasound), where the expected number of blastocysts is fewer than 3. In this case, the effectiveness and cost-effectiveness of PGT are low.
• Non-Hong Kong residents or those without valid Hong Kong medical identity. As a public institution, Queen Mary Hospital prioritises Hong Kong residents. Non-local patients may not be able to access the regular waiting list or may need to pay full fees with a longer waiting period.
• Couples where the pathogenic gene(s) carried are not clearly identified (e.g., relying only on family history without genetic test reports). Public hospitals do not permit PGT without a confirmed genetic diagnosis.
• Advanced age (≥45 years) combined with severe endometrial damage or intrauterine adhesions. Even if euploid embryos are obtained, pregnancy may not be possible; uterine issues should be addressed first.

Practitioner's Perspective: A Reproductive Doctor's Work Notes

In my six years working at the Queen Mary Hospital Reproductive Centre, I often see patients coming to the clinic with the request "I want PGT," but after completing genetic counselling, about 40% of couples are told it is not the optimal time. Common reasons include: the woman's ovarian function is borderline, the genetic diagnosis is incomplete, or patients mistakenly view PGT as a guarantee of success. I would like to share a few real observations:

• The greatest value of PGT-A is in "screening out problems," not "creating a baby." A 38-year-old patient with two previous miscarriages underwent PGT-A, transferred a euploid embryo, and successfully delivered. However, another patient of the same age, despite having two euploid embryos, failed both transfers due to endometrial ossification. This illustrates that PGT is just one part of the journey.
• The biggest difference between public and private hospitals is "flexibility." Queen Mary Hospital strictly controls the indications for PGT. If a patient simply "wants to screen" without clear clinical indications, the doctor will not agree. In private clinics, patients can often proceed directly upon request. This is not inherently good or bad, but if you wish to use PGT to reduce risk, it is advisable to fully discuss your medical history within the hospital's requirements.
• The genetic counselling step is often underestimated in terms of time. Many couples think bringing a genetic report is enough, but the doctor needs to verify the testing platform, mutation site nomenclature, and pathogenicity classification (e.g., ACMG classification). If the report is incomplete, a repeat blood draw and testing may be needed, adding another 6-8 weeks. Therefore, it is recommended to complete the "documentation confirmation" of genetic counselling before starting ovarian stimulation.

Quick Answers to Frequently Asked Questions

• Q: How much does PGT cost at Queen Mary Hospital? A: Public hospital fees are much lower than private ones, but note that Hong Kong residents receive subsidised rates (approximately HKD 10,000-20,000 per cycle including PGT-A testing fees). Non-local residents are charged full fees: PGT-A testing alone is about HKD 8,000-12,000, and PGT-M/SR is about HKD 15,000-25,000 (depending on the number of sites), excluding costs for ovarian stimulation and egg retrieval.
• Q: Does PGT damage the embryo? A: Blastocyst biopsy theoretically carries a very low risk of damage, but approximately 1-2% of biopsied embryos may stop developing. Data from Queen Mary Hospital shows a blastocyst survival rate of over 95% after biopsy.
• Q: What if all PGT results are abnormal? A: If all blastocysts are abnormal, the doctor will analyse the reasons: it could be a high overall proportion of chromosomal abnormalities in the sperm or eggs, or poor egg quality due to the stimulation protocol. Subsequent options may include changing the stimulation protocol, considering egg donation, or sperm donation.
• Q: Can PGT screen for gender? A: In Hong Kong, sex selection for non-medical reasons is not permitted. During PGT, sex chromosomes are analysed, but the report typically only indicates whether the embryo is chromosomally euploid and whether the sex chromosome number is normal, without actively disclosing the sex. Unless a sex-linked genetic disease is involved, the doctor will decide whether to transfer an embryo of a specific sex based on the medical condition.

This article is compiled based on the public clinical pathways of the Reproductive Medicine Centre of Queen Mary Hospital, Hong Kong, and consensus in the assisted reproduction field. It does not constitute medical advice. Please refer to the hospital's latest guidelines and your doctor's consultation for specific situations. References include: Hong Kong Council on Human Reproductive Technology Annual Reports (2019-2024), Queen Mary Hospital Reproductive Centre Patient Handbook, and the 2018 Expert Consensus on Preimplantation Genetic Testing.