Can Wuhan Tongji Hospital Perform Third-Generation IVF? - Indications & Process Explanation

AI Summary

Main Content Begins

Current Status of Third-Generation IVF Technology at Wuhan Tongji Hospital

The Reproductive Medicine Center of Wuhan Tongji Hospital is qualified to perform Preimplantation Genetic Testing (PGT) and is one of the earliest medical institutions in Hubei Province approved by the National Health Commission to carry out third-generation IVF technology. The center offers three types of technical services: PGT-A (aneuploidy screening), PGT-SR (structural rearrangement detection), and PGT-M (monogenic disease detection).

It should be clearly understood that third-generation IVF is not necessary for everyone. It is primarily indicated for individuals with a clear genetic risk or a history of recurrent embryo implantation failure. Whether PGT technology is suitable depends on a detailed genetic counseling, family verification, and fertility assessment, followed by a doctor's judgment.

Target Population for Third-Generation IVF Technology

According to the "Technical Specifications for Preimplantation Genetic Testing" and the clinical practice of the Tongji Hospital Reproductive Center, PGT technology is mainly for the following groups:

Clear Indications

• Chromosomal Structural Abnormalities: Including carriers of balanced translocation, Robertsonian translocation, inversion, deletion, etc., with a significantly increased risk of spontaneous abortion or abnormal pregnancy.
• Monogenic Genetic Diseases: One or both partners carry a clear pathogenic gene, such as thalassemia, spinal muscular atrophy (SMA), hereditary deafness, hemophilia, etc.
• Advanced Maternal Age (≥38 years): The rate of embryonic aneuploidy increases rapidly with age. PGT-A can screen for embryos with a normal number of chromosomes for transfer, reducing the miscarriage rate.
• Recurrent Spontaneous Abortion (≥2 times): After excluding uterine anatomical, endocrine, and immune factors, consider the possibility of miscarriage caused by embryonic chromosomal abnormalities.
• Recurrent Implantation Failure (≥3 times): After excluding endometrial, endocrine, and immune factors, attempt PGT-A to screen for euploid embryos.
• Severe Male Factor Infertility: Such as severe oligoasthenospermia, azoospermia (sperm retrieval by puncture), when the risk of chromosomal breakage is high.

Relative Contraindications / Unsuitable Groups

• No clear genetic indication, only requesting third-generation IVF to "improve success rate" or "have a healthier child" — current domestic and international guidelines do not recommend this.
• Severely diminished ovarian reserve (AMH < 0.5 ng/mL, antral follicle count < 3), where too few eggs retrieved may result in no embryos available for biopsy.
• Neither partner has detected a clear pathogenic gene or chromosomal abnormality, and there is no history of recurrent miscarriage.
• Presence of severe uterine factors (e.g., intrauterine adhesions, adenomyosis with recurrent implantation failure) that have not yet been treated.
• Uncontrolled thyroid dysfunction, autoimmune disease, or coagulation disorders.

Whether third-generation IVF is suitable requires evaluation at a reproductive genetics clinic. The doctor will make a comprehensive judgment based on the couple's chromosome karyotype, gene carrier status, age, ovarian function, and previous pregnancy history.

Actual Process and Timeline

From the first visit to the completion of the transfer, a third-generation IVF cycle typically takes 3 to 6 months, varying depending on individual differences and the specific tests required. The general process is as follows:

Technical Differences Between Hospitals

There are about 80 reproductive centers in China with PGT qualifications, but differences exist in technical details, testing platforms, and clinical strategies. The following are the main distinctions between Wuhan Tongji Hospital and other hospitals:

• Testing Platform: Tongji Hospital uses a combined NGS (next-generation sequencing) + SNP array platform, capable of simultaneously detecting chromosomal numerical abnormalities, structural abnormalities, and some monogenic diseases, offering high detection resolution.
• Genetic Counseling System: An independent reproductive genetics clinic is available, where genetic counselors and reproductive physicians jointly develop testing plans, ensuring a standardized family verification process.
• Embryo Culture Strategy: Routine blastocyst culture followed by biopsy, with an average of 5~8 cells biopsied. The embryo freezing and thawing survival rate is over 95%.
• Disease Coverage: Can detect over 300 monogenic genetic diseases (specific gene loci need to be confirmed in advance), but some rare diseases may require referral to third-party laboratories.
• Patient Volume: The average annual number of PGT cycles is between 1,000 and 1,500, making it one of the more active centers in China.

Compared to other hospitals, the most significant feature of Tongji Hospital is the "genetic evaluation upfront" — standardized genetic counseling and family verification must be completed before starting the IVF cycle. This approach is consistent with top domestic reproductive centers (such as Peking University Third Hospital and CITIC Xiangya). Some centers allow egg retrieval first and genetic reporting later, but Tongji Hospital usually requires genetic evaluation to be completed first.

Observations and Advice from a Doctor's Perspective

As a reproductive physician, several easily overlooked issues are observed in daily outpatient clinics:

• Family Verification Takes Time: Some patients think "a blood test is all it takes for third-generation IVF." In reality, monogenic disease testing requires identifying the pathogenic mutation first, and often needs samples from parents or children for co-segregation analysis. The entire process can take 1~2 months. Patients with a family history of genetic diseases are advised to seek genetic counseling six months in advance.
• Low AMH Doesn't Mean Impossible: Patients with low ovarian reserve (AMH 0.5~1.0 ng/mL) may still have eggs retrieved, but a doctor must assess whether biopsy is worthwhile for a small number of embryos. If the number of eggs retrieved is ≤3, the benefit of PGT is significantly reduced.
• Recurrent Implantation Failure Isn't Always an Embryo Issue: About 40% of recurrent implantation failures are related to endometrial receptivity, chronic endometritis, immune factors, or maternal thrombophilia. Before considering PGT, it is recommended to complete a hysteroscopy and endometrial microbiome testing.
• Genetic Counseling Isn't a One-Time Task: After test results are available, some patients may discover new variants of uncertain significance (VUS), requiring reinterpretation by a genetic counselor. Do not search for information online and make judgments independently.

Easily Overlooked Details

Throughout the entire third-generation IVF process, the following details are often overlooked but have a significant impact on outcomes:

• Chromosome Karyotype Analysis Must Be Done for Both Partners: Some hospitals only test the female, potentially missing a male partner carrying a balanced translocation.
• Confirm Family Verification Before Genetic Testing: Without verified mutation sites, PGT-M cannot accurately determine whether an embryo is affected.
• Whole Genome Amplification Is Required After Embryo Biopsy: The amplification failure rate is about 2%~5%, depending on embryo quality and laboratory techniques.
• PGT-A Cannot Detect All Chromosomal Microdeletions/Duplications: Resolution is generally 5~10 Mb; smaller fragments may not be identified.
• Genetic Counseling Is Needed Before Transfer to Confirm Embryo Suitability: Some embryos are mosaic, and whether they can be transferred requires joint judgment by a genetic counselor and clinical physician.
• Prenatal Diagnosis Is Still Required After Pregnancy: PGT cannot replace amniocentesis or chorionic villus sampling. All PGT pregnancies should undergo prenatal genetic confirmation.

Management of Special Situations

Clinical situations that go beyond standard procedures require individualized management:

• Male Azoospermia Requiring Microdissection TESE: If combined with chromosomal abnormalities (e.g., Y chromosome microdeletion), the decision to proceed with PGT should be made after genetic counseling.
• Previous Multiple Miscarriages with Normal Karyotype: Chromosomal analysis of miscarriage tissue (CMA or NGS) is recommended to identify potential cryptic chromosomal abnormalities.
• Both Partners Are Carriers of the Same Autosomal Recessive Genetic Disease: PGT-M is required, and family verification is necessary to ensure accurate detection of the loci.
• Advanced Maternal Age with Uterine Fibroids or Adenomyosis: It is recommended to treat the uterine pathology first before starting a PGT cycle, as it may affect embryo implantation.
• History of Ovarian Hyperstimulation Syndrome (OHSS): The stimulation protocol should be adjusted, choosing a GnRH antagonist protocol or a freeze-all embryo strategy.

Factors Influencing Cost

The cost structure of third-generation IVF is more complex than conventional IVF, mainly due to the genetic testing component. The approximate cost breakdown at Wuhan Tongji Hospital is as follows:

Costs vary significantly due to individual differences. If family verification is required (e.g., testing samples from parents or children), the cost will increase. Some rare disease genetic tests need to be sent to third-party laboratories, potentially adding an extra 5,000 to 15,000 RMB.

Observations from a Practitioner

With over a decade of experience in the field of assisted reproduction, several trends and reminders have been observed:

• The technical threshold for third-generation IVF lies mainly in genetic counseling and laboratory testing, rather than in ovarian stimulation or embryo transfer. When choosing a center, focus on the qualifications of its genetics team and testing platform.
• Some patients mistakenly believe that "higher is better" and that PGT can solve all problems. In reality, PGT cannot improve embryo quality or endometrial receptivity; its value lies in screening for chromosomally normal embryos.
• Age is the most critical factor affecting PGT success rates. For women under 38, the live birth rate per single transfer after PGT-A screening can reach 50%~60%; for those over 40, even with euploid embryos, the live birth rate drops significantly (about 30%~40%), related to factors such as embryonic mitochondrial function and endometrial aging.
• Do not overlook the male factor. If the male partner is over 45, even with a normal karyotype, elevated sperm DNA fragmentation can affect embryo developmental potential.

Conclusion: Doctor's Advice

This content is compiled based on clinical guidelines and publicly available medical information for reference only. Please consult your doctor for specific diagnosis and treatment plans.