IUI and uterine lavage of in vivo–produced blastocysts for PGT purposes: is it a technically and ethically reasonable perspective? Is it actually needed?


A recent study by Munné et al. portrayed a protocol to retrieve in vivo produced blastocysts after IUI and uterine lavage for preimplantation genetic testing (PGT) purposes. The authors claimed this protocol might represent a reasonable future perspective for patients who do not want to undergo IVF, but still want to be informed about their embryos’ genetic/chromosomal defects. Although the intent of making PGT available also to patients who cannot or do not need to undergo IVF is respectable, the value of this study is undermined by severe technical and ethical issues. Munné and colleagues’ paper was discussed within the executive committee (i.e., president and vice-president of the society, director and vice-director of the scientific committee, secretariat, and counselors), the special interest group in reproductive genetics, the scientific committee, and the collegio dei probiviri of the Italian Society of Embryology, Reproduction and Research (SIERR). The points raised from this discussion are summarized in this opinion paper.

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  1. 1.

    Munne S, Nakajima ST, Najmabadi S, Sauer MV, Angle MJ, Rivas JL, et al. First PGT-A using human in vivo blastocysts recovered by uterine lavage: comparison with matched IVF embryo controls. Hum Reprod. 2020;35(1):70–80. https://doi.org/10.1093/humrep/dez242.

    Article  PubMed  Google Scholar 

  2. 2.

    Capalbo A, Hoffmann ER, Cimadomo D, Maria Ubaldi F, Rienzi L. Human female meiosis revised: new insights into the mechanisms of chromosome segregation and aneuploidies from advanced genomics and time-lapse imaging. Hum Reprod Update. 2017:1–17. https://doi.org/10.1093/humupd/dmx026.

  3. 3.

    Girardi L, Serdarogullari M, Patassini C, Poli M, Fabiani M, Caroselli S, et al. Incidence, origin, and predictive model for the detection and clinical management of segmental aneuploidies in human embryos. Am J Hum Genet. 2020. https://doi.org/10.1016/j.ajhg.2020.03.005.

  4. 4.

    Franasiak JM, Forman EJ, Hong KH, Werner MD, Upham KM, Treff NR, et al. The nature of aneuploidy with increasing age of the female partner: a review of 15,169 consecutive trophectoderm biopsies evaluated with comprehensive chromosomal screening. Fertil Steril. 2014;101(3):656–63 e1. https://doi.org/10.1016/j.fertnstert.2013.11.004.

    Article  PubMed  Google Scholar 

  5. 5.

    Popovic M, Dhaenens L, Boel A, Menten B, Heindryckx B. Chromosomal mosaicism in human blastocysts: the ultimate diagnostic dilemma. Hum Reprod Update. 2020. https://doi.org/10.1093/humupd/dmz050.

  6. 6.

    Popovic M, Dhaenens L, Taelman J, Dheedene A, Bialecka M, De Sutter P, et al. Extended in vitro culture of human embryos demonstrates the complex nature of diagnosing chromosomal mosaicism from a single trophectoderm biopsy. Hum Reprod. 2019;34(4):758–69. https://doi.org/10.1093/humrep/dez012.

    Article  PubMed  CAS  Google Scholar 

  7. 7.

    Goodrich D, Tao X, Bohrer C, Lonczak A, Xing T, Zimmerman R, et al. A randomized and blinded comparison of qPCR and NGS-based detection of aneuploidy in a cell line mixture model of blastocyst biopsy mosaicism. J Assist Reprod Genet. 2016;33(11):1473–80. https://doi.org/10.1007/s10815-016-0784-3.

    Article  PubMed  PubMed Central  Google Scholar 

  8. 8.

    Capalbo A, Ubaldi FM, Rienzi L, Scott R, Treff N. Detecting mosaicism in trophectoderm biopsies: current challenges and future possibilities. Hum Reprod. 2016. https://doi.org/10.1093/humrep/dew250.

  9. 9.

    Huang A, Adusumalli J, Patel S, Liem J, Williams J 3rd, Pisarska MD. Prevalence of chromosomal mosaicism in pregnancies from couples with infertility. Fertil Steril. 2009;91(6):2355–60. https://doi.org/10.1016/j.fertnstert.2008.03.044.

    Article  PubMed  Google Scholar 

  10. 10.

    Munne S, Alikani M, Ribustello L, Colls P, Martinez-Ortiz PA, McCulloh DH, et al. Euploidy rates in donor egg cycles significantly differ between fertility centers. Hum Reprod. 2017;32(4):743–9. https://doi.org/10.1093/humrep/dex031.

    Article  PubMed  CAS  Google Scholar 

  11. 11.

    Capalbo A, Ubaldi FM, Cimadomo D, Maggiulli R, Patassini C, Dusi L, et al. Consistent and reproducible outcomes of blastocyst biopsy and aneuploidy screening across different biopsy practitioners: a multicentre study involving 2586 embryo biopsies. Hum Reprod. 2016;31(1):199–208. https://doi.org/10.1093/humrep/dev294.

    Article  PubMed  Google Scholar 

  12. 12.

    Cimadomo D, Rienzi L, Romanelli V, Alviggi E, Levi-Setti PE, Albani E, et al. Inconclusive chromosomal assessment after blastocyst biopsy: prevalence, causative factors and outcomes after re-biopsy and re-vitrification. A multicenter experience. Hum Reprod. 2018. https://doi.org/10.1093/humrep/dey282.

  13. 13.

    Oron G. How far should we go in the name of science? Hum Reprod. 2020;35(1):3–4. https://doi.org/10.1093/humrep/dez249.

    Article  PubMed  Google Scholar 

  14. 14.

    Blockeel C, Mock P, Verheyen G, Bouche N, Le Goff P, Heyman Y, et al. An in vivo culture system for human embryos using an encapsulation technology: a pilot study. Hum Reprod. 2009;24(4):790–6. https://doi.org/10.1093/humrep/dep005.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  15. 15.

    Scott RT Jr, Upham KM, Forman EJ, Zhao T, Treff NR. Cleavage-stage biopsy significantly impairs human embryonic implantation potential while blastocyst biopsy does not: a randomized and paired clinical trial. Fertil Steril. 2013;100(3):624–30. https://doi.org/10.1016/j.fertnstert.2013.04.039.

    Article  PubMed  Google Scholar 

  16. 16.

    Scott RT Jr, Ferry K, Su J, Tao X, Scott K, Treff NR. Comprehensive chromosome screening is highly predictive of the reproductive potential of human embryos: a prospective, blinded, nonselection study. Fertil Steril. 2012;97(4):870–5. https://doi.org/10.1016/j.fertnstert.2012.01.104.

    Article  PubMed  Google Scholar 

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This opinion paper was produced after being approved from the executive committee of SIERR (LDS, DC, AA, EL, CS, LSF, and FGK) and the special interest group in reproductive genetics (AC, CDP, and DZ). The document was circulated among the scientific committee (Stefano Canosa, Francesco Capodanno, Livio Casarini, Sandra Cecconi, Mariabeatrice Dal Canto, Laura Di Renzo, Roberto Gualtieri, Csilla Krausz, Sergio Ledda, Roberta Maggiulli, Massimo Menegazzo, Sandra Moreno, Stefania Nottola, Francesco Pallotti, Marianna Pelloni, Valerio Pisaturo, Maurizio Poli, Liborio Stuppia, Carla Tatone, Carlotta Zacà, Filippo Zambelli, and Maurizio Zuccotti) and the collegio dei probiviri (Paolo Giovanni Artini, Rosanna Ciriminna, and Laura Rienzi) of the SIERR, and all members agreed with it.

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Correspondence to Danilo Cimadomo.

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De Santis, L., Cimadomo, D., Capalbo, A. et al. IUI and uterine lavage of in vivo–produced blastocysts for PGT purposes: is it a technically and ethically reasonable perspective? Is it actually needed?. J Assist Reprod Genet 37, 1579–1582 (2020). https://doi.org/10.1007/s10815-020-01813-7

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  • Uterine lavage
  • PGT
  • Blastocyst
  • Ethics
  • Preimplantation development