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Munné S, Nakajima ST, Najmabadi S, Sauer MV, Angle MJ, Rivas JL, Mendieta LV, Macaso TM, Sawarkar S, Nadal A, Choudhary K, Nezhat C, Carson SA, Buster JE. First PGT-A using human in vivo blastocysts recovered by uterine lavage: comparison with matched IVF embryo controls†. Hum Reprod 2021; 35:70-80. [PMID: 31886877 PMCID: PMC6993848 DOI: 10.1093/humrep/dez242] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 09/07/2019] [Indexed: 01/10/2023] Open
Abstract
STUDY QUESTION After controlled ovarian stimulation (COS) and IUI, is it clinically feasible to recover in vivo conceived and matured human blastocysts by uterine lavage from fertile women for preimplantation genetic testing for aneuploidy (PGT-A) and compare their PGT-A and Gardner scale morphology scores with paired blastocysts from IVF control cycles? SUMMARY ANSWER In a consecutive series of 134 COS cycles using gonadotrophin stimulation followed by IUI, uterine lavage recovered 136 embryos in 42% (56/134) of study cycles, with comparable in vivo and in vitro euploidy rates but better morphology in in vivo embryos. WHAT IS KNOWN ALREADY In vivo developed embryos studied in animal models possess different characteristics compared to in vitro developed embryos of similar species. Such comparative studies between in vivo and in vitro human embryos have not been reported owing to lack of a reliable method to recover human embryos. STUDY DESIGN, SIZE, DURATION We performed a single-site, prospective controlled trial in women (n = 81) to evaluate the safety, efficacy and feasibility of a novel uterine lavage catheter and fluid recovery device. All lavages were performed in a private facility with a specialized fertility unit, from August 2017 to June 2018. Subjects were followed for 30 days post-lavage to monitor for clinical outcomes and delayed complications. In 20 lavage subjects, a single IVF cycle (control group) with the same ovarian stimulation protocol was performed for a comparison of in vivo to in vitro blastocysts. PARTICIPANTS/MATERIALS, SETTINGS, METHODS Women were stimulated with gonadotrophins for COS. The ovulation trigger was given when there were at least two dominant follicles ≥18 mm, followed by IUI of sperm. Uterine lavage occurred 4–6 days after the IUI. A subset of 20 women had a lavage cycle procedure followed by an IVF cycle (control IVF group). Recovered embryos were characterized morphologically, underwent trophectoderm (TE) biopsy, vitrified and stored in liquid nitrogen. Biopsies were analyzed using the next-generation sequencing technique. After lavage, GnRH antagonist injections were administered to induce menstruation. MAIN RESULTS AND THE ROLE OF CHANCE A total of 134 lavage cycles were performed in 81 women. Uterine lavage recovered 136 embryos in 56 (42%) cycles. At the time of cryopreservation, there were 40 (30%) multi-cell embryos and 96 (70%) blastocysts. Blastocysts were of good quality, with 74% (70/95) being Gardener grade 3BB or higher grade. Lavage blastocysts had significantly higher morphology scores than the control IVF embryos as determined by chi-square analysis (P < 0.05). This is the first study to recover in vivo derived human blastocysts following ovarian stimulation for embryo genetic characterization. Recovered blastocysts showed rates of chromosome euploidy similar to the rates found in the control IVF embryos. In 11 cycles (8.2%), detectable levels of hCG were present 13 days after IUI, which regressed spontaneously in two cases and declined after an endometrial curettage in two cases. Persistent hCG levels were resolved after methotrexate in three cases and four cases received both curettage and methotrexate. LIMITATIONS, REASON FOR CAUTION The first objective was to evaluate the feasibility of uterine lavage following ovarian stimulation to recover blastocysts for analysis, and that goal was achieved. However, the uterine lavage system was not completely optimized in our earlier experience to levels that were achieved late in the clinical study and will be expected in clinical service. The frequency of chromosome abnormalities of in vivo and IVF control embryos was similar, but this was a small-size study. However, compared to larger historical datasets of in vitro embryos, the in vivo genetic results are within the range of high-quality in vitro embryos. WIDER IMPLICATIONS OF THE FINDINGS Uterine lavage offers a nonsurgical, minimally invasive strategy for recovery of embryos from fertile women who do not want or need IVF and who desire PGT, fertility preservation of embryos or reciprocal IVF for lesbian couples. From a research and potential clinical perspective, this technique provides a novel platform for the use of in vivo conceived human embryos as the ultimate benchmark standard for future and current ART methods. STUDY FUNDING/COMPETING INTEREST(S) Previvo Genetics, Inc., is the sole sponsor for the Punta Mita, Mexico, clinical study. S.M. performs consulting for CooperGenomics. J.E.B. and S.A.C. are co-inventors on issued patents and patents owned by Previvo and ownshares of Previvo. S.N. is a co-author on a non-provisional patent application owned by Previvo and holds stock options in Previvo. S.T.N. and M.J.A. report consulting fees from Previvo. S.T.N., S.M., M.V.S., M.J.A., C.N. and J.E.B. are members of the Previvo Scientific Advisory Board (SAB) and hold stock options in Previvo. J.E.B and S. M are members of the Previvo Board of Directors. A.N. and K.C. are employees of Previvo Genetics. L.V.M, T.M.M, J.L.R and S. S have no conflicts to disclose. TRIAL REGISTRATION NUMBER Protocol Registration and Results System (PRS) Trial Registration Number and Name: Punta Mita Study TD-2104: Clinical Trials NCT03426007.
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Affiliation(s)
- Santiago Munné
- CooperGenomics, 3 Regent St., Suite 301, Livingston, NJ 07039, USA.,Overture Life, Avenida de Europa 4, Alcobendas, Madrid 28108, Spain.,Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University, 310 Cedars Street, RM 337, New Haven, CT 06510, USA
| | - Steven T Nakajima
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Sam Najmabadi
- Center for Reproductive Health and Gynecology, 99 N. La Cienega Blvd., Suite 109, Beverly Hills, CA 90211, USA.,Punta Mita Fertility Center/Center for Reproductive Health and Gynecology, Punta Mita Hospital, Ramal Carretera Federal 200 KM 19 No. 1, Punta Mita, Nayarit C.P. 63734, Mexico
| | - Mark V Sauer
- Department of Obstetrics, Gynecology and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, Clinical Academic Building, 125 Paterson St., Room 2150, New Brunswick, NJ 08901, USA
| | - Marlane J Angle
- Laurel Fertility Care, 1700 California St., San Francisco, CA 94109, USA
| | - José L Rivas
- Punta Mita Fertility Center/Center for Reproductive Health and Gynecology, Punta Mita Hospital, Ramal Carretera Federal 200 KM 19 No. 1, Punta Mita, Nayarit C.P. 63734, Mexico
| | - Laura V Mendieta
- Punta Mita Fertility Center/Center for Reproductive Health and Gynecology, Punta Mita Hospital, Ramal Carretera Federal 200 KM 19 No. 1, Punta Mita, Nayarit C.P. 63734, Mexico
| | - Thelma M Macaso
- Center for Reproductive Health and Gynecology, 99 N. La Cienega Blvd., Suite 109, Beverly Hills, CA 90211, USA
| | - Sarthak Sawarkar
- CooperGenomics, 3 Regent St., Suite 301, Livingston, NJ 07039, USA
| | - Alexander Nadal
- Previvo Genetics, Inc., 1599 Industrial Road, San Carlos, CA 94070, USA
| | - Kajal Choudhary
- Previvo Genetics, Inc., 1599 Industrial Road, San Carlos, CA 94070, USA
| | - Camran Nezhat
- Center for Special Minimally Invasive and Robotic Surgery, 900 Welch Road, #403, Palo Alto, CA 94304, USA
| | - Sandra A Carson
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University, 310 Cedars Street, RM 337, New Haven, CT 06510, USA
| | - John E Buster
- Previvo Genetics, Inc., 1599 Industrial Road, San Carlos, CA 94070, USA.,Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University, 101 Dudley St., Providence, RI 02905, USA
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Munné S, Nakajima ST, Najmabadi S, Sauer MV, Angle MJ, Rivas JL, Mendieta LV, Macaso TM, Sawarkar S, Nadal A, Choudhary K, Nezhat C, Carson SA, Buster JE. Corrigendum. First PGT-A using human in vivo blastocysts recovered by uterine lavage: comparison with matched IVF embryo controls. Hum Reprod 2021; 36:2069-2070. [PMID: 33904920 PMCID: PMC8213447 DOI: 10.1093/humrep/deab097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Santiago Munné
- CooperGenomics, Livingston, NJ, USA.,Overture Life, Madrid, Spain.,Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University, New Haven, CT, USA
| | - Steven T Nakajima
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, USA
| | - Sam Najmabadi
- Center for Reproductive Health and Gynecology, Beverly Hills, CA, USA.,Punta Mita Fertility Center/Center for Reproductive Health and Gynecology, Punta Mita Hospital, Nayarit C.P., Mexico
| | - Mark V Sauer
- Department of Obstetrics, Gynecology and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | | | - José L Rivas
- Punta Mita Fertility Center/Center for Reproductive Health and Gynecology, Punta Mita Hospital, Nayarit C.P., Mexico
| | - Laura V Mendieta
- Punta Mita Fertility Center/Center for Reproductive Health and Gynecology, Punta Mita Hospital, Nayarit C.P., Mexico
| | - Thelma M Macaso
- Center for Reproductive Health and Gynecology, Beverly Hills, CA, USA
| | | | | | | | - Camran Nezhat
- Center for Special Minimally Invasive and Robotic Surgery, Palo Alto, CA, USA
| | - Sandra A Carson
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University, New Haven, CT, USA
| | - John E Buster
- Previvo Genetics, Inc, San Carlos, CA, USA.,Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University, Providence, RI, USA
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