Paracentric chromosome inversions occur when a single chromosome undergoes two breaks and recombines with the segment between the two breaks inverted. Paracentric inversions do not include the centromere. Inversion carriers are most often phenotypically normal, however they are at risk of producing genetically unbalanced gametes due to recombination within inverted segments. The traditional model for the meiotic behavior of a pair of chromosomes heterozygous for a paracentric inversion assumes occasional crossing over within the inverted region. When this occurs, a dicentric and an acentric are formed. When the dicentric’s two centromeres subsequently separate toward opposite poles, it breaks into two monocentrics. Resulting cells will have deficiencies, and may have duplications, of genetic material. Crossing over need not occur within the inversion; therefore chromosomally balanced gametes predominate. As unbalanced gametes are relatively rare and most of these would result in early pregnancy loss, paracentric inversions are rarely found to be involved in reproductive failure. Two recent cases of unbalanced live-born progeny with intact dicentrics have been described. It appears that, in these cases, one of the two centromeres inactivated immediately after dicentric formation with subsequent migration of an intact dicentric into the secondary oocyte or ootid. Therefore, we will determine the cytogenetic status of embryos from a female paracentric inversion carrier. Analysis of embryonic cells apparently with a derived dicentric chromosome. Case report. In vitro fertilization (IVF) and PGD was performed on a couple due to three pregnancy losses. The husband has normal semen parameters. The 36 year old female is a carrier of a paracentric inversion of chromosome 9[46, XX, inv(9)(q21.2q22.3)]. PGD-aneuploidy was first performed for chromosomes 9, 14, 15, 22, X and Y. We next performed PGD for teleomeric sequences of chromosome 9. Routine protocols were followed. Microscopy was performed using an epi-fluorescent microscope and multiple fluorescent signal detection was accomplished using a Spectral Cube imaging system. Eleven of 13 embryos were aneuploid. Seven of the 11 showed three chromosome 9 centromeres. As the standard model of paracentric behavior does not predict trisomic progeny, 9p and 9q telomere sequences were analyzed to determine whether entire chromosome 9s were present within the blastomeres. Five of 7 trisomy 9 blastomeres showed three 9p and one 9q sequence. The other two showed two 9p and two 9q sequences. Each of the remaining (n = 6) diploid chromosome 9 embryos tested showed the correct number of 9 telomeric sequences expected from two entire chromosome 9s. Dicentrics whose centromeres are joined by their q arms will have two p-arm and no q-arm telomeric sequences. Cells with a dicentric and a normal chromosome will therefore have a total of 3 p-arm and one q-arm telomeres. This was found in 5 of 7 embryos with three chromosome 9 centromeres. The apparent presence of a dicentric chromosome in a high percentage of embryos suggests the possibility that the recombinational event took place during a mitotic division in the maternal germ line. To our knowledge, this is the first report of a dicentic chromosome in embryos from couples undergoing IVF-PGD and the first suggesting mitotic recombination as a mechanism for the generation of a dicentric chromosome.