bluuebunny/crossref_metadata_2025_split huggingface dataset:
Management of Female-to-Male Transgender Patients with Hereditary Gynecologic Cancer Syndromes [26A]
Authors: Palavalli Parsons Lavanya , Pitt Taylor , Spirtos Alexandra , Lea Jayanthi 
Published: April 2018

INTRODUCTION:
There are screening guidelines for hereditary gynecologic cancers to aid with prevention and early detection of these cancers, however, there are no clear guidelines for those patients that are transgender. This case report describes management of two distinct female-to-male transgender patients with hereditary cancer syndromes.

METHODS:
The clinical cases were analyzed followed by literature review of transgender patients undergoing screening and management of hereditary cancer syndromes.

RESULTS:
A 28-year-old female-to-male transgender patient presented with a new diagnosis of Lynch Syndrome with a known MLH1 mutation. Secondary to his low socioeconomic status, he had not been able to access transgender health resources. Traditional work up for Lynch syndrome were bypassed secondary to being a vaginal virgin. He was planned for a hysterectomy and bilateral salpingectomy with possible oophorectomy, secondary to the patient not potentially having future resources for hormonal replacement. In contrast, a 19-year-old female-to-male transgender patient presented with a known BRCA 2 mutation. He has been engaged in counseling regarding gender issues and has been receiving testosterone injections since the age of 16. At age 17, he underwent a prophylactic mastectomy for risk reduction. At the age of 18, he underwent laparoscopic hysterectomy and bilateral salpingo-oophorectomy.

CONCLUSION:
This is the first body of research to our knowledge describing management of gynecologic hereditary cancer syndromes in transgender patients. Considerations that need to be taken into account on an individualized basis include the patient’s desire to undergo gender-affirming surgery, resources for obtaining hormonal replacement, future fertility, and comfort level for pelvic exams.
Extended VTE Prophylaxis in Morbidly Obese Patients Who Underwent Robotic Surgery For Endometrial Cancer [31A]
Authors: Balavage Kristi , Falanga Alexis , Castagno Jacqueline , Cardenas-Goicoechea Joel 
Published: April 2018

INTRODUCTION:
Robotic surgery for gynecologic malignancy is associated with a lower rate of venous thromboembolism (VTE) than laparotomy. However, guidelines for extended-duration thromboprophylaxis (e.g. 4 weeks) following robotic surgery for gynecologic malignancy are unclear. Obese patients (BMI >35Kg/m2) represent a particularly high-risk group for VTE, but prior studies regarding extended thromboprophylaxis after robotic surgery tend to focus on patients with a much lower average BMI. This study aimed to examine the role of extended post-operative thromboprophylaxis in morbidly obese patients who underwent robotic hysterectomy for endometrial cancer.

METHODS:
A retrospective chart review of robotic procedures for endometrial cancer performed at the University of Florida from January 2013 to May 2017 was conducted. The primary outcome was a VTE event (e.g. DVT or PE) within the 3- 6 month post-operative period.

RESULTS:
68 robotic cases for endometrial cancer were included in the final analysis based on BMI >35 (median = 42.2 Kg/m2). 91% received pre-operative thromboprophylaxis with heparin or enoxaparin, and 100% used pneumatic compression devices. 14 patients (20.6%) received extended duration prophylaxis (range = 28-30 days). One patient in the group that did not receive extended prophylaxis developed a VTE in the 30-day post-operative period (1.9%), versus 0% in the group that did receive extended prophylaxis (P=1).

CONCLUSION:
In obese patients undergoing robotic surgery for endometrial cancer, extended duration thromboprophylaxis may not be necessary to decrease VTE. The low rate of VTE events in this study could possibly be attributed to the high rate of pre-operative pharmacologic and mechanical thromboprophylaxis.
Developing Sustainable Cervical Cancer Screening in Mwanza, Tanzania: Implementation of a Screen-and-Treat Model [33A]
Authors: Bernstein Megan , Hari Anjali Y. , Farfel Allison , Patel Priya , Raman Kaavya 
Published: April 2018

INTRODUCTION:
The purpose of this study is to evaluate the development of a one-week screening campaign and efforts towards the implementation of a sustainable system that addresses cervical cancer in Mwanza, Tanzania with a screen-and-treat model utilizing visual inspection of the cervix with acetic acid (VIA) and cryotherapy.

METHODS:
In partnership with CureCervicalCancer (CCC), a nonprofit organization based in Los Angeles, California, 11 medical students at the University of California, Irvine School of Medicine established a model for sustainable HPV screening practices in Mwanza, Tanzania. This study both quantitatively and qualitatively assesses the successes and limitations of the program model.

RESULTS:
During the 5-day training, a total of 614 women attended the screenings and 556 women were screened with VIA, of which 10.6% (n=59) were VIA positive and 89.4% (n=499) were VIA negative. Of those who for VIA positive, 83.1% (n=49) received cryotherapy while 16.9% (n=10) did not due to suspicions for advanced cancer (n=7), refusal to receive cryotherapy (n=2), or pregnancy (n=1).

CONCLUSION:
The screen-and-treat model for the identification and treatment of pre-cancerous cervical lesions is an effective public health intervention with potential to impact women by both providing the tools and education needed by local healthcare professionals. However, limitations common to resource-poor settings such as continuity of funding, loss to follow-up, and transportation costs, remain barriers to sustainability.
Maximum Cervical Dilation Achieved Prior to Uterine Rupture [38A]
Authors: Nitzsche Brad , King Victor , Zavala Kathryn , Wallace Erika , Reyes Natalie , Elkattah Rayan 
Published: April 2018

INTRODUCTION:
Uterine rupture is a catastrophic obstetrical event with high rates of maternal and fetal morbidity and mortality. Uterine rupture occurs most commonly in patients with prior uterine scars, especially those undergoing a trial of labor after cesarean section. It is intuitive that uterine rupture is more likely to occur in the active stage of labor or at advanced cervical dilation, but data on this subject is lacking.

METHODS:
All cases of uterine rupture that occurred at a single institution from 2010-2016 were identified using ICD codes. Inclusion criteria were pregnant women age 18 and greater with a history of a prior low transverse uterine incision who underwent a uterine rupture while in labor. The primary endpoint was the maximum cervical dilation achieved prior to the diagnosis of uterine rupture.

RESULTS:
19 cases were initially identified, but five of these did not meet inclusion criteria. In the remaining 14 cases, the maximum cervical dilation ranged from 0 to 10 cm with a mean of 3.1 cm. In 9 of the 14 cases, uterine rupture occurred at 4 cm dilation or less.

CONCLUSION:
Uterine rupture does not appear to be more likely to occur in active than in latent labor.
Is a 'High Normal' Basal Follicle Stimulating Hormone Level Predictive of IVF Outcomes in Young Women? [1B]
Authors: Persch Paige , Strawn Estil , Alexis Visotcky , Szabo Aniko , Charles David , Schoyer Kate 
Published: April 2018

INTRODUCTION:
The purpose of the study was to determine if young women (age 35 or younger) with follicle stimulating hormone (FSH) levels between 8-10 mIu/mL have lower clinical pregnancy rates in their first in vitro fertilization cycle (IVF) compared to young women with FSH levels less than 8.

METHODS:
Retrospective cohort study of young women undergoing their first IVF attempt between 1/1/2010 and 12/19/2016. All subjects had a day 2/3 FSH and estradiol drawn within one year of their IVF cycle. The probability of clinical pregnancy was compared between the two groups using Pearson’s chi-squared test at a 5% significance level. Logistic regression analysis was used to assess the effect of confounding factors. An ROC analysis was conducted to evaluate other potential cutoffs.

RESULTS:
Three hundred fifty two women age 35 or younger with FSH levels less than 10 and normal estradiol levels met criteria. There were no significant differences in age, BMI, gravidity, or parity between groups. Stimulation outcomes were similar. Clinical pregnancy rates were lower in the FSH 8-10 group (28.3% versus 43.8%, P=.035) and remained significant when controlling for potential confounders via logistic regression analysis.

CONCLUSION:
Young women with FSH levels between 8-10 had lower clinical pregnancy rates after IVF than those with FSH levels less than 8. An FSH level of 8 or greater may represent premature ovarian aging in young women. Anticipatory counseling and sooner referral to reproductive endocrinology and infertility may be warranted at a new threshold level in young women.
Is Oocyte Quality During IVF Reduced in PCOS? [2B]
Authors: Scogin Mallory , Kim Beomsu , Yu Taechin , Yeh John , Kiltz Robert , Arroyo Armando 
Published: April 2018

INTRODUCTION:
Determine whether oocyte morphology during IVF is different in women with polycystic ovarian syndrome (PCOS) compared to normal controls. (NC).

METHODS:
362 IVF cycles in PCOS women and 268 IVF cycles in normal controls (NC) between the ages of 25-35 were selected from 2012 to 2016. PCOS women were selected using Rotterdam criteria. In addition, all PCOS patients had AMH > 5 ng/mL. Normal controls had normal serum total testosterone < 50 ng/dL, FSH < 12 IU/mL, AMH < 5 ng/mL and normal ovaries on transvaginal ultrasound. Semen analysis was > 14 million/ml with motility. Patients received antagonist or agonist protocol. Oocytes were evaluated by CNY embryologists 4 hours after retrieval. Six categories were defined-metaphase II (MII) good, MII fair, MII poor, metaphase I (MI), germinal vesicle (GV), and degenerated.

RESULTS:
6224 oocytes from PCOS women and 3119 oocytes from NC women were studied. The percentage of MII good (39.3 vs 36.5%; p=0.21), fair (24.5 vs 28.0%; p=0.054), and poor (13.3 vs 12.7%; p=0.67) oocytes was not different in PCOS and NC. The percentage of MI (6.34 vs 5.61%; p=0.33), GV (8.09 vs 8.99%; p=0.35), and degenerated oocytes (8.17 vs 7.25%, p=0.28) was not different in both groups. The fresh cycle live-birth rate (# births/cycle) was not different in PCOS women compared to NC (36.7 vs 31.7%, p=0.19).

CONCLUSION:
Oocyte morphology and live-birth rate during IVF was not different between PCOS women and NC. This suggests that oocyte quality in PCOS women is not reduced.
AMH Serum Level as a Predictor of In Vitro Fertilization (IVF) Parameters [3B]
Authors: Baum Stephanie R. , Or Drorit , Georgia Panagopoulos , Hershlag Avner , Mullin Christine , Singer Tomer 
Published: April 2018

INTRODUCTION:
Anti-müllerian hormone (AMH) serum level is a component of the infertility workup to evaluate ovarian reserve. Diminished ovarian reserve is one of the major causes of female infertility. Our study examines the relationship between AMH serum level and IVF success.

METHODS:
We performed a retrospective cohort study at a single academic institution, including 145 patients undergoing 185 IVF cycles. The IVF outcomes were reviewed for completed cycles within 12 months of collected follicle stimulating hormone (FSH) and AMH serum levels, under an exempt IRB in 2012. Data included number of oocytes retrieved, number of mature oocytes, number of oocytes fertilized, number of cleavage stage embryos, number of embryos transferred, number of embryos frozen, and number of embryos discarded. The Shapiro-Wilk test of normality and Spearman’s rank correlation coefficient were used for statistical analysis with p<0.05.

RESULTS:
There is a positive correlation between AMH serum level and the number of oocytes retrieved, the number of mature oocytes, the number of fertilized oocytes, and the number of cleavage stage embryos. These findings are statistically significant. There is no correlation between AMH serum level and embryo quality.

CONCLUSION:
AMH serum level correlates with certain IVF parameters, including oocytes retrieved and the number of cleavage stage embryos. AMH serum level does not predict embryo quality. However, an IVF cycle with an increased number of retrieved and fertilized oocytes is likely to have a higher chance of resulting in embryos preferable for transfer in a current or future cycle.
Successful Pregnancy Outcomes after Septum or no Septum Resection in Patients with Recurrent Pregnancy Loss [4B]
Authors: Whelan Anna , Burks Channing , Stephenson Mary 
Published: April 2018

INTRODUCTION:
Acquired uterine malformations caused by incomplete fusion or reabsorption of the Mullerian ducts can lead to reproductive issues including infertility, recurrent pregnancy loss (RPL), malpresentation and/or preterm birth. The septate uterus is the result of partial or complete lack of reabsorption. It is the most common acquired uterine malformation with a prevalence of ∼2.3% in the general reproductive population compared to ∼6% in women with RPL. Surgical management of the septate uterus is controversial and subsequent pregnancy outcomes are based on retrospective studies to date.

METHODS:
Observational cohort study using prospectively collected data from a well-defined RPL Database. Subsequent pregnancy outcomes in subjects with a history of RPL and septate uterus were analyzed, based on whether hysteroscopic metroplasty was performed or not.

RESULTS:
36 subjects with RPL and septate uterus were identified, with 82 subsequent pregnancies. Mean maternal age and body mass index were 34.6 years (SD 3.6) and 28.5 kg/m2 (SD 8.2). Analysis of subsequent pregnancy outcomes revealed no significant difference in live birth rate ≥4 weeks of gestation, 36.8% (21/58) with surgery versus 45.3% (11/24) without surgery, OR 1.14 (P = 0.74, 95% CI 0.43 - 3.25). No significant difference in rate of subsequent miscarriage, fetal demise or preterm birth were noted, χ2 = 1.67 (df=3, P =0.65).

CONCLUSION:
The outcomes of this study highlight the need for a randomized controlled trial to evaluate the management of septate uterus in RPL.
Increased Likelihood of Pregnancy from Sex on the Two Days Before Ovulation [5B]
Authors: Johnson Sarah , Marriott Lorrae , Zinaman Michael 
Published: April 2018

INTRODUCTION:
Home ovulation tests are a convenient method to maximize chances of becoming pregnant naturally. This study examined intercourse patterns in women using tests and likelihood of pregnancy in relation to timing.

METHODS:
Women seeking to conceive used Clearblue Advanced digital ovulation tests to time intercourse, kept an intercourse diary and collected daily urine samples for 1 cycle. The home ovulation tests detect estrogen rise to identify the onset of the fertile period (approximately 4 days prior to ovulation) and Lutenising hormone (LH) surge (24h prior to ovulation). LH was also measured using AutoDELFIA to assign ovulation day. From the wider population of 1925 volunteers with sufficient data, comparative analysis was conducted on all viable pregnancies (n=288), and a random selection of ovular cycles from not pregnant volunteers (n=677).

RESULTS:
One cycle conception rate was 15%. Women were able to effectively target intercourse to their fertile period using home tests, with >60% having sex on day of LH surge compared to <30% in the luteal phase. More women who became pregnant had sex on the day -1 (p=<0.0001) and -2 (p=0.001) prior to ovulation; with an increased likelihood of pregnancy of 18.5% for day-1 and 23.6% for day -2. The day after the LH surge saw a marked decrease in pregnancy rates.

CONCLUSION:
Women using home tests do target intercourse effectively to the fertile window, and there is an increased likelihood of pregnancy with successful timing. Sex on the day preceding the LH surge, which identifiable only by home tests that measure estrogen, significantly increases likelihood of pregnancy.
Impact of Employer Coverage on Elective Oocyte Cryopreservation: A Study of Graduate Students [9B]
Authors: Turocy Jenna , Cardozo Eden , James Kaitlyn , Freeman Marlene , Toth Thomas 
Published: April 2018

INTRODUCTION:
Our aim is to assess female graduate student's attitudes toward elective oocyte cryopreservation (OC) and the potential impact of employer coverage on their family planning decisions.

METHODS:
This cross-sectional study was performed via an online survey distributed to 2,314 female graduate students enrolled in 5 graduate degree programs including masters, doctorate, MBA, law and dental programs from May through October 2016. Survey answers were stratified by demographic factors including relationship status and graduate degree.

RESULTS:
171 female graduate students completed the survey. The majority of respondents were between the ages of 21 and 30 (80%) and had no children (95%). The most common reasons for deferring childbearing were professional goals (63%), followed by no partner (18%) or financial (11%). The majority of participants (97%) have heard of elective OC, citing their largest concern was cost (59%) and success rates (14%). Without employee coverage, only 10% would consider elective OC. However if offered employer coverage for OC, an additional 39% would consider OC and 20% would delay when they planned to have children. Participants enrolled in Dental and Law programs were more likely to delay childbearing if provided employer coverage for OC compared to all other programs (p<0.05).

CONCLUSION:
Among female graduate students surveyed, more women would consider OC and delay childbearing if financial coverage were provided by their employer. As more companies offer coverage for OC, further research is needed to better understand how employer coverage for OC may impact a woman’s family planning decisions and potentially lead to a delay in childbearing.
The Association of Relationship Status and Fertility Awareness [14B]
Authors: Hammer Karissa , Kahan Alyssa N. , Fogg Louis , Walker Mark , Hirshfeld-Cytron Jennifer 
Published: April 2018

INTRODUCTION:
Women worldwide are delaying childbearing. Technological advances, such as oocyte cryopreservation (OC) and in vitro fertilization (IVF), allow women to achieve pregnancy despite age related fertility decline. This paper seeks to investigate whether relationship status plays a role in fertility knowledge in order to understand which populations should be targeted for fertility education.

METHODS:
Primary analysis of a national online survey of 1213 nulliparous patients from March 4- March 9, 2016. A linear regression model and ANOVA tests were performed. Results were stratified based on relationship status: partnered (married, living with domestic partner) or unpartnered (single, widowed, divorced).

RESULTS:
Of the 1213 women who completed the survey, 98.8% were analyzed. The majority of participants identified as white, heterosexual, and from urban locations. Partnered women were more likely to report they would have made different life choices had they been more knowledgeable about fertility (p=0.01), and also more likely to “know a lot” about the age-related decline in fertility (p<0.01). When asked about familiarity with oocyte cryopreservation, majority of the survey population responded that they have “heard of it, but don’t know much about it.”

CONCLUSION:
This national survey demonstrates that having a partner significantly increases the likelihood that a woman is knowledgeable about fertility; nevertheless, partnered women are also more likely to wish they had been more knowledgeable about fertility. More effort is necessary to educate all women on ART and the natural age related decline in fertility, specifically young, single women of childbearing age.
Unexplained Infertility: A Biomarker for Decreased Ovarian Reserve in Young Women [15B]
Authors: Starostanko Andrea , Ayers Jonathan 
Published: April 2018

INTRODUCTION:
After 12 months of regular intercourse and appropriate evaluation to assure normal ovulation and sperm quality with patent fallopian tubes, no etiology is identified in up to 1/3 of couples. The treatment for Unexplained Infertility (UI), especially for younger couples (<35 years), is largely empiric. Recent IVF data suggests UI in younger women is associated with lower embryo quality and may be related to prematurely Decreased Ovarian Reserve (DOR). In the present study DOR, as measured by Anti-Mullerian Hormone (AMH), was assessed as part of the initial evaluation of young nulligravid couples with >12 months attempting pregnancy.

METHODS:
Three hundred and forty-three nulligravid couples (18-34 yrs) were evaluated with assessment of tubal patency, ovulatory and anatomic status by mid-cycle TVUS, comprehensive semen analysis, and assessment of DOR with serum AMH.

RESULTS:
An infertility diagnosis was confirmed in 142/343 (41%): anovulation 30%; anatomic abnormality 9%; male factor 6%. UI, the default diagnosis, was made in 201/343 (59%). Of the 201 women with UI, AMH was <95% of age appropriate values in 118 (59%). Most surprisingly, 53/201 (26%) UI women <35 had an AMH value of <1.5.

CONCLUSION:
The results of this study suggest 1) In all women with UI, independent of age, assessment of ovarian reserve should be included in the initial evaluation of fertility status; 2) In young women with premature DOR, consultation with a fertility specialist is warranted to discuss appropriate treatment modalities; 3) Beyond fertility concerns, DOR may herald a premature perimenopausal transition with the associated cardiovascular health implications.
Amphetamine Abuse/Dependence Among Pregnant Women, United States 2003-2014 [20B]
Authors: Admon Lindsay K. , Kozhimannil Katy B. , Rowe Meghan E. , Dalton Vanessa K. , Winkelman Tyler 
Published: April 2018

INTRODUCTION:
Nearly one million individuals in the United States reported using amphetamines in 2015. Particularly high levels of use have been identified among rural populations in the West and Midwest. Our objective was to characterize the incidence and geographic distribution of amphetamine abuse/dependence among women who give birth in the United States.

METHODS:
We conducted a retrospective, serial cross-sectional analysis using 2003 to 2014 data from the National Inpatient Sample, a nationally representative sample of hospital discharges. The cohort included all obstetric deliveries. Amphetamine abuse/dependence was identified with ICD-9-CM codes 305.7x and 304.4x. Incidence rates were calculated with logistic regression models.

RESULTS:
Amphetamine use disorders were identified in 16,469 of 9,921,691 unweighted delivery hospitalizations. Maternal amphetamine abuse/dependence reached a nadir in 2009-10 and then increased disproportionately in rural compared to urban counties. Incidence in rural Western, Midwestern, and Southern counties was significantly higher in 2013-14 compared to urban counties in those regions (all P<.001). The highest incidence of amphetamine abuse/dependence was identified among pregnant women living in rural, western counties at 9.6 (95% CI 8.2-11.0) per 1,000 hospital deliveries in 2013-14.

CONCLUSION:
Maternal amphetamine abuse/dependence increased in the United States after 2009-10 and disproportionately impacted rural residents and communities in the West. These findings amplify recent calls for policy- and practice-level interventions to facilitate the prevention and treatment of substance use disorders among pregnant women. In contrast to opioid use disorders, evidence-based pharmacologic treatment options for amphetamine abuse/dependence are lacking. Prevention may play a key role in improving outcomes for mothers and their infants.