commercial interests: Consultant: AbbVie, Agile Therapeutics, Bayer
Healthcare, CHEMO, Endoceutics, Ferring Pharmaceuticals, HRA Phar-
ma, Merck, Pfizer, Shionogi, TEVA Womans Health, Warner-Chilcott, and
Watson Pharmaceutical. Research Support: AbbVie, Bayer Healthcare, En-
doceutics, Merck, Pfizer, Warner Chilcott, and Watson Phamaceutical.
Honoraria: Bayer Healthcare, Besins, Ferring Pahamacuticals, and Merck.
James A. Simon, MD—This author has relevant financial relationships with
the following commercial interests: Consultant, Advisory Boards Member:
Abbott Laboratories/AbbVie, Inc, Agile Therapeutics, Inc, Amgen Inc, Apo-
tex, Inc, Ascend Therapeutics, BioSante, Depomed, Inc, Everett Laborato-
ries, Inc, Intimina by Lelo, Inc, Lupin Pharmaceuticals, TherapeuticsMD,
Meda Pharmaceuticals Inc, Merck & Co., Inc, Novartis Pharmaceuticals
Corporation, Noven Pharmaceuticals, Inc, Novo Nordisk, Novogyne, Pfizer
Inc, Shionogi Inc, Shippan Point Advisors LLC, Slate Pharmaceuticals Inc,
Sprout Pharmaceuticals, Teva Pharmaceutical Industries Ltd, Warner Chil-
cott, Watson Pharmaceutical Inc. Grant: Abbott Laboratories/AbbVie, Inc,
BioSante, EndoCeutics Inc, Novo Nordisk, Novogyne, Palatin Technologies,
Teva Pharmaceutical Industries Ltd, and Warner Chilcott. Ginger Con-
stantine, MD—This author has relevant financial relationships with the
following commercial interests: Clinical and regulatory consultant: Shionogi
Pharmaceuticals, New Jersey d/b/a EndoRheum Consultants, LLC.
Preconception Cystic Fibrosis
Screening in Infertile Couples
Using an Expanded Carrier
Screening Test
Alexandra S. Higgins
Sanford School of Medicine of the University of South Dakota,
Vermillion, SD
Jason D. Flanagan, MS, Tiffany Von Wald, MD,
and Keith A. Hansen, MD
INTRODUCTION: The American College of Obstetricians
and Gynecologists recommends offering preconception and
prenatal screening to all couples for cystic fibrosis, whereas
the American College of Medical Genetics also recom-
mends screening for spinal muscular atrophy. Both groups
suggest specific screening if there is a family or personal
history of a genetic disease or if the individual is from
a high-risk ethnic group. The purpose of this study was to
determine whether availability of a more comprehensive,
affordable genetic screening tool increased the number of
infertility patients choosing to be screened for cystic fibrosis
and other genetic diseases.
METHODS: This was a retrospective chart review of new
infertility patients evaluated between May 2010 and May
2013. These couples had a detailed pedigree and were
offered the Counsyl expanded carrier screening test.
RESULTS: Sixteen hundred sixty-nine new infertility couples
were offered Counsyl expanded carrier screening. The carrier
frequency for cystic fibrosis was 6.8% with 0% of the couples
concordant heterozygotes. The carrier frequency for spinal
muscular atrophy was 2.51% with 0% of the couples concordant
heterozygotes. Fragile X premutation was found in 2.78% (2/72).
CONCLUSIONS: With availability of the Counsyl screen-
ing test, the percentage of new infertility patients choosing to
VOL. 123, NO. 5 (SUPPLEMENT), MAY 2014
have preconception genetic screening increased from 2% to
8%. The largest increase (17.5% of new patients) in screening
followed the reduction in out-of-pocket expense in May 2012.
Infertility patients are in a unique position to investigate their
family history, discuss appropriate preconception genetic
screening, and, if discovered to be at high risk of a genetic
illness, review their reproductive options.
Financial Disclosure: Alexandra S. Higgins, Jason D. Flanagan, MS,
Tiffany Von Wald, MD, and Keith A. Hansen, MD—These authors have no
conflicts of interest to disclose relative to the contents of this presentation.
Comparison of Low-Dose
Dienogest With Low-Dose
Danazol for Long-Term
Treatment of Adenomyosis
Hidenori Sasa, MD
National Defense Medical College, Tokorozawa, Saitama, Japan
Kanoko Imai, MD, Ayako Suzuki, CT, Kiguna Sei, MD,
Noriko Makimura, PhD, and Kenichi Furuya, MD
INTRODUCTION: The objective of this study was to
compare low-dose dienogest with low-dose danazol for the
long-term treatment of adenomyosis because evidence
regarding the effects of its long-term use is scarce.
METHODS: We compared 20 patients receiving low-dose
dienogest treatment with 22 patients receiving low-dose
danazol treatment for endometriosis including adenomyosis.
We evaluated the effects and complications of low-dose
dienogest treatment in comparison with those of low-dose
danazol treatment. In addition, the values of serum hor-
mones, tumor markers, and lipid metabolism were com-
pared between both groups. This study was approved by the
institutional review board.
RESULT: The daily dose of dienogest could be decreased
from 2.0 to 1.5 or 1.0 mg. Although irregular genital
bleeding was recorded as an adverse effect, it was control-
lable; however, the monthly cost incurred by the low-dose
dienogest treatment group was higher than that by the low-
dose danazol treatment group. The daily dose of danazol
could be decreased from 200 to 50 or 33 mg in patients with
adenomyosis, but it was difficult to determine the adequate
dose for individual patients. Some patients in the low-dose
danazol treatment group developed polycythemia as an
adverse effect, and the administration of the drug was
therefore discontinued. There was no significant difference
in the values of serum hormones, tumor markers, or lipid
metabolism between both groups.
CONCLUSION: We suggest that both low-dose dienogest
and low-dose danazol are effective and safe for long-term
management of endometriosis. However, the selection of
either treatment for adenomyosis depends on each patient’s
baseline condition.
MONDAY POSTERS 97S
Financial Disclosure: Hidenori Sasa, MD, Kanoko Imai, MD, Ayako
Suzuki, CT, Kiguna Sei, MD, Noriko Makimura, PhD, and Kenichi
Furuya, MD—These authors have no conflicts of interest to disclose relative
to the contents of this presentation.
A Case of Cervical Agenesis in a
Patient Who Desires Fertility
Elsa J. Whitmore, DO
University of Illinois College of Medicine at Peoria, Peoria, IL
Jacek Graczykowski, MD, and Chiravudh Sawetawan, MD
INTRODUCTION: The objective of this study was to
understand how cervical agenesis affects fertility
management. Congenital absence of the cervix with
functioning endometrial tissue is extremely rare. Pri-
mary amenorrhea and cyclic abdominal pain are the
usual presentation. Creation of a functional cervix is
difficult as a result of a lack of cervical mucus pro-
duction. Thus, women who desire pregnancy must
undergo in vitro fertilization with zygote intrafallopian
transfer.
METHODS: A 33-year-old nulligravid diagnosed with
cervical agenesis, uterine didelphys, and blind vaginal
pouch desires fertility. A 25-year-old patient was diag-
nosed after ultrasound finding of a pelvic mass of
unknown origin. Desirous of fertility, the patient received
thorough evaluation and was determined to have a func-
tional uterus with thin endometrium of 4 mm, functional
ovaries, and endometriosis. The patient was not a candi-
date for cervical anastomosis; thus, her only option was
in vitro fertilization.
RESULT: During the ovarian stimulation process, it was
discovered her endometrial lining did not respond to
standard doses of follicle-stimulating hormone and leu-
prolide. Increased doses were given; the patient achieved
a 6-mm endometrial echocomplex along with 31 retrieved
oocytes. Despite an additional endometrial anomaly,
likely secondary to years without menses, a zygote intra-
fallopian transfer procedure was performed and deemed
unsuccessful.
CONCLUSION: Cervical agenesis in the setting of uterine
didelphys is an uncommon cause of infertility. The anatom-
ical and hormonal changes present a unique challenge for
conception.
Financial Disclosure: Elsa J. Whitmore, DO, and Chiravudh Sawetawan,
MD—These authors have no conflicts of interest to disclose relative to the con-
tents of this presentation. Jacek Graczykowski, MD—This author has a relevant
financial relationship with the following commercial interest: Shareholder:
Peoria Day Surgery Center.
98S MONDAY POSTERS
ULTRASOUND
Prenatal Diagnosis of
Circumvallate Placenta and
Pregnancy Outcomes
Adanna L. Anyikam,
MD
University of California–San Diego, San Diego, CA
Andrew D. Hull, MD, Sarah Benke, Neha Trivedi, MD,
D. Yvette LaCoursiere, MD, MPH, and Dolores H. Pretorius, MD
INTRODUCTION: The objective of this study was to
determine pregnancy-related outcomes associated with cir-
cumvallate placenta identified on ultrasonography among
women referred to a large tertiary fetal diagnostic center.
METHODS: A nested case–control analysis was conducted
among referrals to the University of California–San Diego
Fetal Care and Genetics Center between January 2003 and
July 2012. Cases of circumvallate placenta were diagnosed in
the first or second trimester and matched one-to-two with
consecutively selected women in a control group based on
maternal age, parity, and gestational age at diagnosis.
RESULTS: Between January 2003 and July 2013, 81 single-
ton cases of circumvallate placenta were identified. Of these
cases, 19 (23%) were diagnosed in the first trimester.
Outcome data were available for 65 patients. No significant
difference between low birth weight, preterm delivery, or
5-minute Apgar score was seen between groups.
CONCLUSION: The clinical significance of circumvallate
placenta remains unclear. Larger cases series are needed to
determine its effect on obstetric outcomes.
Financial Disclosure: Adanna L. Anyikam, MD, Andrew D. Hull, MD,
Neha Trivedi, MD, D. Yvette LaCoursiere, MD, MPH, Sarah Benke, and
Dolores H. Pretorius, MD—These authors have no conflicts of interest to disclose
relative to the contents of this presentation.
Fetal Growth Restriction May
Be Underestimated in Obese
Patients
Megha Gupta, MD
Pennsylvania State University–Milton S. Hershey Medical Center,
Hershey, PA
Julianne Lauring, MD, Allen R. Kunselman,
John T. Repke, MD, and Jaimey M. Pauli, MD
INTRODUCTION: Fetal growth restriction is associated with
poor perinatal outcomes. Unfortunately, only approximately
OBSTETRICS & GYNECOLOGY