Separation of miscarriage tissue from maternal decidua for chromosome analysis

This video demonstrates a technique for separating miscarriage tissue from maternal decidua to reduce maternal cell contamination for chromosome analysis.

Original Video Article


Gayathree Murugappan, M.D., Stephanie Gustin, M.D., Ruth B. Lathi, M.D.



To report a novel mechanism suggestive of early ovarian failure secondary to the anti-tumor hedgehog-pathway inhibitor vismodegib.


Case report and literature review.


Academic and private dermatology and fertility practices.


A 34-year-old nulliparous woman with locally advanced basal cell carcinomas who became amenorrheic while receiving oral therapy with vismodegib.


Physical examination and endocrine evaluation.

Main Outcome Measure(s):

Elevated follicle-stimulating hormone (FSH) and low estrogen in the setting of a normal anti-Müllerian hormone.


FSH was elevated; estrogen was low. Preantral follicles were detected and anti-Müllerian hormone activity was normal. Menses resumed 5 weeks after cessation of therapy.


Vismodegib, a first-in-class inhibitor of the hedgehog signaling pathway is indicated for advanced basal cell carcinoma and is associated with amenorrhea. The mechanism is unknown; it has some features of ovarian failure but preserves ovarian potential through blockading of FSH-receptor–dependent signal transduction. This effect appears to be rapidly reversible upon cessation of therapy. Vismodegib and related compounds may have potential for a role in intervention for gynecologic and endocrine disorders and in therapy for other issues involving FSH-dependent function.

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