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Evaluate practice patterns in ovarian tissue cryopreservation (OTC) provision in pediatric, adolescent and young adult (AYA) populations. United States providers practicing or developing OTC programs were invited to participate in a survey disseminated via the Oncofertility Consortium. Twenty-eight programs representing a wide geographic area responded, largely representing academic institutions (85.7%). Of these, 22 (78.6%) perform OTC at their facility. Primary involved parties in fertility preservation counseling were fertility patient navigators (86.2%), gynecologists (63.6%) and treating oncologists (36.4%). Most centers perform OTC for oncology patients receiving gonadotoxic therapy, relapsed patients and non-oncologic patients receiving gonadotoxic therapy (95.8, 87.5, 83.3% respectively). However, practices for lower risk and non-oncologic populations were variable with OTC less commonly completed for patients with 'moderate' gondadotoxic risk therapy, Turner Syndrome, differences of sex development and gender dysphoria (71.4, 29.2, 20.8, 16.7% respectively). Most programs (68.8%) refer patients to outside facilities when OTC was not offered in the patient population. Most (63.6%) perform OTC as standard of care, 31.8% with an IRB-approved research protocol, and 4.5% with a mixed approach. Of those performing exclusively standard of care OTC, 57.1% utilize an IRB for data collection. Surgeons performing OTC are most commonly pediatric gynecology surgeons (72.7%), followed by pediatric general surgeons (63.6%) and adult gynecology surgeons (13.6%). The most common surgical method was laparoscopic oophorectomy (90.9%) using an electro-thermal bipolar (33.3%) or ultrasonic instrument (23.8%) for dissection. The majority of centers reported using an outside compensated service (52.4%) or an REI group (42.9%) for processing tissue. Of the 8 centers whose OTC programs are in the planning or early stages, common barriers were lack of priority within their institutions or lack of protected time (both 37.5%) and lack of funding or resources to process ovaries (both 12.5%). Of those who referred for OTC, the majority (5/7, 85.7%) ask patients to travel over 50 miles and 1 (14.2%) over 200 miles, with 42.9% having funding. OTC is commonly offered for high risk AYA oncology patients with gynecologists frequently involved in counseling and performing OTC. Variability exists in offering OTC to other patient populations, as well as in surgical technique and processing. Institutions continue to face barriers to offering OTC when necessary resources are not prioritized by leadership. [ABSTRACT FROM AUTHOR]

The most common anorectal malformation in girls is imperforate anus (IA). There is a known association between gynecologic anomalies and IA, but data are limited. The approach to gynecologic evaluation in girls with IA is not well described and may contribute to neglect of gynecologic evaluation in these patients. One hundred forty-four patients with imperforate anus were retrospectively reviewed with a focus on gynecologic evaluation. Cloacal malformations were excluded. Statistical analysis included descriptive statistics, Chi squared, and Fisher's exact tests. IRB approval obtained. Seventy-eight (54%) patients had any type of gynecologic evaluation. Thirty-six (25%) had both vaginal evaluation and pelvic imaging, 68 (47%) had pelvic imaging, and 45 (31%) had vaginal evaluation. Of those with gynecologic evaluation, 28 (36%) were found to have an anomaly, all with an upper genital tract anomaly and 19 (24%) also with a lower genital tract anomaly (Table 1). Of 28 patients with a normal vagina and single cervix noted on vaginoscopy, 6 (21%) were found to have a uterine anomaly on imaging. Seven patients had uterine anomalies diagnosed on pelvic ultrasound prior to age 2; however, three patients eventually diagnosed with a uterine anomaly had an initial pelvic ultrasound read as normal. Comparing girls with a gynecologic anomaly to those without, there was a significant difference in age (13.0 years vs 6.6 years, p<0.01) and having at least one additional anatomic anomaly (93% vs 68%, p=0.01) but no difference in other baseline characteristics (Table 2). Girls with IA were also noted to have non-anatomic gynecologic complaints such as labial adhesions (3, 2%), urethral prolapse (2, 1%), and precocious puberty (3, 2%). Our study reiterates the high incidence of gynecologic anomalies in girls with IA without cloaca, consistent with findings in prior case series. We found the incidence of uterine anomaly is high even with normal vaginoscopy. Universal vaginoscopy in this population, ideally by a gynecologist, has been previously recommended. Based on our findings, we also recommend universal pelvic imaging in addition to vaginoscopy. Given parents express a desire for earlier knowledge of gynecologic anatomy, we recommend pelvic ultrasound at the time of initial diagnosis/evaluation and again at puberty. Despite previous reports of this association, gynecologic evaluation of girls with IA without cloaca remains inconsistent. Ultimately, increased awareness of the need for gynecologic assessment in girls with IA is needed along with further studies to increase understanding of the association. [ABSTRACT FROM AUTHOR]

Recommendations from the Children's Oncology Group Long-Term Follow-Up (COG-LTFU) Guidelines for Survivors of Childhood, Adolescent, and Young Adult Cancer emphasize the importance of reproductive health care, yet little is known regarding adherence to these recommendations and non-fertility-related sexual and reproductive health (SRH) outcomes. Follow-up of outcomes on the basis of the COG-LTFU guidelines was assessed in female patients who underwent fertility preservation consultation before gonadotoxic therapy between 2016 and 2022 at a single institution and were at least 6 months from treatment completion. We included 140 patients, with a mean time of 2.7 years from treatment completion. Eighty-six patients were 12 years old or older, of whom sexual activity was recorded in 59 (68.7%), and 12 of 31 (38.7%) sexually active patients underwent sexual function assessment. The 57 (66.3%) patients at high risk of premature ovarian insufficiency (POI) at diagnosis were more likely than minimal-risk counterparts (29, 33.7%) to have abnormal uterine bleeding (42.1% vs 17.2%, P =.03), to be diagnosed with POI (29.8% vs 0%, P =.01), and to have sexual activity recorded (77.2% vs 51.7%, P =.03). Of 17 patients with POI, 82.4% were on hormone replacement therapy, and 58.8% had undergone bone mineral density testing. This study adds to the limited literature regarding non-fertility-related SRH outcomes after gonadotoxic therapy and illustrates opportunities to improve adherence to the COG-LTFU guidelines. Increased attention to SRH guidelines may increase detection and treatment of SRH conditions, improving the health and quality of life of female cancer survivors. [ABSTRACT FROM AUTHOR]

TikTok is a dominant social media platform with appeal to a relatively young consumer base. An estimated 1 in 4 of its users are under age 20 and up to 57% of users are female. The platform is commonly used by viewers to seek information regarding medical conditions. However, given its ease of content creation and algorithm to increase engagement, the platform is also rife with misinformation, which can cause harm to patients. The main objective of this study was to assess the content and reliability of TikTok videos made by medical professional creators versus other creators about polycystic ovarian syndrome (PCOS). A TikTok scraper was used to collect the top 250 TikTok videos using the hashtag #PCOS from 2020-2023. Each video was analyzed by two independent reviewers. Data collected included self-reported credentials of content creator and video content (number of symptoms listed, characterization of symptoms). The modified DISCERN scale was used to rate educational quality of each video. This study was IRB exempt. A total of 243 videos were included for analysis; 7 videos were deleted by the time of analysis and excluded. Most videos were created by laypeople (73%), followed by dieticians (17%), and medical professionals (including physicians, advanced practitioners, and nurses) (10%). Laypeople and dieticians were more likely to identify as having PCOS (78% and 60%, respectively) compared to medical professionals (22%) (p < 0.001). The most common mentioned symptoms associated with PCOS were weight gain (29%), hirsutism (19%), and acne (16%). Dieticians were more likely to mention sugar cravings (19%) and fatigue (33%) compared to other creators (p=0.023 and < 0.001, respectively). Medical professionals were more likely than other creators to mention acne (35%) (p=0.045). Medical professionals were also more likely to mention polycystic appearance of the ovaries (26%) as part of diagnostic criteria than other creators (p=0.004). The average DISCERN score overall was 1.3/5. This score was highest among videos created by medical professionals (1.7), followed by dieticians (1.3). Videos created by laypeople were more likely to have lower DISCERN scores compared to others, on average 1.2/5 (p=0.002). PCOS is frequently misunderstood outside of the gynecologic community and subject to misinformation. This study finds that most creators lack a medical background and frequently focus on symptoms which are not necessarily attributable to PCOS. Since social media is becoming increasingly used as a source of information, especially for younger generations, medical professionals should consider investing time in understanding these platforms to combat the spread of misinformation. [ABSTRACT FROM AUTHOR]

Benign vaginal masses are relatively uncommon in adults, with an estimated incidence of 1.6% in an adult urogynecologic surgical population, and the incidence in adolescents is unknown. The most common midline anterior vaginal wall mass is a urethral diverticulum, but the differential diagnosis of anterolateral wall masses is broad and includes cysts of embryonic origin (Mullerian cysts, Gartner's duct cysts), Skene's duct cysts, epithelial inclusion cysts, endometriosis, leiomyoma, fibroma, and lipoma. We present a case of anterior vaginal wall mass due to a previously unreported etiology. Our patient is a 17 year-old nonbinary person with a history of chronic pelvic pain. Surgical history includes cystoscopy with bilateral injection of Deflux in 2018 for vesicoureteral reflux (VUR). They presented for LNG-IUD insertion under sedation and examination revealed a firm, smooth 1 cm nodule palpable in the midline anterior vaginal wall which was unable to be visualized on speculum exam. The remainder of the pelvic exam was typical and pelvic ultrasound showed a typical uterine shape without evidence of pelvic mass. Given its location in the anterior vagina, initial suspicion was for urethral diverticulum, thus the patient was referred to urology for consultation. The patient has a history of chronic dysuria and perineal pain, but no typical urinary symptoms of urethral diverticulum. Urology performed cystoscopy and examination under anesthesia in coordination with gynecology, which revealed mound-like prominences of both ureteral orifices consistent with prior bilateral Deflux injection. Digital manipulation of the vaginal mass during cystoscopy correlated with movement of the mounds of Deflux material. Benign vaginal masses are rare and poorly understood, especially in the adolescent population. A vaginal mass due to injection of Deflux material has not been previously reported. Injection of Deflux, a bulking agent composed of dextranomer microspheres suspended in hyaluronic acid, is an endoscopic method of correcting VUR. Compared to ureteral reimplantation, Deflux injection is safer and has few reported serious complications. Calcification of Deflux material can occur as early as 3 years following injection and may mimic a ureteral stone on imaging; there have otherwise been no reported long-term sequelae of calcification. The incidence of a palpable vaginal mass in patients with a history of Deflux injection may increase as this technique becomes more common and should be included in the differential diagnosis of vaginal mass in patients with a history of VUR. Supporting Figures or Tables https://www.abstractscorecard.com/uploads/Tasks/upload/19245/RGXGDRUQ-1376941-1-ANY.pdf https://www.abstractscorecard.com/uploads/Tasks/upload/19245/RGXGDRUQ-1376941-2-ANY.pdf [ABSTRACT FROM AUTHOR]

Endometriosis is estimated to affect 49-75% of adolescents with chronic pain who undergo laparoscopy. The prevalence of endometriosis in transgender-nonbinary (TGNB) adolescent and young adults (AYA) is estimated at 25% but data is limited. Interaction between gender dysphoria and pelvic pain have been poorly characterized. We aimed to describe the characteristics and rate of endometriosis in TGNB AYA patients who underwent diagnostic laparoscopy for pelvic pain at a single institution. We performed a retrospective chart review of TGNB patients who underwent diagnostic laparoscopy for dysmenorrhea and/or chronic pelvic pain at an academic children's hospital with a pediatric and adolescent gynecologist from July 1, 2019 to June 15, 2023. IRB approval was obtained. Data on demographics, medical history, gynecologic history, social history, operative and pathology reports were collected. Descriptive statistics are reported. Of 11 TGNB patients 4 (36.4%) were diagnosed with endometriosis. The mean age of chronic pain onset was 13.5 years and average age at surgery was 16.4 years. Ten (90.9%) had dysmenorrhea and 8 (72.7%) had chronic pelvic pain. In sexually active patients 16.7% reported dyspareunia. Eight (72.7%) reported a family history of endometriosis. Gender identities included transgender male 54.5%, nonbinary 18.2%, gender fluid 9.1% and gender dysphoria not specified 18.2%. Four (36.4%) were receiving testosterone for a mean treatment length of 8.5 months, with no difference in rate of endometriosis from those not using testosterone (50% and 28.6% respectively, p=0.58). Mean number of different non-testosterone hormonal therapies ever used pre-operatively was 1.8, and 5 patients had a levonorgestrel intrauterine device (IUD). The most common concomitant procedure was IUD insertion (7, 63.6%). Peritoneal biopsies were performed in 8 (72.7%) patients with a mean number of 2.38. Endometriosis diagnosis did not affect improvement in pain at 6 months (p =0.52) and 12 months (p=1) (Figure 1). One patient without endometriosis went on to have a hysterectomy due to continued pelvic pain and gender dysphoria, with a second patient planned for the same. In this small study, the rate of endometriosis diagnosis in TGNB patients undergoing diagnostic laparoscopy was lower than previously reported for adolescents. Time from symptom onset to surgery was shorter than generally reported for endometriosis diagnosis. Rate of endometriosis was not different between testosterone users and non users. Further study is needed involving a comparison group of cis gendered AYA patients. [ABSTRACT FROM AUTHOR]

There is no standardized grading system or protocol for management of pediatric female genital trauma (PFGT). Rates of operative intervention among large multi-center database studies vary considerably. Retrospective review of female patients < 19 years presenting to our American College of Surgeons-verified Level 1 pediatric trauma center with genital trauma between 1/2018-12/2022. Patient demographics, injury characteristics, and interventions were recorded. Summary statistics were calculated. A novel grading system to classify PFGT injuries was developed in conjunction between pediatric surgery and pediatric & adolescent gynecology. 353 patients met inclusion criteria, with median age of 6.4 years (Interquartile range: 4.2,8.6). Straddle injuries were most common (76.1%), followed by non-straddle blunt injuries (11.8%). Most patients had low-grade injuries. Following bedside evaluation, 65.6% of injuries were discharged with expectant management and did not require suture repair. Among patients transferred to our center from another facility, 54.1% required no further intervention at our center. Those requiring intervention underwent general anesthesia (83.6%) for sedation, most commonly for either an exam under anesthesia without suture repair (18.6%) or single-layer suture repair (48.0%). Median operative time for all injuries was 15.0 minutes (IQR: 9.0, 22.0). Few patients (16.4%) were repaired under procedural sedation or local anesthesia. We propose a standardized grading system and algorithm to guide appropriate management of female genital trauma. There are significant potential cost savings if admission and OR utilization can be avoided, and healthcare resources used more appropriately. Grade 1 and 2 injuries can be managed without surgical consultation, as do not require suture repair. Surgical consultation is recommended for higher grade injuries, however given the typical short operative times and single-layer closure, strong consideration should be given to repair with bedside sedation when resources allow. [ABSTRACT FROM AUTHOR]

With the changing political landscape, there is significant uncertainty regarding the future of reproductive autonomy. The purpose of this study is to better understand the factors adolescents and young adults (AYA) consider when choosing methods for contraception and/or menstrual management. This is especially pertinent considering the upcoming ballot issue on reproductive rights in Ohio. This is an IRB-approved survey study of female patients age 11-26 years who desired to start a new hormonal suppression or contraception (hereafter known as "method") from 5/2023-9/2023. Informed consent was obtained. Data collected include demographics, insurance, zip code, previous contraception, and decision-making factors. The child opportunity index (COI) and median annual income were determined based on zip code from published statistics and used as markers of socioeconomic status (SES). Descriptive statistics and Fisher's exact test data are reported. A total of 20 respondents completed the survey. The majority (57%) were non-Hispanic white with a mean age of 16.2 years. 50% lived in areas of low COI, with a median annual income of $36,020, and 43% had Medicare insurance. Prior to the visit, 50% had previously used at least one type of birth control, including 50% of these who had used long-acting reversible contraceptives (LARC). Patients most commonly chose to initiate combined oral contraceptives (40%); 25% opted for LARC placement. SES did not affect previous use of contraception and whether LARC was the new method (p=0.19 and 0.37, respectively). The most common reasons cited for choosing a method included dysmenorrhea (55%), heavy bleeding (45%), irregular periods (40%), and contraception (35%). The most frequent reasons given for choosing a specific method were: ease of use (selected as one of the top 3 reasons by 35%), desire for more predictable periods (35%), desire for menstrual suppression (30%), and ease of self-initiation/discontinuation (30%). Only 15% selected concern for future access to contraception as one of their top reasons. When asked if recent changes in politics had affected the decision, 10/19 reported no effect, 4/19 little to moderate effect, and 6/19 a large effect. One patient declined to answer. Whether or not a respondent felt recent politics had an impact on decision-making did not affect their choice of method (p=0.58). Recent concerns regarding reproductive rights have not significantly impacted AYA decision-making. AYA were more concerned with ease of use and self-control of each method, rather than future access. AYA consider may factors when choosing a contraceptive method and public policy may play a role. [ABSTRACT FROM AUTHOR]

CDC data shows that 25% of adolescents experience verbal, physical, emotional or sexual abuse from a dating partner. We aimed to determine the incidence of IPV among adolescents, and to characterize the types of IPV experienced in order to allow for early identification, intervention, and prevention of IPV among adolescents. This was a retrospective cohort study of IPV screenings for patients seen in pediatric and adolescent gynecology (PAG) clinics from 1/2022-6/2022. Using QI methodology, we previously developed and implemented an IPV screening tool for adolescents. All adolescents ≥13 years receiving care at PAG clinics are screened for IPV at each in-person visit. Screens were considered positive if patients indicated ever experiencing IPV. Data were collected on demographics, details of experienced IPV, mental health disorders, and resources provided. Descriptive statistics were used for analysis. The study was IRB approved. 1151 IPV screens were completed by 916 individual patients. 68 screens (5.9%) were positive, completed by 65 patients (7%). Patients with positive IPV screening were more likely to be younger (mean age 16.5 years) compared to those who screened negative (mean age 17.4 years), p=0.019. Both groups were similar in race. Among unique positive responses, 7.7% reported current IPV, 76.92% reported past IPV, and timing was unspecified for 15.38%. The types of IPV experienced were sexual (36.92%), physical (10.77%), verbal (23.08%), mental (55.38%), and unspecified type (16.92%). 26% of patients experienced more than one type of IPV. Among patients who screened positive for IPV, 72.3% had a history of a mental health diagnosis at time of screening. 12.3% of patients were seen by social work at the time of the positive screen, 83.1% given resources in office, and 4.6% did not have documented management. 5.9% of our patients experienced IPV – with mental abuse being the most commonly experienced modality of IPV. Most IPV had occurred in prior relationships. Those reporting IPV were of younger age compared to those who screened negative. The incidence of IPV in our study population was markedly lower than the nationally reported 25%. We may be under identifying IPV based on patient interpretation of questions and perception of experiences. The incidence of mental health disorders was higher than the reported rates in adolescents. Our findings affirm the importance of early screening for all forms of IPV. As mental abuse can be more difficult to identify, educational resources and provider counseling should address ways for patients to more readily recognize it and seek assistance. [ABSTRACT FROM AUTHOR]

Fertility counseling prior to gonadotoxic treatment at pediatric hospitals has increased, but pediatric cancer survivors also need tailored sexual and reproductive healthcare (SRH) post gonadotoxic treatment, which few studies have examined. We sought to quantify the implementation of the 2018 Children's Oncology Group (COG) long term follow-up (LTFU) SRH recommendations in our female patients after fertility preservation consult. IRB approved retrospective chart review was performed on females qualifying for oncofertility consultation at a tertiary pediatric institution from 2016 to 2020. Study exclusions included consultation after treatment or transfer of follow up care. Baseline demographics/characteristics, fertility preservation option chosen, recurrence, and adherence to COG LTFU SRH recommendations, including annual assessment of puberty, menstrual history, sexual function, menopausal symptoms, medication use, and further evaluation (laboratory evaluation, endocrinology/gynecology referral, bone mineral density (BMD) testing) with signs of premature ovarian insufficiency (POI), were collected. SRH follow up outcomes were compared between risk (high vs minimal) of fertility failure stratified by menarchal status. Chart review of 265 patients yielded 130 subjects who met inclusion criteria. At the time of fertility consult, the mean age was 11.2 years, 63 (48.5%) were menarchal, and 25 (19.2%) underwent ovarian tissue cryopreservation (Table 1). Seven of 27 (25.9%) patients who recurred received repeat fertility counseling. Mean time in remission was 2.97 years. Of 32 high risk, premenarchal patients, 11/19 (57.9%) older than 8 years had Tanner staging, 2 (6.3%) had delayed puberty, and 3 (9.4%) had primary amenorrhea, although most patients were too young for final assessment of these diagnoses (69% and 75% respectively) (Table 2). Of 37 high risk, menarchal patients, 33 (89.2%) were asked about sexual activity, 7 (38.9%) were asked about sexual function, 12 (33.3%) about menopausal symptoms, and 24 (64.9%) were on hormonal therapy post treatment. Of 21 patients diagnosed with POI, 16 (76.2%) received hormone replacement therapy and 13 (61.9%) had BMD testing. We describe the proportion of young female cancer survivors whose LTFU care has included the COG recommendations regarding SRH at our pediatric hospital. Identified areas of improvement include repeat fertility counseling at relapse, hormonal treatment of POI, and increased assessment of pubertal development, sexual activity/function, and menopausal symptoms. We plan to use these results to develop an institution wide, multidisciplinary quality improvement project to improve SRH care for cancer survivors. Supporting Figures or Tables: https://www.abstractscorecard.com/uploads/Tasks/upload/19245/RGXGDRUQ-1380444-1-ANY.docx [ABSTRACT FROM AUTHOR]

Human papillomavirus (HPV) immunization is known to decrease rate of HPV infection and future cancers. Screening for cervical dysplasia following complex pelvic reconstruction for cloacal malformations can be difficult due to anatomic variation limiting examination. We previously undertook a quality improvement project for females with anorectal malformations presenting to our multidisciplinary Center for Colorectal and Pelvic Reconstruction (CCPR) clinic and demonstrated feasibility in administration of vaccinations. We aimed to assess completion of the HPV vaccination series in patients with cloacal malformations. Data for this project were collected from 2018 – 2021. Beginning in 2018, vaccination was offered in clinic to all females from 9-26 years old who had not previously been vaccinated. Data were collected including eligibility, administration in CCPR or at an outside facility, and, if declined, reason for declining. A completed series was considered two vaccinations if initiated before age 15 and three vaccinations if initiated at age 15 or older. We analyzed all patients for completion of HPV vaccination series. Data were summarized descriptively. Prior to 2018, there were 68 eligible women for vaccination, and 12 patients were vaccinated (17.6%). After 2018, there have been 86 patients eligible for vaccination. Of these 86 patients, 13 patients (15.1%) began a vaccination series during our timeframe. A total of 8 patients (9.3%) completed vaccination series. Three (3.5%) completed their series at our hospital, three (3.5%) completed at an outside facility, and two (2.3%) completed their first vaccine at NCH and completed at an outside facility. Two patients (2.3%) are in the process of completing the series. Three patients (3.5%) were lost to follow up. The difference between pre-2018 vaccination rates and post-2018 vaccination rates was not statistically significant (17.6% vs 15.1%, p=0.34). Reasons for refusing vaccination included prefer to complete the HPV vaccination series with their PCP and concern for vaccine administration at patients' young age. Offering HPV vaccines in clinic has been shown to be feasible in eligible females with anorectal malformations. This same trend is not observed in the cloacal malformation population. Given that this population faces significant challenges in screening for cervical dysplasia via speculum exam, vaccination efforts should be focused here more strongly. Supporting Figures or Tables https://www.abstractscorecard.com/uploads/Tasks/upload/19245/RGXGDRUQ-1380055-1-ANY(4).docx https://www.abstractscorecard.com/uploads/Tasks/upload/19245/RGXGDRUQ-1380055-2-ANY.docx [ABSTRACT FROM AUTHOR]

Adolescents with heavy menstrual bleeding (HMB) are at risk for developing iron deficiency anemia (IDA) due to excessive menstrual blood loss. First line therapy for IDA is oral iron (OI), but gastrointestinal adverse effects often decrease adherence. Adult studies have shown alternate day use may increase fractional iron absorption, while also reducing GI effects. Our objective was to assess the feasibility of performing a randomized trial comparing daily to alternate day dosing of OI in adolescents with IDA and HMB. This IRB approved study was a randomized, open-label, two arm feasibility trial. Eligible subjects were 9 to 22 years of age with HMB (Pictorial Blood Loss Assessment Chart (PBAC) score >100) and IDA (hemoglobin < 12 g/dL; ferritin < 15 ng/mL). Enrolled subjects were randomized 1:1 to daily versus alternate day dosing of ferrous sulfate 325 mg tablet (65 mg elemental iron) for 24 weeks. Laboratory assessments (CBC, iron panel) and clinical assessments (PBAC score, fatigue, adverse effects) were performed at 4-, 12- and 24-week follow-up visits. Our primary outcome was feasibility, defined as 50% of eligible patients consenting to participate. Our secondary aim was to determine acceptability of each arm (defined as retention ≥75% and medication adherence ≥80% at the 12-week visit). Between 12/21/2020 and 6/30/2022, 351 patients were screened; 44 patients met eligibility criteria (Figure 1). Thirteen (32%) eligible subjects consented to enroll in the trial; 11 have completed the study with 2 subjects currently on trial. The median age was 14 years; (69% white, and 54% Hispanic/Latina). Median PBAC score was 325, median hemoglobin was 6.3 g/dL, median ferritin was 5 ng/mL, and 9 subjects (69%) received a blood transfusion prior to enrollment (Table 1). The control group (daily dosing) had a higher retention rate (5 of 7, 71%) than the intervention group (alternate day dosing; 2 of 6, 33%). Analysis of adherence is pending study completion of the remaining two subjects. Change in hemoglobin at 12 weeks was similar (3 g/dL alternate vs 4 g/dL daily). This feasibility study illustrated potential challenges to eligibility for and acceptability of a randomized trial of OI in adolescents with IDA and HMB. Challenges included a global pandemic and increasing accessibility of IV iron for patients with severe anemia. Enrollment improved with protocol updates including Spanish translated forms and utilization of telehealth research visits. A future larger randomized study of OI may be improved with incorporation of telehealth visits, multi-site enrollment, and short follow-up with the option of IV iron at the end of study. Supporting Figures or Tables: https://www.abstractscorecard.com/uploads/Tasks/upload/19245/RGXGDRUQ-1378987-1-ANY.pdf https://www.abstractscorecard.com/uploads/Tasks/upload/19245/RGXGDRUQ-1378987-2-ANY.pdf [ABSTRACT FROM AUTHOR]