Monday, August 12, 2013

Early Detection of Micropenis during Pregnancy

This post is an overview of a study published in 2011 in the "International Journal of Case Reports and Images" , named "Early detection of fetal micropenis after IVF-ICSI". 

In this study, the authors describe what is probably the earliest diagnosis of micropenis ever performed. While the condition is usually diagnosed after birth, in this case it was diagnosed when the boy was still in the mother's womb, at the "age" of  15.5 weeks, just before the fourth month of pregnancy. The study emphasizes the importance of ultrasound and its ability to diagnose micropenis and other genital malformations during pregnancy.

Introduction
The authors first mention that the micropenis term is used when the measured penile length is more than 2.5 standard deviations below the mean for age, and that it can either be isolated or the result of a syndrome (e.g. Klinefelter syndrome).

Next, they explain that the treatment should include a course of HCG or testosterone, adding that early diagnosis is very crucial in choosing the proper treatment protocol.

Case Report
The authors present the case of a primiparous - pregnant for the first time - woman, who got pregnant with the help of in vitro fertilization-intracytoplasmatic sperm injection (IVF-ICSI).

An early anatomy scan - via ultrasound - at 15.5 weeks,  revealed the baby to be a boy with a suspected micropenis with no other genital malformations. Penis length was measured and found to be 1.5 mm. The mother then had an amniocentesis which revealed a normal karyotype, 46 XY for the boy.

Following ultrasound scans found the penis length to be:
  • 2.4 mm at 20.5 weeks gestational age
  • 3.5 mm at 23 weeks
  • 4.2 mm at 28 weeks
  • 5.5 mm at 32 weeks


Image showing a fetal micropenis at 15.5 weeks of gestation
Fetal micropenis at 15.5 weeks gestation.

The mother delivered normally after 38 weeks and gave birth to a 3 kg (2956 g) male infant. Psychical examination confirmed that the boy had a severe case of micropenis, with a stretched penile length of only 0,8 cm (borderline for micropenis is 2.5 cm at this age). The infant also presented with bilateral cryptorchidism

The patient than received Human Chorionic Gonadotropin (HCG) treatment for three months without showing any improvement and underwent three operations with "partial improvement".


Image showing a newborn with the micropenis condition
Micropenis at birth 

Conclusion
The authors finish their paper concluding that
"The demonstration of the genital area during ultrasound anatomy scan is essential and important to determine normal anatomy and development. Early detection of micropenis requires detailed evaluation and multidisciplinary approach."


Reference
Bashiri A, Hershkovitz R, Mazor M, Friedler JM. Early detection of fetal micropenis after IVF-ICSI. International Journal of Case Reports and Images 2011;2(10):1-5.

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