Monday, August 12, 2013

Early Detection of Micropenis during Pregnancy

So, today we will examine 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 research, the authors describe what is probably the earliest diagnosis of micropenis ever performed. While the condition is typically diagnosed sometime 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.

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 possible treatment options include a course of HCG or testosterone, adding that early diagnosis is very crucial in choosing the proper treatment protocol and having a good final result.

Case Report
The authors describe 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 soon received Human Chorionic Gonadotropin (HCG) treatment for three months without showing any improvement and later underwent three operations with "partial improvement".

Image showing a newborn with the micropenis condition
Micropenis at birth 

Conclusion & My thoughts
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."

Now, now, diagnosing the condition so early during pregnancy is pretty impressive if you ask me! And definitely a handy tool so that the parents know what to expect before the young boy is even born!

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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