Congenital virilization of female infants recognized after pregnancies with retained levonorgestrel intrauterine devices

Helen Y Hougen; Casey A Seideman; Margaret P Adam; Anne-Marie Amies Oelschlager; Patricia Y Fechner; Linda Ramsell; Margarett Shnorhavorian; Audrey Squire; J Christopher Austin

doi:10.1016/j.jpurol.2020.03.008

Congenital virilization of female infants recognized after pregnancies with retained levonorgestrel intrauterine devices

J Pediatr Urol. 2020 Apr;16(2):241-243. doi: 10.1016/j.jpurol.2020.03.008. Epub 2020 Mar 20.

Authors

Helen Y Hougen¹, Casey A Seideman², Margaret P Adam³, Anne-Marie Amies Oelschlager⁴, Patricia Y Fechner⁵, Linda Ramsell⁶, Margarett Shnorhavorian⁷, Audrey Squire⁶, J Christopher Austin⁸

Affiliations

¹ Department of Urology, Oregon Health and Sciences University, 3303 SW Bond Ave. CH10U. Portland, OR, 97239, USA. Electronic address: hougen@ohsu.edu.
² Division of Pediatric Urology, Department of Urology, Oregon Health and Sciences University, 3181 SW Sam Jackson Park Rd. Portland, OR, 97239, USA. Electronic address: seideman@ohsu.edu.
³ Division of Genetic Medicine, Department of Pediatrics, University of Washington School of Medicine, 4800 Sand Point Way NE, Seattle, WA, 98105, USA; Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA, 98105, USA. Electronic address: Margaret.adam@seattlechildrens.org.
⁴ Department of Obstetrics and Gynecology, University of Washington School of Medicine, 1959 NE Pacific Street, Seattle, WA, 98195, USA. Electronic address: aamies@uw.edu.
⁵ Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA, 98105, USA; Division of Endocrinology, Department of Pediatrics, University of Washington School of Medicine, 4800 Sand Point Way NE, Seattle, WA, 98105, USA.
⁶ Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA, 98105, USA.
⁷ Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA, 98105, USA; Division of Pediatric Urology, Department of Urology, University of Washington School of Medicine, 4800 Sandpoint Way NE, Seattle, WA, 98105, USA. Electronic address: margarett.shnorhavorian@seattlechildrens.org.
⁸ Division of Pediatric Urology, Department of Urology, Oregon Health and Sciences University, 3181 SW Sam Jackson Park Rd. Portland, OR, 97239, USA. Electronic address: austin@ohsu.edu.

PMID: 32265103
DOI: 10.1016/j.jpurol.2020.03.008

Abstract

The Mirena intrauterine device (IUD) is a hormone-secreting contraceptive device. Pregnancy with the Mirena is rare and effects to the fetus are unknown. Here we present four females with genital virilization after pregnancy with persistent Mirena IUD. All patients had a 46, XX karyotype and normal hormone evaluation. All underwent exam under anesthesia, demonstrating posterior labial fusion and short urogenital sinus with normal bladder, urethra, vagina, and cervix. Three of four patients underwent flap vaginoplasty without complications and good cosmetic outcomes. This series suggests that persistent levonorgestrel-secreting IUD during pregnancy is associated with genital virilization in female fetuses.

Keywords: Ambiguous genitalia; Genital virilization; Levonorgestrel; Urogenital sinus; Vaginoplasty.

MeSH terms

Female
Humans
Infant
Intrauterine Devices, Medicated* / adverse effects
Levonorgestrel*
Pregnancy
Virilism

Substances

Levonorgestrel