Human Reproduction Archives
Human Reproduction Archives
CASE REPORT Contraception

Ovary transmigration of a levonorgestrel-releasing intrauterine device and ectopic pregnancy: a case report

Fernanda Marino Lafraia, Ana Luisa Dias Barbosa, Luisa Abreu Zorzanelli, Luiza Russo Morais, Fernanda Parciasepe Dittmer, Cristina Aparecida Falbo Guazzelli

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Introduction: Intrauterine devices (IUD) are safe long-term contraceptive methods frequently used. Though it is a rare event, the uterine perforation and migration of an IUD is possible. Case description: This study is based on a single patient who has been using Levonorgestrel (LNG)-IUD for the last two years without previous complications. A control ultrasound in October/2019 reported a normally placed LNG-IUD. However, in July/2020, she was admitted to our hospital with intermittent pain in the right iliac fossa associated with minor vaginal bleeding for the last 30 days. Her hCG level was 827,3 mUI/mL. The LNG-IUD was not identified in the ultrasound exam, and there was a mass of 5.6 centimeters with a hyperechogenic line in the right adnexa. In surgery, we found a right tubal ectopic pregnancy, and the LNG-IUD was located within the right ovary parenchyma, confirmed by pathological examination. We performed a right salpingo-oophorectomy, and there were no procedure complications. The patient presented good clinical evolution, receiving discharge the next day. Discussion: The spontaneous IUD migration can affect any adjacent structures, but the exact pathophysiology is unknown. Although uterine perforation and migration are rare complications, the medical team should discuss their possibility with the patient before IUD insertion. Moreover, professionals should be aware of this possibility and diagnose it rapidly to avoid further complications. With this case report we intend to review similar cases described previously and discuss the best options available for management of this complex situation.


Ectopic pregnancy; Intrauterine Device Expulsion; Intrauterine Device Migration; Levonorgestrel; Ovary; Salpingo Oophorectomy


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