Case Report: Ovarian Torsion Prior to Oocyte Trigger in a Woman Undergoing In Vitro Fertilisation

Abstract

Background: Ovarian torsion accounts for 2.7% of the surgical emergencies in women 1 yet remains a morbid and frequently misdiagnosed condition 2 . Aim: Here we describe a case of ovarian torsion prior to administration of the trigger in a 35-year-old multigravida undergoing controlled ovarian stimulation on a background of bilateral salpingectomy, along with the outcome of post detorsion oocyte pick up. Result: An antagonist protocol was used with a follicular count on day 12 confirming eight follicles in each of the right and left ovaries. The day prior to the planned GnRH agonist trigger, she developed a sudden onset of severe abdominal pain associated with vomiting. Urgent laparoscopy demonstrated a 720-degree torsion of the right ovary, which was detorted without complication. The patient was discharged home on the same day, a trigger was administered, and oocyte retrieval completed as per schedule. Post torsion 11 oocytes were collected, four from the left and seven from the right, a final embryo cryopreservation rate of 57% from the affected right ovary compared with 50% from the left ovary was achieved. Conclusion: In vitro fertilisation is a recognised risk factor for ovarian torsion 2 . Here we report the first case of a torsion in a woman prior to the administration of a trigger, who successfully underwent detorsion with salvage of oocytes collection and embryo cryopreservation.