Ovarian torsion following gonadotropin therapy: a case report

Abstract

Background: Ovarian torsion is a potential complication of gonadotropin stimulation, which prompts practitioners to caution patients against strenuous activity during the stimulation cycle. Patients who do not conceive are typically not monitored in the subsequent cycle unless they plan back-to- back gonadotropin stimulation. Objective: We describe a patient who developed ovarian torsion while exercising during the natural cycle following a failed gonadotropin cycle. Materials and Methods: Case report Results: A 38-year-old G1P1 underwent a gonadotropin/IUI cycle which resulted in 2 follicles on each ovary. The cycle was unsuccessful and the patient was found to have persistent cysts on a baseline ultrasound which led to the cancellation of the next gonadotropin cycle. Two weeks later, while the patient was participating in a kickboxing class, she began experiencing severe pelvic and abdominal pain, which was attributed to abdominal wall sprain by the Urgent Care physician. Over the next 2 weeks the patient had intermittent abdominal pain. She reported to her gynecologist for another baseline ultrasound after her subsequent period, in order to begin a new gonadotropin cycle. She was then noted to have an enlarged left ovary measuring 7 × 8 × 10cm. A laparoscopy was performed and showed a torsed left ovary with 80% necrosis. A partial oophorectomy was performed to remove the necrotic portion. A recent ultrasound revealed a 20 × 15mm left ovary with 3 antral follicles present. Conclusion: A significant proportion of patients who fail gonadotropin stimulation take a break before undergoing a repeat cycle, either by choice or due to persistent cysts. These women typically resume normal activities which often include exercise during this drug-free cycle. This report suggests that the risk of ovarian torsion persists beyond the treatment cycle and that patients should limit strenuous activity if regression to normal ovarian size has not been documented. Ovarian torsion should remain high on the differential diagnosis of abdominal pain following a gonadotropin cycle.