Successful Pregnancy Complicated by Adnexal Torsion after IVF in a 45-Year-Old Woman

Cirillo F,Zannoni E

doi:10.21767/2471-8165.1000027

Abstract

Ovarian torsion accounts for 3% of gynaecological emergencies. Its incidence is higher in all those cases of ovarian hypermobility and adnexal masses, such as ovarian hyperstimulation syndrome (OHSS) as a consequence of in vitro fertilization (IVF) treatments. It is an acute condition; its diagnostic work-up is difficult because of its vague clinical presentation. Nonetheless its diagnosis must be as rapid as possible because a prompt surgical detorsion is the only treatment assuring ovarian function recovery. The diagnostic iter includes complete cell blood count, D-dimer, transabdominal ultrasound (US), transvaginal US and magnetic resonance (MRI). Our patient was a 45-year-old woman with good ovarian reserve indexes. She underwent a second level IVF stimulation because of a male infertility factor. Despite her age she developed an OHSS. Furthermore, twenty minutes after the embryo transfer, a right ovarian torsion occurred; the definitive diagnosis was made thanks to TV US and abdominal MRI. The patient was immediately treated with laparoscopic detorsion and after two weeks from the embryo transfer her beta HCG were positive with regular duplication times. The significance of this case stands in the chosen diagnostic iter, which actually underlines the importance of MRI in the prevention of useless surgeries, and in the patient’s clinical peculiarity: despite the advanced age she developed an OHSS and, despite the ovarian torsion and the surgery, she successfully got pregnant.

Highlights

Ovarian torsion occurs when the ovarian vascular pedicle performs a complete or partial rotation around its axis with consequent impairment in vascular supply [1].Torsion is considered the 5th most common surgical emergency in women, accounting for more than 3% of all gynaecological emergencies [2]
Among the women undergoing in vitro fertilization (IVF), the incidence of adnexal torsion ranges from 0.08% to 0.13% [3]
When our patient was diagnosed with ovarian torsion, her case immediately gathered great attention because of its unicity

Summary

Introduction

Ovarian torsion occurs when the ovarian vascular pedicle performs a complete or partial rotation around its axis with consequent impairment in vascular supply [1].Torsion is considered the 5th most common surgical emergency in women, accounting for more than 3% of all gynaecological emergencies [2]. The ultrasonographic examination showed a mild pelvic free fluid accumulation; the right ovary was not visible at all making the picture very suspicious for ovarian dislocation.

Results

Conclusion