Bilateral ovarian torsion: A rare complication of ovarian stimulation in in vitro fertilization

Abstract

Aim: To enlighten about one of the rare complications of ovarian stimulation during in vitro Fertilization (IVF) and how to manage it with early diagnosis and intervention. Background: Torsion of ovary, tube or both are estimated to be responsible for a minimal number of overall gynecological emergencies with an incidence of 2.7–7.4%. It is considered a common diagnostic challenge in any emergency setting. Torsion should be referred and managed at a tertiary health center with all emergency facilities. The trending availability of assisted reproductive technology and its increasing success day by day has resulted in an increase in ovulation induction and its complications including OHSS and ovarian torsion in the present scenario. Case report: At our center, one case of bilateral ovarian torsion as a consequence of controlled ovarian stimulation in a woman with PCOS was reported. This can be considered as a potentially fatal complication of pharmacological stimulation of ovary in assisted reproduction. Life–saving emergency laparoscopic surgery was undertaken. Timely diagnosis and intervention prevented oophorectomy and fertility was preserved. Conclusion: An Early and prompt intervention to preserve ovarian function and conduct a fertility-conserving surgery should be laparoscopic whenever and wherever possible. Detorsion should be the treatment of choice in reproductive age women whose families are incomplete, regardless of the fact of the color of the ovary. Oophoropexy may be considered to prevent recurrence. In older women whose family are complete and in postmenopausal women, oophorectomy is the treatment of choice to remove the risk of retorsion. Clinical significance: If on laparoscopy, a cyst whether non-functional or not is found in the ovary or paraovarian structure, cystectomy or interval cystectomy should be performed in younger women. Ovarian mutilating surgery is not considered to be a viable option in the management of torsion in a patient who is undergoing fertility preserving management except in cases with complete tissue necrosis.