Clinical characteristics, diagnosis and treatment of ovarian torsion in assisted reproductive technology: cases analysis for ten years
10.3760/cma.j.cn101441-20220730-00319
- VernacularTitle:辅助生殖技术助孕中卵巢扭转的临床特点与诊治——十年病例分析
- Author:
Feng DENG
1
;
Shuo YANG
1
;
Xueling SONG
1
;
Yan YANG
1
;
Jiajia ZHANG
1
;
Rui YANG
1
;
Caihong MA
1
;
Rong LI
1
;
Jie QIAO
1
Author Information
1. 北京大学第三医院妇产科生殖医学中心，北京 100191
- Publication Type:Journal Article
- Keywords:
Ovarian torsion;
Fertilization in vitro;
Embryo transfer;
Pregnancy outcome;
Surgical treatment
- From:
Chinese Journal of Reproduction and Contraception
2023;43(2):191-197
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To explore the characteristics of ovarian torsion in in vitro fertilization-embryo transfer (IVF-ET) cycles and identify factors that may affect the outcome. Methods:Patients who underwent surgery for ovarian torsion during IVF treatment in the Center of Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital from January 2010 to December 2019 were included. The general information, IVF cycle characteristics, and intraoperative findings of patients were retrospectively analyzed. The diagnosis and treatment process were summarized. The pregnancy outcomes were followed up, and the possible influencing factors were analyzed.Results:There were 141 539 cycles of controlled ovarian stimulation (COS) and 75 585 cycles of frozen-thawed embryo transfer (FET) during the study period. A total of 50 patients were diagnosed with ovarian torsion and treated surgically, 90.0% of them occurred in the COS cycles (39 cases in fresh embryo transfer cycles and 6 cases in embryo freezing cycles), and 10.0% (5/50) occurred in the FET cycles (endometrial preparation in natural cycles or ovulation induction cycles). About 86.0% (43/50) of the patients occurred during pregnancy assisted with IVF-ET and 81.4% (35/43) occurred in the first trimester of pregnancy. All patients except one had abdominal pain as the first symptom, only 34.0% (17/50) of the patients had definite inducements, and all patients had signs of tenderness in the lower abdomen and adnexal area. Preoperative ultrasound examination showed that the average diameter of the torsional ovaries was (78.17±15.98) mm, compared with (48.69±15.96) mm in the controls, with an average difference of (30.13±19.69) mm (-3.5-80.0 mm). About 76.2% (32/42) of the torsional ovaries showed blood flow signals by color doppler ultrasound. All patients underwent surgery, and the coincidence rate between the preoperative diagnosis and the surgical diagnosis was 96%. Totally 22 torsional ovaries (44%) were found to be purplish-black, of which 16 cases underwent adnexectomy by laparoscopy or laparotomy. Totally 34 cases (68%) underwent ovarian detorsion. The average torsional degree of ovaries in the adnexectomy group was higher than that in the ovarian detorsion group [(727.50±206.54)° vs. (477.35±262.92)°, P=0.002]. There were no statistical differences between the two groups in the duration from onset to operation and the ratio of ovarian blood signal deficiency (all P>0.05). Among 44 patients with the embryo transfer, 84.1% (37/44) of patients obtained live birth, 1 case had implantation failure, and 6 cases had a spontaneous abortion. Patients with an adverse pregnancy outcome and patients with a live birth did not have significantly different ovarian torsion time, surgical methods, the duration from onset to operation, and other factors. Conclusion:Ovarian torsion in patients with IVF-ET treatment mostly occurs in the first trimester of pregnancy after fresh embryo transfer. Abdominal pain accompanied by differential enlargement of bilateral ovaries may suggest the possibility of ovarian torsion. We are unable to rule out ovarian torsion by observation of ovarian blood flow with color Doppler ultrasound. Active surgery was helpful to make a clear diagnosis and protect the fertility of patients. Patients with long torsional durations, purplish-black ovaries, or ovarian blood deficiency still have the opportunity to retain the torsional ovary. The pregnancy outcome of patients with ovarian torsion was satisfactory after surgical treatment.
