Adnexal Torsion in Pregnancy after Assisted Reproduction – Case Study and Review of the Literature

Abstract

Purpose: Aim of the study was to investigate the incidence, progress, management and outcome of adnexal torsion after controlled ovarian hyperstimulation in embryo transfer cycles. Materials and Method: A retrospective analysis was done of 1007 patients of a private IVF centre. The literature on adnexal torsion is reviewed. Results: In the literature, the incidence of adnexal torsion after assisted reproductive technologies (ART) is given as around 0.2 %. A significant increase of up to 33 % has been reported for cases with additional ovarian hyperstimulation syndrome (OHSS) and in pregnant women. In our retrospective analysis of 1007 women (incidence 0.46 %) with 1411 fresh embryo transfer cycles, we found an incidence of 0.35 % per embryo transfer. All adnexal torsions were treated by laparoscopic derotation to preserve fertility. All 5 cases with torsion were pregnant, 2 patients had mild OHSS. We recorded 3 term deliveries, 1 induced abortion for sirenomelia, and 1 missed abortion. Conclusion: Adnexal torsion must be kept in mind after hyperstimulation and embryo transfer, especially when pregnancy or OHSS is also present. With early diagnosis, it should be possible to preserve fertility using laparoscopic derotation.

Zusammenfassung

Fragestellung: Häufigkeit, Verlauf, Therapie und Outcome von Adnex-Torsionen nach kontrollierter ovarieller Hyperstimulation in Embryotransfer-Zyklen. Material und Methodik: Literatursichtung und retrospektive Untersuchung von 1007 Patientinnen eines privaten IVF-Zentrums. Ergebnisse: In der Literatur wird die Inzidenz von Adnex-Torsionen nach ART mit maximal 0,2 % angegeben. Ein deutlicher Anstieg bis auf 33 % wird bei gleichzeitigem OHSS und einer Schwangerschaft beschrieben. In unserer retrospektiven Analyse an 1007 Frauen (Inzidenz 0,46 %) in 1411 frischen Embryotransfer-Zyklen konnten wir eine Inzidenz von 0,35 % pro Embryotransfer beobachten. Alle Adnex-Torsionen konnten mittels laparoskopischer Derotation fertilitätserhaltend behandelt werden. Alle 5 Patientinnen waren schwanger, in 2 Fällen trat ein leichtes OHSS auf. Drei Termingeburten stehen 1 Abort-Induktion wegen Sirenen-Malformation und 1 Missed Abortion gegenüber. Schlussfolgerung: An Adnex-Torsionen muss nach Hyperstimulation und Embryotransfer gedacht werden, vor allem, wenn eine Schwangerschaft eintritt oder zusätzlich ein OHSS besteht. Bei rechtzeitiger Erkennung sollte durch Laparoskopie und Derotation die Erhaltung der Fertilität möglich sein.

Key words

Adnexal torsion - controlled ovarian hyperstimulation - assisted reproduction - laparoscopic derotation

Schlüsselwörter

Adnex-Torsion - kontrollierte ovarielle Hyperstimulation - assistierte Reproduktion - laparoskopische Derotation

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