Geburtshilfe Frauenheilkd 2012; 72(8): 716-720
DOI: 10.1055/s-0032-1315186
GebFra Science
Georg Thieme Verlag KG Stuttgart · New York

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

Adnex-Torsionen in der Schwangerschaft nach künstlicher Befruchtung
D. Spitzer
1   IVF Zentren Prof. Zech Salzburg, Salzburg, Austria
B. Wirleitner
2   IVF Zentren Prof. Zech Bregenz, Bregenz, Austria
H. Steiner
3   Universitätsklinik für Frauenheilkunde und Geburtshilfe, Landeskrankenhaus Salzburg, Paracelsus Medizinische Privatuniversität, Salzburg, Austria
N. H. Zech
2   IVF Zentren Prof. Zech Bregenz, Bregenz, Austria
› Author Affiliations
Further Information

Publication History

received 11 April 2012
revised 15 May 2012

accepted 29 May 2012

Publication Date:
28 August 2012 (online)


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.


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.

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