Retrospective analysis of ovarian torsion incidence in 5186 women undergoing controlled ovarian hyperstimulation

Year 2021, Volume: 4 Issue: 5, 630 - 633, 05.09.2021

Nur Dokuzeylül Güngör , Arzu Yurci , Mehmet Güçlü

https://doi.org/10.32322/jhsm.946002

Cited By: 1

Abstract

Aim: Ovarian torsion (OT) is one of the common gynecologic emergencies in reproductive age women. In our study, it is aimed to make a retrospective evaluation of OT cases developed after controlled ovarian stimulation (COH) for in vitro fertilization (IVF) treatment.
Material and Methods : This retrospective study was carried out in an IVF clinic between January 2015- December 2020 . Ten cases who definitely diagnosed as OT were included in this study. The medical records of these patients were examined. Data were analyzed according to demographic, clinicopathological, and sonographic findings.
Results: Ten of 5186 IVF patients developed OT (10/5186; % 0.19) and all OT cases were PCOS. The mean age of OT patients was 27.3±4.1 and the mean body mass index (BMI) was 23.5±6.2 respectively. The mean number of retrieved oocytes was 21.46 ± 4.12. Laparoscopy was performed in all OT patients for detorsion of the ovaries. It was found that OT occurred more frequently on the right side (8/10;80%).
Conclusion: OT is more common in cases with polycystic ovary syndrome (PCOS). The risk of OT is reduced by decreasing gonadotropin dosage as well as retrieved number of oocyte. Also, prefering frozen-thawed embryo transfer can decrease OT risk in PCOS patients.

Keywords

ovarian torsion, in vitro fertilisation, polycystic ovary syndrome

References

• Speroff L, Fritz MA. Clinical gynecologic endocrinology and infertility: 7th ed.Philedelphia.Lippincott Williams & Wilkins, 2005.
• Raouf N, Hikmat R, Munib A, Shamdeen M, Salahaldeen R, Abdullah H. Success of controlled ovarian hyperstimulation and intrauterine insemination in couple with unexplained infertility. J Womens Health Dev 2020; 3: 77-9.
• Firouz M, Noori N, Ghasemi M, Dashipour A, Keikha N. Comparing the effectiveness of doing intra-uterine insemination 36 and 42 hours after human chorionic gonadotropin (HCG) injection on pregnancy rate: a randomized clinical trial. J Family Reprod Health 2020; 14: 173-9.
• Hibbard LT. Adnexal torsion. Am J Obstet Gynecol 1985; 152: 456–61.
• Bekci T, Polat AV, Aslan K, Tomak L, Bilgici MC, Danaci M. Diagnostic performance of diffusion-weighted MRI in the diagnosis of ovarian torsion: comparison of torsed and nonaffected ovaries. Clin imaging 2016; 40: 1029-33.
• Albayram F, Hamper UM. Ovarian and adnexal torsion: spectrum of sonographic findings with pathologic correlation. J Ultrasound Med 2001; 20: 1083-9.
• Wilkinson C, Sanderson A. Adnexal torsion-a multimodality imaging review. Clin Radiol 2012; 67: 476-83.
• Chang HC, Bhatt S, Dogra VS.Pearls and pitfalls in diagnosis of ovarian torsion. Radiographics 2008; 28: 1355-68.
• Sasaki KJ, Miller CE. Adnexal torsion: review of the literature. J Minim Invasive Gynecol 2014; 21: 196-202.
• Tanrikulu Y, Tanrıkulu CS, Sabuncuoglu MZ, Kokturk F, Temi V, Bicakci E. Is the neutrophil-to-lymphocyte ratio a potential diagnostic marker for peptic ulcer perforation? A retrospective cohort study. Am J Emerg Med 2016; 34: 403-6.
• Cass DL. Ovarian torsion. Semin Pediatr Surg 2005; 14: 86-92.
• Krishnan S, Kaur H, Bali J, Rao K. Ovarian torsion in infertility management-Missing the diagnosis means losing the ovary: ahigh price to pay. J Hum Reprod Sci 2011; 4: 39-42.
• Shadinger L, Andreotti RF, Kurian RL. Preoperative sonographic and clinical characteristics as predictors of ovarian torsion. J Ultrasound Med 2008; 27: 7-13.
• Sahlu Z, Negash S, Yusuf L. Adnexal torsion a five-years retrospective review in two hospitals. Ethiop Med J 2014; 52: 155-64
• Mazouni C, Bretelle F, Menard J, Blanc B, Gamerre M. Diagnosis of adnexal torsion and predictive factors of adnexal necrosis. Gynecol Obstet Fertil 2005; 33: 102-6.
• Eric J, Balcı O. Diagnostic value of neutrophil to lymphocyte ratio in over torsion. Bozok Tıp Der 2018; 8: 127-33.
• Bhat T, Teli S, Rijal J, et al. Neutrophil to lymphocyte ratio and cardiovascular diseases: Review. Expert Rev Cardiovasc Ther 2013; 11: 55-9.
• Tanrikulu CS, Tanrikulu Y, Sabuncuoglu MZ, Karamercan MA, Akkapulu N, Coskun F. Mean platelet volume and red cell distribution width as a diagnostic marker in acute appendicitis. Iran Red Crescent Med J 2014; 16: 10211.
• Yilmaz H, Celik H, Namuslu M, et al. Benefits of the neutrophil-to-lymphocyte ratio for the prediction of gestational diabetes mellitus in pregnant women. Exp Clin Endocrinol Diabetes 2014; 122: 39-43.
• Guzel AI, Kokanali MK, Erkilinc S, et al. Predictive role of the neutrophil lymphocyte ratio for invasion with gestational trophoblastic disease. Asian Pac J Cancer Prev 2014; 15: 4203-6.
• Soysal S, Baki RB. Diagnostic value of neutrophil to lymphocyte ratio in differentiation of ruptured ovarian cysts and adnexal torsion. Turk J Obstet Gynecol 2018; 15: 91-4.
• Hyttel TE, Bak GS, Larsen SB, Lokkegaard EC: Re-torsion of the ovaries. Acta Obstet Gynecol Scand 2015; 94: 236–44.
• Weitzman VN, DiLuigi AJ, Maier DB, Nulsen JC. Prevention of recurrent adnexal torsion. Fertil Steril 2008; 90: 2018.
• Roest J, Mous HV, Zeilmaker GH, Verhoeff A. The incidence of major clinical complications in a Dutch transport IVF programme. Hum Reprod Update 1996; 2: 345–53.
• Govaerts I, Devreker F, Delbaere A, Revelard P, Englert Y. Short-term medical complications of 1500 oocyte retrievals for in vitro fertilization and embryo transfer. Eur J Obstet Gynecol Reprod Biol 1998; 77: 239–43.
• Gorkemli H, Camus M, Clasen K.Adnexal torsion after gonadotrophin ovulation induction for IVF or ICSI and its conservative treatment. Arch Gynecol Obstet 2002; 267: 4–6.
• Tay J, Parker H, Dhange P, Paton-Forrester C, Atiomo W. Isolated torsion of the fallopian tube in a patient with polycystic ovarian syndrome (PCOS). Eur J Obstet Gynecol Reprod Biol 2010; 150: 218–9.
• Matsuoka S, Kobayashi T, Kusunoki S, Ogishima D. Polycystic ovary syndrome with  asynchronous bilateral adnexal torsion in a natural cycle. BMJ Case Rep 2017: bcr-2016218880.
• Ben-Rafael Z, Bider D, Mashiach S. Laparoscopic unwinding of twisted ischemic hemorrhagic adnexa after in vitro fertilization. Fertil Steril 1990; 53: 569–71.
• Kemmann E, Ghazi DM, Corsan GH. Adnexal torsion in menotropin-induced pregnancies. Obstet Gynecol 1990; 76: 403–6.
• Mashiach S, Bider D, Moran O, Goldenberg M, Ben-Rafael Z. Adnexal torsion of hyperstimulated ovaries in pregnancies after gonadotropin therapy. Fertil Steril 1990; 53: 76–80.
• Berkkanoglu M, Coetzee K, Bulut H, Ozgur K. Risk of ovarian torsion is reduced in GnRH agonist triggered freeze-all cycles: a retrospective cohort study. J Obstet Gynaecol 2019; 39: 212-17.