Abstract
Purpose
Ovarian torsion is a surgical emergency that can be clinically challenging to diagnose. Patients who have received assisted reproductive technologies (ART) are a subset of women with an increased risk for torsion. As the ART population continues to increase, there is a need to delineate risk factors for the development of ovarian torsion in this unique population. A pilot study was performed to determine the proportion of patients with suspected ovarian torsion who have received ART and to identify possible diagnostic biomarkers for ovarian torsion among these patients.
Methods
A single institution retrospective cohort study of patients taken to surgery for suspected ovarian torsion over a 5-year period.
Results
During the study period, 171 patients were taken to surgery for suspected ovarian torsion. Patients receiving ART constituted 19 (11%) of these patients. Among the 19 fertility treatment patients, 16 had received treatment with gonadotropins, 10 of which had surgically confirmed ovarian torsion. These ten patients had higher preoperative peak estradiol levels (3122 versus 1875 pg/mL, p = 0.05) and a larger ovarian diameter (9.7 versus 7.6 cm, p = 0.05) than the six patients receiving gonadotropins found to not have ovarian torsion.
Conclusions
These results suggest infertility treatment using gonadotropins for ovarian hyperstimulation may be an independent risk factor for ovarian torsion as suggested by the disproportionate number of such individuals represented in the study population (9% of all patients, 84% of fertility patients). Additionally, among women taking gonadotropins, an association exists between peak estradiol levels, ovarian diameter, and risk for ovarian torsion.
Similar content being viewed by others
References
Hibbard LT. Adnexal torsion. Am J Obstet Gynecol. 1985;152:456–61.
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.
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.
Huchon C, Staraci S, Fauconnier A. Adnexal torsion: a predictive score for pre-operative diagnosis. Hum Reprod. 2010;25:2276–80. doi:10.1093/humrep/deq173.
Linam LE, Darolia R, Naffaa LN, Breech LL, O'hara SM, Hillard PJ, Huppert JS. US findings of adnexal torsion in children and adolescents: size really does matter. Pediatr Radiol. 2007;37:1013–9. doi:10.1007/s00247-007-0599-6.
Pena JE, Ufberg D, Cooney N, Denis AL. Usefulness of Doppler sonography in the diagnosis of ovarian torsion. Fertil Steril. 2000;73:1047–50.
Bouguizane S, Bibi H, Farhat Y, Dhifallah S, Darraji F, Hidar S, Lassoued L, Chaieb A. Khairi H adnexal torsion: a report of 135 cases. J Gynecol Obstet Biol Reprod (Paris). 2003;32:535–40.
Chang HC, Bhatt S, Dogra VS. Pearls and pitfalls in diagnosis of ovarian torsion. Radiographics. 2008;28:1355–68. doi:10.1148/rg.285075130.
Huchon C, Fauconnier A. Adnexal torsion: a literature review. Eur J Obstet Gynecol Reprod Biol. 2010;150:8–12. doi:10.1016/j.ejogrb.2010.02.006.
Mashiach R, Melamed N, Gilad N, Ben-Shitrit G, Meizner I. Sonographic diagnosis of ovarian torsion: accuracy and predictive factors. J Ultrasound Med. 2011;30:1205–10.
Bar-On S, Mashiach R, Stockheim D, Soriano D, Goldenberg M, Schiff E, Seidman DS. Emergency laparoscopy for suspected ovarian torsion: are we too hasty to operate? Fertil Steril. 2010;93:2012–5. doi:10.1016/j.fertnstert.2008.12.022.
Cohen SB, Weisz B, Seidman DS, Mashiach S, Lidor AL, Goldenberg M. Accuracy of the preoperative diagnosis in 100 emergency laparoscopies performed due to acute abdomen in nonpregnant women. J Am Assoc Gynecol Laparosc. 2001;8:92–4.
Bayer AI, Wiskind AK. Adnexal torsion: can the adnexa be saved? Am J Obstet Gynecol. 1994;171:1506–10. discussion 1510-1
Ozcan C, Celik A, Ozok G, Erdener A, Balik E. Adnexal torsion in children may have a catastrophic sequel: asynchronous bilateral torsion. J Pediatr Surg. 2002;37:1617–20.
Centers for Disease Control and Prevention, American Society for Reproductive Medicine, Society for Assisted Reproductive Technology. 2014 Assisted Reproductive Technology National Summary Report. Atlanta (GA): US Dept of Health and Human Services; 2016
Wang J, Sauer MV. In vitro fertilization (IVF): a review of 3 decades of clinical innovation and technological advancement. Ther Clin Risk Manag. 2006;2:355–64.
SAS Institute Inc. SAS/STAT® 9.2 User’s Guide. Cary, NC: SAS Institute Inc.; 2008.
Hasson J, Tsafrir Z, Azem F, Bar-On S, Almog B, Mashiach R, Seidman D, Lessing JB, Grisaru D. Comparison of adnexal torsion between pregnant and nonpregnant women. Am J Obstet Gynecol. 2010;202:536.e1–6. doi:10.1016/j.ajog.2009.11.028.
Arslan M, Bocca S, Mirkin S, Barroso G, Stadtmauer L, Oehninger S. Controlled ovarian hyperstimulation protocols for in vitro fertilization: two decades of experience after the birth of Elizabeth Carr. Fertil Steril. 2005;84:555–69.
Elchalal U, Schenker JG. The pathophysiology of ovarian hyperstimulation syndrome—views and ideas. Hum Reprod. 1997;12:1129–37.
Ferraretti AP, La Marca A, Fauser BC, Tarlatzis B, Nargund G, Gianaroli L. ESHRE working group on poor ovarian response definition ESHRE consensus on the definition of ‘poor response’ to ovarian stimulation for in vitro fertilization: the bologna criteria. Hum Reprod. 2011;26:1616–24. doi:10.1093/humrep/der092.
Licciardi FL, Liu HC, Rosenwaks Z. Day 3 estradiol serum concentrations as prognosticators of ovarian stimulation response and pregnancy outcome in patients undergoing in vitro fertilization. Fertil Steril. 1995;64:991–4.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Human rights
For this type of study formal consent is not required.
Rights and permissions
About this article
Cite this article
Romanski, P.A., Melamed, A., Elias, K.M. et al. Association between peak estradiol levels and ovarian torsion among symptomatic patients receiving gonadotropin treatment. J Assist Reprod Genet 34, 627–631 (2017). https://doi.org/10.1007/s10815-017-0901-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10815-017-0901-y