Background Adnexal torsion requires a high degree of suspicion in women presenting with pelvic pain. Polycystic ovaries are an infrequent cause of ovarian torsion but should be considered in cases without adnexal masses. Case A 25-year-old woman had a delayed diagnosis of adnexal torsion due to polycystic ovaries despite typical presentation and imaging. A unique finding was ovarian fusion; separation was required in order to resolve the torsion. Oophoropexy was performed to prevent the recurrence of torsion. Conclusion Ovarian torsion should be suspected in the setting of abdominal pain, enlarged polycystic ovaries, and absent adnexal blood flow on ultrasound. This case demonstrates the resilience of the adnexa and the highly variable time to necrosis in the setting of torsion.

As oocyte cryopreservation use increases among reproductive-aged women, health care professionals are challenged with counseling patients on fertility-sparing technology based on limited high-quality research. Since the first successful slow freezing of mouse embryos in England in 1972, reproductive scientists have employed various protocols for successful cryopreservation and warming of gametes. From outdated slow-freeze technologies to improved vitrification methods, science has successfully shifted the pendulum from cryoinjury-related cell death to the preservation of cellular immortality. The clinical applications of oocyte cryopreservation first increased among oncofertility patients faced with limited fertility-sparing options. Breakthroughs in oncofertility opened a window of opportunity for the transgender community, which also led to an entirely new frontier—planned oocyte cryopreservation for potential future use. Reasons for cryopreservation are complex and often overlap. Socially, these can include not having a support person to share childcare responsibilities, prioritizing career goals and aspirations, and the financial constraints of the ever-rising cost of childrearing. Medically, reasons can include diseases, primary ovarian insufficiency, traumatic injury, planned female to male gender transition, and fertility loss that occurs with aging. Women are faced with many, if not all, of the above scenarios during their “ideal” reproductive window. These women are presenting to fertility centers in hopes of allowing for future reproductive freedom. Owing to media influence, women may be misled of the success potential of cryopreserved oocytes as a guarantee of future biological children. Here, we review current literature and propose guidelines for counseling patients on planned oocyte cryopreservation.

Patient: Female, 34-year-old Final Diagnosis: Ectopic pregnancy Symptoms: Pain Medication: — Clinical Procedure: — Specialty: Obstetrics and Gynecology Objective: Unusual clinical course Background: Interstitial ectopic pregnancy, a pregnancy occurring in the part of the fallopian tube that is within the body of the uterus, poses a significant risk to patients, with a mortality rate of up to 2.5%, which is 7 times higher than for tubal ectopic pregnancies. Hysteroscopic sterilization reversal carries a potential risk of interstitial ec-topic pregnancy; therefore, it is important to counsel patients appropriate and review the alternative option for in vitro fertilization. In vitro fertilization has been shown to have a superior pregnancy and live birth rate in comparison to sterilization reversal. Women who have undergone sterilization via hysteroscopic placement of the Essure device may complete in vitro fertilization with sterilization devices left in situ without significantly reducing the pregnancy rate. Case Report: A 34-year-old woman, G6P3023, presented to the Emergency Department after incidental detection of left interstitial ectopic pregnancy measuring 9 weeks of gestation. She had previously undergone a right salpingectomy for ectopic pregnancy soon after reversal of Essure sterilization via bilateral tubouterine reimplantation; this is a procedure that is infrequently performed due to limited evidence to suggest that this is a safe and efficacious method to achieve future pregnancies. This patient underwent an uncomplicated left cornuostomy and salpingectomy, rendering the need for in vitro fertilization to conceive in the future. Conclusions: Patients seeking fertility treatment after hysteroscopic sterilization should be counseled that tubouterine reimplantation poses significant morbidity risk based on the nature of the surgery. Instead, patients who have undergone hysteroscopic sterilization who desire future pregnancy should be advised that in vitro fertilization, with or without salpingectomy, may be a safer and more efficacious option to achieve live birth.

INTRODUCTION:A simple ovarian cyst at baseline ultrasound for ovulation induction/intrauterine insemination (OI/IUI) is a finding of unclear clinical significance, and its effect on achieving pregnancy remains undetermined. Establishing the effects of a baseline ovarian cyst(s) is necessary to optimize OI/IUI cycle outcomes.METHODS:A retrospective cohort analysis of OI/IUI cycles from 2011-2021 at the UC Health Center for Reproductive Health was performed with institutional review board approval. The exposure variable was a simple appearing ovarian cyst(s) diagnosed at baseline ultrasound measuring >10 mm with estradiol level <75 ng/ml. The primary outcome analyzed was an ultrasound-confirmed intrauterine pregnancy. Secondary outcomes included positive pregnancy test and live birth. STATA was used to perform unpaired t-tests for continuous variables, Chi-square tests for dichotomous variables and a generalized linear model for regression analysis.RESULTS:A total of 161 cycles with inactive cysts were compared to 300 control cycles. Polycystic ovarian syndrome was more common in the control group and diminished ovarian reserve was more common in the baseline cyst group. Other specific diagnoses were similar between groups. The clinical pregnancy rate was higher in cycles without a baseline cyst compared to those with a cyst present, (15% vs. 9.3%, RR 0.63 [0.36–1.1]). After adjusting for body mass index and age, cycles with baseline cyst(s) were 35% less likely to result in a clinical pregnancy (adjusted RR=0.65 [0.37–1.1]).CONCLUSION:A baseline ovarian cyst is associated with a lower clinical pregnancy rate in OI/IUI cycles. This finding is clinically significant and patients should be counseled accordingly.