Successful Pregnancy Complicated by Adnexal Torsion after IVF in a 45-Year-Old Woman

Abstract

Ovarian torsion accounts for 3% of gynecological emergencies. Its incidence is higher in all those cases of ovarian hypermobility and adnexal masses, such as Ovarian Hyperstimulation Syndrome (OHSS) as a consequence of in vitro fertilization (IVF) treatments. It is an acute condition; its diagnostic work-up is difficult because of its vague clinical presentation. Nonetheless its diagnosis must be as rapid as possible because a prompt surgical detorsion is the only treatment assuring ovarian function recovery. The diagnostic iter includes complete cell blood count, D-dimer, transabdominal ultrasound (US), transvaginal US and magnetic resonance (MRI).Our patient was a 45-year-old woman with good ovarian reserve indexes. She underwent a second level IVF stimulation because of a male infertility factor. Despite her age she developed an OHSS. Furthermore, twenty minutes after the embryo transfer, a right ovarian torsion occurred; the definitive diagnosis was made thanks to TV US and abdominal MRI. The patient was immediately treated with laparoscopic detorsion and after two weeks from the embryo transfer her beta HCG were positive with regular duplication times.The significance of this case stands in the chosen diagnostic iter, which actually underlines the importance of MRI in the prevention of useless surgeries, and in the patient's clinical peculiarity: despite the advanced age she developed an OHSS and, despite the ovarian torsion and the surgery, she successfully got pregnant.