Adnexal torsion

The term adnexal torsion refers to when the stimulated ovary twists on itself, cutting off its own blood supply. It usually involves the Fallopian tube and ovary but it can involve the ovary alone.

Ovarian torsion is a rare complication of IVF treatment. The overall risk is about 0.2%. It is greater in the presence of OHSS (7.5%). Ovarian torsion may cause severe pain and tenderness in the lower abdomen, sickness and vomiting.

The clinical presentation of ovarian torsion is non- specific with few distinctive physical findings and thus a high index of suspicion is required to make an early diagnosis. Colour Doppler ultrasound scan may help in predicting viability of ovary (as a decrease or absent ovarian blood flow is suggestive of torsion). Definitive diagnosis is made by laparoscopy.

If not treated early enough the twisted ovary may die (gangrene). Treatment is surgery to untwist the ovary and even removing it sometimes. Laparoscopy is the gold standard for making the diagnosis and may allow treatment.

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