Gynecology & Obstetrics
Open Access
ISSN: 2161-0932
ISSN: 2161-0932
DR.karimi mahtab
Gynecologist and obstetrician (infertility specialist )at nime shaaban Hospital SARi
Scientific Tracks Abstracts: Gynecol Obstet (Sunnyvale)
mohseni adeleh Master of health care Management, Hazrate Maryam Fertility Center Department Of Obstetrics and Gynaecology, Bharati Vidyapeeth Deemed University, Pune. ABSTRACT(AQ2) We here report two case of ovarian torsion We checked the presence of all possible factors that could explain the onset of the syndrome. Ovarian hyperstimulation syndrome (OHSS) is almost exclusively associated with ovulation induction with gonadotropins(3) OHSS continues to be a serious complication of assisted reproductive therapy (ART), with no universally agreed upon best method of prevention if OHSS is diagnosed, the etiology should be determined in order to focus the treatment and avoid future complications(4) KEYWORDS:(AQ3) Ovarian torsion; ovarian hyperstimulation syndrome ,Case report Introduction Ovarian hyperstimulation syndrome (OHSS) is rather frequent (1-5%) in women submitted to superovulation with gonadotropins for in vitro fertilisation (IVF). Multiple pregnancy, gestational trophoblastic disease, primary hypothyroidism, thyroid-stimulating hormone/gonadotropin-secreting adenomas, and mutations of the FSHR gene may trigger spontaneous OHSS(1,2) Purpose: Aim of the study was to investigate the incidence, progress, management and outcome of adnexal torsion after controlled ovarian hyperstimulation in embryo transfer cycles Presentation of case Woman 25 years old (gravida 0 para 0). with fi rst infertility of 2-year duration with bilateral polycystic ovaries and timed intercourse came for further treatment to our clinic. her body mass index was 20 She was planned for controlled ovarian stimulation for IVF and was given short protocol Stimulation with urinary FSH was started on day 2 of menstrual cycle, starting recagon dose was 225 IU s/c for duration of 8 days. And antagonist was started on day 7 of menstrual cycle (AQ5) Decapeptyle 0/1 Subcutaneous was given for oocyte maturation On day 12 there were 15 dominant follicles in left&right ovary Oocyte retrieval was done on day 14 of cycle. she came with sudden onset of severe right-left sided abdominal pain with increasing severity in next 2 hours On the day of pick up rotation occurred. she had no medical or surgical history. On examination, she had tachycardia+ 108/min, blood pressure – 110/80, respiratory rate – 18/mnt. She had moderate abdominal distension, severe right-left sided guarding. Abdominal ultrasound done suggested enlarged bilateral ovary-right 14×10 cm and left 8×9 cm with multiple cysts, fl uid in paracolic gutter and Morrison's pouch. She was diagnosed with severe OHSS. Doppler study was not conclusive about torsion. Pain decreased with injection Tramadol. With further episode of severe abdominal pain after 2 hours of admission, decision was made for emergency laparoscopy. Ultrasonography showed that bipolar ovaries of normal diammonotic and large ovaries with thick blood fl ow in the left and right ovary, in the abdominal cavity indicative of hemoperitoneum, were shown. Emergency laparoscopy was done and bilateral ovarian torsion with retained vascularity was noted. Biochemistry and thyroid function were normal. Laparoscopy for suspicion of OHSS complicated by ovarian torsion confi rmed bilateral ovarian enlargement and hemoperitoneum.(5) .(AQ4) the left adnexa was twisted around the stem and an ischemic adenosectomy was performed and two liters of blood was sprayed. Later, anatomopathological examination confi rmed ovarian ischemia(5,7) The pathogenesis of OHSS involves hyperstimulation of FSHR by FSH or other glycoproteins with similar structures. Recently, mutations of the FSHR gene leading to an increased sensitivity of the receptor to normal levels of hormones have been also described, although a standard genetic test has yet to be developed. Several circumstances may increase the levels or biological activity of these glycoproteins(6,3) (AQ1) Running title missing??? Ovarian torsion after ovarian hyperstimulation syndrome Presentation of case Woman 28years old (gravida 0 para 0). with fi rst infertility of 1years duration with top normal ovaries and timed intercourse came for further treatment to our clinic. her body mass index was 19/8 She was planned for controlled ovarian stimulation for IVF and was given short protocol Stimulation with urinary FSH was started on day 3 of menstrual cycle ,starting recagon dose was 225 IU s/c for duration of 8 days. And antagonist was started on day 7 of menstrual cycle (AQ5) Decapeptyle 0/1 Subcutaneous was given for oocyte maturation On day 10 there were 20-30 dominant follicles in left&right ovary Oocyte retrieval was done on day 12 of cycle. she came with sudden onset of severe right-left sided abdominal pain with increasing severity in next 2 hours On the day of pick up rotation occurred The left ovary torso, which had been rotating, turned open Conclusion OHSS can be associated with life-threatening complications that require early diagnosis for successful management. The etiology should be determined in order to focus the treatment and avoid future complications References (AQ6) 1. Hibbard L T. Adnexal torsion. Am J Obstet Gynecol. 1985;152:456–461. [PubMed] 2. Mashiach S, Bider D, Moran O. et al. Adnexal torsion of hyperstimulated ovaries in pregnancies after gonadotropin therapy. Fertil Steril. 1990;53:76–80. [PubMed] 3. Olatunbosun OA, Gilliland B, Brydon LA, Chizen DR, Pierson RA. Spontaneous ovarian hyperstimulation syndrome in four consecutive pregnancies. Clin Exp Obstet Gynecol. 1996;23:127–32.[PubMed] 4. Lussiana C., Guani B., Restagno G., Rovei V., Menato G., Revelli A. Ovarian hyperstimulation syndrome after spontaneous conception. Gynecol. Endocrinol. 2009;25(7):455– 459. [PubMed] 5. Ahmed Kamel R.M. Spontaneous ovarian hyperstimulation syndrome in a naturally conceived singleton pregnancy. Fertil. Steril. 2010;94(1):351. 6. Munshi S., Patel A., Banker M., Patel P. Laparoscopic detorsion for bilateral ovarian torsion in a singleton pregnancy with spontaneous ovarian hyperstimulation syndrome. J. Hum. Reprod. Sci. 2014;7(1):66–68. [PubMed] 7. Di Carlo C., Savoia F., Fabozzi A., Gargano V., Nappi C. A case of ovarian torsion in a patient carrier of a FSH receptor gene mutation previously affected by spontaneous ovarian hyperstimulation syndrome. Gynecol. Endocrinol. 2015;31(2):105–108. [PubMed]